Trauma proliferation and stress generation (TPSG) dynamics and their implications for clinical science.

The current research and clinical focus on single traumas fails to assess numerous important trauma dynamics including trauma proliferation. In this study, 2 trauma proliferation pathways were identified that utilize a developmentally based trauma framework (DBTF). Data previously collected from 6 different cultural groups (N = 2279; 2 mental health clinics in Egypt and the United States, Native Americans, Palestinian adults in Gaza, and college students in Poland and Egypt) were reanalyzed. The 6 studies utilized DBTF-based measures of cumulative trauma and trauma types. Path analysis was used to test the trauma proliferation model and PROCESS software was used to identify mediators and their effect sizes. Results of the analyses indicated that attachment trauma and collective identity trauma independently predicted (directly and through mediators) personal identity trauma, role identity trauma, secondary trauma, and survival trauma. The pattern of proliferation was configurally invariant across the 6 groups and strictly invariant across genders. Implications for the consideration of trauma global dynamics, such as trauma proliferation, are discussed. (PsycINFO Database Record

Hierarchical structure of emotional disorders: From individual symptoms to the spectrum.

Classification of emotional disorders faces challenges of within-disorder heterogeneity and between-disorder comorbidity. The current study addressed these issues by analyzing all emotional disorder symptoms to identify homogeneous dimensions that characterize this domain. These dimensions were, in turn, used to define coherent syndromes and higher order factors. All of the emotional disorder symptoms specified in diagnostic manuals were assessed by interview in 2 treatment-seeking samples (N = 426 and 305), alongside clinical diagnoses and functioning measures. Exploratory and confirmatory factor analyses were employed to elucidate replicable lower and higher order structures. We found 31 homogenous symptom dimensions that clustered, at different levels of generality, into 8 syndromes (Vegetative Symptoms, Cognitive Depression, Posttraumatic Stress Disorder, Panic, Social Anxiety, Phobia, Obsessive-Compulsive Disorder [OCD], and Mania), 3 subfactors (Distress, Fear, and OCD/Mania), and a single Internalizing spectrum. This structure replicated in both samples. Identified dimensions showed considerable convergence with categorical diagnoses, but provided more information about global functioning than diagnoses. Overall, current results propose a novel comprehensive description of the lower order structure of emotional disorders. The empirical syndromes generally paralleled disorders listed in diagnostic manuals, although several differences were notable. The higher order results also confirmed previously reported Distress, Fear, and Mania subfactors of the Internalizing spectrum using homogeneous dimensional markers. Taken together, results highlight a bottom-up approach to constructing an empirical nosology that does not rely on analysis of diagnostic categories. The resulting hierarchical system can be used clinically and to facilitate research on the pathophysiology of emotional disorders, which, in turn, can inform intervention and prevention. (PsycINFO Database Record

Latent profile analyses of posttraumatic stress disorder, depression and generalized anxiety disorder symptoms in trauma-exposed soldiers.

Posttraumatic stress disorder (PTSD) is comorbid with major depressive disorder (MDD; Kessler et al., 1995) and generalized anxiety disorder (GAD; Brown et al., 2001). We aimed to (1) assess discrete patterns of post-trauma PTSD-depression-GAD symptoms using latent profile analyses (LPAs), and (2) assess covariates (gender, income, education, age) in defining the best fitting class solution. The PTSD Checklist (assessing PTSD symptoms), GAD-7 scale (assessing GAD symptoms), and Patient Health Questionnaire-9 (assessing depression) were administered to 1266 trauma-exposed Ohio National Guard soldiers. Results indicated three discrete subgroups based on symptom patterns with mild (class 1), moderate (class 2) and severe (class 3) levels of symptomatology. Classes differed in symptom severity rather than symptom type. Income and education significantly predicted class 1 versus class 3 membership, and class 2 versus class 3. In conclusion, there is heterogeneity regarding severity of PTSD-depression-GAD symptomatology among trauma-exposed soldiers, with income and education predictive of class membership.

[Anxiety, obsessive-compulsive disorder and trauma in the DSM-5]. / Angst, obsessieve-compulsieve stoornis en trauma in de DSM-5.

