The current study investigated attachment representations and complex trauma in a sample of gender dysphoric adults. Although it has been proven that the psychological wellbeing of gender diverse persons is largely mediated by family acceptance and support, research on their relationships with parental figures is scarce. A total of 95 adults took part in the study. The attachment distribution was as follows: 27% secure, 27% insecure and 46% disorganized. Regarding early traumas, 56% experienced four or more traumatic forms. (...) Further, gender dysphoric adults showed significantly higher levels of attachment disorganization and polyvictimisation, relative to controls. Comparisons of subgroups, defined by natal gender, showed that trans women, compared to control males, had more involving and physically and psychologically abusive fathers, and were more often separated from their mothers; trans men, relative to female controls, had more involving mothers and were more frequently separated from and neglected by their fathers. The research has several implications for treatment, clinical health psychology, family support and education. (shrink)

ObjectiveEven if the relationship between adverse childhood experiences and intimate partner violence has already been established, there are no sufficient studies examining the relationships between these factors and attachment representations, specifically attachment disorganization. Thus, this study aimed to explore, in a sample of women who experienced IPV the presence of interpersonal adversities during childhood, and attachment representations, with a particular focus on disorganization.MethodsWomen’s representations of attachment experiences were investigated through the Adult Attachment Interview, while the presence of various forms of (...) interpersonal adversities during childhood was assessed using the Complex Trauma Questionnaire. The results of the IPV group were compared with those of women with no history of IPV.ResultsWomen in the IPV group showed higher values of multiple forms of adverse experiences within their caregiving system. They presented significantly higher rates of disorganized states of mind regarding attachment, indicative of a lack of resolution regarding traumatic experiences, and of disorganized working models resulting from complex trauma. Our results highlighted that, more than the presence of traumatic experiences, it is their irresolution – reflected in the disorganized states of mind regarding attachment at the Adult Attachment Interview – to be a significant predictor of IPV.ConclusionThese results suggest underline the significance of offering a trauma- and attachment-informed therapy to those who experience IPV. Such results could help both clinicians and researchers in formulating clearer guidelines for IPV interventions. (shrink)

Across care settings, the practice of lying to or withholding the truth from people living with dementia is common, yet it is objected to by many. Contrary to this common discomfort, I have argued in previous work that respecting members of this group as moral equals sometimes requires deceiving them. In this paper, I test my proposed practice against complex, controversial cases, demonstrating both its theoretical strength and its practical value for those working in social care.

Having a premature or critically ill infant in a neonatal intensive care unit is a traumatic experience for parents that can alter their lives. Parents navigate complex emotions of fear, unc...

This paper examines the deployment of the concept of psychological trauma in the field of sexual assault service provision, a field in which a feminist understanding of sexual violence has achieved a position of ‘truth’. Using a Foucauldian methodological approach, the investigation centred on service provision in New South Wales, Australia, and analysis focused on the everyday practices of workers illuminated through documents collected from the field, in particular the interview texts produced from interviews with thirty sexual assault practitioners. (...) The paper focuses on the adult survivor of child sexual assault who emerged in the study as the most traumatised category of victim. I lay out how ‘trauma’, specifically the concept of ‘complex trauma’, operates as the conceptual (emotional, relational, neurobiological) link between past abuse and current problems, redefining them not as ‘problems’ but as the symptoms or effects of untreated childhood trauma. I argue that in the local field this deployment is simultaneously enabling and problematic. The production of a subject position of ongoing ontological vulnerability has the effect of repositioning the ‘adult survivor’ outside the socio-political context of their current lives and as such appears misaligned with a feminist ‘regime’ centred on enabling practices and structural gender inequality. However, I demonstrate how this same knowledge of the neurobiological, relational and emotional effects of trauma on the survivor self is used by practitioners as part of their established feminist practices of enabling victims to regain a sense of power and control, of interrupting blame and working for victims at a broader systemic level. The research adds to feminist research and commentary that has drawn critical attention to uptake of trauma in sexual assault work by showing the specificity of how trauma operates in a specific location, and illustrating both the potential and the problematic aspects of trauma as a feminist knowledge practice. (shrink)

L’hôpital Avicenne évalue et suit des mineurs de retour de zone d’opérations de groupements terroristes depuis sept ans. L’équipe a ainsi pu mesurer l’importance de la prise en charge en psychomotricité pour ces enfants, souvent séparés de leur famille et souffrant de trauma complexe ou développemental. À travers une séquence de soins en psychomotricité et psychothérapie avec deux enfants aux trajectoires familiales complexes, l’article met en évidence les bénéfices d’une prise en charge conjointe. Les auteures développent l’incidence de cette (...) configuration sur la clinique, la complémentarité de ces espaces, les enjeux psychosomatiques du trauma, l’impact de ces derniers sur le développement psychomoteur de l’enfant et de l’adolescent, enfin la dynamique à l’œuvre dans le contre-transfert. (shrink)

