Treatment implications of past trauma in borderline personality disorder

Recent research and clinical experience have shown childhood trauma to be common in the histories of patients with borderline personality disorder. This article reviews the association between borderline personality disorder and early trauma, and how an awareness of the role of trauma may improve the treatment of patients with this disorder. Particularly when early trauma is in the form of childhood abuse, clinicians may be better able to understand the difficulties these patients experience in relational skills, affect tolerance, behavioral control, self-identity, and self-worth. Clinicians may be able to facilitate a stronger therapeutic alliance through acknowledgement of the patient's victimization and empathy with the effects of early trauma on the patient's life. Reframing the patient's experience as a consequence of childhood trauma is essential, especially when making traditional interventions such as interpretation and confrontation. The role of trauma in the development of borderline personality disorder suggests the need for modification of models of individual, family, and group psychotherapies that may allow more productive and successful treatment.     

Substance use after residential treatment among individuals with co-occurring disorders: The role of anxiety/depressive symptoms and trauma exposure.

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma center 2000. How many and which trauma centers does Europe need around the year 2000?

The treatment of severely injured patients is a challenge for preclinical and clinical treatment concepts, causing financial aspects of increasing importance for the German health care system. A total of 32,500 polytraumatized patients (PTS III and IV) are managed in trauma center levels I-IV in Germany. Trauma center levels I or II are by definition capable of supporting the full range of treatment for the severely injured. With the baseline calculation of 64,000 DM per patient and 104 polytrauma treated per year in the Berlin Virchow Clinic, 6.66 million DM primary costs must be spent for treatment. The total annual costs of this center are nearly 24 million DM for emergency cases and 7 million DM fixed costs per year, for a trauma center level I. In Europe the distribution of trauma center levels I or II is sufficient and can be specified with 1 center per 1 million inhabitants. Nevertheless, the european air medical service could support more intensive use of these central trauma institutions. This was shown by comparing the number of polytrauma patients and the number of trauma centers. Less then half of these patients are treated in levels I or II trauma centers. The financial pressure on the health system and the rising quality must lead to better utilization of trauma centers. To meet this goal a annual treatment rate of 300-400 polytrauma patients should be aimed at. The claim of the American College of Surgeons that a trauma surgeon should treat 50 severely injured patients per year would then be possible.     

Feminist Paradigms of Trauma Treatment.

This article reviews feminist models of treatment, then applies those paradigms to working with survivors of trauma. Feminist therapists and theorists have been central to discussions of trauma arising from interpersonal violence, betrayal, and oppression. Consequently, much of what has emerged as standards of treatment for survivors of these types of violence is implicitly feminist. In this article, explicit feminist perspectives on trauma treatment are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The trauma response: Treatment for emotional injury.

Reviews the book, The trauma response: Treatment for emotional injury by Diana S. Everstine and Louis Everstine (see record 1993-97113-000). The major premise of this book is that PTSD, as defined in the DSM-III-R, should be reconceptualized and recognized as "trauma response." This shift in focus emphasizes normalcy and a nonpathological recovery process as opposed to adherence to a disease model of psychological affliction in which a "disorder" is diagnosed and treated. The stated purpose of this book is to help clinicians identify, measure, and treat emotional trauma. This book is comprehensive and divided into four parts, covering topics such as the phenomenon of trauma, treatment for adult trauma, hidden trauma, trauma in the work place and trauma and the law. According to the reviewer, the book as a whole reflects valuable learning that has accrued from the authors' clinical experiences in working with victims of trauma. A diverse readership would benefit from this addition to the clinical literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The diagnosis and treatment of blunt renal trauma

225 patient with blunt renal trauma were treated from 1955 to 1994. Coexistent injuries of other organs were noted in 79 patients (35.11%). The extent of renal trauma was not demonstrated by hematuria. B-ultrasonography seemed to be best for the diagnosis of renal trauma. Abdominal incision was helpful to explore injuries of other organs and manage renal trauma. Early treatment of renal trauma was necessary for the treatment of shock and prevention of serious complication.     

Dental defects of congenital syphilis

Emotionally focused marital therapy (EFT), a marital therapy that particularly focuses on the creation of secure attachment, has proven in empirical studies to be effective for distressed couples. This paper discusses the application of EFT in couples where one or both of the partners have experienced significant trauma. EFT, in this context of trauma, incorporates the nine steps of conventional EFT and also encompasses the three stages of the "constructivist" self development theory of trauma treatment. This paper illustrates how the integration of EFT and trauma treatment can prove effective in treating not only relationship distress but also the individual symptoms of posttraumatic stress disorder (PTSD).     

Results of the conservative treatment of severe renal trauma in childhood

Surgical treatment of severe renal trauma usually ends in loss of high percentage of kidneys. In consequence of this, in the last decade several authors prefer a conservative management of kidneys severely injured. There include stabilization in Intensive Care Unit, with the goal of preservation the most possible functioning renal tissue. The purpose of this paper is to present the results of conservative management of severe renal trauma in our Center in the last five years. We conclude that this type of management is accurate and effective.     

