Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma

In this study, the prevalence and severity of traumatic experiences as reported by patients with dissociative disorders and with other DSM-IV psychiatric diagnoses were compared. Furthermore, the predictive value of emotional, physical, and sexual trauma with respect to somatoform and psychological dissociation was analyzed. In contrast with comparison patients, dissociative disorder patients reported severe and multifaceted traumatization. Physical and sexual trauma predicted somatoform dissociation, sexual trauma predicted psychological dissociation as well. According to the memories of the dissociative disorder patients, this abuse occurred in an emotionally neglectful and abusive social context. Pathological dissociation was best predicted by early onset of reported intense, chronic and multiple traumatization. Methodological limitations restricting causal inferences between reported trauma and dissociation are discussed.     

Dispositional Optimism, Trait Anxiety, and Coping: Unique or Shared Effects on Biological Response to Fertility Treatment?

The aim of this study was to examine the unique and shared predictive power of psychological variables on reproductive physical health. Three months before fertility treatment, 97 women completed measures of dispositional optimism, trait anxiety, and coping. Information about biological response to treatment (e.g., estradiol level) was collected from medical charts after treatment. Structural equation modeling showed that measured psychological variables were all significant indicators of a single latent construct and that this construct was a better predictor of biological response to treatment than was any individual predictor. This research contributes to evidence suggesting that the health benefits of dispositional optimism are due to its shared variance with neuroticism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning in families of children with anxiety disorders.

The authors examined maternal and paternal reports of family functioning and their relationship with child outcomes as well as the association between anxiety and depression in family members and family functioning. Results reveal that maternal and paternal reports of family functioning were both significantly associated with worse child outcomes, including child anxiety disorder (AD) severity, anxiety symptoms, and child global functioning. Maternal and paternal anxiety and depression predicted worse family functioning, whereas child report of anxiety and depression did not. Parents of children with ADs reported significantly worse family functioning and behavior control, but only fathers reported worse problem solving and affective involvement compared with fathers of children with no psychological disorders. Findings from this study suggest that paternal as well as maternal anxiety and depression play a role in worse family functioning in children with ADs and that unhealthier family functioning is associated with worse child outcomes in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ongoing traumatic stress response (OTSR) in Sderot, Israel.

[Correction Notice: An erratum for this article was reported in Vol 41(2) of Professional Psychology: Research and Practice (see record 2010-06890-002). In the article “Ongoing Traumatic Stress Response (OTSR) in Sderot, Israel,” by Diamond, Lipsitz, Fajerman and Rozenblat (Professional Psychology: Research and Practice, 2010, Vol. 41, No. 1., pp. 19–25), due to a production error, the last author’s name was misspelled in the byline and the author note. The correct spelling is Ornit Rozenblat.] In Sderot, a small city in southern Israel, seven years of continuous missile attacks have led to dramatic increases in treatment seeking for anxiety symptoms. For some clients, the clinical picture is consistent with a diagnosis of post traumatic stress disorder (PTSD). For other clients, however, the onset and constellation of symptoms are less typical of PTSD. In these cases, anxiety symptoms seem to evolve gradually and be associated with ongoing, daily stress about imminent attacks, rather than with a discrete, past traumatic event. Much of their avoidance behavior is reality based. They report hyperarousal, severe distress, and loss of control during and immediately following actual missile attacks. However, they are less likely to exhibit reexperiencing symptoms. Furthermore, in contrast to the typical presentation of PTSD, their symptoms tend to diminish dramatically or completely resolve when they are no longer within harm’s way. We suggest that this clinical presentation may be best understood as an ongoing traumatic stress response (OTSR), rather than PTSD or PTSD symptoms. We consider diagnostic features which discriminate between these two phenomena as well as implications for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experimentally induced anxiety attenuates alcohol-related aggression in men.

The purpose of this study was to test the hypothesis that state anxiety operates as moderator of the alcohol-aggression relation. Participants were 80 healthy male social drinkers between 21 and 33 years of age. They were randomly assigned to 1 of 4 groups: (a) alcohol + anxiety induction (n = 20), (b) placebo + anxiety induction (n = 20), (c) alcohol + no anxiety induction (n = 20), and (d) placebo + no anxiety induction (n = 20). Anxiety was induced by informing participants that they had to deliver a speech about what they liked and disliked about their body in front of a video camera. A modified version of the Taylor Aggression Paradigm (S. Taylor, 1967) was then used to measure aggressive behavior in a situation where electric shocks were administered to, and received from, a fictitious opponent under the guise of a competitive reaction time task. Results indicated that the anxiety induction was successful in suppressing aggression for participants who received alcohol equal to levels seen in placebo controls. Findings are discussed within the context of a number of theories of alcohol's anxiolytic effects in relation to intoxicated aggression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why do people with an anxiety disorder utilize more nonmental health care than those without?

