Has "Iron" Felix Dzerzhinsky been affected by post-traumatic embitterment disorders?

Retrospective psycho-historical personality analysis of "Iron" Felix Dzerzhinsky presents an opportunity to evaluate development and progression of events and behaviors associated with the killing of hundreds of thousands during the "Red Terror". A biopsychosocial assessment provides evidence suggestive of the presence of post-traumatic embitterment disorder (PTED) as an underlying pathological catalyst for his actions. The introduction of PTED as a possible psychopathology leading to such violent and destructive events promotes the significance of understanding the diagnosis and how negative events may lead to maladaptive behaviors on a broad scale.

The psychobiology of stress, depression, adjustment disorders and resilience.

OBJECTIVES: This paper focuses on the psychobiology of stress, depression, adjustment disorders (ADs), and resilience. Since the ADs fall under the rubric in DSM-5 of Trauma and Stressor-Related Disorders, essentials of the psychobiology of stress-response syndromes will be reviewed. METHODS: A narrative review of the psychobiology of stress-response syndromes is undertaken, and the implications for our understanding of ADs are discussed. RESULTS: Advances in our understanding of the psychobiology of stress-response syndromes provide an important foundation for understanding ADs, and for conceptualizing their diagnosis, as well as issues of resilience. CONCLUSIONS: Future investigations of the psychobiology of trauma- and stressor-related disorders may shed additional light on ADs, and ultimately improve their treatment.

Altered autonomic reactivity in Korean military soldiers with adjustment disorder.

Only few studies addressing the biological background of adjustment disorder (AD) exist. We examined the psychophysiological correlates indicative of autonomic regulation in AD. Heart rate variability (HRV), skin conductance, skin temperature, electromyography, and respiration were measured during serial stress tasks in 33 soldiers with AD and 60 healthy controls (HC). Patients with AD displayed lower relative power of high frequency (rHF) HRV and higher relative power of very low frequency (rVLF) HRV compared with HC at baseline. Inversely, the rHF of patients with AD remained higher and their rVLF remained lower compared with HC parameters after the single stress task, which suggests a reversed sympathovagal balance in AD. Mean heart rate and skin conductance increased during stress tasks in patients, although to a lesser extent than in HC. Skin temperature remained unchanged in all tasks in patients with AD. The tension of the frontalis muscle was higher in patients compared with HC from the second stress task onward. Thoracic breathing was more prevalent in patients with AD. Our study suggests altered autonomic reactivity in AD, which leads to a lack of sympathetic response to stress. We conclude that the distinctive biological mechanisms underlying AD are different from normal stress reactions.

The role of cognitive biases in short-term psychodynamic psychotherapy.

The concept of biased thinking - or cognitive biases - is relevant to psychotherapy research and clinical conceptualization, beyond cognitive theories. The present naturalistic study aimed to examine the changes in biased thinking over the course of a short-term dynamic psychotherapy (STDP) and to discover potential links between these changes and symptomatic improvement. This study focuses on 32 self-referred patients consulting for Adjustment Disorder according to DSM-IV-TR. The therapists were experienced psychodynamically oriented psychiatrists and psychotherapists. Coding of cognitive biases (using the Cognitive Errors Rating Scale; CERS) was made by external raters based on transcripts of interviews of psychotherapy; the reliability of these ratings on a randomly chosen 24% of all sessions was established. Based on the Symptom Check List SCL-90-R given before and after, the Reliable Change Index (RCI) was used. The assessment of cognitive errors was done at three time points: early (session 4-7), mid-treatment (session 12-17), and close to the end (after session 20) of the treatment. The results showed that the total frequency of cognitive biases was stable over time (p = .20), which was true both for positive and for negative cognitive biases. In exploring the three main subscales of the CERS, we found a decrease in selective abstraction (p = .02) and an increase in personalization (p = .05). A significant link between RCI scores (outcome) and frequency of positive cognitive biases was found, suggesting that biases towards the positive might have a protective function in psychotherapy. PRACTITIONER POINTS: Therapists may be attentive to changes in biased thinking across short-term dynamic psychotherapy for adjustment disorder. Therapists may foster the emergence of positive cognitive biases at mid-treatment for adjustment disorder.

Is adjustment disorder unidimensional or multidimensional? Implications for ICD-11.