This study discusses the issue of emotional crisis and trauma in terms of opportunities to develop and grow. The article seeks to show the complex psychological conditions pertaining to emotional crises, a constructive way of dealing with them, and the possibility of growing and developing thanks to having experienced such a crisis. These issues are usually omitted when describing crises; however, as the author postulates, they constitute a foundation for differentiating — as we surely must do — between (...) emotional crisis and trauma, development and growth through crisis, and the positive adaptive changes observed in cases of post-traumatic disorder. Such changes cannot always be identified as instances of so called post-traumatic growth. The latter is described by the author, with reference to Maslow's theory, as development “resulting from the lack of something”, where this in turn reflects some trauma or other. Moreover, considerations pertaining both to current work in health psychology, and to the distinction between emotional crisis and trauma proposed here, could well prove relevant where practices of intervention are concerned. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:CALL FOR PROPOSALS TRAUMA AND HEALING 12TH EAST-WEST PHILOSOPHER’S CONFERENCE MAY 24-31, 2024 The 12th East-West Philosopher’s Conference will explore the many dimensions of trauma and healing. While trauma can be physical, it can also be psychological, social, political, economic, and cultural—encompassing the immediate effects of global pandemics, the ongoing impacts of ethnic and gender bias, the intergenerational legacies of colonization and geopolitical strife, and the (...) planetary ramifications of anthropogenic climate disruption. Ours is an era in which differences of histories, cultures, and identities are engaged as sources of insight, but also one of retrenchment—a period of relational appreciation, but also one of schism. The global scientific community’s response to the COVID-19 pandemic was a stunning example of human potential for empathetic collaboration in the face of global personal and public health trauma. Yet, the economic trauma of the pandemic has resulted in crumbling international alliances, deepening trade wars, and an unfortunate collective reinvestment in zero-sum endgame framings of geopolitics against which there is no vaccination and through which the terms of healing have become delinked from the restoration of global wholeness. These traumas do not stop shaping our lives when the immediate danger comes to an end. Traumatic pain remains stored in the memories of peoples and individuals, it populates their imagination and shapes horizons of possibility. Thus a philosophical exploration of trauma and healing is not only diagnostic of current problems but also a form of genealogy. We invite participants to reflect upon the relational complexity of both trauma and healing, critically and historically engaging concrete occurrences of trauma while also drawing out theoretical insights regarding healing that strengthens and empowers and resists the forms of personal and social amnesia that make the repetition of trauma so tragically common. Of special interest are panels and papers that explore the trauma and healing at all scales from the interpersonal, to the relational traumas experienced by nations at war and cultures in conflict, thus addressing the interplay of the private and public spheres, of ethics and economics, of the human and the natural sciences, and among disciplines, classes, genders, and generations. Panel and paper proposals are encouraged that explore trauma and healing during the ongoing COVID-19 pandemic, the trauma of refugees, displaced and colonized peoples, trauma and healing in personal relationships, climate change as a form of trauma to the planet and its people, trauma and healing related to issues of gender and sexuality, and how philosophers of all traditions, ancient and modern, cross-culturally deal with trauma and healing. KEYNOTE PRESENTERS: Jin Y. Park, Chair of Philosophy and Religion at American University, Washington DC, “Translating Violence.” Ato Quayson, Jean G. and Morris M. Doyle Professor of Interdisciplinary Studies at Stanford University, CA, “The Ethnography of the Private Sphere: Trauma, Domesticity, and Healing in the Work of Toni Morrison.” We invite proposals for individual papers and panels. Please submit a 250-300 word abstract to the Conference organizers via: [email protected]. Submission Timeline: November 1, 2023 Notifications of acceptance for abstracts and panel proposals received by November 1 will be sent out by December 15, 2023. We have established an early submission timeline to facilitate faculty applying to their own institutions for travel funding. Abstracts received after November 1, 2023, will be vetted as received, taking into consideration the late submission. The absolute deadline for abstract submissions is March 15, 2024. After this, we will not be able to accommodate additional proposals. Final Papers Due: April 15, 2024 CONFERENCE REGISTRATION AND LOGISTICS: Hosted in keeping with the Hawaiian Islands’ spirit of aloha, breakfast and lunch will be provided for all registered presenters, as well as an opening reception and final dinner. The Conference does not provide lodging or travel support, but economical lodgings of various kinds are readily available in Honolulu. ABOUT THE EAST-WEST PHILOSOPHER’S CONFERENCE: The East-West Philosophers’ Conference series is the premier forum for convening philosophers from across the academy who are committed to cross-cultural inquiry. The Conference is the oldest continuous international gathering in Hawai‘i and has been a model of productive collaboration between the University of Hawai‘i at... (shrink)

Although much recent social science and humanities work has been a revolt against simplification, this volume explores the contrast between simplicity and complexity to reveal that this dichotomy, itself, is too simplistic. John Law and Annemarie Mol have gathered a distinguished panel of contributors to offer—particularly within the field of science studies—approaches to a theory of complexity, and at the same time a theoretical introduction to the topic. Indeed, they examine not only ways of relating to complexity but complexity _in (...) practice._ Individual essays study complexity from a variety of perspectives, addressing market behavior, medical interventions, aeronautical design, the governing of supranational states, ecology, roadbuilding, meteorology, the science of complexity itself, and the psychology of childhood trauma. Other topics include complex wholes in the sciences, moral complexity in seemingly amoral endeavors, and issues relating to the protection of African elephants. With a focus on such concepts as multiplicity, partial connections, and ebbs and flows, the collection includes narratives from Kenya, Great Britain, Papua New Guinea, the Netherlands, France, and the meetings of the European Commission, written by anthropologists, economists, philosophers, psychologists, sociologists, and scholars of science, technology, and society. _Contributors._ Andrew Barry, Steven D. Brown, Michel Callon, Chunglin Kwa, John Law, Nick Lee, Annemarie Mol, Marilyn Strathern, Laurent Thévenot, Charis Thompson. (shrink)

Specialists on issues of sexual abuse in religious institutions unanimously stress that this kind of experience significantly affects the victims’ spirituality. Particularly devastating and distorting for their spirituality is sexual abuse committed by clergy. In order to explore this issue for the first time in Poland, the authors conducted a qualitative study in the form of semi-structured interviews with five women who had experienced sexual abuse by Catholic clergy and/or religious in adolescence and young adulthood. The interviews were analyzed using (...) the interpretative phenomenological analysis and narrative methodology. The results showed that four respondents experienced or had experienced religious struggles in three areas: interpersonal, intrapsychic, and relationship with God. These struggles are complex and intense enough to be referred to as “spiritual trauma”, “religious trauma”, or “spiritual violence”. The results of the study may be of importance for people helping or having any other kind of contact with victims of clergy sexual abuse. (shrink)

This paper seeks to provide a noetic analysis of emotional trauma. It highlights three essential features of trauma, as well as one non-essential feature, and attempts to make sense of them phenomenologically. The first essential feature of trauma that the paper considers is the disbelief that pervades traumatic experience. When traumatized, we cannot believe that the traumatic event has taken place. This is because we will, not for the event not to have happened—we cannot will something that (...) is in the past—but to believe that it did not happen so as to shield ourselves from our painful emotional response to it. The second essential feature of trauma is our inability to distinctly categorially intuit the central state of affairs around which our trauma revolves. The traumatic situation is literally unthinkable by us, for it is incongruent with both our expectations regarding the subject of the trauma and our horizon of sense more generally. The third essential feature of trauma is the temporal disorientation that it brings about. Such disorientation arises from our prolonged and single-minded attention to an increasingly complex categorial object: the traumatic situation. Finally, the paper considers a non-essential feature of trauma, namely, how traumatic experience can motivate phenomenological and scientific reactions. (shrink)

_The Dissociative Mind in Psychoanalysis: Understanding and Working With Trauma_ is an invaluable and cutting edge resource providing the current theory, practice, and research on trauma and dissociation within psychoanalysis. _Elizabeth Howell and Sheldon Itzkowitz _bring together experts in the field of dissociation and psychoanalysis, providing a comprehensive and forward-looking overview of the current thinking on trauma and dissociation. The volume contains articles on the history of concepts of trauma and dissociation, the linkage of complex (...) class='Hi'>trauma and dissociative problems in living, different modalities of treatment and theoretical approaches based on a new understanding of this linkage, as well as reviews of important new research. Overarching all of these is a clear explanation of how pathological dissociation is caused by trauma, and how this affects psychological organization -- concepts which have often been largely misunderstood._ _This book will be essential reading for psychoanalysts, psychoanalytically oriented psychotherapists, trauma therapists, and students. (shrink)

