The Effect of Denial of Childhood Trauma on the Self-Report of Suicidality on Psychiatric Inpatients

Abstract Childhood trauma is an overwhelming tragedy in our world today; from physical and emotional abuse and neglect to sexual abuse. Children who experience these tragic events suffer not only throughout the years that the abuse occurs but throughout their entire life and adulthood. They may experience personality changes, depression, and even suicidal ideations (Li, Wang, Hou, Wang, Liu, Wang, 2013). One way to deal with the negative effects of their childhood is to deny its occurrence. Denial exists in many different situations whether it is denial of death, illness or even a traumatizing event (Simon & Hales, 2012). Freud believed that individuals used denial to cope with unbearable situations and even the feelings associated with those situations; whereas Kubler-Ross believed denial was a natural stage of the healing process that all individuals experienced (Telford, Kralick & Koch, 2006). However, both theorists encompass the idea that denial is a way to hide from reality. We wanted to investigate if individuals from a psychiatric inpatient unit who deny their childhood trauma will also minimize their suicidality, trying to suppress their feelings of the past. Results indicated that suicidality was minimized in patients who also denied their childhood trauma. Additionally, we found that self-esteem provides a more accurate measure of psychiatric inpatients’ suicidality rate rather than asking patients for a self-report of their suicidality. The Effect of Denial of Childhood Trauma on the Self-Report of Suicidality on Psychiatric Inpatients Childhood trauma is a major problem which exists in our world for many years. Past research has shown that on average 28-32% of primary and elementary school students suffer from child neglect growing up (Li et al., 2013). Unfortunately, that is only the reported cases of childhood trauma while many cases may go unnoticed. Not only does childhood trauma affect the child’s emotional and physical needs at the time in which it occurs, it has neurological effects as well. Abused and neglected children tend to show more signs of behavioral and emotional problems which are related to the size of the amygdala in their brain (Petersen, Joseph & Feit, 2014). This decrease in the amygdala size puts individuals at risk for a much harder time dealing with internalizing problems, anxiety and emotional reactivity. Additionally, adults have been found to have a decreased size of their hippocampus region when they had experience childhood physical and sexual abuse. The hippocampus plays a vital role in learning and memory causing individuals who were abused to lack the ability of formulating and storing new memories. Nevertheless, both Mehta and colleagues (2009) and Sheridan and colleagues (2012) found that individuals who were abused as children had a much physically smaller brain. This shows that childhood trauma does not only affect the child’s physical and emotional aspect but also the neurobiological aspect as well. Not only is childhood trauma influential on the neuropathology of an individual’s brain but it has a long withstanding effect on the individual’s personality as well. Trauma exposure often leads individuals to psychopathology including ADHD, depression which may lead to suicidal thoughts, anxiety and even personality disorders in adolescence and adulthood, with each type of trauma having various outcomes (Li et al., 2013). For example, sexual and physical abuse is linked with borderline personality disorder, physical abuse is linked with antisocial personality disorder and emotional trauma is related to poor impulse control and interpersonal behavior. While none of these outcomes are certain in every individual who experiences childhood trauma, they are very common among the amount of individuals who get abused or neglected in some way as a child. Individuals have various ways of dealing with trauma. Depending on the individual, one may cope with using different mechanisms such as alcohol, drugs or medication. However, some individuals cope with their trauma through denial. Freud defined denial as “the refusal to acknowledge the existence of an unbearable situation or the feelings associated with it,” (Telford, Kralik & Koch, 2006). Individuals who have experienced trauma as a child may be inclined to deny that trauma ever happened creating a psychological protection from the event(s) (Tse). It is also a way to both implicitly and explicitly avoid the confrontation of dealing with the reality of the traumatizing event. Kubler-Ross believed the denial was a form of grief (Telford, Kralik & Koch, 2006). When dealing with a painful situation, mainly death, one of the first stages is denial that death ever took place. According to Kubler-Ross, this type of denial is natural for human beings to have when dealing with a mournful situation. Some studies agree with Freud and Kubler-Ross that denial may be useful and healthy early on