Search Results (109)

Background: Youth with chronic rheumatologic diseases undergo medical experiences that can lead to post-traumatic stress disorder (PTSD). Understudied in pediatric rheumatology, medical PTSD can be significantly distressing and impairing. Objective: This study explored the prevalence of medical PTSD symptoms in youth with chronic inflammatory arthritis and associated factors, including pain, disease activity, mental health history, and anxiety sensitivity. Methods: A cross-sectional study of 50 youth (ages 8–18) with juvenile idiopathic arthritis (JIA) and childhood-onset systemic lupus erythematous (cSLE) was conducted at a pediatric rheumatology clinic. Participants completed self-report measures assessing post-traumatic stress symptoms (CPSS-V), pain, anxiety sensitivity (CASI), pain-related self-efficacy (CSES), adverse childhood experiences (ACEs), and fibromyalgia symptoms (PSAT). Clinical data included diagnoses, disease activity, treatment history, and demographics. Results: Forty percent had trauma symptoms in the moderate or more severe range. The 14% likely meeting criteria for probable medical PTSD were older (median 17 vs. 15 years, p = 0.005), had higher pain scores (median 4 vs. 3, p = 0.008), more ACEs (median 3 vs. 1, p = 0.005), higher anxiety sensitivity scores (median 39 vs. 29, p = 0.008), and higher JIA disease activity scores (median cJADAS-10 11.5 vs. 7.5, p = 0.032). They were also more likely to report a history of depression (71 vs. 23%, p = 0.020). No associations were found with hospitalization or injected/IV medication use. Conclusions: Medical trauma symptoms are prevalent in youth with chronic inflammatory arthritis. Probable PTSD was associated with pain and psychological distress. These findings support the need for trauma-informed care in pediatric rheumatology. Full article

Background and Objectives: We investigated whether early psychological trauma can contribute to the development of dysfunctional personality traits and emotional dysregulation. Personality disorders (PDs) are often characterized by using immature defense mechanisms and maladaptive coping strategies. Materials and Methods: We evaluated the relationship between early traumatic experiences, PDs, defense mechanisms, and coping strategies. A total of 90 patients aged between 18 and 70 with PDs were studied to detect different subtypes of early trauma, along with the defensive mechanisms and the prevailing coping strategies. Correlation and regression analyses aimed at establishing if specific trauma subtypes were associated with specific defense mechanisms and coping strategies. The Childhood Trauma Questionnaire—Short Form (CTQ-SF), the Defense Style Questionnaire 40 (DSQ-40), and the Coping Orientation to Problem Experienced (COPE) were used as psychodiagnostic tools. Results: Our findings determine emotional abuse, emotional neglect, and physical neglect as the most represented subtypes of trauma and underline the use of immature defense mechanisms in PD patients, while adaptive coping strategies, such as social support and positive aptitude were used. Conclusions: Early trauma, such as abuse and neglect, can be associated with dysfunctional defense mechanisms and coping strategies. This may have significant implications for managing not only pathological areas of the patient but also the functional ones. Moreover, being aware of these aspects can be useful for psychotherapy, reinforcing therapeutic alliance and reducing symptoms. Full article

The COVID-19 pandemic is considered a potentially traumatic event, as it introduced new challenges and threats to people around the world, disrupting daily life due to the restrictions imposed. The psychological defenses of individuals mobilized to deal with stress reactions are influenced by a set of factors, including previous traumatic experiences, which can amplify the current trauma. Recognizing that people exposed to adverse childhood experiences (ACEs) have increased risks of an array of adverse mental and physical health outcomes throughout life, the present study aimed to investigate the relationship between ACEs—more specifically, child abuse and child neglect—and PTSD symptoms in a sample of European adults during the pandemic. A sample of 8459 participants (67.1% female and 32.9% male, with a mean of 43.95 years old) was evaluated. The survey questionnaire included questions on sociodemographic and clinical characteristics, the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), and the Adverse Childhood Experiences (ACEs) questionnaire. According to our findings, younger women who have suffered from child abuse or child neglect are more likely to develop PTSD symptoms. The most significant factor influencing the PTSD risk was child neglect, contrary to many studies that indicate that child abuse is the most impactful adverse childhood experience. Full article

