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B van der Kolk

Publications and source records attributed to B van der Kolk.

12 recordsLinked to original sources
PubMed1997

Development of a criteria set and a structured interview for disorders of extreme stress (SIDES).

Data regarding the development of a structured interview measuring alterations that may accompany extreme stress are presented. A list of 27 criteria often seen in response to extreme trauma and not addressed by DSM-IV criteria for posttraumatic stress disorder (PTSD) were generated based on a systematic review of the literature and a survey of 50 experts. A structured interview for disorders of extreme stress (SIDES) measuring the presence of these criteria was administered to 520 subjects as part of the DSM-IV PTSD field trials. Inter-rater reliability as measured by Kappa coefficients for lifetime Disorders of Extreme Stress was .81. Internal consistency using coefficient alpha ranged from .53 to .96. Results indicate that the SIDES is a useful tool for investigation of response to extremes stress.

Adolescent↗
PubMed1997

Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder.

Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.

Adaptation, Psychological↗
PubMed1987

Reports of childhood incest and current behavior of chronically hospitalized psychotic women.

Of the female patients (N = 26) on a state hospital unit who remained chronically institutionalized and actively psychotic despite psychopharmacologic and psychosocial treatment, 12 (46%) reported histories of childhood incest. These 12 patients were more likely than the others to engage socially with ward staff. A higher proportion had sexual delusions, affective symptoms, substance abuse, suspected organicity, and major mental problems, and they spent more time in seclusion than other patients. The authors acknowledge the difficulty of assessing the accuracy of reports of incest. They discuss the implications of a possible relationship between incest and severe, intractable psychotic disorder.

Adolescent↗
PubMed1985

Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of post traumatic stress.

Chronic post traumatic stress has been described as a "physioneurosis" (Kardiner 1941), that is, a mental disorder with both psychological and physiological components. The behavioral sequelae of inescapable shock in animals and of massive psychic trauma in people show a striking parallel. Inescapable shock in animals leads to both transient catecholamine depletion and subsequent stress-induced analgesia. We postulate that the numbing and catatenoid reactions following trauma in humans correspond to the central nervous system (CNS) catecholamine depletion that follows inescapable shock in animals. We further explore the evidence for a human equivalent of "stress-induced analgesia" in animals, which is known to be mediated by endogenous opioids. Although reexposure to trauma may produce a paradoxical sense of calm and control due to endogenous opioid release, a cessation of traumtic stimulation will be followed by symptoms of opioid withdrawal and physiological hyperreactivity mediated by CNS noradrenergic hypersensitivity. This hyperreactivity can, in turn, be temporarily modified by reexposure to trauma. This factor could account for voluntary reexposure to trauma in many traumatized individuals and would provide a complementary formulation to the conventional psychodynamic concept of attempted mastery of the psychosocial meaning of the trauma.

Animals↗
PubMed1984

Nightmares and trauma: a comparison of nightmares after combat with lifelong nightmares in veterans.

In this study the chronic traumatic nightmares of men who had been in combat were found to differ from the lifelong nightmares of veterans with no combat experience in that they tended to occur earlier in the sleep cycle, were more likely to be replicas of actual events, and were more commonly accompanied by gross body movements. Traumatic nightmares may arise out of varying stages of sleep and are not confined to REM sleep alone. The group with lifelong nightmares showed evidence of thought disorder on the Rorschach. The men with posttraumatic stress disorder had failed to psychologically integrate their traumatic experiences and used dissociation as a way of dealing with strong affects.

Combat Disorders↗
PubMed1981

A preliminary study of the personality of the nightmare sufferer: relationship to schizophrenia and creativity?

Through psychiatric interviews and psychological tests the authors studied 38 adults who reported experiencing at least one nightmare per week. Nearly all of the subjects had a lifelong history of frequent nightmares. Four of the subjects met DSM-III criteria for schizophrenia, 9 met the criteria for borderline personality, and 6 met the criteria for schizotypal personality. The others had no specific diagnosis, and none of the subjects had a diagnosis of typical neurosis. Many had mentally ill relatives. Most had artistic interests and talents. These nightmare sufferers may be seen as unusually vulnerable, with a potential for mental illness--especially schizophrenia--as well as a potential for artistic achievement.

Adolescent↗
PubMed1980

Psychotropic drug prescriptions for elderly patients in a general hospital.

A survey was made of drug prescriptions written for all medical/surgical patients in a general hospital on a single weekday in 1978. Of these 348 patients, 195 were over the age of 60. In this elderly group, 62 (32 percent) were receiving psychoactive drugs. Flurazepam was the drug most commonly prescribed (in 63 percent of the patients). Diazepam was the most frequently prescribed nonhypnotic psychoactive drug (in 29 percent). Neuroleptic drugs and phenothiazine anti-emetics (in 52 percent) were not prescribed for psychosis but for augmenting analgesia and sedation and for reducing nausea. The average daily doses were about 20 percent of those used to treat psychotic young adults. All antidepressants (in 9.7 percent) had been prescribed before admission. No monoamine oxidase inhibitors were used, and doses of tricyclic antidepressants were half to one-third lower than those used to treat younger depressed adults. Antidepressants, which pose a risk to the elderly patient, were overprescribed and underdosed.

Aged↗
PubMedDate not supplied

Phenotype of blood lymphocytes in PTSD suggests chronic immune activation.

Patients with posttraumatic stress disorder (PTSD) have a past history of extremely stressful experience and often present with somatic complaints. Peripheral blood lymphocytes (PBL) of patients with PTSD associated with a history of childhood sexual abuse were examined for changes in immune phenotype. The ratio of CD45RO-positive to CD45RA-positive lymphocytes (CD45RO/CD45RA), an index of lymphocyte activation, was higher (P = 0.04) in the PTSD subjects than in the normal subjects. No differences were observed for the number of PBL or the representation of major T, B, or NK lymphocyte subsets. These findings suggest the presence of increased lymphocyte activation in the PBL of patients with PTSD.

Adult↗
PubMedDate not supplied

What psychological testing and neuroimaging tell us about the treatment of Posttraumatic Stress Disorder by Eye Movement Desensitization and Reprocessing.

To better understand the pathophysiology and treatment of Posttraumatic Stress Disorder (PTSD), standard psychological testing, Rorschach Ink Blot testing, and neuroimaging using Single Photon Emission Computed Tomography (SPECT) were administered to subjects with PTSD prior to and following three sessions of Eye Movement Desensitization and Reprocessing (EMDR). Using this within-subject design, data from one of six subjects in our series is presented as a case report. Following EMDR, the subject experienced improvement in his level of distress, which correlated with decrements in PTSD and depressive symptomatology on psychological testing. Analysis of the Rorschach data corroborated these changes. Among other findings, the Hypervigilance Index went from positive to negative, indicating that the subject was spending less time scanning the environment for threats, and available ego resources also increased, as measured by the Experience Actual variable. Upon recall of the traumatic memory during SPECT scanning, two areas of the brain were hyperactive post-EMDR treatment relative to pretreatment: the anterior cingulate gyrus and the left frontal lobe. These changes were consistent with summed data from four out of six subjects in the ongoing study. An important implication of these findings is that successful treatment of PTSD does not reduce arousal at the limbic level, but instead, enhances the ability to differentiate real from imagined threat. The psychology and neurophysiology of PTSD are discussed in greater detail.

Adult↗