Objective: It is unclear why nonmental healthcare utilization is greater among those with psychological problems. The authors examined healthcare utilization in HMO patients to determine whether greater utilization in anxiety disorder (AD) patients was explained by anxiety symptoms (increasing sensitivity to physical symptoms) or comorbid illness (causing greater need for services). Design: Patients were randomly selected from the database of a multi-specialty practice and 1,041 completed a survey assessing psychological symptoms, health behaviors, and demographics. Anxiety symptoms were assessed by questionnaire and the presence of an AD was determined from the medical chart. Healthcare encounters and medication use were abstracted from medical charts and HMO claims data. Main Outcome Measures: Healthcare utilization. Results: Both AD and anxiety symptoms predicted utilization, but symptoms were not associated with utilization in a model that also included AD. Comorbid illness was significantly associated with utilization independent of AD and somewhat reduced the strength of the AD-utilization association. The results were replicated in comparison of those with any psychiatric disorder to those without. Conclusion: Among those with AD, greater utilization is not explained by anxiety symptoms but is partly explained by greater comorbid illness. Further study is needed to understand excess healthcare utilization among AD patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissociation in the laboratory: a comparison of strategies

Several methods for inducing dissociation in the laboratory were examined in a sample of 78 undergraduate students. Participants scoring high or low on the Dissociative Experiences Scale participated in three dissociation challenge conditions: (a) dot-staring task, (b) administration of pulsed photic and audio stimulation and (c) stimulus deprivation. Participants recorded their dissociative experiences both before and after each of the three challenge conditions. Across conditions, high DES participants reported significantly more dissociative sensations than low DES participants, even after controlling for pre-challenge dissociation. Moreover, regardless of DES status, pulsed photo and audio stimulation produced the greatest level of dissociative symptoms. The findings suggest that the induction of dissociative symptoms in a nonclinical sample is easily accomplished in the laboratory and that those who report more dissociative symptoms in their day-to-day life exhibit more pronounced dissociative symptoms when undergoing dissociative challenge in the laboratory. Implications for the study and treatment of dissociative symptoms are discussed.     

Converging Toward an Integrated Theory of Self-Esteem: Reply to Crocker and Nuer (2004), Ryan and Deci (2004), and Leary (2004).

In this response to the commentaries regarding their terror management analysis of self-esteem (T. Pyszczynski, J. Greenberg, S. Solomon, J. Arndt, & J. Schimel, 2004). the authors focus on the convergence on certain points regarding self-esteem as a way of progressing toward an integrative perspective. In doing so, they briefly discuss how the need for self-esteem relates to anxiety, interpersonal relations, growth, evolution, and death. They also discuss sources of self-esteem, whether the pursuit of self-esteem is good or bad, and whether such a pursuit could fruitfully be abandoned. They conclude that self-esteem buffers anxiety, is greatly influenced by social relations, and can either facilitate or undermine growth and that the value of the pursuit of self-esteem depends on the sources on which it is based but that its pursuit is too inextricably woven into the way people manage their anxieties and regulate their behavior to ever be abandoned. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Injection anxiety remains a long-term barrier to medication adherence in multiple sclerosis.

Objective: To evaluate the contribution of injection anxiety to disease modifying therapy (DMT) adherence among individuals with multiple sclerosis (MS). Injection anxiety has been associated with medication discontinuation early in the course of treatment, but little is known about the relationship between injection anxiety and sustained DMT adherence over time. Method: Eighty-nine outpatients receiving care at a Veterans Administration MS clinic completed a telephone survey at baseline and monthly telephone follow-up for 6 months. Results: Participants were established DMT users (M = 3.43 years, SD = 3.29), with relatively high adherence overall (over 80% achieved 80% adherence or greater). Using logistic regression and controlling for demographics, MS disability, type of DMT, and time on DMT, the authors found that baseline injection anxiety predicted lower levels of adherence at 4 months and 6 months, with a similar trend at 2 months. Conclusion: Sustained adherence to DMT remains a challenge for a subset of individuals with MS well beyond the initial period of acclimation. Injection anxiety is an important and promising target of psychological intervention during all periods of medication use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment in individuals with social anxiety disorder: The relationship among adult attachment styles, social anxiety, and depression.