Dissociative symptoms may result from both neurobiological conditions, such as Attention-Deficit/Hyperactivity Disorder (ADHD), and traumatic events/exposure, such as Post-Traumatic Stress Disorder (PTSD) and Adverse Childhood Experiences (ACEs). However, identifying whether dissociative manifestations are associated with ADHD symptoms or trauma-related manifestations may drive clinicians to select the most effective intervention. Four hundred participants from the general population completed an online survey and were classified based on the presence of PTSD, ACEs, or ADHD symptoms. We compared the severity of dissociation and its dimensions across groups using the Dissociative Experiences Scale-II (DES-II) and explored its association with ADHD symptoms, PTSD manifestations, and ACEs. Dissociative symptoms were more pronounced in individuals with combined ADHD and PTSD or ACEs, but a hierarchical pattern of dissociation severity was also observed in isolated symptoms: ADHD > PTSD > ACEs. More specifically, participants who reported ADHD symptoms obtained higher scores on the Amnesia dimension of the DES-II than PTSD and more severe Absorption subscores than individuals reporting ACEs. Correlational analyses confirmed that DES-II scores were mostly associated with the scale evaluating the severity of ADHD symptoms rather than those evaluating trauma-related manifestations. These findings suggest that neurodevelopmental vulnerabilities, such as ADHD, may play a more significant role in dissociative symptomatology than trauma-related disorders. Full article

Children with intellectual disabilities experience unique developmental, social, and environmental challenges that intersect with adverse childhood experiences (ACEs) and positive childhood experiences (PCEs), shaping their psychosocial outcomes. While prior research has mainly examined single adversities or protective elements, the frameworks of ACEs and PCEs provide a broader understanding of their cumulative and interactive effects. However, these constructs remain underexplored in children with intellectual disabilities. This scoping review maps the range, conceptualization, and impact of ACEs, PCEs, and related concepts on psychosocial outcomes. Following the Joanna Briggs Institute (JBI) methodology, a search of PsycInfo, MEDLINE, CINAHL, Web of Science, and Google Scholar identified studies until October 2024. Two reviewers screened and extracted data using standardized criteria. Findings reveal variability in how ACEs and PCEs are defined and measured. ACE exposure, particularly the cumulative impact of multiple ACEs (polyvictimization), links to adverse psychosocial outcomes, including emotional (e.g., anxiety, depression, Post-Traumatic Stress Disorder), behavioral (e.g., aggression, conduct problems), and developmental (e.g., social and adaptive skill deficits) difficulties. PCEs—such as positive parent–child relationships, teacher–student support, and peer acceptance—mitigate risks, though impact varies by context. Intellectual disabilities severity and socioeconomic adversity shape associations. Further research is needed to inform the adaptation of ACE–PCE frameworks for children with intellectual disabilities. Full article

Background: Exposure to early life stress significantly increases the risk of psychopathology later in life. However, the impact of early life stress on the gut microbiome and its potential role in mental health outcomes remains insufficiently understood. This narrative review examines the current knowledge on how early life stress and its associated consequences may affect the gut microbiome, with a particular focus on conditions such as anxiety, depression, and post-traumatic stress disorder. Method: A comprehensive literature search was conducted in the PubMed and Web of Science databases between January and February 2025, covering studies published between 2015 and 2025. Results: Early life stress can profoundly impact cognitive function and neurodevelopment, with maternal early-life nutrition playing a significant role in modulating the effects of prenatal and postnatal stress. Early life stress influences the gut microbiome, disrupting its composition and function by altering the synthesis of microbial metabolites, neurotransmitters, and the activation of key metabolic pathways. However, the precise role of the gut microbiome in modulating stress responses during childhood and adolescence has not yet been fully elucidated. Conclusions: Several studies have demonstrated an association between early life stress and the gut microbiome. However, causality has not yet been established due to the numerous intrinsic and extrinsic factors influencing the microbiome-gut–brain axis. In the coming years, research on key microbial regulators, such as short-chain fatty acids, amino acids, and psychobiotics, may represent a promising approach for addressing central nervous system alterations linked to early life stress. Thus, further studies will be necessary to evaluate their potential as therapeutic agents. Full article

