Dissertations / Theses on the topic 'Complex PTSD'

Complex posttraumatic stress disorder (CPTSD) integrates symptoms common to victims of "complex" traumas, like childhood physical or sexual abuse, with the diagnostic criteria of posttraumatic stress disorder (PTSD). It was hypothesized that a history of witnessing interparental violence would be related to adulthood CPTSD symptoms. Results from hierarchical multiple regressions with 287 college students showed that witnessing interparental violence and experiencing child physical abuse predicted higher levels of CPTSD, PTSD, and depression symptoms. After controlling for child abuse, witnessing interparental violence predicted higher levels of traditional PTSD symptoms, but it did not predict an increase in overall CPTSD symptom severity or depression. Results suggest that the traditional PTSD construct, rather than CPTSD, best accounts for the symptoms of those who witnessed interparental violence in childhood.

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

The work group in charge of editing the trauma disorders in the upcoming edition of the International Classification of Diseases (ICD-11) made several changes to the trauma criteria. Specifically, they simplified the criteria for posttraumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). To assess the new and newly defined trauma disorders, Litvin, Kaminski and Riggs developed a self-report trauma measure called the Complex Trauma Inventory (CTI). Although the reliability and validity of the CTI has been supported, no empirically-derived cutoff scores exist. We determined the optimal CTI cutoff scores using receiver operating characteristic (ROC) analyses in a diverse sample of 82 participants who experienced trauma and were recruited from an inpatient trauma unit, student veteran organizations, and university classrooms. We used the Clinician-Administered Interview for Trauma Disorders (CAIT) to diagnose the presence of an ICD-11 trauma disorder, and we correlated the results of the CAIT with the Clinician-Administered PTSD Scale for the DSM-5 to establish the convergent validity of the CAIT, r = .945, p < .001. For the ROC analyses, the CTI was used as the index test and the CAIT was used as the criterion test. The area under the curve (AUC) analyses indicated good to excellent effect sizes, AUC = .879 to .904. We identified two sets of cutoff scores for the CTI: the first set prioritized the sensitivity of the CTI scores and ranged from .884 to .962; the second set prioritized the specificity of the CTI scores and the false-positive scores (1-specificity) ranged from .054 to .143. Our study enhanced the utility of the CTI and addressed another need in the trauma field by developing a structured clinical interview (CAIT) that can be used to diagnose the ICD-11 trauma disorders.

Background The effects of prolonged, interpersonal trauma have long been recognised. Such traumatic events can lead to the development of post-traumatic stress disorder (PTSD), but are also associated with a range of other psychological difficulties. The forthcoming ICD-11 has proposed the inclusion of a new diagnostic category to cover such trauma reactions, named complex-PTSD (CPTSD). CPTSD is conceptualised as including the core elements of PTSD with additional difficulties with affect regulation, self-concept, interpersonal relationships. This thesis presents a systematic review of the research into the proposed CPTSD diagnosis. In addition, this thesis investigates the association between difficulties with emotional regulation, interpersonal problems and PTSD symptoms in a group of male prisoners, and a male community sample. Aims This project aims to investigate whether the proposed CPTSD diagnosis accurately describes the difficulties seen following complex trauma, and examines whether it is best to view CPTSD is different from exiting disorders, including PTSD and borderline personality disorder (BPD). In addition, it aims to investigate the association between difficulties with emotional regulation, interpersonal problems and PTSD among men in prison. Methods We systematically assessed and synthesised the available research regarding the proposed ICD-11 CPTSD diagnosis. In the second paper, data regarding PTSD, emotional regulation, and interpersonal problems were collected from HMP Glenochil, a male-only prison in Scotland (n=51), and matched to an existing community data set (n=46). Results The results of the systematic review provide partial support for the factorial validity of CPTSD. In addition, they indicate that CPTSD can be conceptualised as distinct from both PTSD and BPD, and that CPTSD is more closely related to prolonged interpersonal trauma than PTSD. However, there is overlap between PTSD and CPTSD in terms of both symptomology and aetiology. The results also indicate high levels of PTSD among male prisoners. In addition, PTSD was found to be strongly associated difficulties with emotional regulation, but not interpersonal problems, in the forensic sample. In the community sample emotional regulation was a less strong predictor of PTSD symptoms, and both emotional regulation, and interpersonal problems were associated with the severity of PTSD. Conclusions This thesis supports the inclusion of CPTSD as a distinct diagnostic entity. Inclusion of CPTSD may allow survivors a better understanding of the aetiology of their difficulties, and may initiate research into effective ways of working with individuals who have experienced complex-trauma. I addition, they demonstrate the need for trauma-informed prison services, which prioritise the development of emotional regulation strategies in recovery and rehabilitation.