In preparation for ICD-11, the adjustment disorder (AjD) diagnosis has undergone considerable revisions; however, the latent structure of AjD remains uncertain. It is unclear whether AjD is best represented as a unidimensional or multidimensional construct. This study performed a comprehensive assessment of the latent structure of AjD symptomatology and assessed its concurrent and discriminant validity. Individuals who experienced involuntary job loss (N = 333) completed a self-report measure of AjD symptoms. Seven alternative models of AjD were tested using confirmatory factor analysis. General psychological distress, impairment in social functioning, occupational self-efficacy, and sense of coherence were used as criterion variables for construct validity. In the confirmatory factor analysis, a bifactor solution with one dominant general AjD factor and 5 correlated group factors (preoccupation, failure-to-adapt, avoidance, affective reaction, and impulsivity) provided optimal fit. As expected, the AjD factor showed strong positive associations with general psychological distress and impairments in social functioning and moderately negative associations with occupational self-efficacy and sense of coherence. With regard to unidimensionality or multidimensionality of AjD symptoms, the current results indicate the plausibility of a unidimensional conceptualization. Future research should focus on essential key characteristics and a reduction of symptoms for the AjD definition.

The Comorbidity of Daydreaming Disorder (Maladaptive Daydreaming).

To determine the comorbidity profile of individuals meeting criteria for a proposed new disorder, daydreaming disorder (more commonly known as maladaptive daydreaming [MD]), the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Structured Clinical Interview for DSM-IV Dissociative Disorders were administered to 39 participants who met criteria for MD on a structured interview. We determined high rates of comorbidity: 74.4% met criteria for more than three additional disorders, and 41.1% met criteria for more than four. The most frequent comorbid disorder was attention deficit hyperactivity disorder (76.9%); 71.8% met criteria for an anxiety disorder, 66.7% for a depressive disorder, and 53.9% for an obsessive-compulsive or related disorder. Notably, 28.2% have attempted suicide. Individuals meeting criteria for MD have complex psychiatric problems spanning a range of DSM-5 disorders. This finding provides evidence that MD is different than normal daydreaming and that these individuals experience considerable distress and impairment.

[Psychotraumatology : Differentiation, extension and public discourse]. / Psychotraumatologie : Differenzierung, Erweiterung und öffentlicher Diskurs.

The first description of posttraumatic stress disorder (PTSD) in the 1980s marked the origin of psychotraumatology. Based on the variety of developments in the meantime and being relevant for basic research and clinical application, a differentiation of diagnoses according to the new International Classification of Diseases (ICD-11) are presented including PTSD, complex PTSD, prolonged grief disorder and adjustment disorder. In addition, extension towards traumatic and adverse childhood experiences and their significance for lifetime mental and somatic morbidity are described. Concerning these childhood traumata and adversities, distinct biological and epigenetic factors have been extensively investigated. Also, research groups have postulated that important psychological disorders should be differentiated according to those with and those without reference to pathogenetic trauma. Lastly, regarding relevant public discourses, societal dimensions of victimhood and compensation are discussed as well as a global perspective with respect to continuous and historical traumatization.

Abnormal regional homogeneity and functional connectivity in adjustment disorder of new recruits: a resting-state fMRI study.

PURPOSE: To explore the regional spontaneous neural activity and functional connectivity alterations of adjustment disorder (AD) in new recruits with in vivo resting-state functional MR (rs-fMRI). MATERIALS AND METHODS: Resting-state fMRI was performed in 31 recruits with AD and in 31 control recruits. Regional homogeneity (ReHo) was used to detect the regional synchronizing features of neuronal activations. Correlative analysis was performed to investigate the relationship between the Symptom Check List-90 (SCL-90) score and ReHo in regions with significant group differences. Regions with significant correlation were then defined as regions of interest (ROIs), and seed-ROI based whole-brain functional connectivity was performed. RESULTS: Compared with the controls, patients with AD had significantly lower ReHo in the left posterior cerebellar lobe, bilateral medial orbitofrontal cortex, bilateral caudate and left middle temporal gyrus, whereas regions with enhanced ReHo were confined to bilateral posterior cingulate gyrus/precuneus. Only the left posterior cerebellar lobe showed significant correlation between ReHo and the SCL-90 score, and was defined as the seed ROI. Decreased functional connectivity was found between the ROI and bilateral supplementary motor area. CONCLUSION: This study reveals abnormalities in recruits with AD in baseline brain function activities, which could further improve our understanding of the neural substrates of cognitive impairment in AD.

Psychopathological characteristics of adjustment disorder among outpatients with and without work related stress.