This is a phenomenological-hermeneutic case study of Tariq who initially presented with panic disorder. It documents how, as therapy proceeded, the underlying meaning of his initial panic deepened as its roots in traumatic memories of childhood emerged. There were four spaced phases of treatment over four years. The first focused on anxiety management; the second was conceptualized within schema-focused therapy, and evoked and worked with childhood memories using inner child guided imagery; in the third and fourth phases insights gained led (...) to an authentic re-engagement with family members in relationships that had been problematic. The panic attacks resolved and there were two dreams representing a reconfiguring of his relationship with his deceased father. The first two phases were the focus of an unpublished case study presented at a conference in 1995. This article incorporates material from that study and looks back at the case both in light of developments in phases two and three and also in light of theoretical developments in our understanding of complex trauma since the initial presentation. (shrink)

Dystopian literature authored by Arab novelists serves as a reflective medium that elucidates the traumatic experiences endured by individuals in the Arab world amidst on-going crises and conflicts. This article employs trauma theory to explore the complexities of establishing a dystopian text showing how trauma manifests within the unconscious layers of the human psyche, thus leaving an indelible scar that persists over time. The article argues that the events associated with such traumatic experiences emerge into the realm of (...) reality through literary texts, a process that not only allows for the articulation of hidden traumas but also provides the writer with a means to alleviate personal dilemmas through the act of writing. By briefly analysing a selection of prominent and translated Arabic dystopian works, this article examines how certain narratives encapsulate experiences of trauma resulting from oppression and societal upheaval and explores how these texts present harsh realities while engaging readers and fostering resistance against personal adversities. The depicting of dystopian themes and characters in these texts enables readers to understand genuine traumas that bridge the gap between imaginative constructs and lived realities. In conclusion, the article asserts that Arabic dystopian literature acts as a mirror that reflects the injustices and oppression faced by Arabs under authoritarian regimes and the legacies of former colonial powers. (shrink)

Since trauma is a thoroughly relational phenomenon, it is highly unpredictable, and cannot be made to fit within the scientific framework Freud so admired. In _Toward a Psychology of Uncertainty: Trauma-Centered Psychoanalysis,_ Doris Brothers urges a return to a trauma-centered psychoanalysis. Making use of relational systems theory, she shows that experiences of uncertainty are continually transformed by the regulatory processes of everyday life such as feeling, knowing, forming categories, making decisions, using language, creating narratives, sensing time, remembering, (...) forgetting, and fantasizing. Insofar as trauma destroys the certainties that organize psychological life, it plunges our relational systems into chaos and sets the stage for the emergence of rigid, life-constricting relational patterns. These trauma-generated patterns, which often involve denial of sameness and difference, the creation of complexity-reducing dualities, and the transformation of certainty into certitude, figure prominently in virtually all of the complaints for which patients seek analytic treatment. Analysts, she claims, are no more strangers to trauma than are their patients. Using in-depth clinical illustrations, Dr. Brothers demonstrates how a mutual desire to heal and to be healed from trauma draws patients and analysts into their analytic relationships. She recommends the reconceptualization of what has heretofore been considered transference and countertransference in terms of the transformation of experienced uncertainty. In her view the increased ability of both analytic partners to live with uncertainty is the mark of a successful treatment. Dr. Brothers’ perspective sheds fresh light on a variety of topics of great general interest to analysts as well as many of their patients, such as gender, the acceptance of death, faith, cult-like training programs, and burnout. Her discussions of these topics are enlivened by references to contemporary cinema and theatre. (shrink)

O objetivo desta apresentação é comentar as diferenças entre a noção de trauma em Freud e em Winnicott. Mostra-se que Freud concebeu a noção de trauma como uma excitação não descarregada, usando a histeria como modelo, e enfatizando que essa noção de trauma é construída com a ajuda de conceitos especulativos. Em seguida, comenta-se que para Winnicott o trauma não é pensado em função do ponto de vista econômico, nem basicamente como de natureza sexual, nem centrado (...) no complexo de Édipo, mas diz respeito às falhas ambientais que interrompem a continuidade de ser. Procura-se, nesse sentido, explicitar que a noção de trauma em Winnicott é concebida em termos da quebra na confiabilidade do ambiente. Ao mostrar que, para Winnicott, a noção de trauma tem significados diferentes em função do momento do processo de amadurecimento no qual ele ocorre, também procura-se caracterizar o modo como Winnicott teoriza.The intention of this presentation is to comment on the differences between the notions of trauma in Freud and Winnicott. As such, it will be demonstrated how Freud conceived of trauma as unreleased excitement, using hysteria as a model, and emphasized that his concept of trauma is constructed with the aid of speculative auxiliary concepts. Next, it will be demonstrated that for Winnicott the notion of trauma is not conceived of in function of an economic point of view, nor, basicly, of sexual nature, nor centered on Oedipus Complex, but it is related to environmental failures that interrupt the continuation of being. As such, we try to explain that the notion of trauma in Winnicott is conceived of in terms of breakage in the environment`s trustfulness. In showing that, for Winnicott, the notion of trauma expresses itself in diverse meanings it is also noted that this is one of the characteristics of his theorizing, in that concepts have their meaning and their language in terms of the moment in which they are inserted in the process of maturation. (shrink)

Self-harm, or self-mutilation, is generally viewed in academic literature as a pathological act, usually born out of trauma and/or a psychological and personality defect. Individuals who engage in self-harm are usually seen as damaged, destructive, and pathological. While self-harm is not a desirable act, this paper argues through the narratives of those who engage in such acts that self-harm may be better construed as a meaningful, embodied emotional practice, bound up in social understandings of psychological pain and how best (...) to attend to such pain. In particular, this paper suggests that those who engage in self-harm practices are performing embodied, socially situated acts of healing, survival, and self-creation in a physical attempt to retell complex, fragmented stories of abuse, existential angst, trauma, and loss of self. While these individuals may be more or less successful in such attempts, this paper suggests that understandings of self-harm would benefit from more nuanced approaches to individuals’ embodied expressions of pain that take into account the difficult nature of psychological suffering and the effects of trauma. (shrink)