The World Health Organization has proposed for the ICD-11 a differentiation of symptoms to distinguish separate disorders of PTSD and complex PTSD (CPTSD), rather than one disorder of PTSD as in the current DSM-5. In addition, the accuracy and usefulness of the borderline personality disorder (BPD) diagnosis has been debated for years due to this history of trauma often associated with the diagnosis. New instruments have been developed to assess CPTSD, allowing needed research to expand our understanding of CPTSD and how it may differ from PTSD. The present study explored the relationships between the three different patterns of symptom expression associated with these disorders and various coping strategies in a sample of trauma survivors. A canonical correlation analysis (CCA) showed a significant relationship between trauma symptoms and coping strategies and suggested that individuals with higher borderline personality disorder symptoms, and subsequently complex PTSD and PTSD symptoms, were more likely to cope using avoidant coping strategies- behavioral disengagement, denial, and substance use. This finding was similar to previous research findings that suggested high rates of negative psychological outcomes for adults cognitive and behavioral avoidant coping strategies. Contributions from other coping techniques, such as restraint and venting, also showed significant, but not as strong relationships to higher psychological symptoms.

The provisional construct “moral injury” has been proposed as a means to recognize the impact of certain stressor events commonly encountered in war, yet excluded from the current definition of posttraumatic stress disorder (PTSD), especially the psychological consequences of moral violations, whether experienced as perpetrator, witness, or victim. Although frequently co-morbid and exhibiting similar symptom syndromes, there is at the present time no clear means by which to conceptualize the relationship moral injury and PTSD. Drawing upon resources from diverse disciplines, including contemporary neuroscience, dynamical systems theory, cognitive psychology, and psychoanalysis, this dissertation addresses this conceptual gap by first proposing a model of psychological health as the integration of information processing in the mind and in the brain—alternatively conceptualized as the integration of “the self”—as well as corresponding general theoretical models of psychological disorder and psychological trauma as the impairment of this integration. On this basis, this dissertation then proposes an integrated theoretical model of both moral injury and PTSD, including the relationships between them and their associated symptom syndromes. The implications of this model for clinical care and further research are also briefly considered.