Exposure therapy for posttraumatic stress disorder in a residential substance use treatment facility.

Clinical lore abounds when discussing the issue of treating trauma-related symptoms in substance-dependent clients. Historically, clinicians have wondered whether they should wait until the client has gained substantial abstinence from abused substances before initiating trauma treatment or if trauma treatment should be conducted during substance use treatment. Furthermore, questions arise with regard to exactly how trauma-related symptoms should be addressed and how trauma treatment should be incorporated into the recovery process. In this article, the growing literature suggesting that posttraumatic stress disorder (PTSD) can be treated concurrently with substance use disorders is reviewed. In addition, the unique challenges of implementing treatment for PTSD with substance-dependent clients seeking treatment in a residential treatment facility are discussed. Specifically, we provide concrete suggestions about how to utilize prolonged exposure, a very effective treatment for PTSD, with clients in a residential substance use treatment facility, including use of the internet to facilitate exposure therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Post-traumatic hemiplegia in a patient with fibromuscular dysplasia of the carotid artery

A 44-year-old patient, without remarkable medical history, was admitted with a head trauma with initial loss of consciousness and a thoracic trauma. The initial treatment included the insertion of a chest drain for evacuation of a pneumothorax and intrapleural analgesia with bupivacaine. The day after admission, the patient experienced a generalized epileptic crisis, without prodomes. Later, a left proportional hemiplegia with aphasia was recognized. The CT scan obtained immediately after the crisis, as well as the carotid Doppler ultrasonography and echocardiography were normal. The bilateral carotid angiography showed an image of fibromuscular dysplasia of the extracranial segment of the right internal carotid artery. The migration of a carotid thrombus initiated by the trauma was hypothetized. A treatment with a platelet aggregation inhibiting drug was started and associated 20 days later with low molecular weight heparin. The patient recovered a normal motility within 10 days; only the aphasia remained. Trauma of the carotid artery is not a frequent cause of cerebrovascular accident. The occurrence of the latter is favoured by a pre-existing lesion of this artery. This case demonstrates that in a trauma patient not all central nervous system manifestations are initiated by a head trauma.     

Mobile surgical transport team

The "golden hour" of trauma is based on the principle that severely injured patients are more likely to survive with rapid, appropriate resuscitation and treatment. An inequality exists between sophisticated urban trauma centers and rural/community hospitals in their efforts and abilities to treat severely injured patients. A level I trauma center developed a unique program in an attempt to equalize this inequality--a mobile surgical transport team (MSTT). This article explains the origin of the MSTT, how and why the MSTT is activated, and the roles and responsibility of MSTT members. To further explain the MSTT, two contrasting case studies on trauma patients are presented.     

Combat and human existence: Toward an intersubjective approach to combat-related PTSD.

The author proposes a short-term, intersubjective model for treating combat-related post-traumatic stress disorder (PTSD). Psychodynamic approaches to adult-onset PTSD lack the evidence and popularity of other approaches because adult-onset traumas are fundamentally distinct from the developmental, or childhood-based, traumas that psychoanalysis evolved to treat. An approach based in intersubjective systems theory can address this problem. The writings of Robert Stolorow (2007) in Trauma and Human Existence, which the author first read while deployed to Iraq as a psychiatrist, fundamentally changed his understanding of trauma and its treatment. The author gives an overview of Stolorow's ideas about trauma, and then describes his six-phase short-term intersubjective treatment approach. Extensive case material from a treatment that occurred in Iraq illustrates each of these phases. The author then compares his and Stolorow's views to those of other contemporary relational psychoanalytic writers. Future directions include the manualization and empirical testing of this approach in order to determine its replicability, its utility for therapists who lack extensive psychoanalytic training, and its generalizability to populations with adult-onset trauma outside the military. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Neurosyphilis with multiple gummas and AIDS. Report of a case

Victims of facial trauma require global, and not exclusively surgical, management. We describe the psychological and psychiatric problems associated with facial trauma and emphasize the need for psychiatric care to complete surgical treatment in facial trauma.     

Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic posttraumatic stress disorder

History of early childhood trauma was prevalent and highly correlated with Disorders of Extreme Stress Not Otherwise Specified (DESNOS) in a sample of veterans in inpatient treatment for chronic posttraumatic stress disorder (PTSD). DESNOS predicted reliable change on a variety of measures of psychiatric symptomatology (including PTSD) and psychosocial functioning independently of the effects of PTSD diagnosis and early childhood trauma history. DESNOS also predicted treatment outcome on PTSD and quality of life measures after controlling for the effects of ethnicity, war zone trauma exposure severity, initial level of symptomatic severity or quality of life, Axis I (PTSD and major depression) and Axis II (personality disorder) diagnostic status, and early childhood trauma history. Early childhood trauma was not predictive of outcome. DESNOS appears to play an important role in assessment and treatment planning for psychotherapeutic rehabilitation of chronic PTSD.     