A broad sociocultural perspective defines trauma as the result of an event, a series of events, or a set of circumstances that is experienced as physically or emotionally harmful or life threatening, with lasting impacts on an individual’s physical, social, emotional, or spiritual wellbeing. Contexts and practices that aim to be “trauma-informed” strive to attend to the complex impacts of trauma, integrating knowledge into policies and practices, and providing a sanctuary from harm. However, there is a (...) body of critical and decolonial scholarship that challenges the ways in which “trauma-informed” practice prioritizes individualized interventions, reinscribes colonial power relations through its conceptualizations of safety, and obscures the role of systemic injustices. Within music therapy trauma scholarship, research has thus far pointed to the affordances of music in ameliorating symptoms of trauma, bypassing unavailable cognitive processes, and working from a strengths-based orientation. In critiquing the tendency of the dominant trauma paradigm to assign vulnerability and reinforce the individual’s responsibility to develop resilience through adversity, this conceptual analysis outlines potential alternatives within music therapy. Drawing on a case example from a research project with young people in school, I elucidate the ways in which music therapy can respond to power relations as they occur within and beyond “trauma-informed” spaces. I highlight two overarching potentials for music therapy within a shifting trauma paradigm: (1) as a site in which to reframe perceived risk by fostering young people’s resistance and building their political agency and (2) in challenging the assumption of “safe spaces” and instead moving toward practices of “structuring safety.”. (shrink)

How do the experiences of people who undergo extreme suffering and trauma in one generation get passed on to the next generation? And how do these experiences affect religious–spiritual beliefs and practices? Can we help to create resilience in these later generations through these religious–spiritual beliefs? In order to answer these questions, one must remember and understand not only how trauma is embodied and inherited, but also the role that religious beliefs and practices play in facing and overcoming (...) the trauma. People who have experienced trauma can pass on the effects to subsequent generations biologically through epigenetic changes to their DNA, but also through their religious and spiritual beliefs and practices. The ways people remember and recover from trauma involve complex biological, psychosocial, and spiritual processes. We use the sciences of embodied cognition and epigenetics to analyze the heritability of trauma and its spiritual–religious manifestations in the next generations. Having done so, our hope is that we can understand how spiritual and religious practices can be developed to help people who undergo trauma so that they can become resilient and thrive. (shrink)

Trauma is notoriously difficult to communicate, as it often defies understanding. It unfolds over time and cannot be told through linear narratives. Nevertheless, we show that narratives can become a medium through which experiences of trauma may be shared, alleviating the sense of alienation common to post-traumatic experience. Drawing from one of the authors’ lived experiences of cancer and her illness narrative, we focus on the question of whether traumatic events can be narrated, known, and shared. In conversation (...) with one another, and building on phenomenological literature on trauma (Husserl, 1973, Walther, 1923), illness (Carel, 2021, 2016), and working with an autoethnographic approach to cancer (Pini, 2022; Pini and Maguire-Rosier, 2021; Pini and Pini, 2019) in this chapter we address the ways in which creative and expressive illness narratives—particularly the sharing of such experiences—can help patients heal or repair from trauma. We identify the moment of the cancer diagnosis as a traumatic event, as it constitutes the expulsion of the individual into an alienworld: the world of the sick. We demonstrate how a philosophical account of unification (Walther 1923) may help shed light on the complexities of traumatic experience and highlight the potential of embodied narratives to re-establish a sense of belonging through sharing trauma experiences. We present a case in which performance art serves not only as an act of creatively re-modelling the performer’s illness narrative, but as a means to communicate this experience. Sharing the experience of trauma and recovery contributes to a re-constitution of a sense of belonging. We highlight that the (re-)constitution of feelings of belonging is a dyadic process between the traumatized individual and others. An illness narrative needs to be heard, seen, or otherwise witnessed in order to fulfil its full healing potential. In this way, we hope to contribute to a better understanding of how a narrative approach can be fruitfully applied in clinical practice. (shrink)

Studies in adults with mental disorders suggest that the experience of early and chronic trauma is associated with changes in reward expectancy and processing. In addition, severe childhood trauma has been shown to contribute to the development of mental disorders in general. Data on effects of early childhood trauma on reward expectancy and processing in middle childhood currently appear insufficient. The present study aims to fill this research gap by examining the effects of developmental trauma disorder (...) on reward expectancy and processing in children aged 8–12 years, testing the hypothesis that children with multiple complex traumas exhibit altered reward processing as a result of prior disappointing reward experiences. One main feature of developmental trauma disorder is early experiences of multiple separation from important and close relationships alongside other experiences of emotional or physical harm. In the sequel children often show affect regulation disorders. To investigate this, we have developed an adapted version of the Monetary Incentive Delay Task, which examines children’s expectation of reward or frustration. In this first study, behavioral data will be collected from N = 40 children using this adapted version of the MID Task. Children in the experimental group will be recruited from youth welfare centers in Frankfurt a.M., Germany. Healthy control subjects will be recruited from after-school-care facilities. A brief trauma screening will be conducted for both groups, experimental and control. If children show signs of trauma, the presence of a developmental trauma disorder will be further delineated by a German translation of the Developmental Trauma Disorder Structured Interview for Children which was translated the first time in German by our research group. We hypothesize that children in the experimental group will be less accurate in performing the Monetary Incentive Delay Task because of their impaired emotion regulation skills due to emotional avoidance following developmental trauma. If the results of our initial behavioral study are promising, the MID task will be used in a future study to elucidate the relationship between trauma developmental disorder, reward expectancy and processing, and neurobiological processes in middle childhood. (shrink)

The aim of the present study was to assess the impact of past traumatic war experiences on preadolescents in the Gaza Strip, which could be useful for psychological intervention with current and future child victims. Participants were 521 preadolescents from United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) schools, aged 11 and 13 years old. Sections I to IV from Iraqi Version-Arabic of Harvard Trauma Questionnaire was used to assess trauma experiences and (...) Post-Traumatic Stress Disorder (PTSD). The results show that the preadolescents in the Gaza Strip witnessed the destruction of their homes and the murder of family members and friends. A quarter of the individuals assessed either suffered torture or witnessed others undergoing it, including sexual assaults. Almost half of them experienced a lack of food and clean water. The traumatic and torture experiences seriously affected preadolescents’ mental health as 26.29% met criteria for the diagnosis of PTSD. The data analysis revealed two PTSD modalities, with the severity of impact depending on whether social implications were involved. Further research is required to check whether these two modalities fit to PTSD and complex PTSD. Understanding the effects of past wars on preadolescents in Gaza and distinguishing between different PTSD types could enhance comprehension of the impacts of current attacks on child victims. It can also aid in determining the type of intervention needed to minimize the impact on the mental health of Palestinian youth, enhancing their resilience through psychological and social support. (shrink)

