Trauma and identity: A reciprocal relationship?

Trauma can alter the course of identity development and destabilize existing identity commitments. Trauma, whether past or current, can also impact the resources a person brings to identity work. However, identity can also be a lens through which trauma is perceived and interpreted, helping to determine whether a traumatic experience results in posttraumatic stress disorder or posttraumatic growth. Despite the apparent implications each construct has for the other, the scholarship at the intersection of trauma and identity remains sparse. This Special Issue explores how and when trauma and identity influence one another by considering their association across various adolescent populations, methodologies, traumatic event types, and facets of identity. In doing so, this Special Issue lays the groundwork necessary for exploring, proposing, and testing more complex and nuanced reciprocal relations models between identity and trauma.

Acculturation, identity distress, and internalizing symptoms among resettled adolescent refugees.

INTRODUCTION: This study examines the relations among native and host country acculturation, identity distress, and internalizing symptoms among multicultural adolescent refugees (N = 33) resettled to the United States from a range of countries including Cuba, Iraq, Jordan, Haiti, Colombia, and Venezuela. Despite previous research supporting the advantages of developing a bicultural style to acculturation, mixed results have been found regarding native and host country acculturation patterns among resettled refugees and how these patterns may be associated with refugee mental health outcomes. METHODS: The objective of this study was not only to consider the roles that US and native acculturation may play on the self-report of identity distress and internalizing symptoms among refugee adolescents more broadly, but also to consider the role various dimensions of acculturation (e.g., cultural identity, language competence, and cultural competence) may play for refugee adolescents post-resettlement. RESULTS AND CONCLUSIONS: The study findings indicate that native acculturation, and more specifically native cultural identity, may serve as significant protective factors against identity distress among adolescent refugees post-resettlement, with native cultural identity additionally serving as a protective factor against internalizing symptoms. US acculturation was not found to be significantly associated with identity distress or internalizing symptoms, nor were the acculturative dimensions of language learning (i.e., English and native language competencies), cultural knowledge (i.e., US and native cultural knowledge competencies), or US cultural identity. Recommendations and implications for practice and future research are discussed.

Brain activation during emotion regulation in women with premenstrual dysphoric disorder.

BACKGROUND: Difficulties in regulating emotions are linked to the core symptoms of premenstrual dysphoric disorder (PMDD). We therefore investigated the neural substrates of emotion-regulation problems in women with PMDD. METHODS: On the basis of self-evaluations over 2 months on the Daily Record of Severity of Problems, eligible participants were assigned to two groups: PMDD and control (18 per group). Functional magnetic resonance imaging (fMRI) and a well-validated task were used to assess brain function during emotion regulation. Participants were tested twice, once during the follicular (asymptomatic) and once in the late luteal (symptomatic) phase of the menstrual cycle. RESULTS: Women with PMDD gave higher ratings of negative affect in the luteal phase than in the follicular phase, and compared with healthy control participants during the luteal phase. A region-of-interest fMRI analysis indicated that during the late luteal phase, women with PMDD had hypoactivation in right dorsolateral prefrontal cortex (dlPFC) during all conditions of the emotion-regulation task, not only in the contrast that isolated emotion regulation. An exploratory whole-brain, voxel-wise analysis showed that women with PMDD had less activation in the precentral gyrus during the luteal phase than the follicular phase, and less activation in the postcentral gyrus compared with control participants. CONCLUSIONS: During the luteal phase of the menstrual cycle, women with PMDD experience difficulty regulating emotions. Hypoactivation in the right dlPFC may contribute to this problem, but may be related more generally to other affective symptoms of PMDD. Hypofunction in the right pre- and postcentral gyri warrants additional study.

Existential Anxiety Among Adolescents Exposed to Disaster: Linkages Among Level of Exposure, PTSD, and Depression Symptoms.