in stages of life-threatening situations; however, if denial remains over a long period of time it may become dangerous causing pathological grief. Constant behaviors of denial in illnesses inevitably lead to poorer illness management and higher levels of distress and depression. According to Robins (1981), 25% of psychiatric patients at risk for suicide deny having suicide ideations to their health professionals (Simon & Hales, 2012). This is because individuals who do not think they need help, or who are determined to kill themselves, look at mental health professionals as an enemy and try to hide their true suicidal ideations. Therefore, the purpose of the present research is to determine if one’s denial of their childhood trauma events (physical, emotional, sexual abuse and physical and emotional neglect) impacted their self-report of their suicidality rate. It was hypothesized that patients who denied their childhood trauma would also have a lower suicidality rate, indicating denial in their suicidality, compared to non-denying individuals. Method Participants One hundred and forty six consecutively admitted psychiatric inpatients within three days of their admission were selected by the clinical staff of Dr. Karper or Amy Blitz, CRNP in the Lehigh Valley Hospital Muhlenberg: Inpatient Psychiatric Unit, BH2, Bethlehem, PA. Participants were chosen based on availability, cooperativeness and severity of disorder: excluded participants consisted of uncooperative or decompensated individuals. Participants consisted of mostly females with the majority being white, see table 1 for demographics. Materials Two instruments were used to assess the participants. The Personality Inventory for DSM-5: Adult (Krueger, Derringer, Markon, Watson, Skodol, 2013) is a 220 self-report questionnaire to measure the participants’ personality. The PID-5 assesses participants’ personality: negative affect (“I worry a lot about terrible things that might happen”), detachment (“I prefer not to get too close to people”), antagonism (“I’m good at making people do what I want them to do”), disinhibition (“Others see me as irresponsible”) and psychoticism (“I often have ideas that are too unusual to explain to anyone”). This measure was scored on a 4-point Likert-type scale; 0 = very false or often false, 1 = sometimes false, 2 = sometimes true, 3 = very true. The Childhood Trauma Questionnaire (Bernstein & Fink, 1998) is a 28 self-report questionnaire to measure the participants’ childhood trauma: sexual abuse (“Someone tried to touch me in a sexual way, or tried to make me touch them”), physical abuse (“I was punished with a belt, a board, a cord, or some other hard object”), emotional abuse (“People in my family called me things like “stupid”, “lazy” or “ugly”), emotional neglect (“There was someone in my family who helped me feel that I was important and special”) and physical neglect (“I didn’t have enough to eat”). Self-esteem was then measured by combining six of the questions on the PID-5 together (“I often feel like nothing I do really matters”). The higher the rating of self-esteem, the worse individuals thought about themselves. Suicidality was also measured by combining six of the questions on the PID-5 (“The future looks really hopeless to me”) to create a suicidality score for each participant. Denial was then measured by three of the CTQ questions (“I had the perfect childhood”). Individuals who answered never true to very often true on these questions were considered to be either low, moderate or severe deniers of their childhood trauma. Procedure Patients were picked each day by Dr. Karper or an RN on the inpatient BH2 unit. They were chosen based on cooperativeness, severity of illness and patience; only those who the doctor or the RN thought would be a good fit to fill out the survey were chosen. Two of Dr. Karper’s students would fill out the demographic information with the patients’ birth date, the current date, the patients’ room number and the survey number. The patients were told the survey was a measure of personality and childhood events that would help Dr. Karper better assist them. They were then asked if they would be willing to fill out the survey. If they agreed to fill it out they were given as much time as needed (usually 45-60 minutes). If they refused, they were not penalized in any way. When the survey was finished Dr. Karper’s students scored the survey appropriately and entered the data into the computer to be analyzed. Results A multiple regression in an analysis program, STATA, showed that for deniers both self-esteem and suicidality have a significant positive relationship with one another, F(1,177)=290.41, p\u3c0.00; specifically the higher the participants’ score on self-esteem (higher scores represents low self-esteem) the higher the suicidality level of participants. Figure 1 shows the significant relationship between suicidality and self- esteem. The higher the rating the worse self-esteem participants had. A one way analysis of variance showed that