Adverse Childhood Experiences are associated with choice of partner, both partners' relationship and psychosocial health as reported one year after birth of a common child. A cross-sectional study.

Adverse Childhood Experiences (ACEs) are common and known to have consequences for individuals' adult health, leading to a higher risk of illness. The aims of the study were to investigate the ACEs in couples, to examine the extent of assortative mating and to investigate the association between the relationship of the load of ACEs within couples and health outcomes, one year after the birth of a common child. At antenatal clinics in Sweden 818 couples were recruited and investigated one year after the birth of a common child answering a questionnaire including the exposure to ten ACE categories and several outcome variables. In total, 59% of both mothers and partners reported exposure to at least one of the ten ACE categories. Among the mothers 11% and among the partners 9% reported exposure to ≥4 ACE categories (p = 0.12). There was a correlation between the numbers of ACE categories reported by the mothers and their partners (Spearman's ρ = 0.18, p<0.001). This association pertained to six of the ten ACE categories. In multiple logistic regression analyses, there were associations between the ACE exposure load and unfavourable outcomes among the mothers, the partners and within the couples. Unfavourable outcomes concerning health were most prominent in couples where both members reported exposures to ≥4 ACE categories (self-rated bad health (OR 13.82; CI 2.75-69.49), anxiety (OR 91.97; CI 13.38-632.07), depression (OR 17.42; CI 2.14-141.78) and perceived stress (OR 11.04; CI 2.79-43.73)). Mothers exposed to ACEs tend to have partners also exposed to ACEs. Exposure to ACEs was associated with bad health and unfavourable life conditions within the couples, especially among couples where both members reported exposure to multiple ACEs. These results should stimulate incentives to find, to support and to treat individuals and couples where both members report multiple ACEs. The consequences for the children should be further studied as well as how these families should be treated in health care and society.

"I feel like I do not exist:" A study of dissociative experiences among war-traumatized refugee youth.

OBJECTIVE: War-traumatized refugee children and adolescents have been overlooked in research on trauma-related dissociation, and whatever research has been conducted has relied almost exclusively on questionnaires. The present study was an exploration of dissociative experiences in multitraumatized war-refugee youth. METHOD: In this study, we used a mixed-method approach by grouping participants according to a Western-based dissociation measure (the Adolescent Dissociative Experiences Scale; Armstrong, Putnam, Carlson, Libero, & Smith, 1997), and conducting qualitative and quantitative analyses of their verbal descriptions of mental experiences related to dissociation in the aftermath of war and resettlement. The sample included 40 refugee youth, ages 13 to 21, 19 girls and 21 boys resettled in Sweden because of war and persecution. RESULTS: Severe trauma-related dissociation was a problem for a considerable subgroup of the sample. Some dissociative experiences were present in all the sample; others were restricted to the most dissociative group. The correlates of severe dissociation included high frequency and severity of emotional dysregulation and intensity, negative self- and body-perception, depressive mood, and experiences of detachment. CONCLUSION: Clinicians are urged to be aware of and assess trauma-related dissociation in war-refugee youth, and consider not only dissociative phenomena, but also other important processes such as emotional dysregulation. (PsycINFO Database Record

Tonic immobility during sexual assault - a common reaction predicting post-traumatic stress disorder and severe depression.