Introduction: Childhood emotional maltreatment, which includes emotional abuse and neglect, has been identified as a significant risk factor for the development of disordered eating behaviors related to overeating and reduced dietary control. At the same time, the literature suggests that childhood emotional maltreatment appears to be linked to deficits in reflective functioning which, in turn, may increase vulnerability to dysregulated, impulsive, and addictive behaviors. However, to date, the role of a key factor, such as food addiction (FA), within this model has not yet been investigated. Therefore, the aim of this study was to test a mediation model in which emotional abuse and neglect predict overeating and reduced dietary control through deficits in reflective functioning and FA symptoms. Method: Using a cross-sectional design, a conventional non-clinical sample of 543 participants was recruited and completed a set of standardized questionnaires. A multiple mediation model with observed variables was specified (10,000 bootstrap resampling). Results: The multiple mediation model showed good results, confirming the initial hypotheses. Specifically, emotional abuse and neglect were associated with FA symptoms through deficits in reflective functioning. In turn, FA symptoms predicted overeating behaviors and poor dietary control. Discussion: These findings highlight the central role of FA in linking reflective functioning deficits to disordered eating patterns associated with excessive food consumption. This study advances our understanding of the psychological mechanisms underlying disordered eating behaviors and underscores the need for targeted interventions addressing reflective functioning deficits and food addiction in individuals with a history of childhood emotional maltreatment. Full article

Objective: The present investigation sought to examine the interrelationships between early-life adverse experiences, dissociative symptoms, suicidal ideation, and depressive manifestations among metropolitan firefighters screened with post-traumatic stress disorder (PTSD), and to elucidate the potential mediating effects of these psychological variables on both the presence and severity of PTSD symptomatology in this high-risk occupational cohort. Methods: A cross-sectional investigation was performed to assess psychological conditions among 760 metropolitan male firefighters, employing conditional process analysis with multiple mediation modeling (PROCESS macro Model 6). The investigative protocol employed validated psychometric instruments including the PTSD Checklist (PCL-5); the Childhood Trauma Questionnaire (CTQ-33); the Dissociative Experiences Scale (DES); the Suicidal Behaviors Questionnaire (SBQ-4); and the Patient Health Questionnaire (PHQ-9). Bootstrap resampling (n = 5000) generated bias-corrected 95% confidence intervals, enabling interrogation of complex trauma response mechanisms. Results: Conditional process analysis demonstrated that childhood trauma functions as a significant mediator (indirect effect = 0.142, 95% CI [0.086, 0.198]), with emotional abuse pathways revealing significant mediational effects (β = 0.285, p < 0.001). Stratifying participants using a PCL-5 ≥ 33 threshold (non-PTSD: n = 543, 71.5%, median PCL-5: 22; PTSD: n = 217, 28.5%, median PCL-5: 39), the investigation elucidated serial mediation mechanisms, particularly through childhood trauma to dissociative experiences (serial indirect effect = 0.168, 95% CI [0.092, 0.244]), collectively explaining nearly half of PTSD variance through complex psychological interaction pathways. Conclusions: Conditional process analysis revealed childhood trauma as a pivotal mediator, with emotional abuse pathways demonstrating significant mediational effects, while dissociative experiences emerged as a significant secondary mechanism, collectively explaining a substantial portion of PTSD variance through interactions between occupational trauma exposure and intrinsic psychological vulnerabilities. Full article