there was no difference in self-reported self-esteem between deniers and non-deniers, F(1, 144) =2.31, p=0.13. Alternatively, it showed that suicidality was statistically significant between deniers and non-deniers, F (1, 144) =4.15, p=0.04; specifically deniers (M= 5.61, SD= 4.54) minimized their suicidality more than non-deniers (M=7.56, SD= 5.44). A one way analysis of variance also showed that participants, whether deniers or non-deniers, did not differ in their report of their personality (n.s. for all personality domains). Another one way analysis of variance showed that participants who were deniers rated all types of childhood abuse lower than participants who were non-deniers, see table 2. This confirmed that deniers did significantly deny their childhood trauma compared to those who were not considered deniers. Discussion The intention of the present study was to determine if one’s denial of their childhood trauma impacted the self-report of their suicidality rate. It was hypothesized that patients who denied their childhood trauma would also portray a lower suicidality rate, indicating minimization/denial in their suicidality, compared to non-denying individuals. The results of the data support our contentions that when individuals denied their childhood trauma they also reported a lower suicidality rate, indicating minimization on their thoughts of suicidality. This shows that when an individual uses denial as a coping mechanism, they will not be reporting proper results on their suicidal ideations. This is very detrimental in clinical usage because mental health professionals will not be getting an accurate analysis of the patients’ suicidality which can be life threatening. However, results show that participants did report accurately their personality and self-esteem. These findings show that individuals did not deny all aspects of themselves, only childhood trauma and the minimization of suicidality. These findings lead to implications that should be taken into clinical consideration when dealing with psychiatric inpatients. Since inpatients properly report only their self-esteem, and as found self-esteem and suicidality are related, the best measure of psychiatric patients’ suicidality rate would be to look at their self-esteem. If they report high levels of self-esteem their suicidality rate is low; however, if they report low levels of self-esteem their suicidality rate would be high. This clinical conclusion is very important for doctors to use when assisting a psychiatric inpatient. One cannot tell by looking at an individual whether they are denying certain information or if they are telling the truth; therefore, in order for a doctor to appropriately assess all patients’ self-esteem should be used to measure suicidality in all appropriate psychiatric inpatients. While this study proved our hypothesis to be correct, there were some limitations of the study. First, all participants were conveniently sampled and therefore these results may not be generalizable to all psychiatric patients; outpatients cannot be assumed to deny similarly to inpatients. While the subjects in this study were recruited from a population that was predominately Caucasian, future work might explore how culture, age, or gender might influence the expression of suicidality. Table 1 Ethnicity and Gender of Psychiatric Inpatient Participants Patient Race Frequency Percentage White 133 83.13 Black 9 5.63 Hispanic 14 8.75 Asian 2 1.25 Middle Eastern 2 1.25 Gender Frequency Percentage Female 112 70 Male 48 30 Table 2 Mean, Standard Deviation and F-Statistic of Childhood Trauma Scores Deniers M (SD) Non-Deniers M (SD) F-statistic 1. Emotional Abuse 10(6) 14 (6) 13.25** 2. Physical Abuse 8 (5) 11 (6) 6.53* 3. Sexual Abuse 8 (5) 11 (7) 8.22* 4. Physical Neglect 7 (3) 9 (6) 8.22** 5. Emotional Neglect 9 (6) 14 (6) 23.88** Note: *= p-value is significant at the 0.01 level, ** = p-value is significant less than 0.001, the higher a mean the more severe a trauma References Bernstein, DP. & Fink, L. (1998). Childhood trauma questionnaire. A retrospective self-report. The Psychological Corporation. Krueger, RF., Derringer, J., Markon, KE., Watson, D., & Skodol AE (2013). The Personality Inventory for DSM-5 (PID-5)—Adult. American Psychiatric Association. Li, X., Wang, Z., Hou, Y., Wang, Y., Liu, J., & Wang, C. (2013). Effects of childhood trauma on personality in a sample of Chinese adolescents. Child Abuse & Neglect. Petersen, AC., Joseph, J., & Feit, M. (2014). Consequences of child abuse and neglect. New Directions in Child Abuse and Neglect Research. Washington (DC): National Academies Press (US), 111-155. Simon, R. & Hales, R. (2012). Textbook of suicide assessment and management: Second edition. Arlington, VA: The American Psychiatric Publishing Company. Telford, K., Kralik, D., & Koch, T. (2006). Acceptance and denial: Implications for people adapting to chronic illness: Literature Review. The Authors Journal. 457-464. Tse, D. Denial in cancer patients. Palliative Medicine Grand Round