Psychological trauma is ubiquitous, an often hidden yet influential factor in care across clinical specialties. Interdisciplinary health professions education is mobilizing to address the importance of trauma-sensitive care. Given their attention to complex human realities, the health humanities are well-poised to shape healthcare learners’ responses to trauma. Indeed, many such arts and humanities curricula propose narrative exercises to strengthen empathy, self-reflection, and sensitive communication. Trauma, however, is often unwordable, fragmentary, and physically encoded, incompatible with storying (...) methods. This article presents a recent innovation, the Art is Patient seminar series, which focuses on aesthetic exercises to help learners access and share non-verbal, embodied, and relational responses to art. Based in an art museum context, it provides successive experiences of approaching, witnessing, and engaging with visual art as an analogue to developing trauma-sensitive relationships. Reflections on the process locate the seminar vis-à-vis health humanities practices, aesthetics, and trauma-informed approaches. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Winnicott’s “Fear of Breakdown” : On and Beyond TraumaMax Hernandez (bio)y no hallé cosa en que posar los ojos / que no fuese recuerdo de la muerte[I could find no thing on which to rest my eyes / which was not a reminder of death]—Francisco de Quevedo, “Sonetos”The ubiquitous occurrence of violent events and the growing realization that the inscription of this violence in the psyches of those exposed (...) to these events remains to be known have helped to make trauma an emblematic issue at the end of a century saturated with unprecedented wounding events [see Caruth, Unclaimed Experience].1 Trauma’s enigmatic immediacy thrusts itself upon any attempt to encompass it within a theory. It is as though no one approximates (even the study of) trauma with impunity: complex affects are stirred. A precipitous interplay of cognitive and affective dispositions, a heightened tension between the intense identifications elicited and the need experienced for some protective distance from the pain evoked undermine the stability of the boundaries between witnessing and telling, event and historical narration, narrative and reading. Hence the ambivalent appeal of the notion of trauma for the historian as well as for the cultural and literary theorist.The most cursory description of trauma reflects the complex temporal structure that punctuates the psyche’s relation to the traumatic event. The asymmetrical relation between experience and memory and the gross disparity between their affective and cognitive components are evident at once. Trauma has been characterized by virtue of the disjunctions it manifests. Its very formulation bears the mark of a construction emerging as the narrative of a belated experience.2 In recent publications on trauma, the references to the works of Freud, Janet, Kardiner, Lacan, and Laplanche take pride of place. Also noticeable is the emphasis placed on certain psychoanalytic notions: deferred action, death instinct, repetition compulsion, the real.Along with the explorations of trauma by psychoanalysts, historians, and literary theorists and the ethical issues they bring to the fore, the research of neurobiologists and cognitive scientists has raised a number of epistemological issues. A new wave of radical questioning of psychoanalysis comparable to that of the beginnings of this century shows its force today. The notions of repression and the repressed are considered logical impossibilities; the operations of the unconscious are deemed entirely inexplicable; and [End Page 134] defense mechanisms are considered to be mere verbal paradoxes. In what appears to be a species of defensive tactics, a supposedly neurophysiological rephrasing of psychoanalysis is taking place in some quarters, seemingly oblivious to the possibility of profoundly altering the very cohesion of this theory through the process of revision.Otto Fenichel in the thirties and Masud Khan in the sixties have provided us with succinct yet comprehensive overviews of the manner in which, since the very beginnings of psychoanalysis, every phase of theory making has influenced and reciprocally been influenced by the current concept of trauma and its clinical evaluation. It could be said that psychoanalytic theories are themselves organized around some sort of trauma. This is clearly the case in Freud’s theorizing. After his initial theory where the interrelated aspects of trauma, repression, and symptom formation became problematic, he arrived at the conclusion that castration constituted what might be termed a nuclear structuring trauma. An analogous theoretical point is implied in the Lacanian notion of the splitting of the subject. A normative trauma defines the limits of these theories and establishes a fixed relation between historical structural events. One has to shift perspectives in reading the works of those analysts concerned particularly with object relations. For example, Melanie Klein’s clinical researches on early childhood led her to postulate that the traumatic pathogenic situation par excellence is the overriding triumph of the death instinct. Winnicott understood this situation as entailing the annihilation of the core self by intrusion, while defining the traumatic impingement as the failure of the holding environment.It is relevant to comment on these different perspectives, as they afford the psychoanalytic clinician the possibility of differentiating between structuring (sexual) trauma and narcissistic trauma. When the sexual seduction trauma theory was displaced by the theory that privileged psychic reality, the Oedipus complex became... (shrink)

Layers of complexity arise when a person arrives in an Intensive Care Unit (ICU) due to self-harm intended to end their life and when there is known past personal trauma. We highlight three importa...

Liana Badr's The Eye of the Mirror explores the historical trauma of the 1975–6 siege of the Palestinian refugee camp Tal el–Zaatar in Beirut and the massacre of thousands of its inhabitants by Christian militias. Analogous to Holocaust writing, Badr's fictionalized history, grounded in actual survivor testimonies, enacts a complex politics of cultural memory, but does so from a specifically female perspective. Collapsing the personal and political, private and public, inside and outside through figured violations of bodies and (...) psyches, Badr repositions women at the centre of the Palestinians’ struggle for and story of survival. Badr's novel traces the annihilation of the possibility of address, accompanied by self–loss and the ability to witness, and the laborious recreation of address. Claiming authority on the basis of the emotional, visceral truth of suffering, she seeks to break the endless cycle of an oppressive and impotent masculine history, constructing an alternative history which at least attempts to address the voice of cultural, national, and gender difference. (shrink)

ABSTRACT Recent police brutality has reminded people in the United States of America that racism and discrimination toward Black Americans is still prevalent. Evidence supports the claim that many Black Americans experience racial trauma due to the relatively common occurrence of discriminatory racial encounters in their life. Racial traumas are events of danger related to real or secondary experiences of racial discrimination that may cause psychological, emotional, or physical injury. The goal of this article is to identify the ethical (...) complexities for psychologists in addressing racial trauma among Black Americans. First, the article describes examples of racial traumas for Black Americans and their impact on overall mental health. Second, there is an in-depth analysis of ethical issues for psychologists relevant to racial trauma in areas such as competency, discrimination and harassment, bias, assessment, training programs, and harm. Finally, recommendations for psychologists are provided to address racial trauma among Black American clients, students, supervisees, and colleagues. (shrink)

This article explores the psychological phenomenon of the transgenerational transmission of trauma. Søren Kierkegaard’s conception of original sin serves as a template for the argument. After outlining the complex psychological process of trauma transmission, the article gleans insights regarding the transgenerationality of trauma as found in Kierkegaard’s thinking. With a focus on The Concept of Anxiety, the article highlights parallel structures of displaying and penetrating original sin and the transmission of trauma. The article argues that (...) the Christian perspective on salvation proves to be a substantial dialog partner for the secular understanding of posttraumatic healing. (shrink)