Exposure to natural disasters can be highly traumatic and have a detrimental effect on youth mental health by threatening the satisfaction of basic human needs and goals. Recent research in adults suggests that exposure to disasters may exacerbate existential anxiety about the meaning of life. The current study expands this investigation to adolescents, who may be particularly vulnerable to the negative effects of disaster. Data came from 325 adolescents (mean age = 15.05 years, SD = 1.05) residing in the Greater New Orleans area who were exposed to Hurricanes Katrina and/or Gustav. Existential anxiety concerns were highly prevalent in the sample and were associated with elevated levels of posttraumatic stress disorder (R2 = .09) and depression symptoms (R2 = .13). Consistent with theoretical predictions, disaster exposure levels moderated the association between facets of existential anxiety and mental health symptoms. Findings highlight the salience of existential concerns in disaster exposed youth, and provide evidence that exposure to traumatic stress may strengthen their association with mental health problems.

Effects of leptin deficiency and replacement on cerebellar response to food-related cues.

Leptin affects eating behavior partly by altering the response of the brain to food-related stimuli. The effects of leptin on brain structure have been observed in the cerebellum, where leptin receptors are most densely expressed, but the function of leptin in the cerebellum remains unclear. We performed a nonrandomized, prospective interventional study of three adults with genetically mediated leptin deficiency. FMRI was recorded three times each year during years 5 and 6 of leptin replacement treatment. Session 1 of each year occurred after 10 months of continuous daily replacement, session 2 after 33-37 days without leptin, and session 3 at 14-23 days after daily replacement was restored. Statistical parametric mapping software (SPM5) was employed to contrast the fMRI blood oxygenation level-dependent response to images of high-calorie foods versus images of brick walls. Covariate analyses quantified the effects of the duration of leptin replacement and concomitant changes in body mass on the cerebral responses. Longer duration of replacement was associated with more activation by food images in a ventral portion of the posterior lobe of the cerebellum, while simultaneous decreases in body mass were associated with decreased activation in a more dorsal portion of the same lobe. These findings indicate that leptin replacement reversibly alters neural function within the posterior cerebellum and modulates plasticity-dependent brain physiology in response to food cues. The results suggest an underexplored role for the posterior cerebellum in the regulation of leptin-mediated processes related to food intake.

Home telehealth in high-risk dialysis patients: a 3-year study.

OBJECTIVE: This study is a continuation of a previous pilot project that demonstrated improved health outcomes and significant cost savings using home telehealth with nurse oversight in patients with end-stage renal disease undergoing chronic dialysis. We are reporting the results of a larger sample size over a 3-year study period to test the validity of our original observations. SUBJECTS AND METHODS: Ninety-nine patients were included in this study; 43 (18 females, 25 males) with a mean age of 58.6 years were enrolled in the remote technology (RT) group, and 56 (26 females, 30 males) with a mean age of 63.1 years were enrolled in the usual-care (UC) group. Health resource outcome measures included hospitalizations, emergency room (ER) visits, and number of days hospitalized. Economic analysis was conducted on hospital and ER charges. RESULTS: Hospitalizations (RT, 1.8; UC, 3.0), hospital days (RT, 11.6; UC, 25.0), and hospital and ER charges (RT, $66,000; UC, $157,000) were significantly lower in the RT group, as were hospital and ER charges per study day (RT, $159; UC, $317). CONCLUSIONS: The results support our previous findings, that is, home telehealth can contribute to improved health outcomes and cost of care in high-risk dialysis patients.

Home telehealth: facilitators, barriers, and impact of nurse support among high-risk dialysis patients.

OBJECTIVE: The value of home telehealth self-monitoring with nurse oversight has been demonstrated; however, there is a dearth of objective documentation of patients' experiences with such a model. We used a mixed methods approach to examine the value of home telehealth monitoring with remote care nurse (RCN) support from the perspective of participants in our study. MATERIALS AND METHODS: Thirty-three patients who used remote technology to self-monitor their health at home participated in a semistructured interview. The instrument was designed to help identify facilitators and barriers and to evaluate patient satisfaction with and effectiveness of home telehealth self-monitoring. RESULTS: Overall, patients reported high levels of satisfaction with RCN support as they received efficient feedback, were better able to identify changes in their health status, and experienced enhanced accountability, self-efficacy, and motivation to make health behavior changes. The most frequently cited barriers related to malfunctioning equipment or trouble with Internet connections, forgetfulness, and feeling poorly. CONCLUSIONS: The results suggest that home telehealth self-monitoring with RCN support is effective in empowering patients to take a more active role in their healthcare and indirectly improve quality of life for those living with chronic illness.

