Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder

Objective: Complex posttraumatic stress disorder (CPTSD) as defined by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) formulation is associated with childhood relational trauma and involves relational impairment, affect dysregulation, and identity alterations. However, the distinct contributions of relational impairment (operationalized in the form fears of closeness or abandonment), affect dysregulation (operationalized in the form of overregulation and under-regulation of affect), and identity alterations (operationalized in the form of positive or negative psychoform or somatoform dissociation) to the relationship between childhood trauma and CPTSD/DESNOS have not been systematically tested. Method and Results: In a clinical sample of adults diagnosed with severe and chronic psychiatric and personality disorders (n = 472; M = 34.7 years, SD = 10.1), structural equation modelling with bootstrap 95% confidence intervals demonstrated that the association between childhood trauma and CPTSD/DESNOS symptoms in adulthood was partially mediated by under-regulation of aff

Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach

Background: Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD). Objective: To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD. Method: Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7–18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians. Results: A four class solution was optimal (LMR = 398.264, p \u3c .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X2(3) = 16.916 and 28.016, respectively, p \u3c .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p \u3c .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X2(3) = 84.66, p \u3c .001). Conclusion: Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms. - Antecedentes: El trastorno traumático del desarrollo (DTD en su sigla en inglés) es un diagnóstico psiquiátrico infantil propuesto para las secuelas psicopatológicas y del desarrollo de la victimización y el trauma del apego que se extiende más allá del trastorno de estrés postraumático (TEPT). Objetivo: Determinar si un subgrupo de niños afectados por un trauma se caracteriza por síntomas de DTD que se extienden más allá o coexiste con los síntomas del trastorno de estrés postraumático (TEPT). Método: Se realizaron análisis de clase latente (LCA en su sigla en inglés) centrados en la persona con datos de 507 niños (de 7 a 18 años de edad, (M = 12.11, DS = 2/92); 49% mujeres) remitidos al estudio por médicos pediátricos o de salud mental. Resultados: Una solución de cuatro clases fue óptima (LMR = 398.264, p \u3c .001; Entropía = .93): (1) combinado DTD + TEPT (n = 150); (2) DTD predominante (n = 156); (3) TEPT predominante (n = 54); (4) síntomas mínimos (n = 147). De acuerdo con investigaciones previas, la clase DTD + TEPT tenía más probabilidades de haber experimentado abuso emocional traumático y negligencia (X2(3) = 16.916 y 28.016, respectivamente, p \u3c .001), y tenía la mayor comorbilidad psiquiátrica (F(3, 502) = 3.204, p \u3c .05). Los miembros de la clase DTD predominante tenían más probabilidades de cumplir los criterios para el trastorno oposicionista desafiante (ODD en su sigla en inglés) (X2(3) = 84.66, p \u3c .001). Conclusión: Los síntomas de DTD pueden ocurrir con, o por separado de, los síntomas de TEPT. Los niños con síntomas de DTD + TEPT altos tenían una comorbilidad psiquiátrica extensa, mientras que aquellos con síntomas de DTD altos y síntomas mínimos de TEPT tenían muchas probabilidades de cumplir con los criterios para ODD. En la evaluación y tratamiento clínico y de investigación de niños con comorbilidad psiquiátrica compleja o problemas de comportamiento disruptivo, se deben considerar los síntomas de DTD, tanto junto con, como en ausencia de, síntomas de TEPT. - 背景：发育性创伤障碍 (DTD) 是一种倡议的儿童精神病学诊断，用于治疗超出创伤后应激障碍 (PTSD) 受害程度和依恋创伤的精神病和发育后遗症。 目的：确定一个受创伤影响的儿童亚组是否具有超出创伤后应激障碍 (PTSD) 症状或与之并发的 DTD 症状。 方法：对 507 名转诊到心理健康或儿科医生的儿童（年龄 7-18 岁，（平均年龄 = 12.11，标准差 = 2/92）；49% 女性）的数据进行了以人分类的潜在类别分析 (LCA)。 结果：四类解决方案是最佳的（LMR = 398.264，p \u3c .001；熵 = .93）：（1）DTD + PTSD 组合（n = 150）； (2) 主要 DTD (n = 156); (3) 主要的 PTSD (n = 54); (4) 轻微症状 (n = 147)。与先前研究一致，DTD + PTSD 类最有可能经历过创伤性情绪虐待和忽视（分别地，X2(3) = 16.916 和 28.016，p \u3c .001），并且有最多的精神并发症（F(3, 502) = 3.204, p \u3c .05)。主要的 DTD 类人群最有可能符合对立违抗障碍 (ODD) 的标准 (X2(3) = 84.66, p \u3c .001)。 结论：DTD 症状可能与 PTSD 症状同时出现，或与 PTSD 症状分开出现。高 DTD|+PTSD 症状的儿童具有广泛的精神并发症，而高 DTD 症状和少 PTSD 症状的儿童很可能符合 ODD 标准。在对患有复杂精神并发症或破坏性行为问题的儿童进行临床和研究评估和治疗时，无论是否存在 PTSD 症状，都应考虑 DTD 的症状

