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Un cas de psychose infantile: How to survive parenthood. Inferences from the dream screen. International Journal of Psycho- Analysis, Lancet , , Das saugen an den fingern, lippen, bei den kindern ludeln. Pennsylvania Medical Journal, 51 , International Journal of Psychoanalysis , 32 , 32— International Journal of Psychoanalysis , 38 3—4 , — On delusional transference transference psychosis. International Journal of Psycho-Analysis , 39 , — Little, Transference neurosis and transference psychosis. To Althea, from prison. Gibt es beim Menschen eine Vakzine-Encephalitis?
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Thinking and negative hallucination. International Journal of Psycho-Analysis, 43 , — Temperature recording in sick children. British Medical Journal , 2 , — Nature, , — A contribution to the psychology of politics and morals. Letters of James and Alix Strachey. Beitrag zur Pathologie der Varicellen. Kegan Paul, Trench, Trubner.
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British Journal of Psychotherapy , 31 , 69— A mixed form of primary myopathy. Shock treatment of mental disorder. Clinical observations on diphtheritic paralysis. The Practitioner , 73 , A case with commentary. Review of Neurology and Psychiatry , 3 11 , Palpebral gangrene and other ocular complications of varicella. Medical Chronicle , 49 , Clinical Journal, 42 1 , Transient hemiplegia in diphtheria.
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A home from home. Common disorders and diseases of childhood , 5 th ed. Schweizerische medizinische Wochenschrift , 55 , Thames and Hudson, Some unconscious factors in reading. International Journal of Psycho-analysis, 11 , The nature of the therapeutic action of psycho-analysis. Standard edition of the psychological works of Sigmund Freud. Psychologists in education services: The report of the working party appointed by the Secretary of State for Education and Science, 20th Feb Disorders and diseases of the heart.
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Close-up of mother feeding baby. End of the digestive process. Hate in the countertransference . The ordinary devoted mother and her baby. Republished in The child and the family. The world in small doses. Young children and other people. Some thoughts on the meaning of the word democracy. The psychoanalytic study of the child Vols.
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Funeral address for Ernest Jones. The manic defence . On the contribution of direct child observation to psycho-analysis . Primary maternal preoccupation . Psycho-analysis and the sense of guilt . Review of The doctor, his patient and the illness , by M. Theoretical statement of the field of child psychiatry. Transitional objects and transitional phenomena. La Psychanalyse , volume 5. A technique of communication. The theory of the parent-infant relationship. The effect of psychotic parents on the emotional development of the child .
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Introduction to The child, the family, and the outside world. The neonate and his mother. Youth will not sleep. The aims of psycho-analytical treatment . Casework with mentally ill children . Is there a psycho-analytic contribution to psychiatric classification? Communicating and not communicating leading to a study of certain opposites . The effect of psychosis on family life . Ego distortion in terms of true and false self .
Ego integration in child development . The family affected by depressive illness in one or both parents . The family and individual development. From dependence towards independence in the development of the individual . Hospital care supplementing intensive psychotherapy in adolescence .
The maturational processes and the facilitating environment. Hogarth and The Institute of Psycho-Analysis. A personal view of the Kleinian contribution . Preface to The family and individual development. The price of disregarding psychoanalytic research. Psychotherapy of character disorders . The relationship of a mother to her baby at the beginning . Psycho-somatic illness in its positive and negative aspects . School refusal as an expression of disturbed family relationships by Max Clyne. Another relevant concern is the degree to which acculturation affects responses to trauma.
Research in this area is limited, but the preponderance of evidence seems to indicate that greater acculturation is associated with lower levels of PTSD symptoms Dunlavy, This is contrary to the evidence relating acculturation, for some immigrant groups, to certain other behavioral health problems, notably substance abuse and depressive symptoms e.
In her own data analysis concerning African immigrants to Sweden, however, Dunlavy found no significant associations between acculturation and PTSD symptoms.
The study found that lower acculturation assessed with the Lowlands Acculturation Scale [LAS] was associated with increased behavioral health problems for individuals who had experienced this trauma but not for those in the control group. The authors observed that their findings may indicate that, in the context of a disaster affecting large numbers of people, a lack of flexibility in terms of cultural norms and values may be a source of additional stress. This domain, which evaluates feelings of isolation, loneliness, boredom, and a lack of access to preferred foods, may also represent difficulties in acculturation, as the sense of isolation may be greater among less acculturated refugees who are not able to establish social connections in their new culture.
Schweitzer and colleagues , in their study of 63 Sudanese refugees in Australia, also found that support from family and others within a Sudanese community was a significant resilience factor with regard to behavioral health, whereas social support from the larger Australian society was not. There are numerous forms and types of trauma. In this section, the research reviewed explores a wide variety of traumas; however, the sheer volume of research available precludes a thorough review of each trauma type.