OBJECTIVES: Study's objective is to assess psychopathological profiles in outpatients with a diagnosis of Adjustment Disorder (AD) who had positive evaluations of work related stress (AD-W) versus those exposed to other stressful life events (AD-O). METHODS: The participants were 70 outpatients with AD-W, compared to 71 outpatients with AD-O, admitted at the Unit of Psychiatry and Occupational Medicine, Sant'Andrea Hospital, Rome. Patients completed the Hamilton Rating Scale for Depression (HRSD), the Hamilton Anxiety Rating Scale (HAM-A), the Minnesota Multiphasic Personality Inventory - 2 (MMPI-2), and the Rorschach test. RESULTS: The emerged data underline that patients with AD-W scored significantly higher than patients with AD-O in the MMPI-2 scales D, Pd, Pa, FAM, and in the Rorschach anxiety scale (Sum Y). CONCLUSIONS: Finally patients with AD-W showed greater levels of psychopathology compared to patients with AD-O. Further studies assessing the harm associated with stress might allow a better understanding of the diagnosis and therapeutic implications of AD.

The bimodal P300 oddball component is decreased in patients with an adjustment disorder: An event-related potentials study.

OBJECTIVE: We found previously that use of a bimodal oddball design with synchronized pairs of audio-visual stimuli increased the sensitivity of the P300 wave to detect subclinical anxiety-depression in otherwise healthy subjects. Here, we wished to determine whether these P300 modulations would also be encountered when a clinical population comprised of patients with an adjustment disorder (AJD) was compared to healthy controls. METHOD: Two groups, each comprised of twenty-five participants (AJD patients, and controls; N=50) had to detect deviant stimuli among frequent stimuli in an oddball task by clicking on a button. Separate blocks involving audio (A), visual (V) or bimodal congruent (AV) stimuli were used and compared. RESULTS: P300 amplitudes of the control group were higher than those displayed by AJD patients, but only in the bimodal AV oddball task, while unimodal (visual or auditory) oddball tasks did not reveal any significant differences. CONCLUSIONS: The increased sensitivity of the bimodal P300 that we observed previously in subclinical anxiety-depression was also observed in AJD patients. SIGNIFICANCE: The impaired "bimodal congruence effect" in AJD suggests that these patients have altered integrative processes, which has potential implications for cognitive therapy.

Relationships among Stress, Experiential Avoidance and Depression in Psychiatric Patients.

This study investigated the specific association of stressful life events (SLE) and experiential avoidance (EA) with depression in patients with mental disorders. It also analyzed the possible mediating role of depression in the relation of EA to well-being and life satisfaction. A total of 147 patients (mean age = 40.16 years) diagnosed with anxiety, mood or adjustment disorder were recruited from a mental health centre. They completed measures of SLE, EA, depression, well-being and life satisfaction. Regression analyses showed that SLE and EA were positively related to depression (R 2 = .45), although the contribution made by EA was higher (ß = .61, p < .001) than the one made by SLE (ß = .19, p < .01). Bootstrap mediation analyses revealed that there was an indirect effect from EA to physical well-being (B = -4.52, SE = .70, p < .001, 95% CI [-6.03, -3.20]) and satisfaction (B = -.14, SE = .02, p < .001, 95%, CI [-.19 -.09]) through depression. This indirect effect was less consistently supported with respect to emotional well-being (B = -3.33, SE = .48, p < .001, 95%, CI [-4.30, -2.41]). These findings give support to the hypothesis that EA could be an important factor contributing to depression in patients with mental disorders. The results also provide evidence that depression seems to play an important mediational role when considering the negative impact that EA exerts on patients´ well-being and satisfaction.

STRESSORS, SYMPTOM PROFILE, AND PREDICTORS OF ADJUSTMENT DISORDER IN CANCER PATIENTS. RESULTS FROM AN EPIDEMIOLOGICAL STUDY WITH THE COMPOSITE INTERNATIONAL DIAGNOSTIC INTERVIEW, ADAPTATION FOR ONCOLOGY (CIDI-O).

BACKGROUND: We aimed to investigate type and frequency of stressors, predominant symptom profiles, and predictors of adjustment disorders (AD) in cancer patients across major tumor entities. METHODS: In this epidemiological study, we examined 2,141 cancer patients out of 4,020 screened with the Composite International Diagnostic Interview, adaptation for oncology (CIDI-O). AD were operationalized as subthreshold disorders according to DSM-IV criteria. RESULTS: In our sample, 265 out of 2,141 patients (12.4%) met all criteria for AD (unweighted 4-week prevalence). The disclosure of the cancer diagnosis, relapse or metastases, and cancer treatments were most frequently described as stressors associated with depressive or anxious symptoms. With regard to AD symptom profiles, patients showed high prevalence rates of affective symptoms according to the DSM-IV criteria of Major Depression: The highest prevalence rates were found for cognitive disturbances (concentration and memory problems) (88%), sleeping disturbances (86%), and depressive mood (83%). We found sex, education, and metastasis as significant predictors for AD. Higher education was the most influential predictor. Men were half as likely to report symptoms fulfilling the AD criteria as women. Patients with metastasized tumors had a more than 80% higher risk of AD than those without metastasis. However, the explained variance of our model is very small (Nagelkerke's R² = 0.08). CONCLUSIONS: Patients with AD can be identified using a standardized instrument and deserve clinical attention, as they often show severe clinical symptoms and impairments. Improving the clinical conceptualization of AD by the adding-on of potential stress-response-symptoms is necessary to identify severe psychological strain.