Despite their apparent implications for social functioning, adult attachment styles have never been specifically explored among persons with social anxiety disorder. In the current study, a cluster analysis of the Revised Adult Attachment Scale (N. L. Collins, 1996) revealed that 118 patients with social anxiety (58.6% males and 41.4% females, mean age 32.43 yrs) were best represented by anxious and secure attachment style clusters. Members of the anxious attachment cluster exhibited more severe social anxiety and avoidance, greater depression, greater impairment, and lower life satisfaction than members of the secure attachment cluster. This pattern was replicated in a separate sample of 56 patients and compared with the pattern found in 36 control participants. Social anxiety mediated the association between attachment insecurity and depression. Findings are discussed in the context of their relevance to the etiology, maintenance, and cognitive-behavioral treatment of social anxiety disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety disorders in plastic surgery

Surgery is a stressful event, with the potential for profound disturbance to the patient's psychological and physiologic homeostasis. Cosmetic surgery is a particularly intense psychological experience because, in addition to the usual concerns about surgical side effects, cosmetic patients bring their hopes and expectations for improved self-image, putting them at risk for the added anxiety of disappointment. High levels of anxiety coupled with the perception of vulnerability or threat to self can cause significant psychological reactions complicating care for the plastic surgical patient. This paper outlines the diagnostic features of the common types of anxiety disorders seen in plastic surgical patients, and it offers treatment strategies for the practitioner, delineating when referral to a mental health expert is advised. Specific clinical case studies of panic attack, posttraumatic stress disorder, and acute stress disorder are presented to illustrate the variety of abnormal anxiety responses that may be encountered in the perioperative setting. Interventions for the anxious patient are part science and part art. Careful questioning and psychosocial assessment can identify those patients who are at greater risk for psychological problems after surgery. However, some patients may mask or keep secret their concerns, which can be manifested with resulting anger and hostility. Plastic surgeons must use appropriate indicators of psychological anxiety and measure a specific patient's reactions to surgery to make the diagnosis of abnormal anxiety. Close follow-up by the plastic surgical team is an essential part of the anxiety disorder patient's psychological treatment, but it is imperative that these problematic patients be referred promptly to a qualified mental health professional to limit their adverse experience and promote their well-being. Patients who are less anxious during the perioperative period report less emotional distress and fewer defensive behaviors and are likely to be more satisfied with the outcome of their surgery.     

For suicidal young adults with comorbid depressive and anxiety disorders, probem-solving treatment may be better than treatment as usual.

Practicing psychologists face many complexities and challenges in caring for suicidal patients who have comorbid mood and anxiety disorders. Not only must suicidal crises be addressed, but co-occurring depressive and anxiety symptoms compete for attention as well and are associated with relatively poor clinical prognosis in usual treatments. The current study compared problem-solving treatment to treatment as usual among depression–anxiety comorbid versus noncomorbid clinically suicidal young adults. Suicidal patients with mood and anxiety disorders were randomized to the 2 treatments and followed over time. Comorbid suicidal patients, in particular, experienced notable symptom improvements from the problem-solving treatment. Features of the problem-solving treatment are described for use in clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Cuevas, Sabina, and Picard (2010).

Reports an error in "Interpersonal victimization patterns and psychopathology among Latino women: Results from the SALAS study" by Carlos A. Cuevas, Chiara Sabina and Emilie H. Picard (Psychological Trauma: Theory, Research, Practice, and Policy, 2010[Dec], Vol 2[4], 296-306). There were citation errors in the last sentence of the first column of text on page 9, and a reference was omitted from the reference list. The sentence should have read: “This result is consistent with other work that has found support for the anxious and dissociative reaction associated with trauma among Latinos and how it may relate to “ataque de nervios” (Hinton, Chong, Pollack, Barlow, & McNally, 2008; Lewis-Fernandez et al., 2002; Schechter et al., 2000; Tolin, Robinson, Gaztambide, Horowitz, & Blank, 2007). (The following abstract of the original article appeared in record 2010-19221-001.) Research on the victimization of Latino women and the subsequent psychological impact has been limited by focusing on individual forms of victimization, primarily partner violence or sexual assault. Another deficiency includes mainly using convenience and/or geographically restricted samples, which impacts the generalizability of the results. To overcome these research limitations, the Sexual Assault Among Latinas (SALAS) study aimed to evaluate the broader scope of victimization among Latino women. The study surveyed a national sample of 2,000 Latino women using random digit dial methodology. Women were asked about various forms of victimization in childhood and adulthood including physical assaults, sexual assaults, stalking, threats, and witnessed violence, as well as psychological symptomatology including depression, anxiety, anger, and dissociation. This analysis found that victimized women were more likely to experience some form of polyvictimization and/or revictimization throughout their lives, with only 36% of victimized women experiencing one form of victimization in childhood or adulthood alone. Furthermore, multiple victimization experiences significantly increased the proportion of women who experienced psychological distress symptoms in the clinical range. For almost all evaluated symptoms, the multiple forms of victimization or varying victimization patterns significantly predicted clinical levels of psychological distress over any specific form or single incident of victimization. The results suggest that victimized Latino women experience multiple forms of victimization and that the evaluation of a broader spectrum of victimization better accounts for pathological symptomatology. Clinical implications for Latino women and future research directions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Child abuse, self-development, and affect regulation.