Background/Objectives: Early parent–child attachment interactions guided by right-to-right brain synchrony are the foundation of emotional development and the quality of attachment relationships. Interactive failures are the hallmark of not only insecurity and trauma but also the internalization of shame. The purpose of this study was to advance our understanding of the relation between attachment and shame. The study explored a range of shame experiences, from normal socialization to harsh treatment and abuse. Debilitating shame was expected for individuals who had not mourned attachment trauma. Methods: Attachment was assessed using The Adult Attachment Projective (AAP) system in a sample of 245 adults. The AAP identifies the traditional regulated attachment classifications (Secure, Dismissing, Preoccupied) and, in addition to Unresolved attachment, three forms of incomplete mourning—Failed Mourning, Preoccupied with Personal Suffering, and Traumatized Secure. The study used participants’ narratives regarding three AAP classifications when “alone” to examine individual differences in representations of the shamed self contexts portraying the self in Private, Exposed, and Threatening situations. Results: All study hypotheses were confirmed. Adults with regulated attachments (Secure, Dismissing, Preoccupied) were significantly less likely to ascribe shame to the AAP pictures than traumatized adults. The patterns of results were the same when comparing differences in shame intensity and outcomes. There were no differences in shame intensity in the regulated group. Shame intensity for the Traumatized Secures was somewhat greater. There was a significant increase observed in the traumatized groups, with the Unresolved group showing the highest ratings. Reparative outcomes were significantly related to attachment security, although not to the extent expected. Secure, regulated insecure (Dismissing, Preoccupied), and some traumatized individuals described reconciliation and functional restitution. Unresolved individuals left shame unremedied. Regression analysis demonstrated that attachment classification was a greater predictor of shame intensity than outcomes. Conculusions: Attachment and neurological development are intertwined. Childhood interactive failures are deeply traumatic. If not mourned, shame takes its place in the identity core. This study provides clinicians with an in-depth perspective on attachment and shame assessment for goal-setting in therapy, consonant with their patients’ attachment representations. Full article

Background/Objectives: Adverse childhood experiences (ACEs) are traumatic childhood events that can disrupt neurologic, endocrine, and immune regulation and increase the risk for poor health outcomes. This Trauma-Informed ACE Screening and Intervention Evaluation (TASIE) Quality Improvement (QI) Project, ECHO, evaluated (1) pediatric provider knowledge of ACEs, toxic stress, and trauma-informed care principles, (2) implementation of ACE screening and clinical response in practice, and (3) patient and provider perspectives around benefits and challenges of ACE screening. Methods: From November 2021 to May 2024, three cohorts, totaling 46 pediatric practices across the U.S., participated in the TASIE Project, which included 2 h ACE training, eight monthly 75 min ECHO sessions, and monthly QI coaching. A mixed-methods approach was used to evaluate monthly data, while patient and provider surveys and provider focus groups were used to evaluate the program. Results: All 46 participating practices implemented ACE screening by the project’s conclusion. Of the patients eligible for ACE screening, over half were screened for ACEs during the program. Providers increased comfort with discussing ACEs and screening questions. During the first month, the practices were reported to have provided education to 56% of patients, and by the end of the project, this rate increased to 79% of patients. Overall, 97% of caregivers and 92% of adolescents screened agreed or somewhat agreed that it is important for providers to know about ACEs and toxic stress so they can offer better care. By the end of the project, for each cohort, providers reported that they were able to screen effectively and efficiently in routine practice and were more familiar with local resources. Full article

Background: Adverse childhood experiences (ACEs) have been identified as a major risk factor for physical and mental ill health in adulthood. So far, no studies have investigated whether ACEs during sensitive periods in infant development are associated with a higher likelihood of chronic pain (CP) in adulthood. Methods: Patients of the University Hospital of Innsbruck (Austria) completed questionnaires retrospectively assessing their ACEs as well as their current levels of CP, psychological distress, and trauma-related symptoms in this cross-sectional study. Dose-dependent associations of ACEs with CP were investigated through binary logistic regressions. To detect vulnerable developmental periods, a machine learning grid search was applied. Results: A total of n = 2577 patients were included in the analyses, with 31.5% reporting CP. Polytraumatization (i.e., four or more types of ACEs) was associated with a threefold increase for CP (OR: 3.01; 95% CI: 2.16–4.19; p < 0.001). The machine learning approach revealed maltreatment between 10 and 12 years to be the most predictive of CP (Ada Boost Classifier). Discussion: CP is a highly prevalent symptom among hospital patients and is clearly associated with ACEs. This is the first study to present evidence for a timing-dependent association of ACEs with CP. Early identification and appropriate psychosocial support for patients with ACEs is a crucial task for healthcare professionals. Full article

