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151.
The concept of complex trauma has been around for a long time and in 2018, it’s expected to become a new diagnosis in the International Classification of Diseases eleventh revision, ICD-11, the World Health Organisation, WHO, manual used formally in the NHS. Psychiatric diagnosis often does not sit well with psychoanalysis, which is at least as interested in unconscious phantasy as it is in symptoms. But as psychodynamically-trained practitioners in the NHS we need to engage with ICD-11 and apply our own understanding to service design so that patients have access to treatment which works for them. The service where I work (a secondary mental health team in the London borough of Lewisham) has already been receiving referrals for ‘complex trauma’ for some time, despite its not being formally classified. Patients so described are most often those with a history of childhood sexual abuse, and refugees with a history of brutality and torture. Differential diagnosis includes personality disorder since many have difficulties with interpersonal issues. In this paper I want to discuss how we might understand the new diagnosis of complex Post-traumatic Stress Disorder, PTSD, and its implications for treatment in the NHS.  相似文献   
152.
    
Background and Objectives: This study examined post-traumatic stress disorder (PTSD) symptoms among young adults that were evicted from their residences in Gaza settlements (“Gush Katif”) as adolescents and actively participated in the resistance events. Furthermore, we examined the moderating role of exposure to forced relocation on the association between attachment orientations and family functioning and PTSD symptoms. Design: We conducted a correlative, cross-sectional study in 2013. Methods: Participants were Israeli evicted residents (ER group; N = 102), comparison groups of evicted nonresidents (ENR group; N = 27), and nonevicted nonresidents (NENR group; N = 53). All participants completed a battery of self-reported questionnaires. Results: The ER group reported a higher number of PTSD symptoms as compared to the comparison groups. However, ER participants did not differ from ENR and NENR participants in their perception of family functioning. Importantly, the group (ER vs. NENR) moderated the association between attachment-anxiety and PTSD symptoms and between family adaptability and PTSD symptoms. Conclusions: Nine years after the forced relocation from Gaza settlements, young adults that were evicted from their residences as adolescents suffer from PTSD symptoms that are more related to the relocation itself than the stress entailed in the resistance events.  相似文献   
153.
Although research has documented the detrimental effects of maternal trauma on child behavior (Lambert, Holzer, & Hasbun, 2014), the role of extended family support in potentially mitigating the effects of intergenerational transmission of trauma is not clearly understood. With a diverse community sample of 52 trauma-exposed mothers and their children between the ages of 7 and 12, we investigated relationships between kinship social support, maternal trauma exposure severity, maternal posttraumatic stress disorder (PTSD) symptom severity, and child behavioral problems. Results showed that kinship social support was negatively related to maternal trauma exposure severity, maternal PTSD symptom severity, child internalizing behaviors, and child externalizing behaviors. Additionally, kinship social support moderated the relationship between maternal trauma exposure severity and child internalizing behaviors. These results have implications in the implementation of interventions aimed at supporting diverse families facing trauma that incorporate extended family networks.  相似文献   
154.
    
Substance use disorders commonly co-occur with posttraumatic stress disorder and are associated with greater impairment. There is some evidence to suggest that different coping strategies, including defence mechanisms and religious forms of coping, may buffer the relationship between trauma and SUDs. The purpose of this study was to evaluate the potential moderating roles of defence mechanisms and religious coping on the already-established relationship between trauma symptoms and substance abuse. Data were gathered from a sample of college students (N?=?380). Trauma symptoms were associated with increased substance use and abuse. The use of immature defences was significantly associated with trauma and substance use. Increased substance abuse was also associated with higher rates of negative religious coping. Individuals who endorsed trauma symptoms were also more likely to use positive and negative religious coping. Defences and coping did not moderate the relationship between trauma and substance use.  相似文献   
155.
    
Illness perception (IP) concerns how patients evaluate living with a disease. To get a broader understanding of IP in patients with chronic obstructive pulmonary disease (COPD), we investigated whether breathlessness is an important precursor of IP and whether IP in its turn is related to mental health, physical health and global quality of life (QOL). One hundred and fifty‐four patients with COPD participated in a cross‐sectional survey. Participants underwent pulmonary function testing, provided socio‐demographic and clinical information, and completed the following standardized instruments: Brief Illness Perception Questionnaire, Respiratory Quality of Life Questionnaire, Short‐Form 12 Health Survey and the Quality of Life Scale. Multiple regression analyses were performed. A high IP score indicates that a patient believes that his/her illness represents a threat. Participants with a high score on the IP dimensions consequences, identity, concern and emotional representation, experienced more breathlessness. High scores on the IP dimensions consequences, identity and concern were associated with impaired physical health and high scores on the IP dimensions consequences, identity and emotional representation were associated with impaired mental health. Impaired global QOL was associated with high scores on the IP dimensions consequences, identity, concern, coherence and emotional representation. The strength of the associations between breathlessness and physical/mental health and global QOL decreased when certain dimensions of IP were included as predictors, indicating that IP to some extent acts as a mediating factor. These findings may have practical implications of patient counselling by helping COPD patients to cope with their disease by restructuring their personal models of illness.  相似文献   
156.
    