Effects of elevated temperature on 8-OHdG expression in the American oyster (Crassostrea virginica): Induction of oxidative stress biomarkers, cellular apoptosis, DNA damage and γH2AX signaling pathways

Global temperature is increasing due to anthropogenic activities and the effects of elevated temperature on DNA lesions are not well documented in marine organisms. The American oyster (Crassostrea virginica, an edible and commercially important marine mollusk) is an ideal shellfish species to study oxidative DNA lesions during heat stress. In this study, we examined the effects of elevated temperatures (24, 28, and 32 °C for one-week exposure) on heat shock protein-70 (HSP70, a biomarker of heat stress), 8-hydroxy-2’-deoxyguanosine (8-OHdG, a biomarker of pro-mutagenic DNA lesion), double-stranded DNA (dsDNA), γ-histone family member X (γH2AX, a molecular biomarker of DNA damage), caspase-3 (CAS-3, a key enzyme of apoptotic pathway) and Bcl-2-associated X (BAX, an apoptosis regulator) protein and/or mRNA expressions in the gills of American oysters. Immunohistochemical and qRT-PCR results showed that HSP70, 8-OHdG, dsDNA, and γH2AX expressions in gills were significantly increased at high temperatures (28 and 32 °C) compared with control (24°C). In situ TUNEL analysis showed that the apoptotic cells in gill tissues were increased in heat-exposed oysters. Interestingly, the enhanced apoptotic cells were associated with increased CAS-3 and BAX mRNA and/or protein expressions, along with 8-OHdG levels in gills after heat exposure. Moreover, the extrapallial (EP) fluid (i.e., extracellular body fluid) protein concentrations were lower; however, the EP glucose levels were higher in heat-exposed oysters. Taken together, these results suggest that heat shock-driven oxidative stress alters extracellular body fluid conditions and induces cellular apoptosis and DNA damage, which may lead to increased 8-OHdG levels in cells/tissues in oysters

Applications of environmental DNA (eDNA) to detect subterranean and aquatic invasive species: A critical review on the challenges and limitations of eDNA metabarcoding

The world is struggling to solve a devastating biodiversity loss that not only affects the extinction of treasured species and irreplaceable genetic variation, but also jeopardizes the food production, health, and safety of people. All initiatives aimed to conserve biodiversity rely heavily on the monitoring of both species and populations to get accurate spatial patterns and overall population assessments. Conventional monitoring techniques, such as visual surveys and counting individuals, are problematic due to challenges in identifying cryptic species or immature life stages. Environmental DNA (eDNA) is a relatively new technology that has the potential to be a faster, non-invasive, and cost-effective tool for monitoring biodiversity, conservation, and management practices. eDNA has been extracted from materials that are both ancient and present, and its applications range from the identification of individual species to the study of entire ecosystems. In the past few years, there has been a substantial increase in the usage of eDNA in research pertaining to ecological preservation and conservation. However, several technological problems still need to be solved. To reduce the number of false positives and/or false negatives produced by current eDNA technologies, it is necessary to improve and optimize calibration and validation at every stage of the procedure. There is a significant need for greater information about the physical and ecological constraints on eDNA use, as well as its synthesis, current state, expected lifespan, and potential modes of movement. Due to the widespread use of eDNA research, it is also essential to assess the extent and breadth of these studies. In this article, we critically reviewed the primary applications of eDNA in subterranean and aquatic invasive species. Through this review, readers can better understand the challenges and limitations of eDNA metabarcoding

Development and assessment of an environmental DNA (eDNA) assay for a cryptic Siren (Amphibia: Sirenidae)

Environmental DNA (eDNA) assays have become a major aspect of surveys for aquatic organisms in the past decade. These methods are highly sensitive, making them well-suited for monitoring rare and cryptic species. Current efforts to study the Rio Grande Siren in southern Texas have been hampered due to the cryptic nature of these aquatic salamanders. Arid conditions further add to the difficulty in studying this species, as many water bodies they inhabit are ephemeral, sometimes constraining sampling efforts to a short window after heavy rain. Additionally, sirens are known to cease activity and reside underground when ponds begin to dry or as water temperatures increase. Conventional sampling efforts require extensive trap-hours to be effective, which is not always possible within the required sampling window. This study presents the development of a novel eDNA assay technique for this elusive species using conventional PCR and Sanger sequencing and compares eDNA sampling results with simultaneous trapping at multiple sites to assess the relative effectiveness of the procedure. Rio Grande Siren detection via eDNA sampling was significantly higher at all sites compared to trapping, confirming the utility of this assay for species detection. This methodology gives promise for future work assessing the distribution and status of the Rio Grande Siren and has potential for use on other southern Texas amphibians