Although the negative consequences of traumatic exposure across various domains of functioning have been well-documented, gaps and discrepancies continue to exist in the understanding of the impact of complex trauma, such as interpersonal violence (IPV), and how outcomes may vary across diverse populations and identities. In this cross-sectional study investigating the impact of traumatic exposure on physiological domains of functioning, a sample of female-identifying college students completed a number of self-reported measures (assessing past and present trauma exposure, complex posttraumatic stress disorder [CPTSD] symptoms, racial-ethnic minority status, and age of onset of first traumatic exposure) and provided resting high-frequency heart rate variability (hfHRV) data, which served as a biomarker for the potential impact of trauma exposure on physiological domains. Correlational and multiple regression analyses were conducted to determine the strength of relationships between variables and the predictive value of the models. Results indicated endorsement of IPV trauma was significantly associated with earlier age of onset, more severe levels of CPTSD symptoms, and higher hfHRV, but not racial-ethnic minority status. Racial-ethnic minority status was significantly related to more severe CPTSD symptoms. Type of trauma exposure was the only variable that emerged as having predictive value for changes in hfHRV. These findings suggest that experiencing IPV may have unique implications for trauma symptomatology and functioning above and beyond other forms of traumatic exposure, but that continued research must be conducted in order to draw more robust conclusions about the effects of exposure on physiological regulation across various racial-ethnic identities.
M.S.
Research has highlighted the consequences that extremely negative, stressful experiences, also called traumatic events, can have on the way humans think, emote, behave, and physically react. It can be more difficult to draw conclusions about the effects of interpersonal violence (IPV), or violence that occurs at the hands of another (i.e., family, partner, or community violence), due to the complex, severe, and long-term nature of symptoms that survivors experience. There is also limited research about what complex trauma looks like across diverse populations. This study aimed to investigate the impact of traumatic exposure on physiology, which falls under biology and broadly includes the functions of living things. A sample of female-identifying college students completed a number of self-reported measures (assessing trauma exposure, complex posttraumatic stress disorder [CPTSD] symptoms, racial-ethnic minority status, and age of onset of first traumatic exposure) and provided resting high-frequency heart rate variability (hfHRV) data, which measures variation in time between beats and served as a measure for the potential impact of trauma exposure on physiology. Results suggested that IPV exposure was associated with earlier age of first traumatic experience, more severe levels of CPTSD symptoms, and higher hfHRV. Racial-minority status was significantly related to more severe CPTSD symptoms. Type of trauma exposure significantly predicted changes in hfHRV. Findings suggest that experiencing IPV may uniquely influence trauma symptoms and functioning above and beyond other forms of traumatic exposure. Continued research will allow for stronger conclusions about the effects of traumatic exposure on physiology across various racial-ethnic identities.

Women interpersonal chronic trauma survivors are frequently misdiagnosed with borderline personality disorder (BPD) or post traumatic stress disorder (PTSD), which often results in mistreatment. Neither PTSD nor BPD adequately describes the unique character alterations observed among those exposed to prolonged early childhood trauma.  Researchers suggest survivors of interpersonal and chronic trauma should be subsumed under complex PTSD (CPTSD)(MacLean & Gallop, 2003).  The primary purpose of this study was to test the validity of complex PTSD as a construct. MANOVA, ANOVA, chi- Square, and independent samples t- Tests were utilized to test hypotheses. Results revealed that women who experienced higher frequencies of trauma met more CPTSD criteria and had higher mean base rate scores on the Major Depression, Depressive, Avoidant, Masochistic, Anxiety, PTSD, and Borderline scales of the MCMI- III than women who experienced fewer traumas. Additionally, findings suggest that the Major Depression, Depressive, Anxiety, PTSD, and Borderline scales may highlight differences among women interpersonal trauma survivors who meet five of six CPTSD criteria versus those who meet full CPTSD diagnostic criteria. Lastly, the mean Borderline scale score for women who met full CPTSD diagnostic criteria was below the cutoff for personality traits. Overall, these findings provide evidence and validation for the distinction of CPTSD from BPD and PTSD.

The work group editing trauma disorders for the upcoming edition of the International Classification of Diseases (ICD-11) made several changes. Specifically, they significantly simplified the guidelines for post-traumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). The new domains for PTSD and the addition of CPTSD require new instruments to assess these novel constructs. We developed a measure of PTSD and CPTSD (Complex Trauma Inventory; CTI) according to the proposed ICD-11 domains, creating several items to assess each domain. We examined the factor structure of the CTI (using both exploratory and confirmatory factor analyses) in two separate samples of diverse college students (n1 = 501; n2 = 500), reducing the original 53 trauma items in the item pool to 21 items. Confirmatory factor analyses supported two highly-correlated second-order factors (PTSD and complex factors), with PTSD (i.e., re-experiencing, avoidance, hyper-arousal) and complex factors (i.e., affect dysregulation, alterations in self-perception and alterations in relationships with others) each loading on three of the six ICD-11-consistent first-order factors (RMSEA = .08, CFI = .92, GFI = .87, SRMR = .06). Internal consistency for PTSD (α = .92) and complex factors (α = .93) are excellent.