INTRODUCTION: Active resistance is considered to be the 'normal' reaction during rape. However, studies have indicated that similar to animals, humans exposed to extreme threat may react with a state of involuntary, temporary motor inhibition known as tonic immobility. The aim of the present study was to assess the occurrence of tonic immobility during rape and subsequent post-traumatic stress disorder and severe depression. MATERIAL AND METHODS: Tonic immobility at the time of the assault was assessed using the Tonic Immobility Scale in 298 women who had visited the Emergency clinic for raped women within 1 month of a sexual assault. Information about the assault and the victim characteristics were taken from the structured clinical data files. After 6 months, 189 women were assessed regarding the development of post-traumatic stress disorder and depression. RESULTS: Of the 298 women, 70% reported significant tonic immobility and 48% reported extreme tonic immobility during the assault. Tonic immobility was associated with the development of post-traumatic stress disorder (OR 2.75; 95% CI 1.50-5.03, p = 0.001) and severe depression (OR 3.42; 95% CI 1.51-7.72, p = 0.003) at 6 months. Further, previous trauma history (OR 2.36; 95% CI 1.48-3.77, p < 0.001) and psychiatric treatment history (OR 2.00; 95% CI 1.26-3.19, p = 0.003) were associated with the tonic immobility response. CONCLUSIONS: Tonic immobility during rape is a common reaction associated with subsequent post-traumatic stress disorder and severe depression. Knowledge of this reaction in sexual assault victims is important in legal matters and for healthcare follow up.

Types of trauma in adolescence and their relation to dissociation: A mixed-methods study.

OBJECTIVE: To study adolescent traumatization and the impact of various types of trauma on dissociative experiences in a sample of 239 Swedish youngsters, 13 to 20 years of age, with diverse socioeconomic and migration backgrounds. We also evaluated whether the type of worst lifetime trauma was associated with higher rates of dissociation. METHOD: Quantitative and qualitative data on posttraumatic stress, dissociative experiences, and potentially traumatic events (PTEs), including participants' written descriptions of their worst lifetime trauma. RESULTS: Most (92%) of the participants had been exposed to at least 1 PTE and 51% to 4 or more, during their life. Number of PTEs correlated with symptoms of posttraumatic stress and dissociation. There were higher rates of dissociation among economically vulnerable and second-generation war refugee participants. Emotional abuse by others (mostly peers) was the only significant predictor of dissociation when controlling for gender, age, total PTEs, posttraumatic stress, and poverty. Moderation analyses showed that lifetime worst traumas categorized as primarily emotional moderated and amplified the relation between total PTEs and dissociation, but only among girls. CONCLUSIONS: Our findings indicate that traumatization is very common among adolescents, with greater prevalence of dissociation among vulnerable groups, and that emotional traumas are linked to higher rates of dissociation, especially among girls. Researchers, clinicians, and school personnel need to focus more on immigrant status and low SES as vulnerability factors, and address the consequences of emotional abuse, including bullying, among adolescents. (PsycINFO Database Record

Women with PTSD have a changed sensitivity to GABA-A receptor active substances.

RATIONALE: The use of benzodiazepines in treating anxiety symptoms in patients with posttraumatic stress disorder (PTSD) has been debated. Studies on other anxiety disorders have indicated changed sensitivity to GABA-A receptor active substances. OBJECTIVE: In the present study, we investigated the GABA receptor sensitivity in PTSD patients. METHODS: Injections of allopreganolone, diazepam, and flumazenil were carried out, each on separate occasions, in 10 drug naïve patients with PTSD compared to 10 healthy controls. Effects were measured in saccadic eye velocity (SEV) and in subjective ratings of sedation. RESULTS: The PTSD patients were less sensitive to allopregnanolone compared with healthy controls. This was seen as a significant difference in SEV between the groups (p = 0.047). Further, the patients were less sensitive to diazepam, with a significant less increase in sedation compared to controls (p = 0.027). After flumazenil injection, both patients and controls had a significant agonistic effect on SEV, leading to decreased SEV after injection. The patients also responded with an increase in sedation after flumazenil injection, while this was not seen in the controls. CONCLUSIONS: Patients with PTSD have a changed sensitivity to GABA-A receptor active substances. As a consequence of this, benzodiazepines and other GABA-A receptor active compounds such as sleeping pills will be less useful for this group of patients.

Erratum to: Women with PTSD have a changed sensitivity to GABA-A receptor active substances.

Erratum to: Pyschopharmacology, DOI 10.1007/s00213-014-3776-y . In the original publication of this paper the name of the first author was incorrectly rendered as "Möller AT." In fact, her name is Anna Tiihonen Möller and her family name is Tiihonen Möller. Thus her name should be rendered as "Tiihonen Möller A."

