The authors' objective was to examine the ability of acute stress disorder (ASD) and other trauma-related factors in a group of physical assault victims in predicting post-traumatic stress disorder (PTSD) 6 months later. Subjects included 214 victims of violence who completed a questionnaire 1 to 2 weeks after the assault, with 128 participating in the follow-up. Measures included the Harvard Trauma Questionnaire, the Trauma Symptom Checklist, and the Crisis Support Scale. Twenty-two percent met the full PTSD diagnosis and 22% a subclinical PTSD diagnosis. Previous lifetime shock due to a traumatic event happening to someone close, threats during the assault, and dissociation explained 56% of PTSD variance. Inability to express feelings, hypervigilance, impairment, and hopelessness explained another 15% of PTSD variance. The dissociative, the reexperiencing, the avoidant, and the arousal criteria of the ASD diagnosis correctly classified 79% of the subsequent PTSD cases.
The present study set out to investigate predictors of first time adolescent peer-on-peer sexual victimization (APSV) among 238 female Grade 9 students from 30 schools in Denmark. A prospective research design was utilized to examine the relationship among five potential predictors as measured at baseline and first time APSV during a 6-month period. Data analysis was a binary logistic regression analysis. Number of sexual partners and displaying sexual risk behaviors significantly predicted subsequent first time peer-on-peer sexual victimization, whereas a history of child sexual abuse, early sexual onset and failing to signal sexual boundaries did not. The present study identifies specific risk factors for first time sexual victimization that are potentially changeable. Thus, the results may inform prevention initiatives targeting initial experiences of APSV.
A group of highly traumatized refugees n = 26 with diverse cultural backgrounds in a Danish Clinic for Traumatized Refugees (CTR) was assessed for symptoms of post-traumatic stress disorder and other aspects of general functioning. Patients were assessed at intake, after the end of treatment and six months later. The results point to very high symptom levels and a large need for treatment in this population. Psychiatric symptoms and their correlates were assessed with the Harvard Trauma Questionnaire (HTQ), the Trauma Symptom Checklist-23 (TSC-23), the Global Assessment of Function (GAF), and the Crisis Support Scale (CSS). The Trail Making Test A & B (TMT) was used as a screening instrument for acquired brain damage, with promising results. Indications of effectiveness from 16-18 weeks of multidisciplinary treatment (physiotherapy, pharmacotherapy, psychotherapy, and social counseling) were supported with small to medium effect sizes on most outcome measures. The results are discussed in terms of clinical implications and future treatment, assessment, and research needs.
In recent years, a number of studies have investigated the prediction of posttraumatic stress disorder (PTSD) through the presence of acute stress disorder (ASD). The predictive power of ASD on PTSD was examined in a population of 148 female rape victims who visited a center for rape victims shortly after the rape or attempted rape. The PTSD diagnosis based solely on the three core symptom clusters was best identified by a subclinical ASD diagnosis based on all ASD criteria except dissociation. However, a full PTSD diagnosis including the A( 2) and F criteria was best identified by classifying victims according to a full ASD diagnosis. Regardless of whether cases were classified according to full PTSD status or according to meeting the criteria for the three PTSD core symptom clusters, the classification was correct only in approximately two thirds of the cases. A regression analysis based on ASD severity and sexual problems following the rape accounted for only 28% of the PTSD severity variance. In conclusion, the ASD diagnosis is not an optimal method for identifying those most at risk for PTSD. It remains to be seen whether a better way can be found.
*The National Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark; †Department of Psychology, University of Aarhus, Aarhus, Denmark; and ‡Department of Psychology, University of Toledo, Ohio.
The three-factor structure of posttraumatic stress disorder (PTSD) specified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, is not supported in the empirical literature. Two alternative four-factor models have received a wealth of empirical support. However, a consensus regarding which is superior has not been reached. A recent five-factor model has been shown to provide superior fit over the existing four-factor models. The present study investigated the fit of the five-factor model against the existing four-factor models and assessed the resultant factors' association with depression in a bereaved European trauma sample (N = 325). The participants were assessed for PTSD via the Harvard Trauma Questionnaire and depression via the Beck Depression Inventory. The five-factor model provided superior fit to the data compared with the existing four-factor models. In the dysphoric arousal model, depression was equally related to both dysphoric arousal and emotional numbing, whereas depression was more related to dysphoric arousal than to anxious arousal.
Dissociative experiences are common in traumatized individuals, and can sometimes be mistaken for psychosis. It is difficult to identify pathological dissociation in the treatment of traumatized refugees, because there is a lack of systematic clinical descriptions of dissociative phenomena in refugees. Furthermore, we are currently unaware of how dissociation measures perform in this clinical group.