Clinicians’ attitudes and behaviors toward patients with borderline personality disorder (BPD) are affected by the label’s stigma. Complex posttraumatic stress disorder (CPTSD) was proposed as a comprehensive and less stigmatizing diagnostic category for clients with BPD and a history of complex trauma. Given considerable similarities across both disorders’ diagnostic criteria, the CPTSD framework holds promise as a means to improve therapists’ attitudes towards clients with BPD and a history of complex trauma. However, this quality of CPTSD had not yet been examined empirically. Using vignettes in a between-subjects experimental design, this study investigated whether CPTSD is a less stigmatizing label than BPD for trauma survivors. Participants were 322 practicing psychotherapists. Evidence of BPD stigma was found, as was an affinity for CPTSD. Results generally supported CPTSD as a less stigmatizing label than BPD; therapists presented with a CPTSD-labeled vignette were somewhat less likely to blame the client for her symptomatic behavior and expected slightly stronger working alliance with the client than therapists presented with the BPD-labeled vignette. However, therapists’ agreement with the BPD diagnosis and theoretical orientation were found to be more salient than diagnostic label in affecting concepts related to the stigmatization of BPD clients. Additionally, familiarity with CPTSD was related to more favorable attitudes toward the client and her course of treatment. Regardless of CPTSD’s recognition as a formal diagnosis, education about the construct is widely recommended for therapists.

Aims There is a growing body of evidence into the prevalence of Complex PTSD, however what is as of yet unclear is whether Complex PTSD is a result of multiple traumas, or a consequence of traumas occurring at a young age. The aim of the current study was to investigate the effect of age at first trauma and the number of traumas experienced on symptoms of Complex PTSD. Method Seventy-two individuals with PTSD were recruited from three mental health outpatient services. Participants were administered standardised measures regarding their experiences of traumatic events (THQ) and symptoms of PTSD (PCL) and Complex PTSD (DES, SDQ-5, IIP-25 and BDI-II). Results Age at first trauma was shown to effect interpersonal problems, with the childhood trauma group displaying increased symptoms once the number of traumas experienced was controlled for. Age at first trauma was not related to dissociation, somatisation, PTSD severity or depression. In contrast, the number of traumas experienced was related to PTSD severity, interpersonal problems, dissociation, somatisation and depression. Conclusion The results suggest that the experience of multiple traumas may lead to symptoms of Complex PTSD. With the exception of interpersonal problems, the study suggests that Complex PTSD is a response to the cumulative effect of multiple traumas, rather than a response to traumas occurring in childhood.

Currently, only the TSI assesses complex traumatic reactions and patient response styles. However, its feigning scale, ATR, uses a flawed detection strategy and is potentially confounded by experiences of complex PTSD. As a consequence, clinicians using the TSI to evaluate severely traumatized patients have no useful method for discriminating genuine and feigned responding. Several detection strategies have demonstrated utility within evaluations of feigned trauma including the assessment of rare symptoms, symptom combinations, symptom selectivity, and symptom severity. The current study created scales on the TSI according to these strategies using a development sample of 107 severely traumatized patients. Validation of all TSI feigning scales was then performed with a second independent sample of 71 severely traumatized patients using a mixed simulation design. Results found support for each scale's convergent validity with SIRS primary scales (M rs = .52) and discriminant validity with measures of defensiveness on the SIRS (M rs = -.07) and TSI (M rs = -.19). Each scale also produced expectedly mild to moderate relationships with SADS-C clinical scales (M rs = .32) and the SCID-IV PTSD module (M rs = -.02). Support for their criterion validity was only moderate (M ds = .69) when comparing the scores of genuine patients to those simulating disability. Potential explanations for this trend were reviewed, including (a) the impact of comorbidity, (b) the restrictions associated with creating embedded feigning scales, and (c) the influence of simulator knowledge in analogue designs. Limitations of the study and future avenues of research were discussed.