Relationships among stress, experiential avoidance and depression in psychiatric patients

This study investigated the specific association of stressful life events (SLE) and experiential avoidance (EA) with depression in patients with mental disorders. It also analyzed the possible mediating role of depression in the relation of EA to well-being and life satisfaction. A total of 147 patients (mean age = 40.16 years) diagnosed with anxiety, mood or adjustment disorder were recruited from a mental health centre. They completed measures of SLE, EA, depression, well-being and life satisfaction. Regression analyses showed that SLE and EA were positively related to depression (R2 = .45), although the contribution made by EA was higher (β = .61, p < .001) than the one made by SLE (β = .19, p < .01). Bootstrap mediation analyses revealed that there was an indirect effect from EA to physical well-being (B = -4.52, SE = .70, p < .001, 95% CI [-6.03, -3.20]) and satisfaction (B = -.14, SE = .02, p < .001, 95%, CI [-.19 -.09]) through depression. This indirect effect was less consistently supported with respect to emotional well-being (B = -3.33, SE = .48, p < .001, 95%, CI [-4.30, -2.41]). These findings give support to the hypothesis that EA could be an important factor contributing to depression in patients with mental disorders. The results also provide evidence that depression seems to play an important mediational role when considering the negative impact that EA exerts on patients' well-being and satisfaction (AU)

No disponible

The mediating role of emotion dysregulation and depression on the relationship between childhood trauma exposure and emotional eating.

Exposure to childhood adversity is implicated in the etiology of adverse health outcomes, including depression, posttraumatic stress disorder (PTSD), and obesity. The relationship between childhood trauma and obesity may be related to the association of childhood trauma and risk for emotional eating. One pathway between trauma exposure, psychopathology, and emotional eating may be through emotion dysregulation and depression. The current study was undertaken to characterize demographic, environmental, and psychological risk factors for emotional eating in a primarily African American, low socioeconomic status (SES), inner-city population (N = 1110). Emotional eating was measured using the Dutch Eating Behavioral Questionnaire and the Emotional Dysregulation Scale was used to assess emotion regulation. The Beck Depression Inventory and the modified PTSD Symptom Scale were used to assess depression and PTSD, respectively. Higher levels of emotional eating were associated with body mass index, income, childhood and adulthood trauma exposure, depressive and PTSD symptoms, negative affect and emotion dysregulation. Childhood emotional abuse was the most associated with emotional eating in adulthood. Hierarchical linear regression and mediation analyses indicated that the association between childhood trauma exposure (and emotional abuse specifically) and emotional eating was fully mediated by depression symptoms and emotion dysregulation, with emotional dysregulation contributing more to the mediation effect. Together these findings support a model in which obesity and related adverse health outcomes in stress- and trauma-exposed populations may be directly related to self-regulatory coping strategies accompanying emotion dysregulation. Our data suggest that emotion dysregulation is a viable therapeutic target for emotional eating in at-risk populations.

DSM-5 alternative personality disorder model traits as maladaptive extreme variants of the five-factor model: An item-response theory analysis.

Over the past two decades, evidence has suggested that personality disorders (PDs) can be conceptualized as extreme, maladaptive variants of general personality dimensions, rather than discrete categorical entities. Recognizing this literature, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alternative PD model in Section III defines PDs partially through 25 maladaptive traits that fall within 5 domains. Empirical evidence based on the self-report measure of these traits, the Personality Inventory for DSM-5 (PID-5), suggests that these five higher-order domains share a structure and correlate in meaningful ways with the five-factor model (FFM) of general personality. In the current study, item response theory was used to compare the DSM-5 alternative PD model traits to those from a normative FFM inventory (the International Personality Item Pool-NEO [IPIP-NEO]) in terms of their measurement precision along the latent dimensions. Within a combined sample of 3,517 participants, results strongly supported the conclusion that the DSM-5 alternative PD model traits and IPIP-NEO traits are complimentary measures of 4 of the 5 FFM domains (with perhaps the exception of openness to experience vs. psychoticism). Importantly, the two measures yield largely overlapping information curves on these four domains. Differences that did emerge suggested that the PID-5 scales generally have higher thresholds and provide more information at the upper levels, whereas the IPIP-NEO generally had an advantage at the lower levels. These results support the general conceptualization that 4 domains of the DSM-5 alternative PD model traits are maladaptive, extreme versions of the FFM. (PsycINFO Database Record

Adjustment disorders as a stress-related disorder: a longitudinal study of the associations among stress, resources, and mental health.