Polyvictimization, Emotion Dysregulation, Symptoms of Posttraumatic Stress Disorder, and Behavioral Health Problems among Justice-Involved Youth: a Latent Class Analysis

Among the 90% of adolescents involved in juvenile justice who have experienced traumatic victimization, a sub-group may be at highest risk due to histories of multiple types of interpersonal and non-interpersonal trauma, termed polyvictims. Latent class analyses (LCA) have identified polyvictimized subgroups in several studies of adolescents and adults, but only one study of traumatic victimization has been conducted with justice-involved youth (Ford et al. 2013). The current investigation replicates and extends that study’s findings using LCA to assess a wider range of victimization- and nonvictimization-related adversities and emotion dysregulation, DSM-5 symptom clusters of posttraumatic stress disorder (PTSD), and behavioral health problems, such as substance use, anger, depression, somatic complaints, and suicide ideation. In a sample of juvenile detainees three latent classes were identified: mixed adversity (MA; n = 327), violent environment (VE; n = 337), and polyvictimization (PV; n = 145). In contrast to MA youth, PV youth were more likely to report exposure to all forms of adversity, and in contrast to both MA and VE youth, exposure to maltreatment and family violence, and higher levels of emotion dysregulation, PTSD, and depression/anxiety symptoms, somatic complaints, and suicidality. VE youth (vs. MA youth) were more likely to report exposure to violence and non-interpersonal traumas, and were higher on some forms of emotion dysregulation, PTSD symptoms, anger and substance use. Findings suggest that most justice-involved youth have experienced substantial adversity, with almost one in five identified as a polyvictim having experienced multiple adversities, including impaired caregivers, and evidencing the most severe problems in emotion dysregulation and PTSD, internalizing, and externalizing symptoms

The Relationship between Sexual Orientation Outness, Heterosexism, Emotion Dysregulation, and Alcohol Use among Lesbian, Gay, and Bisexual Emerging Adults

Introduction Research demonstrates that both proximal personal characteristics (e.g., outness, emotion dysregulation) and distal stressors (e.g., heterosexism) may be associated with harmful alcohol use among lesbian, gay, and bisexual (LGB) individuals. No study has systematically examined the factors linking LGB identity outness to harmful alcohol use. The current cross-sectional study bridges this gap by testing a sequential mediation model wherein heterosexist experiences (HE) and emotion dysregulation (ER) were hypothesized to mediate the relationship between outness and alcohol use. Method Participants were 264 LGB emerging adults in the age range of 18-29 years (M/SD = 25.46/2.74; 16.7% lesbian, 23.1% gay, 60.2% bisexual). Result Findings showed that 8.3% scored above a cutoff indicating harmful alcohol use. Findings supported the hypothesized serial mediation linking low levels of outness with harmful alcohol use via HE and ER, with a significant serial indirect effect (B = −.002, CI = −.004 — −.0004) and indirect effects via both HE (B = −.01, CI = −.02 – −.002) and ER (B = −.01, CI = −.02 – −.003). Conclusion Heterosexist experiences and emotion dysregulation are potential links in the association between outness and harmful alcohol use