Identifying risk factors for PTSD in women seeking medical help after rape.

OBJECTIVES: Rape has been found to be the trauma most commonly associated with Posttraumatic Stress Disorder (PTSD) among women. It is therefore important to be able to identify those women at greatest risk of developing PTSD. The aims of the present study were to analyze the PTSD prevalence six months after sexual assaults and identify the major risk factors for developing PTSD. METHODS: Participants were 317 female victims of rape who sought help at the Emergency Clinic for Raped Women at Stockholm South Hospital, Sweden. Baseline assessments of mental health were carried out and followed up after six months. RESULTS: Thirty-nine percent of the women had developed PTSD at the six month assessment, and 47% suffered from moderate or severe depression. The major risk factors for PTSD were having been sexually assaulted by more than one person, suffering from acute stress disorder (ASD) shortly after the assault, having been exposed to several acts during the assault, having been injured, having co-morbid depression, and having a history of more than two earlier traumas. Further, ASD on its own was found to be a poor predictor of PTSD because of the substantial ceiling effect after sexual assaults. CONCLUSIONS: Development of PTSD is common in the aftermath of sexual assaults. Increased risk of developing PTSD is caused by a combination of victim vulnerability and the extent of the dramatic nature of the current assault. By identifying those women at greatest risk of developing PTSD appropriate therapeutic resources can be directed.

Patterns of injury and reported violence depending on relationship to assailant in female Swedish sexual assault victims.

Earlier studies have explored the differences between known-assailant sexual assaults and stranger assaults and reported the stranger assaults as being more violent. Only a few studies have discriminated between sexual assaults by intimate partners from assaults by other known assailants when comparing with assaults by strangers. In this study, we explored differences in the extent of violence and physical injury in sexual assaults committed by intimate partners compared with assaults by strangers and acquaintances. Medical and forensic records of 690 consecutive women attending a sexual assault center in Stockholm, Sweden were reviewed. The final sample included in the analysis consisted of 503 patients. Our results showed that women sexually assaulted by their intimate partners more frequently reported physical violence (OR = 4.1) than women assaulted by strangers (OR = 2.0) and acquaintances (OR = 1.0). Genital injuries were not found to be related to the victim-assailant relationship in this study. Extragenital injuries showed a tendency toward being more frequently found after intimate partner assaults compared with stranger and acquaintance assaults; however, this was not found to be significant in adjusted analyses. Previous history of sexual assault was more common, and seeking medical care within 72 hr as well as being under the influence of alcohol during the assault was less frequent among intimate partner victims. These results support the conclusion that sexual assaults committed by intimate partners, contradictory to earlier studies, are likely to involve more physical violence and result in injuries just as often as assaults committed by strangers.

Patterns of endogenous steroids in apathetic refugee children are compatible with long-term stress.

BACKGROUND: During the last few years, a number of children of asylum applicants in Sweden developed an apathetic or unconscious state. The syndrome was perceived as new, and various explanations were advanced such as factitious disorder, intoxication, or stress. Considering a potential association between traumatic stress and regulation of steroids biosynthesis, this study explored whether changes in concentrations of endogenous steroids were associated with the above syndrome. METHODS: Eleven children were recruited in the study. Concentrations of steroids in blood samples were determined using high sensitivity liquid chromatography tandem mass spectrometry methods. Symptoms were assessed with a clinical rating scale developed for the study. Steroid concentrations were measured at the entry into study and after recovery; and concentrations were evaluated for the association with the symptoms in apathetic children. RESULTS: Cortisol and cortisone concentrations at baseline were negatively associated with duration of the symptoms from entry into the study to clinical recovery. Higher concentrations of pregnanes (pregnenolone, 17-OH-pregnenolone, and dehydroepiandrosterone) were observed in the symptomatic state and the concentrations decreased after the recovery. CONCLUSIONS: Pattern of low cortisol concentrations found in apathetic children is consistent with long-term stress. An increase of upstream steroid metabolites (pregnanes) was found to be associated with the symptomatic state.