Etiological factors and temporomandibular treatment outcomes: the effects of trauma and psychological dysfunction

This paper examines the effect of trauma and psychological dysfunction as etiological factors in temporomandibular disorder (TMD). It employs a thoroughly validated measurement system, the TMJ Scale, to determine the effects of traumatic temporomandibular joint injury as well as pre-treatment stress and psychological dysfunction levels upon presenting symptom levels. It also addresses these parameters for the eventual treatment outcome. During the course of the study, 754 patients were evaluated at the author's practice, which is limited to the diagnosis and Phase I treatment of temporomandibular dysfunction. Of those individuals, 693 (91.9%) were found to have clinically treatable temporomandibular disorders. At the time of this study, 201 consecutive patients (29%) have completed treatment and were deemed to have reached Maximum Medical Improvement (MMI). The validated measurement system of the TMJ Scale was readministered to this post treatment population. Data analysis revealed that trauma patients did not differ from non-trauma patients in initial symptom levels, nor in levels of symptom improvement (with the exception of a higher palpation pain level reported by the trauma patients). Stress and psychological dysfunction were predictive of higher initial symptom perception levels, but were not significantly related to treatment outcomes. These findings have important implications for practitioners in the field of temporomandibular studies. If it can be confirmed that psychological variables have no impact on treatment outcome, it would be difficult to justify the now frequently employed "dual axis" classifications and major emphasis placed on psychological treatment for temporomandibular patients.     

An emotional exposure-based treatment of traumatic stress for people with chronic pain: Preliminary results for fibromyalgia syndrome.

Emotional trauma occurs in many patients with chronic pain, particularly fibromyalgia syndrome (FMS). Current cognitive-behavioral treatments for chronic pain have limited effects, perhaps because the trauma is not addressed, whereas emotional exposure-based treatments improve post-traumatic stress, but have not been tested on chronic pain. The authors present a novel, brief treatment protocol for people with chronic pain and unresolved trauma (Multi- Stimulus, Multi-Technique Emotional Exposure Therapy), which involves detecting avoidance of a range of emotion-related stimuli, implementing exposure techniques tailored to the patient's avoidances, and negotiating the process and therapeutic alliance. This treatment was pilot tested on 10 women with intractable FMS and trauma histories. Three months post-treatment, the sample showed moderate to large effects on stress symptoms, FMS impact, and emotional distress; and small-to-moderate improvements on pain and disability. Two patients showed substantial improvement, four made moderate gains, two showed modest improvement, and two did not benefit. This pilot study suggests that emotional exposure treatment for unresolved trauma may benefit some patients with FMS. Controlled testing of the treatment for FMS and other chronic pain populations is indicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical evaluation of indomethacin-containing patches for osteoarthritis and extremity trauma

Seventy-eight patients, aged 12-87 years, with osteoarthritis or extremity trauma, attached one indomethacin patch (containing 96 mg indomethacin) to the most symptomatic site twice daily. The final overall treatment outcome was excellent in 52% of the osteoarthritic patients and in 82% of the trauma patients, good in 27% and 13%, and fair in 3% and 0%, respectively. Side effects were reported by 4% of the patients. It is concluded that indomethacin-containing patches were effective and well-tolerated for the treatment of osteoarthritis and extremity trauma.     

UNC-73 activates the Rac GTPase and is required for cell and growth cone migrations in C. elegans

Posttraumatic stress disorder (PTSD) is a common co-occurring diagnosis in patients with substance use disorders (SUDs). Despite the documented prevalence of this particular "dual diagnosis," relatively little is known about effective treatment for SUD-PTSD patients. This article reviews empirical research on the course and treatment of SUD-PTSD comorbidity and highlights clinically relevant findings. Based on this review, the following is noted: PTSD is highly prevalent in SUD patients, consistently associated with poorer SUD treatment outcomes, and related to distinct barriers to treatment. Specific treatment practices are recommended for substance abuse treatment providers: (a) All patients should be carefully screened and evaluated for trauma and PTSD; (b) referrals should be provided for concurrent treatment of SUD-PTSD, if available, or for psychological counseling with the recommendation that trauma/PTSD be addressed; and (c) increased intensity of SUD treatment should be offered in conjunction with referrals for family treatment and self-help group participation.     

Immediate orthopedic surgery in multiple trauma

The increase in mortality and morbidity from multiple trauma due to road accidents, industrial trauma and combat injuries obligates treatment based on emergency systems and trauma centers. Follow-up of the frequency of different types of injury calls attention to increasing involvement of the orthopedic surgeon in primary treatment. This situation calls for appropriate deployment of immediate surgical treatment which will rapidly enable mobility. We present several methods for immediate orthopedic treatment of multiple-trauma patients.