Study addiction and 'dark' personality traits: a cross-sectional survey study among emerging adults

Background: Research has shown that personality traits can have an important role in the development and maintenance of behavioral addictions. However, the relationship between dark personality traits (i.e., Machiavellianism, psychopathy, narcissism, sadism, spitefulness) and ‘study addiction’ has yet to be investigated. Objectives: The purpose of the present study was to examine the associations of dark traits with study addiction among the total sample, males, and females separately, while adjusting for the Big Five personality traits (i.e., extroversion, neuroticism, agreeableness, openness, conscientiousness). Methods: A total of 716 university students completed an online survey, including questions assessing the aforementioned variables. Results: Hierarchical regression analysis suggested that being female, neuroticism, conscientiousness, Machiavellianism, and sadism were positively associated with study addiction. However, dark personality traits (i.e., Machiavellianism, sadism) were significantly related to study addiction only in males but not in females. Conclusions: Findings of this preliminary study suggest that dark personality traits may be better at explaining male addictive studying patterns and that gender should be taken into account when investigating the role of personality in the development of study addiction

Effects of gestational age at birth on cognitive performance : a function of cognitive workload demands

Objective: Cognitive deficits have been inconsistently described for late or moderately preterm children but are consistently found in very preterm children. This study investigates the association between cognitive workload demands of tasks and cognitive performance in relation to gestational age at birth. Methods: Data were collected as part of a prospective geographically defined whole-population study of neonatal at-risk children in Southern Bavaria. At 8;5 years, n = 1326 children (gestation range: 23–41 weeks) were assessed with the K-ABC and a Mathematics Test. Results: Cognitive scores of preterm children decreased as cognitive workload demands of tasks increased. The relationship between gestation and task workload was curvilinear and more pronounced the higher the cognitive workload: GA2 (quadratic term) on low cognitive workload: R2 = .02, p<0.001; moderate cognitive workload: R2 = .09, p<0.001; and high cognitive workload tasks: R2 = .14, p<0.001. Specifically, disproportionally lower scores were found for very (<32 weeks gestation) and moderately (32–33 weeks gestation) preterm children the higher the cognitive workload of the tasks. Early biological factors such as gestation and neonatal complications explained more of the variance in high (12.5%) compared with moderate (8.1%) and low cognitive workload tasks (1.7%). Conclusions: The cognitive workload model may help to explain variations of findings on the relationship of gestational age with cognitive performance in the literature. The findings have implications for routine cognitive follow-up, educational intervention, and basic research into neuro-plasticity and brain reorganization after preterm birth

Psychometric properties of three measures of “Facebook engagement and/or addiction” among a sample of English speaking Pakistani university students

For researchers interested in measuring the construct of “Facebook engagement and/or addiction,” there are a number of existing measures including the Bergen Facebook Addiction Scale, the Facebook Intensity Scale, and the Addictive Tendencies Scale. Currently, there is limited data on the psychometric properties of these three scales, especially among South Asian samples. The present aim was to address this shortfall. A sample of 308 English-speaking Pakistani university students completed the scales, in their original English versions, on two occasions separated by four weeks. Results demonstrated that for each of the scales, across both administrations, satisfactory psychometric properties were found, including internal reliability, temporal stability, and construct validity. Moreover, for these three scales, using confirmatory factor analysis, a one-factor structure was generally found to be a good description of the data for both male and female samples. These data provide further evidence for the reliability and validity of three scales concerned with “Facebook engagement and/or addiction.