The intent of this section is to give the reader a broad science-based perspective on the types of trauma. These experiences include child abuse and neglect as well as substance abuse and mental illness in the family, having a family member incarcerated, and violence directed toward a parent usually the mother; Dube et al. Childhood trauma also appears to be more likely to result in PTSD than trauma experienced in adulthood. Childhood abuse was associated with even greater risk than other trauma experienced in childhood. A major study evaluating the effects of ACEs was conducted with 17, members of a large health maintenance organization HMO in California in collaboration with the Centers for Disease Control and Prevention Dube et al.
In the initial assessment, In this sample, 8. In a multivariate model, almost all of the CAs evaluated in the NCS were associated with increased odds of having a mental disorder; the strongest associations were with parental mental illness, parental substance abuse, family violence, childhood physical abuse, childhood sexual abuse, and life-threatening illness Green et al. These data also show a significant association between certain CAs i. The associations of single trauma to mental disorders were modest, but multiple traumas had a cumulative effect, so that exposure to multiple CAs further increased the strength of the association with both onset and persistence of mental disorders.
These same CAs were also significantly associated with functional impairment related to behavioral health disorders McLaughlin et al. Another large study, the Developmental Victimization Survey, investigated forms of childhood abuse and maltreatment in 2, children and adolescents ages 2 to The study found that However, some literature indicates that all these data underrepresent the extent of childhood abuse and neglect, as both research and expert opinion indicate that these traumas are generally underreported see review by Gilbert et al. Gilbert and colleagues specifically reviewed data on psychological abuse, which is not often evaluated in the literature.
They found that approximately 10 percent of children in the United States and the United Kingdom experience psychological abuse in any given year, and between 4 and 9 percent sustain severe emotional abuse. Children who have sustained one type of abuse or neglect are likely to have experienced other types as well, according to research conducted with a variety of samples see reviews by Edwards et al. Research indicates that women are much more likely to sustain sexual abuse than men. Some studies have found that men are more likely than women to sustain physical abuse in childhood e.
According to the same study, children from low-income families are also significantly more likely to witness domestic violence and violence in their communities, and they are significantly more likely to sustain violent assault or rape not perpetrated by a family member.
Different types of childhood abuse may have different behavioral health effects. More so than other ACEs, physical and sexual abuse in childhood are associated with even greater and more lasting problems, including significantly higher rates of depression, substance use disorders, and PTSD in later life see review by Gilbert et al.
In addition, Gilbert and colleagues found strong evidence linking childhood abuse with suicide attempts, high-risk sexual behavior, criminal behavior, and obesity. Physical abuse in childhood, however, was only associated with significantly higher risk for specific phobias and PTSD. Abuse during childhood also appears to predispose individuals to further abuse and trauma as they grow older. Physical abuse in childhood, to a lesser degree, is also associated with an increased risk for sexual abuse in adulthood Classen et al.
This study, which used data from the ACE study described previously, did not assess the relationship of child abuse to violence perpetrated by women or sustained by men. In addition to likely contributing to behavioral health disorders, childhood abuse may also affect behavioral health treatment outcomes. More recent studies confirm this research. As one example, Dannlowski and colleagues found strong associations between childhood maltreatment assessed retrospectively using the Childhood Trauma Questionnaire and both decreased gray-matter volume in a number of areas of the brain and increased response in the amygdala upon seeing pictures of threatening facial expressions.
Schumm, Briggs-Phillips, and Hobfoll reviewed three theories on why sexual abuse in childhood has extensive and lasting negative effects: The authors noted that these patterns together may contribute to problems with interpersonal relationships, which in turn affect behavioral health. Large-scale traumatic events like natural disasters e. In their review of studies of mass trauma events, Norris and colleagues found that rates of serious psychological impairment measured with a number of different instruments were significantly higher for individuals who endured trauma from mass violence e.
Severe impairment was also more common if the event occurred in a developing rather than developed country, and, in most studies, if the individual who experienced the event was female rather than male. They found that Specific experiences associated with significantly higher odds for PTSD included witnessing a horrific incident e. The authors concluded that individuals need not be directly exposed to mass trauma events for those events to have a negative effect on their behavioral health.
Norris and colleagues reviewed information on risk and protective factors associated with behavioral health disorders and symptoms for survivors of natural disasters and those caused by people drawn from studies published between and For the most part, these are the same as found with other populations of trauma survivors, with possible exceptions being the presence of children, which is a risk factor for anxiety in mothers involved in disasters fathers were not studied in the four articles reviewed , and the loss of material resources, which has been found to be a risk factor for behavioral health disorder symptoms in survivors of disasters but is rarely evaluated in studies involving other types of trauma.
Between and , intimate partner violence accounted for Rates of domestic violence are high for people with behavioral health disorders, especially people with substance use disorders. Among a subsample of men and women who were survivors of intimate partner violence women, men , PTSD rates were high, with 24 percent of the women and 20 percent of the men having moderate to severe levels of PTSD symptoms, indicating possible current PTSD although rates of possible PTSD were higher for women, the difference between genders was not significant.
The authors also found that higher socioeconomic status SES , current marriage, and the cessation of intimate partner violence were all associated with significantly lower odds of having elevated PTSD symptoms. Research from Spain suggests a dose—response relationship between intimate partner violence and PTSD Pico-Alfonso, ; although physical, sexual, and psychological abuse from partners were all significantly related to PTSD, the latter had the strongest relationship.