An understanding of factors that contribute to Complex Post Traumatic Stress Disorder (CPTSD) is of considerable importance to inform the prevention and treatment of the disorder. Moreover, gaining a better understanding of the factors that contribute to the etiology of CPTSD is of interest since most research to date focuses on the etiology of PTSD. Therefore, the purpose of the current study is to test the hypothesized prediction between childhood exposure to violence, childhood attachment, current interpersonal factors, and CPTSD symptoms. Using data from a community clinic and shelter serving victims of domestic violence and sexual assault, a partial least squares path analysis approach was employed to test the model’s strength in predicting contributing factors of CPTSD. Results support the proposed model, however, an alternative and more parsimonious model was found to be superior and revealed relationships between interpersonal variables and CPTSD. Specifically, women who reported child abuse and poor attachment with either parent, a perceived lack of current emotional and tangible support, and recent intimate partner violence (IPV) also reported symptoms of CPTSD. However, other variables, such as adult attachment avoidance and anxiety did not influence IPV or CPTSD as expected. Ultimately, the current findings lend support for Herman’s (1992) original conceptualization of CPTSD symptoms observed in survivors of prolonged and repeated trauma. Implications of these findings are discussed and results highlight the importance of assessing the contextual factors (e.g., social support, family environment) when a victim of prolonged trauma comes for treatment. Lastly, treatment implications and specific points of intervention are presented.

Det finns ett klart samband mellan komplex traumatisering och psykisk och fysik ohälsa. Många människor har stora problem med det dagliga livet och relationer. Förutom det personliga lidandet är effekterna av komplex traumatisering av stor samhällsekonomisk betydelse. Syftet med studien är att undersöka psykoterapeutisk behandling av traumatiserade patienter inom icke specialiserade enheter. Frågeställningarna i studien är: Vad innebär effekterna av komplex traumatisering för individen? Vilka är terapeuters upplevelse av att arbeta med komplext traumatiserade individer? Får individer med diagnosen komplex PTSD den hjälp de behöver? Den metod som använts är en kvalitativ studie där sex legitimerade psykoterapeuter med psykodynamisk inriktning intervjuas. Resultatet av studien visade att effekterna av komplex traumatisering är omfattande och svåra att diagnostisera. Tillståndet har ofta utvecklats till kroniska besvär, t ex ångest och depression, somatiska besvär och personlighetsstörning. Det finns svårigheter och hinder för att traumatiserade patienter ska få adekvat hjälp och utifrån resultatet saknas det i dag både resurser och effektiva behandlingsmetoder. Kunskapen om trauma och dess effekter måste i ökad utsträckning uppmärksammas och prioriteras i tidigare skede inom vård- och behandling.

Thesis advisor: Belle Liang
The study of treatments for complex posttraumatic stress disorder (CPTSD), especially in cases of chronic childhood abuse, has revealed that traditional trauma treatments often lack success due to the complexity of symptom presentation. CPTSD often manifests as a lack of integration between the self and the body. While certain coping strategies used by survivors during the trauma experiences, such as dissociation, may be adaptive in the short-term, prolonged use posttrauma comes at a cost--resulting in a loss of awareness of one's emotional and physical being in the present moment. Mindfulness-based interventions, such as hatha yoga, show promise as alternative or complementary treatments for CPTSD. Furthermore, current trauma treatments have been criticized for their primary focus on psychopathology. More recent conceptualizations of trauma recovery call for a paradigm shift that recognizes not only the need for symptom-reduction, but also the encouragement of positive development and personal growth (i.e., stronger sense of self, relationships with others, and perspective on life). This qualitative study explored the experiences of women with CPTSD in a 10-week, trauma-informed hatha yoga class, specifically examining perceived changes with regard to symptom reduction and personal growth. Six themes were identified through qualitative content analysis. Theme 1 describes the yoga practice and study design characteristics that influenced participants' experiences. Themes 2 through 6 reflect participants' increased feelings of Gratitude and compassion, Relatedness, Acceptance, Centeredness, and Empowerment (referred to as G.R.A.C.E. themes). Findings are discussed in the context of current literature. Limitations of the study are also presented along with recommendations for future research and clinical work
Thesis (PhD) — Boston College, 2011
Submitted to: Boston College. Lynch School of Education
Discipline: Counseling, Developmental, and Educational Psychology