BACKGROUND: The 12 anxiety disorders which were defined in the DSM-IV, have been increased to 27 disorders in the DSM-5. These 27 disorders have been subdivided into three chapters: 1. anxiety disorders, 2. obsessive-compulsive and related disorders (OCRD) and 3. trauma and stressor-related disorders. AIM: To describe the most important differences between the DSM-IV and DSM-5 classifications of the above-mentioned disorders. METHOD: Survey of the relevant literature. RESULTS: Within the chapter on anxiety disorders in DSM-5 the classifications of 'panic disorder' and 'agoraphobia' have been separated. In addition, DSM-5 allows the specification 'with panic attacks' to be applied to all psychiatric disorders. New additions to the group ocrd are: 'trichotillomania' and 'body dysmorphic disorder'. Also newly added to the group are the new classifications 'excoriation disorder' and 'hoarding disorder'. The DSM-IV group of adjustment disorders has been merged with the group of stress disorders. In accordance with the system adopted elsewhere in DSM-5, the disorders which are 'usually first diagnosed in infancy, childhood and adolescence' and which resemble the disorders defined in the three chapters have been added to these chapters. Two extra categories are defined in each of the three chapters. CONCLUSION: The three chapters in DSM-5 are little more than a re-arrangement of the disorders defined in DSM-IV. The revision has not led to any clarification of or insight into the relationship between and the etiology of these disorders.

Polymorphisms in the glucocorticoid receptor co-chaperone FKBP5 predict persistent musculoskeletal pain after traumatic stress exposure.

Individual vulnerability factors influencing the function of the hypothalamic-pituitary-adrenal axis may contribute to the risk of the development of persistent musculoskeletal pain after traumatic stress exposure. The objective of the study was to evaluate the association between polymorphisms in the gene encoding FK506 binding protein 51, FKBP5, a glucocorticoid receptor co-chaperone, and musculoskeletal pain severity 6 weeks after 2 common trauma exposures. The study included data from 2 prospective emergency department-based cohorts: a discovery cohort (n=949) of European Americans experiencing motor vehicle collision and a replication cohort of adult European American women experiencing sexual assault (n=53). DNA was collected from trauma survivors at the time of initial assessment. Overall pain and neck pain 6 weeks after trauma exposure were assessed using a 0-10 numeric rating scale. After adjustment for multiple comparisons, 6 FKBP5 polymorphisms showed significant association (minimum P<0.0001) with both overall and neck pain in the discovery cohort. The association of rs3800373, rs9380526, rs9394314, rs2817032, and rs2817040 with neck pain and/or overall pain 6 weeks after trauma was replicated in the sexual assault cohort, showing the same direction of the effect in each case. The results of this study indicate that genetic variants in FKBP5 influence the severity of musculoskeletal pain symptoms experienced during the weeks after motor vehicle collision and sexual assault. These results suggest that glucocorticoid pathways influence the development of persistent posttraumatic pain, and that such pathways may be a target of pharmacologic interventions aimed at improving recovery after trauma.

Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems.

BACKGROUND: This article reviews the current debate on developmental trauma disorder (DTD) with respect to formalizing its diagnostic criteria. Victims of abuse, neglect, and maltreatment in childhood often develop a wide range of age-dependent psychopathologies with various mental comorbidities. The supporters of a formal DTD diagnosis argue that post-traumatic stress disorder (PTSD) does not cover all consequences of severe and complex traumatization in childhood. DISCUSSION: Traumatized individuals are difficult to treat, but clinical experience has shown that they tend to benefit from specific trauma therapy. A main argument against inclusion of formal DTD criteria into existing diagnostic systems is that emphasis on the etiology of the disorder might force current diagnostic systems to deviate from their purely descriptive nature. Furthermore, comorbidities and biological aspects of the disorder may be underdiagnosed using the DTD criteria. SUMMARY: Here, we discuss arguments for and against the proposal of DTD criteria and address implications and consequences for the clinical practice.

Early-life trauma is associated with rapid eye movement sleep fragmentation among military veterans.

The role of sleep in the relations between early-life trauma and the development of adverse psychological trajectories is relatively unknown and was the primary aim of the present study. Military veterans were evaluated for posttraumatic stress disorder, combat exposure, trauma history, sleep quality, disruptive nocturnal behaviors, and a subsample completed overnight polysomnography that yielded objectively measured sleep parameters. When relevant variables were controlled, increased earlier-life traumatic event exposure was associated with increased rapid-eye-movement sleep (REMs) fragmentation, and increased REMs fragmentation was associated with increased later-life disruptive nocturnal behaviors. REMs fragmentation carried an indirect relation between earlier-life trauma and later-life disruptive nocturnal behaviors. Objectively measured sleep parameters were used to describe REMs fragmentation physiology. The current findings elucidate the important role that earlier-life trauma exposure may have in the development of REM sleep physiology, and how this altered sleep physiology may have dynamic influences on subsequent posttraumatic stress symptoms in adulthood.