Synthesis of family research presents unique challenges to investigators who must delimit what will be included as a family study in the proposed review. In this paper, the authors discuss the conceptual and pragmatic challenges of conducting systematic reviews of the literature on the intersection between family life and childhood chronic conditions. A proposed framework for delimiting the family domain of interest is presented. The framework addresses both topical salience and level of relevance and provides direction to future researchers, with the goal of supporting the overall quality of family research synthesis efforts. For users of synthesis studies, knowledge of how investigators conceptualize the boundaries of family research is important contextual information for understanding the limits and applicability of the results.  相似文献   
157.
    
Given the high prevalence of comorbid conditions found in polytrauma settings, effective screening measures are needed. Several screening tools are commonly used in polytrauma clinics within the Department of Veterans Affairs (VA). This study examined the use of three screening measures—the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and PTSD Checklist–Civilian Version (PCL-C)—to predict scores on the Neurobehavioral Symptom Inventory (NSI). Research suggests that the presence of mental health conditions, such as PTSD, shares a significant amount of variance with postconcussive symptoms. The investigators hypothesized that the PCL-C would be the best predictor of scores on the NSI. All subjects were administered the screening measures as part of an evaluation in an outpatient Level III polytrauma clinic. Regression analysis was used to determine which instrument might serve as the best predictor of NSI total scores. Regression analysis revealed that BAI, BDI-II, and PCL-C total scores were good predictors of NSI total scores, with the BAI accounting for the majority of the variance. Mental health conditions can account for higher scores on the NSI, and screening of other mental health conditions should be taken into account when reviewing the NSI for individuals in polytrauma settings.  相似文献   
158.
    
This prospective study assessed the temporal relationships between the symptom clusters of PTSD in two nonprobability samples of treatment-seeking victims of sexual abuse: rape victims and adult survivors of childhood sexual abuse. Both groups were assessed at three time periods using self-report measures of PTSD symptomology. Findings from two cross-lagged panel analyses indicated weak temporal relationships between the symptom clusters of PTSD; however, avoidance and emotional numbing symptoms were found to exert the strongest cross-lagged effects. Avoidance and emotional numbing symptoms were also found to be the strongest predictor of subsequently meeting caseness for PTSD in both samples. Results suggest that there are minimal cross-lagged effects between the PTSD symptom clusters after three months from traumatic exposure.  相似文献   
159.
    
The aim of this study was to determine whether mental stress moderates perceptions of muscular pain, exertion, pleasure and arousal during a bout of strenuous resistance exercise. Two hundred and ten undergraduate students recruited from resistance exercise classes were screened with the Perceived Stress Scale (PSS). Fifty-seven individuals (age = 20.1 ± 1.2 y) were invited to complete the Undergraduate Stress Questionnaire (USQ), a measure of life event stress, and fitness testing. They later performed a two-phase, acute heavy-resistance exercise protocol: first phase: 10-repetition maximum (RM) leg press test; second phase: six sets at 80–100% of 10-RM. During exercise, participants responded to the Feeling Scale (pleasure), Felt Arousal Scale, Omni-RPE and the Pain Intensity Scale. Affective responses and heart rate were analyzed with a hierarchical linear modeling (HLM) growth curve analysis. USQ moderated the trajectories of affective responses and heart rate during exercise. Higher stress (USQ) levels were significantly related to lower rise in RPE (time2, p = .002; time3, p < .001) and heart rate (time2, p < .001; time3, p < .001). USQ had a main effect on pleasure and arousal (p values < .001), in which higher levels of stress were related to less affect. Models using the PSS scale produced similar results. PSS, but not USQ, interacted with time to predict pain (time2, p = .048; time3, p = .024). Relationships held even after adjusting for covariates, such as depression. Future research should determine if differential responses to exercise by stress have implications for behavioral interventions and mental health outcomes.  相似文献   
160.
    
Posttraumatic growth (PTG) and psychopathology are common outcomes following exposure to adversity and trauma. We examined the relationship of PTG to posttraumatic stress disorder (PTSD) and depression in a group of young Iraqi students with war trauma exposure. These young Iraqis had experienced an average of 13 different war‐related adversities. The prevalence of probable PTSD was 17.2% and probable depression 23.1%. PTSD was associated with higher and depression with lower PTG. In addition, the relationship between PTG and PTSD was stronger among males than females. Although PTSD and depression were relatively common, they were related to PTG in opposite directions.  相似文献   
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