Adolescent identity development and distress in a clinical sample.

OBJECTIVE: The purpose of this study was to examine the relationships of identity development and identity distress to psychological adjustment within adolescents affected by psychological problems. METHOD: Participants included 88 adolescents (43.2% female) ranging from 11 to 20 years of age who were receiving services from a community mental health center. RESULTS: A high proportion of the participants (22.7%) met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for Identity Problem. Regression analyses found psychopathology symptom score was associated with identity distress, identity exploration, and identity commitment, while identity distress was only related to psychopathology symptom score and not the other two identity variables. CONCLUSIONS: Adolescents with a clinical diagnosis may report significant levels of identity distress. Given that the relationship between psychopathology and identity distress may be reciprocal, assessing for identity issues might be prudent when conducting clinical diagnostic interviews and useful in treatment planning.

Linguistic Empathy: Behavioral measures, neurophysiological correlates, and correlation with Psychological Empathy.

Relations among behavioral, psychological, and electrophysiological correlates of Linguistic Empathy were examined in two experiments using lateralized stimuli. Linguistic Empathy is defined as a linguistic manifestation of the point of view the speaker assumes toward the content of the utterance, and of the speaker's attitude toward/identification with the referents therein. Linguistic choices made by the speaker among multiple logically and referentially synonymous lexical and grammatical options reveal the speaker's perspectives. In experiment 1, acceptability ratings were measured for Context-Target sentence pairs that did or did not violate two Empathy Hierarchies (Person Empathy Hierarchy and Topic Empathy Hierarchy); the Empathy Quotient (EQ) test of Psychological Empathy was also administered. Ratings were lower for sentence pairs that violated both hierarchies than for those violating neither and were intermediate for sentences violating only one hierarchy. Linguistic Empathy (LE) was operationalized as the difference in ratings between sentences violating both vs. neither empathy hierarchy; this measure correlated positively with EQ. Experiment 2 replicated those results with new participants and measured reaction time and EEG during ratings. While there were no effects of hemisphere or visual field on the linguistic variables, the amplitude of a positive event-related potential deflection at 380 ms provided a partial electrophysiological correlate for LE. Its difference measure correlated with behavioral LE but not with EQ. Though preliminary, these experiments show that Linguistic Empathy may share information processing computations with Psychological Empathy and have an electrophysiological correlate.

Evidence for alterations in central noradrenergic signaling in irritable bowel syndrome.

BACKGROUND/AIMS: Alterations in noradrenergic (NE) signaling have been implicated in the pathophysiology of irritable bowel syndrome (IBS), and adrenergic receptors are potential treatment targets. METHODS: To characterize central NE signaling in IBS, 11 patients and 11 healthy controls (HCs) were studied 3 times during an auditory oddball vigilance task after double-blind ingestion of the α2-adrenoreceptor (α2AR) antagonist yohimbine (YOH), the α2AR agonist clonidine (CLO), or placebo (PLA). Regional cerebral glucose metabolism was measured with [¹8F] fluorodeoxyglucose (FDG) positron emission tomography (PET). Measures of anxiety, early-life trauma, plasma NE and blood pressure were acquired. RESULTS: Patients had higher plasma NE levels than HCs before and after ingestion of all drugs (all p<0.05). YOH increased plasma NE and more anxiety in patients than in HCs. After YOH, NE levels directly correlated with drug-induced increases in anxiety in IBS patients (r=0.61), but not in HCs. IBS patients showed less YOH-mediated reduction of activity in a central arousal circuit, consistent with fewer functional presynaptic α2AR. In HCs, but not in patients, activation of amygdala and subgenual anterior cingulate cortex (sgACC) was inversely correlated with activation of anterior mid cingulate cortex (aMCC), and state anxiety covaried directly with activity in limbic and right frontotemporal cortices, but indirectly with activity in the left frontotemporal cortex. YOH-mediated reduction of activity in brainstem and amygdala inversely correlated with early life trauma. CONCLUSIONS: IBS patients showed evidence for increased noradrenergic activity consistent with downregulation of presynaptic inhibitory α2ARs. Activity within central arousal circuits was biased toward greater excitability and reduced corticolimbic inhibition in IBS. Early life trauma may be one mediator of these abnormalities.