Analyzing models of work addiction: single factor and bi-factor models of the Bergen Work Addiction Scale

Work addiction ('workaholism') has become an increasingly studied topic in the behavioral addictions literature and had led to the development of a number of instruments to assess it. One such instrument is the Bergen Work Addiction Scale (BWAS - Andreassen et al. 2012 Scandinavian Journal of Psychology, 53, 265-272). However, the BWAS has never been investigated in Eastern-European countries. The goal of the present study was to examine the factor structure, the reliability and cut-off scores of the BWAS in a comprehensive Hungarian sample. This study is a direct extension of the original validation of BWAS by providing results on the basis of representative data and the development of appropriate cut-off scores The study utilized an online questionnaire with a Hungarian representative sample including 500 respondents (F = 251; M age = 35.05 years) who completed the BWAS. A series of confirmatory factor analyses were carried out leading to a short, 7-item first-order factor structure and a longer 14-item seven-factor nested structure. Despite the good validity of the longer version, its reliability was not as high as it could have been. One-fifth (20.6 %) of the Hungarians who used the internet at least weekly were categorized as work addicts using the BWAS. It is recommended that researchers use the original seven items from the Norwegian scale in order to facilitate and stimulate cross-national research on addiction to work

Assessing the Factorial Validity of the Attitudes and Belief Scale 2-Abbreviated Version: A Call for the Development a Gold Standard Method of Measuring Rational and Irrational Beliefs

Rational Emotive Behaviour Therapy (REBT) does not possess a measure of rational and irrational beliefs that meets internationally recognised standards for acceptable psychometric properties. Without such a measure the theory/practice of REBT cannot be rigorously evaluated, thus undermining its scientific veracity. The current study investigates the validity and reliability of a recently developed measure of rational and irrational beliefs: the Attitudes and Belief Scale 2-Abbreviated Version (ABS-2-AV). University students from three countries completed the ABS-2-AV (N = 397). An alternative models framework using confirmatory factor analysis indicated that a theoretically consistent eight-factor model of the ABS-2-AV provided the best fit of the data. A number of post-hoc modifications were required in order to achieve acceptable model fit results, and these modifications revealed important methodological limitations with the ABS-2-AV. Results indicated that the validity of the ABS-2-AV was undermined due to items measuring both the psychological process of interest (rational and irrational beliefs) and the context in which these beliefs processes are presented. This is a serious methodological limitation of the ABS-2 and all questionnaires derived from it, including the ABS-2-AV. This methodological limitation resulted in the ABS-2-AV possessing poor internal reliability. These limitations are discussed in relation to the broader REBT literature and the impact such problems have on research and practice. A call is made for REBT researchers to come together to develop a “gold standard” method of assessing rational and irrational beliefs that meets international standard for psychometric excellence

Factorial validity and internal consistency of the PRAFAB questionnaire in women with stress urinary incontinence

<p>Abstract</p> <p>Background</p> <p>To investigate the factor structure, dimensionality and construct validity of the (5-item) PRAFAB questionnaire score in women with stress urinary incontinence (stress UI).</p> <p>Methods</p> <p>A cross validation study design was used in a cohort of 279 patients who were randomly divided into Sample A or B. Sample A was used for preliminary exploratory factor analyses with promax rotation. Sample B provided an independent sample for confirming the premeditated and proposed factor structure and item retention. Internal consistency, item-total and subscale correlations were determined to assess the dimensionality. Construct validity was assessed by comparing factor-based scale means by clinical characteristics based on known relationships.</p> <p>Results</p> <p>Factor analyses resulted in a two-factor structure or subscales: items related to 'leakage severity' (protection, amount and frequency) and items related to its 'perceived symptom impact' or consequences of stress UI on the patient's life (adjustment and body (or self) image). The patterns of the factor loadings were fairly identical for both study samples. The two constructed subscales demonstrated adequate internal consistency with Cronbach's alphas in a range of 0.78 and 0.84 respectively. Scale scores differed by clinical characteristics according to the expectations and supported the construct validity of the scales.</p> <p>Conclusion</p> <p>The findings suggest a two-factorial structure of the PRAFAB questionnaire. Furthermore the results confirmed the internal consistency and construct validity as demonstrated in our previous study. The best description of the factorial structure of the PRAFAB questionnaire was given by a two-factor solution, measuring the stress UI leakage severity items and the perceived symptom impact items. Future research will be necessary to replicate these findings in different settings, type of UI and non-white women and men.</p