Accurate data on the prevalence of such trauma in the United States is difficult to obtain, because most major surveys do not inquire specifically about it. Because of the high degree of interpersonal violence involved, political violence and torture often result in traumatic stress reactions that pose particular problems for providers in terms of treatment and assessment. Johnson and Thompson reviewed literature on the prevalence of PTSD among survivors of political and civilian war trauma. They cited studies involving torture survivors that found PTSD rates ranging from 18 to 90 percent of study participants.
They observed evidence of a dose—response relationship between torture and both initiation and maintenance of PTSD. This review suggests that protective factors for PTSD that results from torture and civilian war trauma include being prepared for torture, having strong social and family support, and having stronger religious beliefs. Some theories hold that having redress for torture and other political violence may help survivors process their traumatic experiences and thus aid in behavioral health treatment e.
The role of forgiveness in the behavioral health of survivors of torture and other political violence may depend on the context of the violence and the object of forgiveness. Kira and colleagues found, among a group of Iraqi refugees, that those who forgave perpetrators of violence in general as well as those who collaborated with the regime as measured with a modified version of the Forgiveness Versus Refusal To Forgive Scale had significantly better physical and behavioral health than did those who did not forgive those people.
On the other hand, forgiveness of dictators and specific individuals who were the principal perpetrators of the violence was associated with significantly worse physical and behavioral health outcomes. For example, from to , 4. Although women are more likely than men to be sexually assaulted even in prison, there are about 13 times as many men as women in such facilities, so a large number of incarcerated men are affected.
Among prison inmates in —, 1. Histories of sexual abuse among clinical populations are also likely to be considerably more common than in the general population e. Addressing the Specific Needs of Women [ CSAT, b ], for a review of data on sexual assault among female clients in substance abuse treatment settings. Accurate data on sexual assault among patients institutionalized for mental disorders are difficult to locate, but rates of sexual assault should be expected to be high in this group as well.
According to a study by Teplin, McClelland, Abram, and Weiner of patients with serious mental illness SMI attending outpatient residential day treatment at a Chicago program, participants were In addition, sexual abuse in adulthood or childhood is also associated with high levels of other behavioral health disorders. In a meta-analytic review of 37 studies providing data on 3,, individuals, Chen and colleagues found that a history of sexual abuse in childhood or adulthood was associated with more than three times the risk for an anxiety disorder compared with individuals who had no such history; more than twice the risk for depression, an eating disorder, or PTSD; and more than four times the risk for suicide attempts.
On the other hand, the use of positive distancing e. In their own research on women who had been sexually assaulted, Ullman and Filipas determined that, although positive social reactions following the assault were not significantly associated with severe PTSD symptoms, more negative responses from others were associated with more severe PTSD symptoms. In particular, being treated differently or being discriminated against showed the strongest association with more severe PTSD, and responses in which people tried to distract the victim e.
Greater injury severity and a greater perceived threat at the time of the assault were also associated with significantly more severe PTSD symptoms. Because of the resources available to the military including the ability to compile accurate data about a relatively large population , combat trauma is one of the most widely studied types of trauma in terms of behavioral health.
This section summarizes information available in more detail in that TIP. These rates were considerably higher than rates in veterans from that era who did not serve in Vietnam of whom 2. A later reanalysis of NVVRS data, which took into account criticisms of the initial study, provided a more conservative estimate of 9. These authors found that, even for individuals who had substantial impairment relating to PTSD symptoms, PTSD diagnoses decreased over a to year period following the war; for the majority, this occurred without receiving mental health services. The NVVRS also found that war zone stress, which included combat trauma and exposure to other traumatic events, was also significantly related to major depression, dysthymia, obsessive—compulsive disorder OCD , GAD, alcohol use disorders, and antisocial personality disorder ASPD for men Jordan et al.
The majority 63 percent of male veterans who had high levels of exposure to war zone stress met criteria for at least one mental disorder during their lives, and 41 percent had at least one current disorder at the time of assessment. This study found a correlation between a greater intensity of combat exposure and greater likelihood of having PTSD. Combat duty and being wounded both significantly increased the chances that an individual would have PTSD.
Historical trauma refers to trauma inflicted in the past on members of a certain cultural group that may continue to have effects on the current generation. Other groups who experienced large-scale and well-remembered violence, such as attempted genocide or slavery, also have to deal with historical trauma. The phenomenon has been studied most often in the United States with Native American populations, and for many Native Americans receiving behavioral health services, historical trauma may be an important clinical issue Brave Heart, ; Evans-Campbell, Some research indicates that thinking about historical loss is associated with certain behavioral health problems, such as increased risk for alcohol use disorders Whitbeck et al.
These powerful effects of trauma cause the next generation to experience similar consequences, resulting in worse coping skills or attempts to self-medicate distress through substance abuse. Kessler observed that large epidemiological surveys typically ask about the worst or most severe trauma an individual has endured, with the assumption that if the individual has had PTSD, it would appear after such a trauma.