(Post-traumatic) embitterment disorder: critical evaluation of its stressor criterion and a proposed revised classification.

BACKGROUND: In 2003, the German psychiatrist Michael Linden proposed the new mental disorder concept of "post-traumatic embitterment disorder (PTED)". PTED is defined as the mental reaction to a critical event that is normal, but not everyday, such as conflict at work. The patient sees this event as unjust and as a violation of basic beliefs. The principal aspect of the reaction pattern is a prolonged feeling of embitterment. AIM: In the present paper, the concept of PTED is systematically evaluated. Moreover, future developments in terms of diagnostic systems of mental disorders (ICD-11, DSM-V) are addressed. RESULTS: The evaluation of critical points concerning PTED revealed that the question of whether PTED is a mental disorder of the post-traumatic type cannot be finally answered. It is not possible to specify an empirical criterion by means of which traumatic and non-traumatic life events can be differentiated. An empirical criterion for determining the traumatic nature of a given event depends on whether this event has already been classified as traumatic (i.e. circular argument). CONCLUSIONS: For the purpose of a clear classification of embitterment disorders, the new concept of adjustment disorders of Andreas Maercker and co-workers is introduced. Based on the criteria and their findings, the best and most viable possibility to classify embitterment disorders in accordance with the current adjustment disorder and post-traumatic stress disorder definitions of ICD and DSM is by regarding embitterment disorders as a subtype of adjustment disorders.

Clinicians' understanding of International Statistical Classification of Diseases and Related Health Problems, 10th Revision diagnostic criteria: F62.0 enduring personality change after catastrophic experience.

International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) has included a diagnostic category of "enduring personality change after catastrophic experience" (EPCACE). Preliminary investigation suggests that there is considerable endorsement in principle for this new category among experts in the field of intentional human trauma, yet many aspects of the diagnosis remain contentious. Criticisms leveled at EPCACE raised issues that question the reliability, validity, and clinical utility of this diagnostic category. In ICD-10, there are 2 sets of documents describing EPCACE criteria. These are Diagnostic Criteria for Research (DCR) and Clinical Descriptions and Diagnostic Guidelines (CDDG). This study examines how clinicians described the symptoms that conform to or exceed the criteria of EPCACE that they observed in their clients. No other published research examining the descriptive validity of this category has emerged. A qualitative approach from social phenomenology and applied policy research perspectives was used to gather the views and experiences of clinicians. Twenty-four clinicians working in the area of torture and refugee trauma, war trauma, and sexual assault trauma were interviewed in depth. Using the CDDG, clinicians were able to typify the characteristic symptom criteria of EPCACE. Hostile or mistrustful attitude was identified as a prominent symptom. Somatization, self-injurious behaviors, sexual dysfunction, and enduring guilt are suggested additional features that are not encompassed by current EPCACE criteria. This study contributes to the descriptive validity of EPCACE. It demonstrates the utility of a qualitative approach to descriptive validation of diagnostic criteria. Participation of clinicians as members of working parties in the development and review of diagnostic criteria is recommended. The symptom descriptors generated from this study could be used to enhance CDDG.

Metabotropic glutamate receptors as novel targets for anxiety and stress disorders.

Anxiety and stress disorders are the most commonly occurring of all mental illnesses, and current treatments are less than satisfactory. So, the discovery of novel approaches to treat anxiety disorders remains an important area of neuroscience research. Glutamate is the major excitatory neurotransmitter in the mammalian central nervous system, and G-protein-coupled metabotropic glutamate (mGlu) receptors function to regulate excitability via pre- and postsynaptic mechanisms. Various mGlu receptor subtypes, including group I (mGlu(1) and mGlu(5)), group II (mGlu(2) and mGlu(3)), and group III (mGlu(4), mGlu(7) and mGlu(8)) receptors, specifically modulate excitability within crucial brain structures involved in anxiety states. In addition, agonists for group II (mGlu(2/3)) receptors and antagonists for group I (in particular mGlu(5)) receptors have shown activity in animal and/or human conditions of fear, anxiety or stress. These studies indicate that metabotropic glutamate receptors are interesting new targets to treat anxiety disorders in humans.