Shoma Morita, M.D. was a Japanese psychiatrist-professor who developed a unique four stage therapy process. He challenged psychoanalysts who sanctioned an unconscious or unconsciousness that resides inside the mind. Significantly, he advanced a phenomenal connection between existentialism, Zen, Nature and the therapeutic role of serendipity. Morita is a forerunner of eco-psychology and he equalised the strength between human-to-human attachment and human-to-Nature bonds. This book chronicles Morita's theory of "peripheral consciousness", his paradoxical method, his design of a natural therapeutic setting, and (...) his progressive-four stage therapy. It explores how this therapy can be beneficial for clients outside of Japan using, for the first time, non-Japanese case studies. The author's personal material about training in Japan and subsequent practice of Morita's ecological and phenomenological therapy in Australia and the United States enhance this book. LeVine's coining of "cruelty-based trauma" generates a rich discussion on the need for therapy inclusive of ecological settings. As a medical anthropologist, clinical psychologist and genocide scholar, LeVine shows how the four progressive stages are essential to the classic method and the key importance of the first "rest" stage in outcomes for clients who have been embossed by trauma. Since cognitive science took hold in the 1970s, complex consciousness theories have lost footing in psychology and medical science. This book reinstates "consciousness" as the dynamic core of Morita therapy. The case material illustrates the use of Morita therapy for clients struggling with the aftermath of trauma and how to live creatively and responsively inside the uncertainty of existence. The never before published archival biographic notes and photos of psychoanalyst Karen Horney, Fritz Perls, Eric Fromm and other renowned scholars who took an interest in Morita in the 1950s and 60s provide a dense historical backdrop. (shrink)

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

In lieu of an abstract, here is a brief excerpt of the content:Post-Traumatic Hermeneutics: Melancholia in the Wake of TraumaAngelika Rauch (bio)1Classical Analysis: Problems for Trauma TherapyAccording to the Journal of the American Psychoanalytical Association, American ego psychology has taken a leading role in debunking what it considers antiquated Freudian approaches to the study of trauma. As neutral observers and students of the facts, ego psychologists have purportedly reclaimed the study of trauma as the search for an (...) objectifiable traumatic event in the past, one that can be accessed as recovered memory, as a specimen of pathogenic development, or as cognitive and behavioral effects that point to an inaccessible implied memory buried in the psyche. Central to this revision of psychoanalytical trauma therapy is the dismissal of Nachträglichkeit as an antiquated and irrelevant concept. Harold P. Blum, for instance, writes in a recent article of JAPA that “‘deferred action’ is an ambiguous concept, a dubious, antiquated, theoretical legacy.” According to Blum, “deferred action overlooks the immediate and potentially powerful effects of preoedipal trauma and is dissociated from considerations of cumulative trauma and developmental disturbance.” [1155]. With respect to Freud’s case of the Wolf-Man, Blum states that “[d]eferred action emphasized traumatic events and memory rather than cumulative developmental effects of shock and strain trauma, and pathogenic object relationships.” Key to Blum’s view, then, is the assertion that “the concept of deferred action deterred consideration of real infantile experience and the complex overdetermination of pathogenesis through development” [1156]. Blum apparently takes the side of those who like to argue that trauma is more real than imagined. Whereas oedipal trauma is an imaginary or illusory trauma, preoedipal trauma is comprehensible as real shock and, as such, is empirically true. This is an idea that is very compatible with “recovered memory” therapy, a subject that has become controversial in recent debates about child abuse and recovered memory syndrome.In contrast, Arnold H. Modell in Other Times, Other Realities points out that “[t]he concept of Nachträglichkeit is virtually unknown among American psychoanalysts. This may be due in part to Strachey’s faulty translation; but this idea is also inconsistent with the belief in an orderly hierarchical psychic development such as that envisioned by ego psychologists.” [3]. In other words, Freudian Nachträglichkeit violates the principles of space and time assumed by empirical scientists whose conceptions are founded on the causality of such principles as stimulus/response. It is here, of course, that ego psychology’s treatment of trauma would come into conflict not only with Freudian analysis, including its French Freudian variants, but with the kind of trauma studies being conducted by the contributors to Cathy Caruth’s Trauma: Explorations in Memory. They include Bessel [End Page 111] van der Kolk, Onno van der Hart, Shoshana Felman, Dori Laub, Robert Lifton, and, of course, Cathy Caruth herself.Emphasis on the reality of traumatic shock (as abuse, stress, accident, and so on), however important it may be, loses sight of a hermeneutical dimension of psychoanalytic therapy that Caruth and her contributors emphasize: the question of how meanings are associated or bound to the understanding of life’s events. My own clinical approach to psychoanalysis favors the introduction of an even stronger hermeneutical perspective that is sensitive to the kinds of issues raised by philosophers like Dilthey, Heidegger, Benjamin, and Gadamer, for whom the question of experience is not reducible to restricted understandings of stimulus/response, nor—as in the case of Caruth (for example, in Unclaimed Experience)—to the privileging of language as a formal (that is, literary) construct. Rather, I am interested in emphasizing a hermeneutics of the therapeutic encounter within which questions of language, culture, history, and behavior are situated. With respect to trauma therapy, I will introduce a number of well-known analytical contributions even as I take the following statement of Arnold Modell’s as my point of departure:The analyst or therapist becomes an unwitting collaborator in the recreation of the past, while still retaining a proximity to present time. The therapist becomes the person with whom one can reexperience trauma within a new context or experience for the first time what has been absent in the past. Affects belonging to... (shrink)

Dissociation and the Dynamics of Personality addresses the nature of personality in trauma-dissociation and proposes a dynamic understanding of persons that fundamentally challenges conventional views of the self and consciousness. This important book provides a clear and coherent understanding of how childhood trauma can lead to a range of dissociative responses, addressing the fundamental issues underlying the controversy in this field. By recognising causal complexity and the dynamic convergence of biology and culture, Boag demonstrates the significance of (...) class='Hi'>trauma-dissociation for understanding personality and consciousness. Drawing upon both philosophy of mind and current psychiatric and neurobiological evidence, this book proposes a dynamic understanding of persons that fundamentally challenges the conventional view of the self and consciousness. Dissociation and the Dynamics of Personality will be of interest to readers concerned with the trauma-dissociation controversy, including philosophers of mind and psychiatrists. It will also interest psychological practitioners and psychologists, as well as anyone concerned with the implications of the dissociative mind for understanding personality. (shrink)

This paper argues that severe and ongoing trauma (SOT) can lead to impairment at the level of the minimal self (MS), which is the core element in the structure of subjectivity. In the long-term, such impairments can result in complex post-traumatic stress disorder (CPTSD) and schizophrenia. The paper tackles this issue while trying to create meaningful bridges between phenomenology and neuroscience.