Addresses the long-term disturbances in the psychological functioning of abused children from the perspective of self psychology and intersubjectivity theory. From these viewpoints, the symptomatology displayed by abused children is conceptualized as the product of derailments in self-development and impairments in affect regulation, resulting from chronic failures in caregiver attunement to the child's affect. Children who are abused experience a range of affective and dissociative disturbances, including psychic numbing, alexithymia, increased aggression and rage, increased painful affects, and dissociative behavior. Implications for treatment are discussed, and the case of a 3.5 yr old boy suffering from physical and sexual abuse illustrates the points made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of defeat and entrapment in depression, anxiety, and suicide.

Defeat and entrapment are psychological constructs that have played a central role in evolutionary accounts of depression. These concepts have since been implicated in theoretical accounts of anxiety disorders and suicidality. The current article reports on a systematic review of the existing research investigating the links among defeat, entrapment, and psychopathology in the domains of depression, suicidality, posttraumatic stress disorder (PTSD), and other anxiety syndromes. Fifty-one original research articles were identified and critically reviewed. There was strong convergent evidence for a link with depressive symptoms, across a variety of clinical and nonclinical samples. Preliminary support for an association with suicidality was also observed, with effects not readily explainable in terms of comorbid depression. There was strong evidence for an association between defeat and PTSD, although this may have been partly accounted for by comorbid depression. The findings for other anxiety disorders were less consistent. There was, however, evidence that social anxiety in individuals with psychosis may be related to perceptions of entrapment. Overall, there was evidence that perceptions of defeat and entrapment were closely associated with various forms of human psychopathology. These effects were often in the moderate to large range and superseded the impact of other environmental and psychological stressors on psychopathology. We provide a unified theoretical model of how defeat and entrapment may contribute to these different psychopathological conditions. Clinical implications and avenues for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Uncharged S4 residues and cooperativity in voltage-dependent potassium channel activation

The purpose of this study was to investigate psychological testing features of children and adolescents with dissociative disorder diagnoses to provide diagnostic information that might facilitate early intervention. The psychological testing protocols of 30 children diagnosed with dissociative disorders were compared with the testing protocols of 30 consecutive admissions to the Sheppard Pratt Hospital who did not receive a dissociative identity disorder (DID; formerly termed multiple personality disorder) or dissociative disorder not otherwise specified (DDNOS) diagnosis. A rater, blind to the diagnosis, scored these protocols for the presence or absence of behavioral and testing response variables hypothesized to discriminate between the dissociative patients and the mixed group of other diagnoses. Behavioral features significantly more common in the dissociative group included forgetting, staring, unusual motor behaviors, dramatic fluctuations, fearful and angry reactions to stimuli, physical complaints during testing, and expressions of internal conflict. Significant indications of dissociation in the test responses included images of multiplicity, malevolent religiosity, dissociative coping, depersonalized imagery, emotional confusion, extreme dichotomization, images of mutilation and torture, and magical transformation. A combination of these behavioral and response variables was able to select 93% of the dissociative sample. These results add support to the discriminant validity of DID and DDNOS as diagnostic categories in childhood and provide clinical information that may be useful for early diagnosis of traumatized children with dissociative pathology.     

Psychological aspects of asthma.

Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bridging the gap between biological and psychological perspectives in the treatment of anxiety disorders.

Provides an overview of the research and theorizing about the behavioural and cognitive treatment of anxiety and panic. The applicability and usefulness of behavioural and cognitive treatment approaches for anxiety disorders is now well established. Various and different theoretical mechanisms have been proposed to explain their therapeutic effects on anxiety. Today's research suggests that the psychological variables mediating change in behavioural and cognitive therapy for anxiety disorders are similar. Furthermore, the effects of drug and psychological treatment for anxiety disorders appear to be mediated by the same psychological and neurobiochemical variables. It is postulated that a better understanding of the interaction between these variables will lead to new, significant advances in the treatment of anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of posttraumatic stress disorder following cancer.

This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. Individuals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression; individuals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving one's cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)