Deficits in Degraded Facial Affect Labeling in Schizophrenia and Borderline Personality Disorder

Although deficits in facial affect processing have been reported in schizophrenia as well as in borderline personality disorder (BPD), these disorders have not yet been directly compared on facial affect labeling. Using degraded stimuli portraying neutral, angry, fearful and angry facial expressions, we hypothesized more errors in labeling negative facial expressions in patients with schizophrenia compared to healthy controls. Patients with BPD were expected to have difficulty in labeling neutral expressions and to display a bias towards a negative attribution when wrongly labeling neutral faces. Patients with schizophrenia (N = 57) and patients with BPD (N = 30) were compared to patients with somatoform disorder (SoD, a psychiatric control group; N = 25) and healthy control participants (N = 41) on facial affect labeling accuracy and type of misattributions. Patients with schizophrenia showed deficits in labeling angry and fearful expressions compared to the healthy control group and patients with BPD showed deficits in labeling neutral expressions compared to the healthy control group. Schizophrenia and BPD patients did not differ significantly from each other when labeling any of the facial expressions. Compared to SoD patients, schizophrenia patients showed deficits on fearful expressions, but BPD did not significantly differ from SoD patients on any of the facial expressions. With respect to the type of misattributions, BPD patients mistook neutral expressions more often for fearful expressions compared to schizophrenia patients and healthy controls, and less often for happy compared to schizophrenia patients. These findings suggest that although schizophrenia and BPD patients demonstrate different as well as similar facial affect labeling deficits, BPD may be associated with a tendency to detect negative affect in neutral expressions

Patterns of childhood maltreatment and intimate partner violence, emotion dysregulation, and mental health symptoms among lesbian, gay, and bisexual emerging adults: A three-step latent class approach

Background: Childhood abuse and neglect (CAN) and intimate partner violence victimization (IPV) is prevalent among lesbian, gay, and bisexual individuals (LGB). Identification of distinct patterns of childhood and adult victimization, including technology-mediated and face-to-face IPV, and their cumulative relations to mental/behavioral health challenges, among LGB people is needed to facilitate identification of at-risk individuals. Objective: Using latent class analysis, we first sought to identify patterns of lifetime interpersonal victimization, primarily five types of CAN and IPV in LGB emerging adults. Second, we examined if LGB-status and race/ethnicity predicted classmembership; third, we assessed differences between the latent classes on emotion dysregulation, depressive and anxiety symptoms, and alcohol use. Participants: Participants were 288 LGB adults between 18-29 years (M = 25.35, SD = 2.76; 41.7% gay/lesbian) recruited via Amazon MTurk. Methods and Results: The 3-step LCA identified five-latent classes: high victimization, childhood emotional abuse and neglect, cybervictimization, adult face-to-face IPV, and lower victimization. People of color (including Hispanics) were more likely to be in the high victimization class, and bisexual individuals, especially bisexual women, in the childhood emotional abuse and neglect class. High victimization and childhood emotional abuse and neglect classes had elevated emotion dysregulation levels and depression and anxiety symptoms, and the high victimization class reported the highest levels of alcohol use. Conclusion: Findings suggest a detrimental effect of cumulative interpersonal victimization on emotion dysregulation and the mental/behavioral health of LGB emerging adults, with bisexuals and LGB-people of color at heightened risk of cumulative victimization and of related mental/behavioral health challenges

Frequent expansion of Plasmodium vivax Duffy Binding Protein in Ethiopia and its epidemiological significance.

Plasmodium vivax invasion of human erythrocytes depends on the Duffy Binding Protein (PvDBP) which interacts with the Duffy antigen. PvDBP copy number has been recently shown to vary between P. vivax isolates in Sub-Saharan Africa. However, the extent of PvDBP copy number variation, the type of PvDBP multiplications, as well as its significance across broad samples are still unclear. We determined the prevalence and type of PvDBP duplications, as well as PvDBP copy number variation among 178 Ethiopian P. vivax isolates using a PCR-based diagnostic method, a novel quantitative real-time PCR assay and whole genome sequencing. For the 145 symptomatic samples, PvDBP duplications were detected in 95 isolates, of which 81 had the Cambodian and 14 Malagasy-type PvDBP duplications. PvDBP varied from 1 to >4 copies. Isolates with multiple PvDBP copies were found to be higher in symptomatic than asymptomatic infections. For the 33 asymptomatic samples, PvDBP was detected with two copies in two of the isolates, and both were the Cambodian-type PvDBP duplication. PvDBP copy number in Duffy-negative heterozygotes was not significantly different from that in Duffy-positives, providing no support for the hypothesis that increased copy number is a specific association with Duffy-negativity, although the number of Duffy-negatives was small and further sampling is required to test this association thoroughly