Physiological correlates of eye movement desensitization and reprocessing.

Eye movement desensitization and reprocessing (EMDR) is an established treatment for post-traumatic stress disorder (PTSD). However, its working mechanism remains unclear. This study explored physiological correlates of eye movements during EMDR in relation to current hypotheses; distraction, conditioning, orienting response activation, and REM-like mechanisms. During EMDR therapy, fingertip temperature, heart rate, skin conductance, expiratory carbon dioxide level, and blood pulse oximeter oxygen saturation, were measured in male subjects with PTSD. The ratio between the low and high frequency components of the heart rate power spectrum (LF/HF) were computed as measures of autonomic balance. Respiratory rate was calculated from the carbon dioxide trace. Stimulation shifted the autonomic balance as indicated by decreases in heart rate, skin conductance and LF/HF-ratio, and an increased finger temperature. The breathing frequency and end-tidal carbon dioxide increased; oxygen saturation decreased during eye movements. In conclusion, eye movements during EMDR activate cholinergic and inhibit sympathetic systems. The reactivity has similarities with the pattern during REM-sleep.

Disturbed sleep and fatigue in occupational burnout.

OBJECTIVES: The purpose of this study was to investigate sleep with polysomnography and self-ratings and the diurnal pattern of sleepiness and fatigue in a group suffering from severe occupational burnout. METHOD: Twelve white-collar workers on long-term sick leave (>3 months) and 12 healthy controls with high and low scores on the Shirom Melamed Burnout Questionnaire (SMBQ) were included. A 1-night polysomnographic recording (after habituation) was carried out at home, and sleepiness and mental fatigue were rated at different times of the day for weekdays and the weekend. Precipitating factors at the time of the illness at work and real life were considered, and different dimensions of occupational fatigue were described. A repeated-measures analysis of variance using two or three within group factors was used to analyze the data. RESULTS: The main polysomnographic findings were more arousals and sleep fragmentation, more wake time and stage-1 sleep, lower sleep efficiency, less slow wave sleep and rapid eye movement sleep, and a lower delta power density in non-rapid eye movement sleep in the burnout group. The burnout patients showed pronounced sleepiness and mental fatigue at most times of the day for weekdays without reduction during weekends. The precipitating factor was occupational stress (psychiatric interview), and work stress indicators were increased. CONCLUSIONS: Occupational burnout is characterized by impaired sleep. It is suggested that impaired sleep may play a role in the development of fatigue or exhaustion in burnout.

Morphometric and psychometric comparisons between non-substance-abusing patients with posttraumatic stress disorder and normal controls.

BACKGROUND: Hippocampal decrease in size in response to posttraumatic stress disorder (PTSD) is still a subject of controversy. The aims of this study were to: (1) confirm previous hippocampus findings in PTSD patients compared to controls, using ethnically similar study groups where alcohol and drug abuse were non-existent; (2) test influence of disease duration as well as depression scores on possible morphological changes; (3) test whether the voxel-based morphometry (VBM) data confirm the group differences seen in the region of interest (ROI) analysis, and (4) test the associations between the cognitive test scores and the morphological changes. METHODS: VBM and ROI-based analysis were applied in 23 patients and 17 healthy controls. Culture-neutral cognitive tests were used. RESULTS: The ROI-based method showed significantly decreased gray matter volumes for global hippocampal volume, as in a separate analysis of left and right sides in the PTSD group. Total volume of the hippocampus was significantly decreased on the left side, as in the global assessment. A multiple regression VBM model showed significant voxel clusters for group affiliation in the right hippocampus, modelling lowering of gray matter associated with the PTSD group. Disease duration was shown to be negatively correlated to bilateral hippocampal volume and high depression score to bilateral gray matter parahippocampal volume. No significant correlations were found between hippocampal or parahippocampal volumes and cognitive functions. CONCLUSION: The present and previous studies showed that morphologic differences do not appear to be due to drug or alcohol abuse. The VBM data partially confirm the group differences seen in the ROI-based method in the medial temporal lobe. The fact that the significantly lower score on the short-term memory test in the PTSD group is not correlated to hippocampal volume may suggest a more general basis for such memory impairment.