This approach may undercount lifetime prevalence, however, because further trauma following the worst episode of trauma exposure may have a kindling effect that results in PTSD a considerable length of time after the worst episode occurred. Therefore, women who had experienced child abuse and also had been raped as adults were over 17 times more likely than others to be screened as probably having PTSD, whereas women who had experienced only one of those two types of trauma were about six times more likely than others to meet screening criteria for probable PTSD.
Studies conducted with other populations have also found that greater exposure to traumatic events increases risk for a number of behavioral health disorders. The incidence and prevalence of trauma and of behavioral health problems related to trauma vary across demographic groups. Some of the major demographic differences that may affect trauma exposure and behavioral health are discussed in this section. Rates of trauma exposure among some samples of members of certain cultural, ethnic, and racial groups are higher than the U.
Researchers have found that PTSD rates vary considerably among diverse cultures and that rates are high among people exposed to significant trauma, regardless of their culture of origin Marques et al. However, this did not hold true for every type of trauma exposure. African Americans and Latinos were significantly more likely than White Americans to have been exposed to childhood maltreatment, with the largest difference being the increased likelihood of witnessing domestic violence. African Americans were significantly more likely than White Americans to have been violently assaulted.
Asian Americans, who had significantly lower levels of exposure than White Americans to many kinds of trauma, were significantly more likely to have been exposed to war-related trauma mostly as the result of being unarmed civilians in a combat zone and to be refugees from a region where combat was occurring. Of those who reported at least one trauma, 17 percent likely had PTSD at some point during their lives, with a higher rate of likely PTSD for individuals experiencing certain types of trauma e. According to the same research, Asian American men and women were significantly less likely than White American men and women to meet criteria for a lifetime diagnosis of PTSD.
Their data indicated that, after controlling for age, gender, and SES, both White Americans and African Americans were significantly more likely than Asian Americans or Latino Americans to have PTSD at some point during their lives, whereas White Americans and African Americans did not differ from one another significantly in this regard. Latino Americans were also significantly more likely than Asian Americans to have the disorder. Marques and colleagues , in a review of cross-cultural differences in anxiety disorders, observed that the evidence is mixed regarding differences in PTSD prevalence between African Americans and White Americans.
They concluded that the evidence is stronger regarding elevated levels of PTSD among Latinos compared with members of other ethnic racial groups. Research conducted with Vietnam veterans, a group for whom trauma exposure can be fairly accurately determined, identified Latinos as having greater risk for PTSD, and this finding was confirmed in later analyses of the data. Most of these factors could not explain differences in PTSD rates between Latinos and African Americans, the latter of whom faced many of the same stressors. The authors did find that Latinos reported significantly fewer people in their units who they believed were concerned about their welfare than did African Americans or White Americans.
This finding suggests that the higher PTSD rates observed in Latinos in Vietnam were not simply the result of greater identification with the Vietnamese. Two explanations appear to have the greatest support: Marshall and colleagues evaluated differences in PTSD symptoms among a mostly male However, they also observed that certain PTSD symptoms were responsible for this difference.
Of the 17 symptoms included on the PCL, Latinos were significantly more likely than non-Latino White Americans to report 11 of the symptoms, with considerable variation in the magnitude of the differences. Particular types of trauma may have a greater or lesser impact on members of a particular cultural group. The women in the study had experienced multiple traumas in the prior year an average of 36 acts of sexual abuse, 10 acts of severe physical violence, and 17 acts of mild physical violence. The authors found that the African American women in the study had significantly fewer PTSD symptoms as assessed with the Posttraumatic Stress Scale for Family Violence than did the White American women, even though African American women had experienced more severe violence although not significantly more so than the White American women.
Research has also found that the relationship of different types of childhood abuse to PTSD symptoms varies by cultural group. Trauma rates vary by subpopulations within these broad cultural, racial, and ethnic classifications and may be affected more strongly by noncultural factors e. PTSD rates also varied, although the differences were not significant; the largest difference found was between men from the Southwestern Tribes These rates, however, were considerably higher than found in the general population sample of Beals, Manson, Whitesell, Spicer, Novins, and colleagues , indicating that factors other than cultural background in this case, combat exposure likely play a greater role in trauma exposure and traumatic stress reactions.
As suggested by the example of Cambodian American immigrants, rates of trauma are high among immigrants from countries where military action and political violence are occurring, regardless of their specific cultural background. Steel and colleagues conducted a meta-analysis of trauma and traumatic stress reactions among groups exposed to mass conflict and displacement. Although reported rates of PTSD and depression varied widely among the studies included in the review, the authors found that, across surveys, This same review found that various research suggests that between 20 and 22 percent of women experience intimate partner violence, and approximately a quarter of all women are victims of sexual assault.
Women are significantly less likely than men, however, to experience many other types of trauma, including nonsexual assault, combat, traumatic accidents, and witnessing the death or injury of another person. Women were nearly twice as likely as men to have a lifetime PTSD diagnosis, with 8. Women were also more likely to meet criteria for a partial but not full diagnosis of PTSD during their lives 8. The NCS also found that women ages 15 to 54 were about twice as likely as men in that age range to have PTSD at some point during their lives the rates were Although specific percentages differ, these relative PTSD rates among men and women are in line with findings from other large studies in the United States and some studies from other Western countries see review by Olff et al.