OBJECTIVE: Adjustment disorders are re-conceptualized in the DSM-5 as a stress-related disorder; however, besides the impact of an identifiable stressor, the specification of a stress concept, remains unclear. This study is the first to examine an existing stress-model from the general population, in patients diagnosed with adjustment disorders, using a longitudinal design. METHODS: The study sample consisted of 108 patients consecutively admitted for adjustment disorders. Associations of stress perception, emotional distress, resources, and mental health were measured at three time points: the outpatients' presentation, admission for inpatient treatment, and discharge from the hospital. To evaluate a longitudinal stress model of ADs, we examined whether stress at admission predicted mental health at each of the three time points using multiple linear regressions and structural equation modeling. A series of repeated-measures one-way analyses of variance (rANOVAs) was performed to assess change over time. RESULTS: Significant within-participant changes from baseline were observed between hospital admission and discharge with regard to mental health, stress perception, and emotional distress (p<0.001). Stress perception explained nearly half of the total variance (44%) of mental health at baseline; the adjusted R2 increased (0.48), taking emotional distress (i.e., depressive symptoms) into account. The best predictor of mental health at discharge was the level of emotional distress (i.e., anxiety level) at baseline (ß= -0.23, R2corr=0.56, p<0.001). With a CFI of 0.86 and an NFI of 0.86, the fit indices did not allow for acceptance of the stress-model (Cmin/df=15.26; RMSEA=0.21). CONCLUSIONS: Stress perception is an important predictor in adjustment disorders, and mental health-related treatment goals are dependent on and significantly impacted by stress perception and emotional distress.

Focusing on the positive: a review of the role of child positive affect in developmental psychopathology.

This review proposes a transactional model of child positive affect (PA) to reflect the ways that PA, in various contexts, may confer both risk and protection for psychosocial adjustment. Though research has largely explored the ways that low PA relates to maladjustment in youth, much less research has focused on the ways that PA can facilitate adjustment, particularly under conditions of risk. Yet, theory suggests that a greater emphasis on PA as a protective factor is an important endeavor in developmental psychopathology research; such conceptual issues are explored in this review. This review also seeks to spur a more nuanced approach to the study of child PA through the use of increased multi-method, longitudinal assessments as well as the consideration of contextual factors. Building upon this research base is important for aiding in the development of intervention and prevention efforts that attempt to promote positive psychosocial development and mitigate the course of psychopathology in youth at risk for PA difficulties.

Stressor-related disorders in tuberous sclerosis.

BACKGROUND: Patients with tuberous sclerosis complex (TSC) have high rates of psychiatric comorbidity, including mood and anxiety disorders. The aim of this study is to identify patients with stressor-related disorders such as posttraumatic stress disorder (PTSD) or adjustment disorder (AD) and to describe their clinical picture in the setting of TSC. METHODS: Retrospective review of medical charts of TSC patients referred for a stressor-related disorder to a TSC psychiatric clinic. RESULTS: We identified 7 females and 2 males (3 PTSD, 6 AD), including 4 children. Two patients with severe intellectual disability presented with aggression and the remaining patients presented with avoidance. The mean duration of symptoms at the time of the study was 21 months (range: 7 to 48 months) and 7 of the 9 patients still were having trauma-related symptoms. All the patients who received an initial diagnosis of AD had their diagnosis changed to another category because their symptoms lasted >6 months. In most cases, selective serotonin reuptake inhibitors improved the symptoms. CONCLUSIONS: Stressor-related disorders in TSC frequently linger beyond 6 months and may appear with triggering events that typically are not viewed as trauma in a normal population.

Immunological and neuroimaging biomarkers of complicated grief.

Complicated grief (CG) is a disorder marked by intense and persistent yearning for the deceased, in addition to other criteria. The present article reviews what is known about the immunologic and neuroimaging biomarkers of both acute grief and CG, Attachment theory and cognitive stress theory are reviewed as they pertain to bereavement, as is the biopsychosocial model of CG. Reduced immune cell function has been replicated in a variety of bereaved populations. The regional brain activation to grief cues frequently includes the dorsal anterior cingulate cortex and insula, and also the posterior cingulate cortex. Using theory to point to future research directions, we may eventually learn which biomarkers are helpful in predicting CG, and its treatment.