Impaired memory and general intelligence related to severity and duration of patients' disease in Type A posttraumatic stress disorder.

Studies of short-term memory and general intelligence associated with duration and severity of posttraumatic stress disorder (PTSD) on observed Type A scores are rare. The authors' aim was to assess Type A behavior and identify subgroups of patients who performed most poorly on memory and intelligence tests and Type A scores related to the severity and duration of their disease. They administered nonverbal memory and intelligence tests to 30 men with PTSD and 20 men without PTSD who responded. During their initial contact with the participants, 2 experts assessed 3 major coronary-prone characteristics (hyperalertness, tight facial musculature, and explosive speech). They found significant differences between the PTSD and control groups in total Type A scores. Those with the most severe PTSD performed most poorly on visual retention tests and showed the highest scores on self-reported and subjective diastolic blood pressure reactivity during magnetic resonance imaging. In the PTSD group, high error scores on the visual retention test predicted Type A behavior and low scores on the picture memory block design tests predicted high Type A scores. A significant positive correlation was found between Type A and clinician-assessed subjective distress, whereas the correlations were significantly negative between picture memory and Type A behavior Suppressed fear is commonly associated with PTSD; decades of research on Type A behavior have isolated fear as a crucial factor in cardiovascular disease.

Language acquisition in relation to cumulative posttraumatic stress disorder symptom load over time in a sample of re-settled refugees.

OBJECTIVE: To study the effects of symptoms of posttraumatic stress disorder (PTSD), depression and dissociation as well as cumulative symptom load on language learning during the introduction phase in re-settled refugees. METHOD: Participants were re-settled refugees of Iraqi origin. They were assessed by means of a structured interview for PTSD at baseline as well as self-rating questionnaires. Language acquisition was studied by means of register data from the school system. Five levels of language proficiency were recorded. Self-reported symptom scores for PTSD, depression and dissociation (Impact of Events Scale-22, Hopkins Symptom Checklist-25, Dissociative Experiences Scale) were measured at four time points during 9 months immediately after resettlement. In 49 participants in a longitudinal study, data regarding progress in language studies were accessible. RESULTS: The results of the study indicate that the speed of language acquisition - the number of levels taken during the study, adjusted to hours of school presence - is related to the cumulative PTSD symptom load over time (Events Scale-22), but is not related neither to the symptom load of depression and dissociation, nor to the number of previous school years. CONCLUSION: The study shows that the symptom load of PTSD during the follow-up period is significantly inversely related to the speed of language acquisition in refugees. This implies that treatment as well as preventive measures against worsening of PTSD symptoms are important in order to minimise harmful post-migration stress for the facilitation of integration.

A putative role for Toxocara species in the aetiology of multiple sclerosis.

Multiple sclerosis (MS) is a disease of unknown aetiology. The finding of monoclonal antibodies in MS has been attributed to various infectious agents. Nematodes, such as Toxocara species have not been explored as possible aetiologic agents of MS. Some epidemiological studies have found an association between exposure to stress and household pets prior to the diagnosis of MS. In a case known to the authors, slight malaise and eosinophilia in peripheral blood preceded the diagnosis of MS by one year in a middle-aged man who lived in rural surroundings with cats in the household. The ubiquitary parasite Toxocara catis or canis is prevalent and serum antibodies are found regularly in populations examined. It is able to develop into the larval stage in human beings. The hypothesis presented here is that MS could be initiated by such infections in previously unexposed subjects under conditions of long-term stress.