In another analysis of NCS data, Kessler noted that a larger percentage of women exposed to trauma However, women were significantly more likely to have PTSD than men exposed to the same trauma if they had experienced a sexual assault other than rape, a physical attack, a trauma to a loved one, or threat with a weapon. Men, however, had significantly higher PTSD rates connected to combat trauma. According to these data, 4.
However, this study, which evaluated the relative risk for PTSD related to particular types of trauma, also found that this difference could largely be attributed to differences in response to assaultive violence. Although PTSD rates did not differ significantly between men and women exposed to other types of trauma, women were almost six times more likely to develop PTSD in response to assaultive violence than were men In many studies that evaluate PTSD rates by gender for men and women exposed to the same specific trauma or type of trauma, women are more likely than men to develop PTSD.
Even in the absence of PTSD, trauma exposure is associated with significantly higher levels of depressive symptoms and lower levels of substance abuse among women than among men Maguen et al. Using NCS-R data, Dunn, Gilman, Willett, Slopen, and Molnar found that higher rates of rape and sexual assault among women compared with men were in part responsible for higher depression rates among women.
Therefore, women are also significantly more likely to receive treatment for PTSD. Women often respond differently to trauma than do men, which may contribute to higher PTSD rates among women. Women also tend to report more intense emotional responses and more dissociation following trauma exposure see review by Olff et al.
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Research conducted with survivors of serious vehicular accidents indicates that women are significantly more likely than men are to experience certain PTSD symptoms 1 month after the accident e. Pratchett and colleagues reviewed some of the possible explanations for why women have higher PTSD rates compared with men, even after accounting for trauma exposure. One possibility was that women are more likely to experience types of trauma e. However, increased emotional reactivity does not necessarily mean that women are more affected by trauma, just that they are affected differently.
Research conducted with children who have histories of sexual trauma indicates that boys are more likely to present externalizing symptoms, whereas girls more often present internalizing symptoms. Another possible explanation is that women tend to use different coping strategies following trauma exposure, which may make them more prone to developing PTSD Olff et al. Research reviewed by Olff and colleagues also indicates that women who have peritraumatic dissociation at the time of trauma are much more likely than men who have it to develop PTSD; women are also more likely to respond to acute trauma with dissociation and less likely to respond with hyperarousal than are men Fullerton et al.
Research evaluating physiological differences in male and female responses to trauma tends to confirm that such differences exist. Women may also be affected differently than men by some risk and resilience factors, such as social support. For military personnel deployed to OIF, negative changes in intimate relationships according to self-report following deployment were significantly related to PTSD for women but not men, but only when there was a high level of combat exposure Skopp et al.
In addition, culture appears to play a role in the higher PTSD rates observed in women, and culture can also moderate these differences Kimerling et al. In a predominately African American sample of 1, primary care patients with low SES who were living in an urban center, The most common traumas for men in the study were serious accident or injury experienced by For women, the most common traumas were serious accident or injury experienced by Lower income has also been associated with significantly greater PTSD likelihood in other studies with different populations, including Cambodian refugees Marshall et al.
Gapen and colleagues evaluated the relationship of perceived neighborhood disorder measured with the Neighborhood Disorder Scale and PTSD symptoms assessed with the Modified PTSD Symptom Scale among a group of largely 95 percent African American users of an inner-city health clinic. They found a significant relationship between perceived neighborhood disorder and PTSD symptoms that was partially mediated by perceived community cohesion assessed with the Community Cohesion Scale.
The authors suggested that, in communities where high crime and other problems exist, residents develop a lack of trust that, in turn, can exacerbate PTSD symptoms. The fact that losing economic resources as a result of a traumatic event can significantly increase PTSD risk e. For men, being gay or self-identified as heterosexual with same-sex partners, but not being bisexual, was associated with significantly more likelihood of experiencing interpersonal violence and of having learned of trauma experienced by a close friend or relative. For women who were exposed to traumatic events, being bisexual or heterosexual with same-sex partners was associated with a significantly higher likelihood of having PTSD, compared with being heterosexual with no same-sex partners.
For men who were exposed to traumatic events, being gay or heterosexual with same-sex partners was associated with a significantly higher likelihood of having PTSD compared with being heterosexual with no same-sex partners. When the worst type of trauma experienced and the age of its occurrence were factored into the analysis, the odds ratios fell but remained high compared with heterosexual individuals with no same-sex partners.
The greatest increase in the odds of having PTSD, 1. They also were significantly more likely to report abuse from partners in adulthood and sexual assaults in adulthood. The authors found larger differences in sexual victimization among men in the study than among women. Little information is available about trauma and PTSD among transgender individuals. They found that rates of childhood physical abuse were significantly higher for Latinos and Asian Americans than White Americans and that rates of childhood sexual abuse were significantly higher for Latinos and African Americans than White Americans.