The relationships among caregiver and adolescent identity status, identity distress and psychological adjustment.

The present study addresses the relationships of caregiver identity status on their adolescent children's identity distress and psychological symptom severity among a sample of adolescents (age 12-19) in treatment at a community mental health center (N = 60 caregiver-child dyads). A significant proportion of caregivers (10%) and their adolescent children (21.7%) met DSM-IV criteria for Identity Problem. Caregiver identity commitment, significantly predicted adolescent identity distress over and above the adolescents' identity variables, while caregiver identity exploration significantly predicted adolescent psychological symptom severity. These findings and implications are discussed in further detail.

Globalization and identity development: a Chinese perspective.

This chapter begins with a discussion of the unique experience of adolescents and emerging adults who grew up with globalization in China and how it has affected their sense of self. We then discuss the effects of globalization on identity development in general, with a special focus on the sociohistorical context of China. We also review and critique the psychological literature that has been conducted on identity within Chinese and Chinese American populations. Finally, we discuss the applicability of Western concepts of identity on a culture that does not necessarily share the same value structure.

Home-based preventative care in high-risk dialysis patients: a pilot study.

OBJECTIVE: Most dialysis patients have multiple comorbidities with complex healthcare needs and consume a disproportionate share of medical resources. We conducted a pilot study employing telehealth technology to determine whether home-based preventative care can improve healthcare outcomes, impact quality of life (QOL), and be cost effective by proactively managing underlying chronic conditions that place the patient at risk. MATERIALS AND METHODS: Forty-four patients (19 in the remote technology group [RT] and 25 in the usual care group [UC]) participated in this study. The mean age was 57 for those in the RT group (7 females and 12 males) and 62 for those receiving UC (11 females and 14 males). Health outcome measurements included hospitalizations, emergency room visits, and the number of days hospitalized. Economic analysis included total hospital and emergency room charges. QOL was measured using the medical outcomes survey instrument 36-Item Short Form Health Survey (SF-36). RESULTS: Hospitalizations (RT 0.0018 and UC 0.0056 per study day), hospital days (RT 0.008 and UC 0.036 per study day), emergency room visits (RT 0.0003 and UC 0.0019 per study day), and associated charges (RT $114 and UC $322 per study day) were significantly less in the RT group of the study compared with patients receiving UC. The perceived QOL remained the same in the UC group from outset to midpoint of the study (59.1, 59.5), whereas it decreased slightly in the RT group (63.9, 60.76). CONCLUSIONS: The results suggest that remote telehealth technology can play an important role in improving health outcomes and the cost of care of patients with end-stage renal disease who have complex healthcare needs.

Regional cerebral glucose metabolism and anxiety symptoms in bipolar depression: effects of levothyroxine.

We examined the relationships between regional brain activity and anxiety in bipolar depressed patients receiving adjunctive treatment with levothyroxine. Regional brain activity was assessed with positron emission tomography and [18F]fluorodeoxyglucose in 10 euthyroid, depressed bipolar women before and after 7 weeks of adjunctive therapy with levothyroxine. The primary biological measures were relative (to global) regional radioactivity as a surrogate index of glucose metabolism in pre-selected brain regions. Relationships were assessed between regional brain activity and anxiety symptoms while controlling for depression severity. At baseline, Trait Anxiety Inventory measures covaried positively with relative brain activity bilaterally in the dorsal anterior cingulate, superior temporal gyri, parahippocampal gyri, amygdala, hippocampus, ventral striatum, and right insula; state anxiety showed a similar pattern. After treatment anxiety was improved significantly. Change in trait anxiety covaried positively with changes in relative activity in right amygdala and hippocampus. Change in state anxiety covaried positively with changes in relative activity in the hippocampus bilaterally and left thalamus, and negatively with changes in left middle frontal gyrus and right dorsal anterior cingulate. Results indicate that comorbid anxiety symptoms have specific regional cerebral metabolic correlates in bipolar depression and cannot only be explained exclusively by the depressive state of the patients.