Many feminist researchers have been critical of the psychiatric category of borderline personality disorder 1 and have emphasized the gendered nature of the diagnosis. It is estimated that people diagnosed with BPD comprise 1 to 2 percent of the general population in the United States in a given year, and that women represent 75 percent of those diagnosed.2 Critics have argued that the diagnosis reinforces double-binds for women and pathologizes traits associated with both conventional femininity, such as emotionality, dependency, and (...) self-destructiveness, and unconventional femininity, such as rebelliousness and sexual promiscuity (Lester 2013; Potter 2009; Shaw.. (shrink)

Artists, political scientists and art historians share with other professionals the challenge of apprehending and comprehending the complexity of the realities they address in their work. The co‐authors of our article coincide in the prominence they give to disturbing indexical signs (i.e., indications and traces of trauma and normalization in people, in political processes and works of art), as keys of interpretation and problematizing at the basis of their art works, their social work and their historic and political research. (...) They address the challenges and questions they face when interacting with the multiple dimensions inherent to the complex human behaviours, theoretical concepts and artistic statements on which they focus. Finally, they discuss possible aesthetic, ethical and philosophical implications of their proposals and perspectives. (shrink)

According to Frantz Fanon, the psychological and social-political are deeply intertwined in the colonial context. Psychologically, the colonizers perceive the colonized as inferior and the colonized internalize this in an inferiority complex. This psychological reality is co-constitutive of and by material relations of power—the imaginary of inferiority both creates and is created by colonial relations of power. It is also in this context that violence takes on significant political import: violence deployed by the colonized to rebel against these colonial (...) relations and enact a different world will also be violent in its fundamental disruption of this imaginary. The ethics of care, on the other hand, does not seem to sit well with violence, and thus Fanon’s political theory more generally. Care ethics is concerned with everything we do to maintain and repair our worlds as well as reasonably possible. Violence, which ruptures our psycho-affective, material, and social-political realities, seems antithetical to this task. This article seeks to reconsider this apparent antinomy between violence and care via a dialogue between Fanon and the ethics of care. In so doing, this article mobilizes a relational conceptualization of violence that allows for the possibility that certain violences may, in fact, be justifiable from a care ethics perspective. At the same time, I contend that violence in any form will also eventually demand a caring response. Ultimately, this productive reading of Fanon’s political theory and the ethics of care encourages both postcolonial philosophers and care ethicists alike to examine critically the relation between violence and care, and the ways in which we cannot a priori draw lines between the two. (shrink)

This paper compares the free energy neuroscience now advocated by Karl Friston and his colleagues with that hypothesised by Freud, arguing that Freud's notions of conflict and trauma can be understood in terms of computational complexity. It relates Hobson and Friston's work on dreaming and the reduction of complexity to contemporary accounts of dreaming and the consolidation of memory, and advances the hypothesis that mental disorder can be understood in terms of computational complexity and the mechanisms, including synaptic pruning, (...) that have evolved to reduce it. (shrink)

The main concepts of the free energy (FE) neuroscience developed by Karl Friston and colleagues parallel those of Freud's Project for a Scientific Psychology. In Hobson et al. ( 2014 ) these include an innate virtual reality generator that produces the fictive prior beliefs that Freud described as the primary process. This enables Friston's account to encompass a unified treatment—a complexity theory—of the role of virtual reality in both dreaming and mental disorder. In both accounts the brain operates to minimize (...) FE aroused by sensory impingements—including interoceptive impingements that report compliance with biological imperatives—and constructs a representation/model of the causes of impingement that enables this minimization. In Friston's account (variational) FE equals complexity minus accuracy, and is minimized by increasing accuracy and decreasing complexity. Roughly the brain (or model) increases accuracy together with complexity in waking. This is mediated by consciousness-creating active inference—by which it explains sensory impingements in terms of perceptual experiences of their causes. In sleep it reduces complexity by processes that include both synaptic pruning and consciousness/virtual reality/dreaming in REM. The consciousness-creating active inference that effects complexity-reduction in REM dreaming must operate on FE-arousing data distinct from sensory impingement. The most relevant source is remembered arousals of emotion, both recent and remote, as processed in SWS and REM on “active systems” accounts of memory consolidation/reconsolidation. Freud describes these remembered arousals as condensed in the dreamwork for use in the conscious contents of dreams, and similar condensation can be seen in symptoms. Complexity partly reflects emotional conflict and trauma. This indicates that dreams and symptoms are both produced to reduce complexity in the form of potentially adverse (traumatic or conflicting) arousals of amygdala-related emotions. Mental disorder is thus caused by computational complexity together with mechanisms like synaptic pruning that have evolved for complexity-reduction; and important features of disorder can be understood in these terms. Details of the consilience among Freudian, systems consolidation, and complexity-reduction accounts appear clearly in the analysis of a single fragment of a dream, indicating also how complexity reduction proceeds by a process resembling Bayesian model selection. (shrink)

This paper contends that Catherine Malabou’s concepts of cerebrality and the new wounded extend Frantz Fanon’s theory of colonial trauma to illuminate the link between violent oppression and contemporary profile of psychic disorders, as they relate to the diagnostic measure of PTSD. It begins by demonstrating colonial psychoanalyst Octave Mannoni’s failure to engage psychoanalytic theory to negate the racial theses of French colonial psychiatry. Next, it explicates Fanon’s refutation of both Mannoni’s use of the idea of dependence and his (...) theory of social evolutionism to describe the colonial relation. In brief, Fanon critiques Mannoni for neglecting to integrate the psychic effects of colonial violence into his analysis of unconscious complexes in the colonized. Finally, this paper shows that Malabou corelates violent ruptures with the PTSD diagnosis, in order to better understand the relation between sociopolitical violence and neuropsychiatric trauma. This paper proposes that both Fanon and Malabou be mobilized to theorize the violent origins of psychic trauma. (shrink)

Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response. A range of post-traumatic sequelae have been found to mediate the relationship between trauma and psychotic experiences, including the “traditional” symptoms of post-traumatic stress disorder (PTSD). The International Classification of Diseases-11th Edition recognizes a more complex post-traumatic presentation, complex PTSD (cPTSD), which captures both the characteristic symptoms of PTSD alongside more pervasive post-traumatic sequelae known (...) as ‘disturbances in self-organization’ (DSOs). The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored. In the first study of this kind, 144 participants with psychosis recruited from North West United Kingdom mental health services completed measures assessing trauma, PTSD and cPTSD symptoms and symptoms of psychosis. Forty-percent of the sample met criteria for cPTSD, compared to 10% who met diagnostic criteria for PTSD. PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership. Both PTSD and DSOs mediated the relationship between trauma and affective symptoms but did not explain a significant proportion of variance in negative symptoms. Cognitive and excitative symptoms of psychosis did not correlate with trauma, PTSD or DSO scores. These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies. (shrink)