Other research conducted with lesbian, gay, or bisexual youth ages 15 to 19 found that 80 percent had experienced verbal victimization, 11 percent physical victimization, and 8 percent sexual victimization outside the home because of their sexual orientation or atypical gender behavior. In an Internet survey of gay, lesbian, or bisexual adults, approximately 20 percent reported being the victim of hate crimes involving physical violence or damage to property Herek, For example, an analysis of school, foster care, and police records found that children with disabilities were 3.
Govindshenoy and Spencer reviewed four studies that provide data on childhood abuse among people with disabilities. Petersilia observed that studies from a number of Western countries have found that, compared with the general population, people with developmental disabilities have a significantly greater risk for being victims of violence and abuse although data are limited. Plummer and Findley reviewed these and other studies discussing the heightened risk for physical and sexual abuse of women with disabilities. Research on resilience and traumatic stress reactions indicates that greater intelligence protects against PTSD e.
Mevissen and de Jongh reviewed four studies that report PTSD rates in people with cognitive disabilities as ranging from 2. Razza, Tomasulo, and Sobsey also reviewed research that supports the view that people with cognitive disabilities have an increased risk for developing PTSD following trauma exposure. They cited research indicating that developmental level affects how an individual processes traumatic experiences and that cognitive impairments may lead to increases in PTSD. Furthermore, they presented research indicating that trauma itself negatively affects intellectual abilities.
In the NCS-R, individuals who had been homeless for more than 1 week in their adult lives were significantly more likely than those who had remained domiciled to report being in a traumatic environment e. In addition, those who reported at least 1 week of homelessness were significantly more likely to have had PTSD at some point during their lives, with People who have served in the armed forces, in addition to their exposure to combat-related trauma, also have high rates of exposure to other types of trauma before, during, and after their service.
Female veterans report high rates of sexual assault and rape, often occurring during their military service. Surveys of large groups of female veterans receiving U. Department of Veterans Affairs VA services include the following results:. Sexual assault during deployment was reported by 9. The authors determined that, for women, sexual trauma either harassment or assault was associated with greater risk for PTSD than was combat exposure.
Among adults, trauma exposure and traumatic stress reactions vary somewhat according to age. Norris and Slone reviewed research regarding differences in trauma exposure according to age group. They observed that overall trauma exposure is greatest among older adolescents and young adults roughly ages 16 to 20 , but that exposure to particular types of trauma varies more across age groups e.
In the NCS, the lifetime risk of having PTSD among people who had been exposed to trauma peaked in those ages 25 to 35, whereas the lifetime risk of having been exposed to trauma peaked in those ages 35 to 44 Kessler et al. Research regarding the incidence and prevalence of trauma exposure and current PTSD among older adults typically defined as either ages 55 and older or ages 65 and older in the United States is limited, but some studies are available.
For example, national crime data indicate that older adults age 50 and older are much less likely than those who are younger to be the victims of violent crime Truman, Older adult women are also significantly less likely than other adult women to experience recent sexual or physical assault, according to a telephone survey of 3, women Acierno et al.
Overall, most research does indicate that current PTSD rates decline with age even for individuals in groups with high PTSD rates, such as former prisoners of war or Holocaust survivors. One such group is older adults who are incarcerated for review, see Maschi et al. Older adults may also have somewhat different responses to traumatic stress than adults who are younger. This study found that avoidance of prior traumatic memories and situations played a large role in late-life anxiety and depression, accounting for 49 percent of the variance between past trauma and depression and 46 percent of the variance between trauma and anxiety.
Cook and Niederehe reviewed research that generally indicates that PTSD for older adults is typically less severe and that their PTSD symptoms are less intense compared with other adults. Grammer and Moran , in another review, observed that biological changes associated with PTSD differ between older adults and people who are younger e.
Cultural factors appear to play a role in how age affects PTSD risk and traumatic stress reactions. Because they oversampled for members of certain cultural groups, they were able to report cultural, racial, and ethnic differences, but they only reported lifetime rates of disorders. These authors found that 4. Norris and colleagues compared PTSD symptoms following exposure to natural disasters for individuals from different age groups and three different cultural groups American, Mexican, and Polish.
Among military service personnel and veterans, Brewin, Andrews, and Valentine observed that younger age was a PTSD risk factor in military usually combat-exposed but not civilian samples, which may mean that the role of age differed according to the different types of trauma commonly experienced by these groups. Other studies of either active-duty personnel or veterans also found that younger age typically being age 25 and under was associated with significantly higher risk of having PTSD Greiger et al.
Cook and Niederehe reviewed earlier research that found relatively low PTSD rates among World War II and Korean War veterans who were exposed to combat, suggesting that if PTSD had been present at levels similar to those seen in more recent conflicts, it likely resolved during older adulthood. Risk and protective factors for PTSD may also vary between age groups. Also, for older adults only, more days displaced also increased risk for depression and GAD, whereas greater out-of-pocket posthurricane expenses increased risk for GAD alone.