The psychometric properties of the adolescent dissociative experiences scale (A-DES) in a sample of Portuguese at-risk adolescents

Dissociation is a process that often occurs as a sequela of psychological trauma, and it is interrelated with psychological and behavioral problems. In the at-risk adolescent population, dissociation is often underdiagnosed and undertreated. Having reliable measures to assess this phenomenon can help in identifying adolescents at-risk and improve treatment outcomes. This study assessed the psychometric properties of the Adolescent Dissociative Experiences Scale (A-DES) with a sample of 402 Portuguese adolescents recruited from three at-risk populations. Participants completed self-report measures of trauma exposure, posttraumatic symptoms, psychological and behavioral problems, and the A-DES. A subset of the sample also completed test-retest measures. Confirmatory factor analyses revealed a best-fitting 3-factor model. Analyses revealed good internal consistencies and good agreement test-retest reliability for the scale overall and the factor-based sub-scales. Construct and predictive validity was supported with results showing that A-DES discriminates between youth reporting high versus low levels of cumulative trauma exposure and youth who meet or do not meet criteria for a probable PTSD diagnosis. Study findings replicate prior research supporting a 3-factor model of dissociation and the usefulness of A-DES to identify adolescents with dissociative symptoms. Clinical and research implications are discussed.This study was conducted at the Psychology Research Centre (CIPsi/UM) School of Psychology, University of Minho, supported by the Foundation for Science and Technology (FCT) through the Portuguese State Budget (UIDB/01662/2020), as well as through the funding of a research grant awarded to the first author;Foundation for Science and Technology [SFRH/BD/129194/2017,UIDB/01662/2020]

Can Developmental Trauma Disorder be Distinguished from Posttraumatic Stress Disorder? A Confirmatory Factor Analytic Test of Four Structural Models

Developmental Trauma Disorder (DTD) is a proposed child psychopathology diagnosis with emotion/somatic, attention/behavioral, and self/relational dysregulation symptoms extending beyond posttraumatic stress disorder (PTSD). Confirmatory factor analyses (CFAs) tested four structural models with structured interview data for trauma history, PTSD, and DTD with 507 children receiving mental health or pediatric care ( N=162, 32% diagnosed with DTD; N=176; 35% with PTSD; N=169, 33% with neither). A unidimensional model with a single latent variable had unacceptable fit (RMSEA=.094; CFI=.844). Compared to a model with PTSD and DTD as correlated first-order latent variables, a multidimensional model with correlated latent variables corresponding to the PTSD and DTD symptom clusters (Dc 2 =105.62, Ddf=14, p < .001) and a hierarchical variant with correlated second order DTD and PTSD latent variables (Dc 2 =48.10, Ddf=6, p < .001) fit the data better. The non-hierarchical multidimensional model was superior to the hierarchical variant (Dc 2 =66.05, Ddf=8, p < .001). Stronger latent variable inter-correlations within PTSD and DTD domains than across domains, suggested that DTD and PTSD are distinguishable despite their inter-correlation. Exposure to family violence was the primary correlate of both the DTD and PTSD second-order latent variables. Results indicate that children’s trauma-related symptoms involve six inter-correlated domains extend beyond PTSD’s symptoms (i.e., re-experiencing, avoidance, arousal) to include DTD symptoms of emotional, cognitive-behavioral, and self-relational dysregulation. The inter-relationship of the DTD and PTSD latent variables suggest that DTD may constitute a component within a complex PTSD diagnosis paralleling the new adult CPTSD diagnosis