Reduced brainstem inhibition during anticipated pelvic visceral pain correlates with enhanced brain response to the visceral stimulus in women with irritable bowel syndrome.

Cognitive factors such as fear of pain and symptom-related anxiety play an important role in chronic pain states. The current study sought to characterize abnormalities in preparatory brain response before aversive pelvic visceral distention in irritable bowel syndrome (IBS) patients and their possible relationship to the consequences of distention. The brain functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) response to anticipated and delivered mild and moderate rectal distention was recorded from 14 female IBS patients and 12 healthy controls. During cued anticipation of distention, activity decreased in the insula, supragenual anterior cingulate cortex (sACC), amygdala, and dorsal brainstem (DBS) of controls. IBS patients showed less anticipatory inactivation. Group differences were significant in the right posterior insula and bilateral DBS. Self-rated measures of negative affect during scanning were higher in patients than controls (p < 0.001), and the anticipatory BOLD decreases in DBS were inversely correlated with these ratings. During subsequent distention, both groups showed activity increases in insula, dorsal ACC, and DBS and decreases in the infragenual ACC. The increases were more extensive in patients, producing significant group differences in dorsal ACC and DBS. The amplitude of the anticipatory decrease in the pontine portion of DBS was associated with greater activation during distention in right orbitofrontal cortex and bilateral sACC. Both regions have been associated previously with corticolimbic inhibition and cognitive coping. Deficits in preparatory inhibition of DBS, including the locus ceruleus complex and parabrachial nuclei, may interfere with descending corticolimbic inhibition and contribute to enhanced brain responsiveness and perceptual sensitivity to visceral stimuli in IBS.

Effect of abuse history on pain reports and brain responses to aversive visceral stimulation: an FMRI study.

BACKGROUND & AIMS: Abuse history is common in irritable bowel syndrome (IBS) and is associated with greater pain reporting, psychologic distress, and poorer health outcome. These effects may be mediated by enhanced responses to aversive visceral stimuli. We investigated the effects of IBS and abuse history on pain reporting and brain activation in response to rectal distentions. METHODS: Ten female patients with IBS and 10 controls were included. Half of patients in each group reported a history of abuse. Brain functional magnetic resonance imaging (fMRI) images and pain ratings were obtained during rectal distentions. Statistical parametric mapping identified activation in subregions of the dorsal cingulate cortex and covariation with rated pain. RESULTS: (1) Distention-elicited pain correlated with anxiety and activation of the posterior (PCC) and middle (MCC) dorsal cingulate subregions. (2) Subjects with a history of abuse showed greater activation in the left MCC (P = .022; t = 5.61) and PCC (P = .033; t = 5.00) than subjects without abuse. (3) Those with IBS and abuse reported greater pain than all others (P = .004), had more activity in the left MCC (P = .021; t = 5.29) and PCC (P = .049; t = 4.81), and had less activity in the left supragenual anterior cingulate (sACC) (P = .01; t = 4.86). CONCLUSIONS: Pain ratings during rectal distention are associated with activation of dorsal cingulate regions implicated in homeostatic afferent processing, and prior abuse enhances this activation. Patients with IBS and abuse report more pain, greater MCC/PCC activation, and reduced activity of a region implicated in pain inhibition and arousal (sACC). These findings suggest a possible explanation for the clinical observation of greater pain reporting and poorer outcome in IBS patients with a history of abuse.