Younger adults, however, did have significantly higher levels of PTSD symptoms than older adults. Another concern for older adults with trauma histories is the emergence of PTSD in older adulthood resulting from trauma experienced many years earlier. Little research is available on this subject, but Hiskey, Luckie, Davies, and Brewin reviewed 4 studies involving older adult male war veterans and 12 case studies that document this phenomenon. Not all traumas are equally likely to result in a traumatic stress reaction. As an example, he gave data from the NCS.
For men in that survey, 65 percent of those who had experienced rape had PTSD, compared with For women, the highest rate of PTSD PTSD rates among women for other traumas were Trauma in which the individual fears for his or her life is also associated with increased PTSD risk. The odds of developing PTSD when there was a perceived threat to life were 1. Other significant factors associated with PTSD risk included perceiving a greater chance of the traumatic event occurring again, which increased the odds of developing PTSD 1.
Abuse in childhood often results in lasting and severe PTSD because it has physical and behavioral effects on the developing mind Cougle, Timpano et al. Childhood abuse was associated with even greater risk than other childhood trauma. Sexual abuse, in adulthood or childhood, is also associated with high PTSD levels as well as other behavioral health disorders.
Brenner also attempted to distinguish these changes from those associated with traumatic brain injury TBI. A number of risk and protective factors for trauma and for traumatic stress reactions particularly PTSD have been identified in the literature. As Layne, Warren, Watson, and Shalev observed in their review on PTSD-related risk and resilience, there is a lack of general agreement in the literature as to what defines protective or resilience factors, making it difficult to evaluate the relative importance of such factors.
They noted that factors that promote resilience to traumatic stress reactions can range from genetic biological factors e. Research has found a number of factors associated with increased risk for trauma exposure and traumatic stress reactions. Some of these factors are demographic in nature e.
Breslau, Lucia, and Alvarado found that youth with lower intelligence as measured by intelligence quotient [IQ] were significantly more likely to have been exposed in the 10 years following their assessment to traumatic events—specifically, nonassaultive trauma—and to have developed PTSD conditioned upon not having anxiety disorders or high rates of externalizing problems at their initial assessment.
In terms of social support, Moak and Agrawal , using data from Waves 1 and 2 of NESARC, found a modest but significant correlation between lower perceived social support and exposure to traumatic events. A number of reviews and meta-analyses provide an overview of PTSD risk factors. Brewin and colleagues included 77 articles in their meta-analysis, which focused largely on demographic factors. They concluded that PTSD risk following trauma exposure increased with the following factors: They cautioned, however, that only a prior history of behavioral health disorders, childhood abuse, and a family history of behavioral health disorders were uniformly found to increase risk in the studies that included them as variables.
The authors also observed that risk factors differed somewhat between military and civilian samples, with female gender having no significant effect in military samples but younger age being associated with increased PTSD risk in military samples.
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Trauma severity also had a significantly greater effect on PTSD in military than in civilian samples which may reflect differences in the nature of trauma typically experienced by these two groups. Brewin and colleagues found that risk factors vary somewhat by gender as well, so that, for example, childhood abuse has a significantly greater effect on women than on men, and younger age has an effect for men but not women which may explain why it has an effect for largely male military samples but not civilian samples.
These authors concluded that there was a great deal of heterogeneity across the studies and thus cautioned against trying to create a model in which pretrauma risk factors are considered universal rather than mediated by particular responses to trauma or factors associated with the trauma itself. As such, they presented their review as complementary to that of Brewin and colleagues Ozer and colleagues found seven significant risk factors for PTSD:. The authors noted that this may reflect the fact that social support or the lack thereof had a larger effect in studies in which 3 or more years had elapsed since the trauma than in those that assessed individuals sooner after the traumatic event; their review included more of the latter.
They noted that this may indicate that social support has a cumulative effect or is more important when individuals have more chronic PTSD and less important in cases of ASD. Data from NESARC also indicate that lower perceived social support is associated with a number of other mental disorders e.
Their findings did not differ substantially from earlier reviews, but they observed some other factors associated with increased risk that were not included in the meta-analytic reviews cited previously, which had more strict inclusion criteria. They cited studies that found a dose—response relationship between severity of trauma and PTSD, as well as studies that found an increase in PTSD associated with trauma resulting in physical injury, trauma perceived as more malicious or horrifying, trauma in which one is actively involved rather than a participant , and trauma that resulted in peritraumatic dissociation.
The authors also observed that demographic factors i. Prior trauma exposure, preexisting mental disorders, a history of childhood abuse, other exposure to ACEs, a family history of mental disorders, and lack of social support all appeared to have a somewhat large effect on increasing PTSD risk. They also noted that research, mostly conducted with veterans, indicated that the risk factors for onset and maintenance of PTSD appear to be different. Risk factors that existed prior to the traumatic experience did not have as strong an effect on the latter.
However, other factors that came into play after the trauma may have affected the course of and recovery from PTSD. Examples of these include social supports available after the trauma including community reactions , use of coping strategies, and cognitive appraisals of the nature of the trauma. Recent studies not included in the previously discussed reviews that evaluate risk factors associated with PTSD symptoms not only generally confirm the prior findings; they also shed light on how different factors affect PTSD risk following different types of trauma exposure.
