Faculty Bibliography

With the events of September 11th, childhood trauma has come to the forefront of national attention. One of the common psychiatric outcomes of trauma is Posttraumatic Stress Disorder (PTSD). Despite the fact that certain vulnerabilities may contribute to the development of PTSD in traumatized youth, the existence of an identifiable stressor provides a unique opportunity for early intervention. Cognitive Behavioral Treatment (CBT) interventions are considered by many to be the mainstay of treatment of children and adolescents with PTSD. More severe cases of PTSD are often treated with medications in the community. In this article we present a CBT program--developed by our site--STAIR--and provide useful guides and rationales for clinicians to work with when treating this population. We will also briefly review the available literature on the psychopharmacologic interventions to help guide the physician when confronted with such treatment decisions

Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations

Revictimization among women (aged 31-50 yrs) with a history of childhood sexual abuse was investigated within the context of a developmental model of interpersonal schemas. Data from the Interpersonal Schema Questionnaire (ISQ) revealed contrasting schema characteristics among sexually revictimized women (n = 26), compared to those only abused in childhood (n = 18), and those never abused or assaulted (n = 25). Both revictimized women and never victimized women significantly generalized their predominant parental schemas to current relationships and differed only in the content of the schemas. The generalized parental schema of revictimized women viewed others as hostile and controlling while that of never victimized women viewed others as warm and noncontrolling. Women who had only been abused in childhood held schemas of parents as hostile but not controlling and did not generalize from parental to current schemas. The tendency to generalize observed in the first two groups suggest that 'repetition compulsion' is not limited to those who were traumatized and are psychologically distressed. In this article, reasons for the absence of generalization among the childhood abuse only group are explored and implications for the treatment of childhood trauma survivors are discussed.

The outcome of a 12-week interpersonal process group therapy for women with postraumatic Stress Disorder (PTSD) related to childhood sexual abuse with and without borderline personality disorder (BPD) was assessed by comparing three naturally occurring treatment conditions: groups that did not have any members with borderline personality disorder (BPD-) (n = 18), groups in which at least one member carried the diagnosis (BPD+)(n = 16), and a 12-week waitlist (WL) (n = 15). PTSD, anger, depression, and other symptoms were significantly reduced in the BPD- groups. However, the BPD+ and WL conditions did not show any pre- to posttreatment improvements. Furthermore, the BPD+ condition showed a significant worsening on measures of anger. Analyses within the BPD+ condition indicated that women with and without the diagnosis experienced equal posttreatment increases in anger problems. These latter results suggest the presence of an anger 'contagion' effect. That is, women without BPD did well in the BPD- groups but showed increased anger similar to the BPD+ women when treated in groups with them. Implications for client-treatment matching considerations in PTSD group therapy are discussed

Assessed the relationship between retrospective self-reports of childhood abuse and subsequent interpersonal violence among 354 consecutive male inpatients (aged 18-59 yrs) admitted to a psychiatric hospital. Data were obtained through clinical interviews. Three logistic regressions reveal that the association between childhood abuse and 3 mutually exclusive adult negative outcomes were as follows: (1) being a perpetrator of violence, (2) being a victim of violence, and (3) being a perpetrator and victim. The results suggest that, among men with significant psychiatric impairments and childhood abuse, rates of adult victimization are high, and the most frequent negative outcome reflects involvement in dual roles of perpetrator and victim. The possible dynamics of this relationship are discussed.

This study examined the relative contributions of Posttraumatic Stress Disorder (PTSD) symptoms and the extent of trauma exposure as factors contributing to the current health status of childhood abuse survivors. Sixty-seven women with a history of familial childhood abuse (sexual and/or physical) and twenty-nine women with no abuse history were assessed on two distinct aspects of health status: reported number of medical problems and perceptions of overall health. Women with abuse were found to have a greater number of medical problems and poorer perceived physical well-being than the no abuse comparison group. Regression analyses of the women with abuse histories revealed that trauma exposure was a stronger predictor than PTSD symptoms of medical problems. PTSD symptoms, however, were better predictors of the experience of physical well-being than trauma exposure. These results suggest that the nature of a traumatic exposure, especially when there is repeated, cumulative trauma may be more significant to medical problems than the psychological symptoms of PTSD. Perceived health, however, appears to be predominantly influenced by psychological factors, suggesting the importance of these variables in the quality of life of multiply traumatized women

The overlap in definition and presentation between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) has raised questions about the relationship of these disorders. Are they separate disorders, variants of the same disorder, or comorbid conditions? The present study examined etiological variables and current functioning among two groups of outpatient women with a history of childhood sexual abuse: those with PTSD only (N = 45) and those with PTSD and BPD (N = 26). The groups did not differ in severity, frequency, or number of perpetrators of their childhood sexual abuse, or whether the perpetrator was a family member or not. The additional diagnosis of BPD was associated with earlier age of abuse onset and significantly higher rates of physical and verbal abuse by mother. Severity and frequency of PTSD symptoms were not affected by BPD diagnosis, suggesting that the personality disorder and PTSD are independent symptom constructs. The PTSD+BPD group scored higher on several other clinical measures including anger, dissociation, anxiety, and interpersonal problems. They did not differ in their frequency of use of mental health services but tended to be less compliant in their treatment. These and other findings are discussed, and implications for treatment are considered

There are no systematic data available on combining medication and psychotherapy in the treatment of individuals with post-traumatic stress disorder (PTSD), despite its widespread practice. Careful review of the acute trials literature reveals that psychosocial and pharmacologic treatments each leave a substantial proportion of individuals with residual symptoms. This paper discusses a treatment model involving a phase- oriented treatment approach that begins with pharmacotherapy and continues with trauma-focused psychotherapy. Other combined approaches also are discussed. A rationale supporting the need for psychosocial treatment in the majority of patients who receive pharmacotherapy for chronic PTSD is presented

Associations have been reported between childhood sexual and/or physical abuse and adult substance abuse in general. This study investigated the relationship between childhood abuse and opiate use in particular among 763 consecutively admitted psychiatric inpatients. Patients were interviewed about demographic information, alcohol and drug use, and history of interpersonal violence. Opiate users were 2.7 times more likely to have a history of childhood sexual and/or physical abuse than nonopiate users, after controlling for diagnostic and sociodemographic variables. Opiate use was higher among those reporting physical abuse alone (24.1%) or both physical and sexual abuse (27%) than among those reporting sexual abuse alone (8.8%). Implications of these findings are discussed