Faculty Bibliography

Functional magnetic resonance imaging in association with an instructed fear/anticipatory anxiety paradigm was used to explore sex differences in the human fear response. During anticipation of mild electrodermal stimulation, women, as compared with men, demonstrated increased activity in the subgenual anterior cingulate cortex and functionally related regions of the insula and brainstem. The subgenual anterior cingulate cortex is a region critical for emotional control implicated in the pathogenesis of psychiatric disease. Present findings suggest a contributory neural substrate for the greater susceptibility of women to anxiety and affective disorders, and emphasize the importance of considering participant sex when designing and interpreting functional neuroimaging studies

The immediate and long-term consequences of children's exposure to maltreatment and other traumatic experiences are multifaceted. Emotional abuse and neglect, sexual abuse, and physical abuse, as well as witnessing domestic violence, ethnic cleansing, or war, can interfere with the development of a secure attachment within the caregiving system. Complex trauma exposure results in a loss of core capacities for self-regulation and interpersonal relatedness. Children exposed to complex trauma often experience lifelong problems that place them at risk for additional trauma exposure and cumulative impairment (e.g., psychiatric and addictive disorders; chronic medical illness; legal, vocational, and family problems). These problems may extend from childhood through adolescence and into adulthood. This article describes a new theoretical framework for understanding complex trauma in children, explains how to apply the new framework to assessment of traumatized children and families, and discusses intervention models designed specifically for traumatized children and their families.

This study sought to determine the relative contribution of problems in emotion regulation and interpersonal functioning compared to PTSD symptoms in predicting functional impairment among women with childhood abuse histories. One hundred sixty-four treatment-seeking women completed measures of emotion regulation, interpersonal problems, PTSD symptoms, and social adjustment. Severity of PTSD symptoms was a significant predictor of functional impairment. In addition, after controlling for the effects of PTSD symptomatology, emotion regulation and interpersonal problems were both significant predictors and together made contributions to functional impairment equal to that of PTSD symptoms. These data indicate that emotion regulation and interpersonal problems play an important role in functional impairment among women with a history of childhood abuse. These factors should be taken into account in treatment planning to ensure successful rehabilitation from the long-term effects of chronic childhood trauma. (journal abstract)

BACKGROUND: Previous neuroimaging studies have demonstrated exaggerated amygdala responses to negative stimuli in posttraumatic stress disorder (PTSD). The time course of this amygdala response is largely unstudied and is relevant to questions of habituation and sensitization in PTSD exposure therapy. METHODS: We applied blood oxygen level dependent functional magnetic resonance imaging and statistical parametric mapping to study amygdala responses to trauma-related and nontrauma-related emotional words in sexual/physical abuse PTSD and normal control subjects. We examined the time course of this response by separate analysis of early and late epochs. RESULTS: PTSD versus normal control subjects have a relatively increased initial amygdala response to trauma-related negative, but not nontrauma-related negative, versus neutral stimuli. Patients also fail to show the normal patterns of sensitization and habituation to different categories of negative stimuli. These findings correlate with measured PTSD symptom severity. CONCLUSIONS: Our results demonstrate differential time courses and specificity of amygdala response to emotional and control stimuli in PTSD and normal control subjects. This has implications for pathophysiologic models of PTSD and treatment response. The results also extend previous neuroimaging studies demonstrating relatively increased amygdala response in PTSD and expand these results to a largely female patient population probed with emotionally valenced words

(from the journal abstract) Women who have PTSD related to childhood abuse have significant deficits in the areas of emotion regulation and interpersonal skills. These problems are associated with impaired functioning in social, work, and home life. In addition, there is substantial clinical concern that limited emotion-regulation skills puts this population at risk for early dropout and symptom exacerbation in treatment focusing on emotional processing of traumatic memories. Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE) is an evidence-based, 2-phase cognitive behavioral treatment designed to address these concerns. Specifically, this treatment targets PTSD symptoms, emotion-regulation deficits, and interpersonal difficulties. The purpose of this article is to describe the rationale for and clinical application of STAIR/MPE, detailing the essential clinical components and presenting relevant case examples.

In the 2 plus years since the terrorist attacks of Sept. 11, 2001, a substantial number of children have developed psychiatric disorders, severe psychological distress, and functional impairment. Despite significant financial support, the availability of mental health services, and the presence of relatively sophisticated mental health providers, a surprisingly large gap has emerged between documented need and service use. This article identifies some of the factors that appear to have contributed to this situation and potential remedies for ongoing difficulties

Community studies indicate that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. The impact of gender is profound in that it increases the likelihood of developing an anxiety disorder by 85% in women compared to men. Sex difference in prevalence rates are apparent as early as age 6, when girls are twice as likely as boys to have an anxiety disorder. In the National Comorbidity Survey, the prevalence rates for panic disorder in women and men were 5% and 2%, respectively. Agoraphobia, which often coexists with panic disorder, has a lifetime prevalence rate of 7% in women and 3.5% in men. Prevalence of trauma is increased in young women as well, and is experienced earlier in life; 62% of sexual assaults are inflicted on females <18 years of age, and 29% occur in children <11 years of age. Comorbidity of anxiety in women complicates other medical conditions as well. For example, panic disorder is highly comorbid with CHD, which remains the leading cause of death in women in developed countries. Fluctuations in reproductive hormone levels during the female life cycle is thought to be responsible for modulating anxiety. This is often implicated in the later age of onset, the more sudden and acute symptom emergence, and the more episodic course of OCD in women, and in the high prevalence (47.4%) of PMDD. Pregnancy appears to be a protective period for some anxiety disorders, including panic, while for others, such as OCD, it may be associated with onset. Hormonal changes during pregnancy, such as increased prolactin, oxytocin, and cortisol, may contribute to the suppression of stress response that occurs during this period. Despite a large and growing body of literature on anxiety disorders in general, the available data relating to women and girls falls short of informing aspects of diagnosis, treatment, and prevention that may entail sex differences. Additional work is required to understand the biological and psychosocial causes of these differences