To describe the phenomenology of dissociative symptoms in Bosnian treatment-seeking refugees in Denmark.
As a part of a larger study, dissociation was assessed systematically in 86 Bosnian treatment-seeking refugees using a semi-structured clinical interview (Structured Interview for Disorders of Extreme Stress-dissociation subscale; SIDES-D) and a self-report scale (Dissociative Experiences Scale; DES).
The SIDES-D indicated twice as high prevalence of pathological dissociation as the DES. According to the DES, 30% of the refugees had pathological dissociation 15 years after their resettlement. On the SIDES-D, depersonalization and derealization experiences were the most common. Also, questions about depersonalization and derealization at times elicited reporting of visual and perceptual hallucinations, which were unrelated to traumatic re-experiencing. Questions about personality alteration elicited spontaneous reports of a phenomenon of "split" pre- and post-war identity in the refugee group. Whether this in fact is a dissociative phenomenon, characteristic of severe traumatization in adulthood, needs further examination.
Knowledge of dissociative symptoms in traumatized refugees is important in clinical settings to prevent misclassification and to better target psychotherapeutic interventions. Much development in the measurement of dissociation in refugees is needed.
The aim of the present study was to examine specifically whether the relationship between coping style and symptoms of whiplash injury change as a function of gender. A total of 1709 sufferers of whiplash associated disorder (1349 women, 360 men) belonging to the Danish Society for Polio, Traffic and Accident Victims completed questionnaires measuring demographic and psychological factors (including coping style), and symptoms of whiplash trauma (including pain). Men and women were not found to differ significantly in their use of coping strategies, however emotion focused coping strategies were related significantly more strongly to whiplash related symptoms in men compared to women. Women were found to display more symptoms related to whiplash injury compared to men. Possible reasons for the present findings are discussed in light of related research indicating mood as a potential moderating variable in the relationship between maladaptive coping style and degree of symptoms related to injury in men.
ABSTRACT: BACKGROUND: The aim of the study was to examine the combined effect of gender and age on post traumatic stress disorder (PTSD) in order to describe a possible gender difference in the lifespan distribution of PTSD. METHODS: Data were collected from previous Danish and Nordic studies of PTSD or trauma. The final sample was composed of 6,548 participants, 2,768 (42.3%) men and 3,780 (57.7%) women. PTSD was measured based on the Harvard Trauma Questionnaire, part IV (HTQ-IV). RESULTS: Men and women differed in lifespan distribution of PTSD. The highest prevalence of PTSD was seen in the early 40s for men and in the early 50s for women, while the lowest prevalence for both genders was in the early 70s. Women had an overall twofold higher PTSD prevalence than men. However, at some ages the female to male ratio was nearly 3:1. The highest female to male ratio was found for the 21 to 25 year-olds. CONCLUSIONS: The lifespan gender differences indicate the importance of including reproductive factors and social responsibilities in the understanding of the development of PTSD.
This study aimed to test the dimensional structure of acute stress disorder (ASD). Latent profile analysis was conducted on scores from the Acute Stress Disorder Scale (Bryant, Moulds, & Guthrie, 2000) using a large sample of female victims of sexual trauma. Four distinct classes were found. Two of the classes represented high and low levels of ASD, and the high ASD class was associated with a high probability of subsequent posttraumatic stress disorder (PTSD). There were 2 intermediate classes that were differentiated by the number of arousal symptoms, and the class with high levels of arousal symptoms had a higher risk of PTSD. The results suggested that ASD is best described by qualitatively and quantitatively differing subgroups in this sample, whereas previous research has assumed ASD to be dimensional. This may explain the limited success of using ASD to predict subsequent PTSD. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Unfortunately, the number of bank robberies is increasing and little is known about the subsequent risk of posttraumatic stress disorder (PTSD). Several studies have investigated the prediction of PTSD through the presence of acute stress disorder (ASD). However, there have only been a few studies following nonsexual assault. The present study investigated the predictive power of different aspects of the ASD diagnosis and symptom severity on PTSD prevalence and symptom severity in 132 bank employees. The PTSD diagnosis, based on the three core symptom clusters, was best identified using cutoff scores on the Acute Stress Disorder scale. ASD severity accounted for 40% and the inclusion of other risk factors accounted for 50% of the PTSD severity variance. In conclusion, results indicated that ASD appears to predict PTSD differently following nonsexual assault than other trauma types. ASD severity was a stronger predictor of PTSD than ASD diagnosis.