Over the last 102 years, a lot of discussion was being held about the psychoanalytic conception of the “death drive,” but still with inconclusive results. In this paper, we start with a brief review of Freud’s conception, followed by a comprised overview of its subsequent support or criticisms. The core of our argument is a systematic review of current biochemical research about two proposed manifestations of the “death drive,” which could hopefully move the discussion to the realm of science. It (...) was already established that drive satisfaction leads to the secretion of beta-endorphins, and research evidence also shows that the same biochemical mechanisms get activated in the case of masochism and the gambling disorder but only if they are preceded by chronic frustration of the essential drives. We conclude that the actual situation is more complex than Freud hypothesized, and that a fundamental revision of the psychoanalytic drive theory is necessary. (shrink)

A scoping review was conducted to explore the metaphors and related expressions older adults use to describe extremely stressful events that may lead to Post-Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Prolonged Grief Disorder (PGD), or Adjustment Disorder (AjD). Relevant databases from psychology, gerontology, and related fields were searched. In addition, relevant references found in included papers were considered. Inclusion criteria were: qualitative study, sample of older adults (age 65+), and focus on maladaptive rather than adaptive psychological aspects. Eleven (...) studies focusing on PTSD, 5 on CPTSD, 13 on PGD, and 10 on AjD were included. Metaphors and other expressions related to extremely stressful events were then extracted and analyzed. Multiple linguistic expressions to describe extremely stressful events and stress-related symptoms were identified. Metaphors and related expressions often referred to the body and the theme of moving on with one’s life. (shrink)

Analyzing two key figures in Elif Shafak’s novel The Island of Missing Trees—a schoolgirl’s scream and a narrating fig tree—this essay analyzes the intersection between susceptibility and resilience, particularly as these terms are developed in psychology, trauma studies, and ecology. I argue that the novel’s resonant scream critiques the discourse of psychological resilience on multiple counts: its inadequacy as a response to complex trauma, its focus on autonomous individuals, its assumption that responsibility for resilience rests on victims (...) rather than perpetrators of harm, its construction of a “resistance imperative” and its disavowal of the inequalities in access to resilience-building resources. By contrast, the novel’s fig tree, I contend, exemplifies an ecological model of resilience rooted in a recognition of the interdependence of the multiple and diverse organisms that comprise an ecosystem, and of susceptibility as an advantageous suite of capacities that are crucial to resilience. These contrasting conceptions of resilience lead me to advocate for a politics of susceptibility, an eco-psychosocial politics based on the recognition that individuals cannot become resilient on their own, through their own volition, intention, or “self-efficacy”, and that focuses instead on building systemic and sustainable forms of resilience inclusive of the diverse subjects that comprise a community, society or ecosystem; that, rather than fetishizing independence, liberty and rights, fortifies interdependence and reinforces mutual responsibilities; and that rather than exploiting susceptibility as a weakness, nurtures it as the soul of resilience itself. (shrink)

BackgroundThe 11th revision of the International Classification of Diseases included two distinct trauma-related diagnoses—Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder. The initial diagnostic factor for both disorders is exposure to a traumatic event. This study aimed to explore whether exposure to different traumatic experiences distinguish risk for PTSD and CPTSD.MethodsThe study sample comprised 158 trauma-exposed participants, Mage = 33.61. The Life Events Checklist-Revised was used to evaluate trauma exposure, and the International Trauma Questionnaire was (...) used to assess risk for ICD-11 PTSD and CPTSD. Multinomial logistic regression was used to determine traumatic events as predictors of risk for PTSD and CPTSD.ResultsAnalysis revealed that sexual abuse experienced in childhood or adulthood was associated with both PTSD and CPTSD. History of other unwanted sexual experiences and childhood physical abuse predicted CPTSD compared to PTSD, whereas exposure to natural disasters predicted PTSD compared to CPTSD.ConclusionsThe results showed that experiences of certain traumatic events, such as sexual trauma, childhood physical abuse or natural disasters, might help distinguish risk for PTSD and CPTSD. Nevertheless, future studies on specific aspects of trauma exposure are necessary. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Silent Screams; Lily's StoryEva V. Regel"Trauma is personal. It does not disappear if it is not validated. When it is ignored or invalidated, the silent screams continue internally heard only by the one held captive. When someone enters the pain and hears the scream, healing can begin."—Danielle Bernock, "Emerging Wings; A true story of Lies, Pain and the Love that Heals."Some patients stay with you long after they (...) leave. They appear in your mind when you walk by the hospital room they occupied or when someone mentions their name. There is [End Page 19] something about the narrative of their life and illness that makes you hold on to them. Lily is one such patient for me.Lily was a 45-year-old paraplegic woman who was well known to many providers in the hospital. She had a complex trauma history (childhood physical and sexual abuse, intimate partner violence, domestic violence), homelessness, and multiple psychiatric admissions. In addition, she had a complex medical history, including chronic pain issues and substance use disorder. Many providers considered her to be a "very difficult" or "challenging" patient because she would "dictate" her care, had low distress tolerance and would have explosive angry outbursts requiring frequent visits from Police and Security. To top it off, after months of a challenging stay on a unit, she would eventually leave against medical advice. Everyone involved in her care felt that discharge to a safe setting such as a skilled nursing facility would be her best option. Yet, she was a very "hard" sell to any facility because of her behavioral issues, relatively young age, extensive history of drug use, and medication non-compliance. Even though the unit I worked in was familiar with "difficult" patients like Lily, the floor staff was anxious and concerned about the effect Lily would have on patients, staff, and providers. The combined anticipatory anxiety worsened after we were told that Lily left against medical advice three days before her admission to our unit as a reaction to the staff's attempt to develop a behavioral plan.I remember the day I met Lily. I was working as the clinical social worker on the floor, helping patients with adjustment to coping with hospitalization, addressing mental health issues that usually exacerbate in the acute care setting, and providing support to the staff caring for a psychosocially complex patient population. It was the second day after Lily arrived on the floor, and Police and Security had already come up three times. As I walked out of another patient's room, a bedside nurse stopped me in the hallway. "Can you please talk to her? … Please, just talk to her, or sit with her. I just need a break. I have been in that room since I started my shift. I am exhausted." The nurse had an exasperated and pleading look, and even though I was rushing to a meeting, I decided to meet with Lily instead. When I walked into her room, I saw a thin, small-framed woman with brown hair pulled back into a tight bun. She had freckles peppered all over her round face, neck, and chest. Her features were delicate and small, and her almond-shaped green eyes were her most prominent feature. She was wearing a white tee and jeans. She was sitting in her wheelchair; her makeup bag was lying on the table next to her. I introduced myself and my role on the team, trying not to stumble under a very heavy glare. "Tell them to leave me alone. That nurse is always in my room. Spying. I might not be able to walk, but I can still use my hands. I can call if I need help."And so I did. And when I came back, Lily and I talked a little about her life. And the next day, we talked a little more. And then again. Lily was giving me small glimpses of who she was and the events in her life. Then, one day, in the middle of the conversation about her day and telling me how much she hated to be confined to her hospital room, she looked... (shrink)