Female survivors of multiple forms of trauma are increasingly found to be a significant portion of the university population (Briere, Kaltman, & Green 2008). While there is a strong literature base for understanding the effects of individual trauma on psychological functioning (e.g., Briere, 1992; Kaltman, Krumnick, Stockton, Hooper, & Green, 2005), little is known about specific symptom constellations for those who have experienced multiple traumas (Rich, Gingerich, & Roseìn, 1997). Using a clinical population of 500 female university students, this study explored the rates of multiple interpersonal traumatic experiences, the connection between multiple traumas and symptom severity, and the association of specific constellations of multiple types of traumas with specific constellations of trauma symptoms. The Trauma Symptom Inventory-Alternate (Briere, 1995) and self-report measures of demographic data and abuse histories were used to collect data, which was analyzed with frequencies, Multivariate Analysis of Variance, and a Canonical Correlation to explore the interrelationships of abuse and trauma symptoms. Multiple abuse was common, with 81% of participants experiencing two or more types of abuse. Multiple trauma generally predicted more severe trauma-related symptoms than those with no trauma or single traumas. A Canonical Correlation revealed a moderately significant relationship between participants with aggressive types of abuse (e.g., childhood physical, adult physical, and adult sexual abuse) with higher symptoms of intrusive experiences, defensive-avoidance, and dissociation. These findings suggest a differential model of trauma effects, particularly for trauma types characterized by aggression. Implications for future research and clinical practice are addressed.

Critical Review of the LiteratureCan Borderline Personality Disorder be treated effectively in forensic settings? A systematic reviewBorderline Personality Disorder (BPD) is a common diagnosis in forensic settings. Certain features of BPD, such as impulsivity and emotional dysregulation, can create a vulnerability to impulsive acts. The condition is also associated with poor mental and physical health, making the treatment of BPD and its clinical features an important goal in forensic settings. This paper reviews evidence for the effectiveness of treating BPD and its symptoms using psychological approaches in forensic settings. A systematic search found 2913 papers, of which 13 met the inclusion criteria. The papers reported nine separate studies (six controlled) that implemented four distinct interventions, often adapted for particular forensic settings. Improvements in overall BPD symptomatology and specific BPD symptoms were reported for all types of intervention, although few differences in outcome between intervention and control groups were found. There were also reported improvements in BPD-related behaviours, but data on offending behaviour were absent. Heterogeneity in study quality and design makes it challenging to draw any firm conclusions about the effectiveness of any one form of treatment over another, nor about which treatment may best suit a particular setting. Further randomised controlled trials are needed to answer these questions. Service Improvement ProjectEvaluation of a brief educational intervention for clinical staff aimed at promoting trauma-informed approaches to careThere is growing evidence that trauma plays an important role in the aetiology of severe and enduring mental health problems. Yet staff can be reluctant to ask patients about trauma for reasons such as anxiety about harming patients and limited access to training. Where services have adopted trauma-informed approaches (TIAs) to mental health care (i.e., considering the ways in which trauma affects individuals when planning and delivering services), improved clinical outcomes have been observed. With this in mind, a new educational video was developed for mental health staff at an NHS trust. The video was intended to be (a) brief (10 minutes); (b) contemporary and engaging; and (c) accessible using computers, smartphones and tablets. Forty-one multidisciplinary staff viewed the video. Quantitative and qualitative evaluation indicated improvements in self-reported knowledge and confidence with regard to trauma, and a decrease in worries with regard to asking patients about such experiences. Participants found the video to be enjoyable, understandable and informative. Importantly, many indicated that it spurred them to further action, such as further training and asking patients about possible trauma. These findings indicate that a video of this type can offer an important ‘taster’ of trauma-related learning, constituting an important step towards embedding trauma-informed ways of working at a service. Main Research ProjectThe Role of Intrusive Imagery in Hoarding DisorderThe cardinal feature of Hoarding Disorder (HD) is persistent difficulty discarding possessions, with the resulting clutter compromising the intended use of living areas. Within the dominant cognitive-behavioural model of hoarding (Frost & Hartl, 1996), hoarding behaviours are positively and negatively reinforced in the context of certain object-related beliefs. Available treatments for HD have so far yielded modest outcomes, indicating a need for new approaches. Intrusive imagery has so far been neglected in HD research, despite the frequency of trauma in the histories of people with the condition. To address this, 27 individuals who met the DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about their everyday experiences of mental imagery. Participants were also asked about the images they experienced during two recent real-life examples of actual or attempted discard of (1) an object of low subjective value; and (2) an object of high subjective value. Everyday imagery in the HD group commonly reflected themes of illness, death and reminiscence. Imagery in HD participants tended to carry negative emotional valence in comparison with CCs, and was associated with greater interference in everyday life and attempts to avoid the imagery. HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD participants experienced positive imagery when discarding, or trying to discard, high value objects. These findings indicate that although people with HD frequently report traumatic histories, this is not reflected in the everyday imagery that they experience. There is some evidence to suggest that the negative and positive memories experienced in relation to low and high value objects may aid our understanding of discarding and saving behaviour in HD. The theoretical and clinical implications of these findings are further discussed.