Developmental risk factors e. The author noted that, although more research is needed, such risk factors may play a significant role in determining whether an individual is at risk for PTSD following trauma exposure. Risk factors associated with material needs and losses are often ignored in research, but a number of studies have found that such factors do affect PTSD rates. For example, research from Israel indicates that the loss of economic resources following trauma exposure is associated with a significantly greater likelihood of PTSD Hobfoll et al.
Research conducted with survivors of a large fireworks explosion in the Netherlands found that individuals whose homes were destroyed were significantly more likely than others affected by the disaster to have late-onset PTSD Smid et al. Material losses and lack of income appear to have a significantly greater effect on increasing PTSD risk for adults ages 60 and older compared with younger adults Acierno et al. The importance of peritraumatic dissociation as a PTSD risk factor has been debated. However, another review by van der Velden and Wittmann , which included only prospective studies and controlled for persisting symptoms of dissociation, found that peritraumatic dissociation was a relatively weak PTSD predictor, whereas dissociation that persisted after the trauma was a much better predictor.
One reason that some studies have found a stronger relationship between peritraumatic dissociation and PTSD than have others is that the relationship appears to be significantly stronger among women than among men. Research conducted with survivors of serious motor vehicle crashes found that the PTSD risk associated with peritraumatic dissociation was 7.
Some small studies have also found that individuals who develop PTSD following trauma exposure have elevated heart rates e. Research from France suggests that heart rate variability is a better predictor of PTSD than elevated heart rate alone. In this study, 35 survivors of automobile accidents had a positive predictive value of 75 percent and a negative predictive value of 90 percent in relation to the later development of PTSD Shaikh Al Arab et al.
Genetic factors appear to contribute to both trauma exposure and PTSD development in a number of ways. Other research included in this review indicated that genetics affect, to a moderate degree, whether an individual will develop PTSD symptoms as a result of trauma exposure; the degree to which genetic factors contribute may differ depending on the type of symptoms under consideration. Genetic factors may also differ according to the type of trauma and how many incidents of trauma are experienced e.
Other reviews reached similar conclusions regarding the contribution of genetic factors to the development of PTSD. For example, Cornelius, Nugent, Amstadter, and Koenen reviewed a wider range of research not just twin studies , including information concerning the specific genes associated with PTSD. They also focused on some of the limitations of existing research e. Sartor and colleagues looked specifically at genetic and environmental factors that play a role in both PTSD and substance use disorders for women, as fewer data are available on the role of genetics for women than for men.
They found good evidence for a genetic link for both types of disorder among women. Research conducted with veterans has found a common genetic influence on increased exposure to combat, increased alcohol use, and greater likelihood of having PTSD symptoms McLeod et al. Research reviewed by Afifi and colleagues confirmed that genetics may contribute to the co-occurrence of substance use disorders and PTSD as well as to exposure to assaultive trauma. Bryant and colleagues found that, after controlling for pretreatment PTSD severity and number of treatment sessions attended, people with PTSD who had a given genotype had significantly more severe PTSD 6 months after receiving an 8-week exposure therapy ET intervention than others in the study.
However, these authors did review literature indicating that the ability to be hypnotized which has a genetic component , childhood abuse, disturbed attachment in childhood, and a tendency to view events as catastrophic have all been associated with increased risk for ASD. For trauma, protective factors are typically contextual, including characteristics that make it less likely that a person will be in a situation where trauma might occur. A review by Agaibi and Wilson classified protective factors into five categories: Guay, Billette, and Marchand reviewed research and theory on the protective aspects of social support, one of the protective factors most consistently found to have a significant role with regard to PTSD.
In some studies, social support is the most significant factor, with such populations as survivors of childhood abuse Collishaw et al. A good deal of research on protective factors has been conducted with military personnel and veterans. In addition, better training and preparation for combat trauma or at least, feeling more prepared , stronger unit cohesion, and responses from the civilian population upon returning from combat all have a protective function. That is, those who had a better sense of preparedness perceived less threat from their combat experiences, which translated into lower levels of PTSD Renshaw, Protective factors assessed for other specific groups generally do not deviate much from those already mentioned.
For example, Yuan and colleagues evaluated police officers during their academy training and again after serving 2 years, finding that a stronger sense of self-worth, stronger beliefs in the benevolence of the world assessed with the World Assumptions Scale , greater social support, and better social adjustment assessed with the Social Adjustment Scale—Self Report were all significant protective factors against later PTSD development.
However, stronger religious beliefs may not always have a protective function, and much will depend on context. Much of the research in this area has been conducted with youth and adolescents, but the protective factors thus identified do not vary much from those for adults. For example, Van Breda provided an indepth review of factors associated with resilience in general i. For example, Ginzburg, Solomon, and Bleich found that the use of repressive coping styles was linked to significantly lower levels of PTSD symptoms following trauma exposure.
Earlier research conducted with female victims of assault either sexual or nonsexual found that greater use of positive distancing e.