The transmembrane serine receptor Tsr associates with a coupling protein, CheW, and a histidine kinase, CheA, to form a ternary complex that regulates the activity of CheA. CheA activity is inhibited by binding of L-serine to Tsr. This work aims to characterize the ligand-binding properties of Tsr and the inhibitory effect of L-serine on CheA activity. The periplasmic domain of Tsr (pTsr) was purified and characterized. Analytical gel filtration and analytical ultracentrifugation indicated that binding of Lserine promotes dimerization. The binding stoichiometry and dissociation constant for binding of L-serine to pTsr were determined by fluorescence spectroscopy. As protein concentration decreased, the dissociation constant increased. A working model was proposed to account for the interactions between L-serine and pTsr. The activity of CheA in a ternary complex with full-length Tsr and CheW was analyzed by measuring the production of [32P]-phospho-CheY. (Phospho-CheY is the product of CheA catalysis.) The results revealed that binding of L-serine decreased CheA activity without changing its affinity for ATP. These findings suggest that the allosteric effect of L-serine on CheA activity might occur through V-type inhibition. Optimization of an alternative, continuous, non-radioactive assay for CheA is underway.

Objective: Previous studies have established an association between number of traumatic experiences and alexithymia. The present study examines this relationship in a large-scale representative sample of the German general population (N=2,507) and explores the potential mediating effects of posttraumatic symptomatology, particularly avoidance/numbing. Methods: Alexithymia was assessed with the German version of the Toronto Alexithymia Scale (TAS-20). Posttraumatic symptomatology was operationalized by the symptom score of the modified German version of the Posttraumatic Symptom Scale, and traumatic experiences were assessed with the trauma list of the Munich Composite International Diagnostic Interview. Two mediation analyses were conducted. Results: Of the total sample, 24.2% (n=606) reported at least one traumatic experience, 10.6% (n=258) were classified as alexithymic, and 2.4% (n=59) fulfilled the criteria of posttraumatic stress disorder (PTSD). Participants who had survived five or more traumatic experiences had significantly higher alexithymia sum scores. The PTSD symptom cluster avoidance/numbing mediated the association between the number of traumatic experiences and alexithymia. Conclusions: Our findings illustrate an association between number of traumatic experiences and alexithymia and the influence of emotional avoidance and numbing within this relationship. The significant relationship between alexithymia and number of traumatic experiences in a general population sample further supports the concept of multiple and complex traumatization as associated with alexithymia. The results suggest the importance of further investigations determining the causal impact of alexithymia both as a potential premorbid trait and as consequence of traumatization. Lastly, future investigations are needed to clarify alexithymia as a distinct trauma-relevant characteristic for better diagnostics and specialized trauma-integrative therapy.