Objectives: Adverse childhood experiences (ACEs) pose a significant public health concern, negatively impacting children’s physical and mental health. This study examines the association between ACEs and the co-occurrence of somatization and post-traumatic stress symptoms (PTSSs) among Chinese college students. Additionally, it explores the roles of both internal (psychological resilience) and external (social support) protective factors in this relationship. Methods: A sample of 701 students were analyzed using the Adverse Childhood Experiences International Questionnaire, the Somatization subscale from the Symptom Checklist-90, the PTSD Checklist from the DSM-5, the Connor–Davidson Resilience Scale, and the Multidimensional Scale of Perceived Social Support. A four-level outcome variable was created based on measures of somatization and PTSSs: no symptoms, somatization-only, post-traumatic stress symptoms-only (PTSSs-only), and co-occurring symptoms. Data analysis was conducted using multiple logistic regression. Results: Among Chinese college students, the prevalence of ACEs was 62.9%, while the prevalence of co-occurring somatization and PTSSs was 13.7%. The results of the multiple logistic regression analysis indicated a positive association between ACEs and the co-occurrence of somatization and PTSSs compared to no symptoms (OR = 2.28, p < 0.001). Furthermore, social support (OR = 0.26, p < 0.001) and psychological resilience (OR = 0.48, p = 0.049) were negatively associated with the co-occurrence. Conclusions: ACEs are risk factors for the co-occurrence of somatization and PTSSs among college students, while social support and psychological resilience serve as effective protective factors against this risk. Full article

Background: Adverse childhood experiences (ACEs) are potentially traumatic experiences that may promote poor mental health, including substance use and suicidality, as well as chronic pain. Telementoring may be used to provide education to school-based health center (SBHC) clinicians and other health professionals in the community to identify and support youth with ACEs. Methods: This study was an evaluation of the novel ACEs ECHO telementoring program, which incorporates didactics, case-based learning, and a community of practice to serve school-based health clinicians in New Mexico, a rural state with a high prevalence of ACEs. Results: In the program’s first two years, there were 704 unique participants, including SBHC clinicians from 25 of New Mexico’s 33 counties. The pre/post survey demonstrated that the participants reported increases in knowledge in identifying children that experienced ACEs (4.3 versus 3.7, p = 0.001) and confidence in supporting children who may be at high risk (4.1 versus 3.3, p = 0.001) compared with before they began attending the ACEs ECHO program. The participants also reported that they felt more hopeful that they could help youth with ACEs (4.2 versus 3.3, p = 0.001). Conclusions: The ACEs ECHO telementoring program may be considered for other rural states and globally as a capacity-building model to educate SBHC clinicians and other health professionals to identify youth at risk for adverse childhood experiences. Full article

Background/Objectives: Childhood trauma is associated with psychiatric sequelae beyond post-traumatic stress disorder (PTSD), including eating disorders (EDs) and cognitive dysfunction. While eating pathology is related to cognition irrespective of childhood trauma exposure, such experiences may influence the way in which these symptoms develop. One method that has garnered increased interest in studying the interrelationships between symptoms and pinpointing core features of psychopathology is network analysis. Methods: Using data from the Nathan Kline Institute Rockland Sample, the present study utilized network analysis to examine associations between ED symptoms and cognitive deficits among a community sample. Comorbidity networks were constructed in two samples: adult reporters of childhood trauma (n = 116) and non-reporters (n = 101). Results: In line with the cognitive-behavioral model of EDs, overvaluation of weight/shape was central to both networks but demonstrated higher strength centrality among trauma reporters. Additionally, among trauma reporters, executive functioning deficits were linked to food-related attentional biases; alternatively, affective symptoms were salient among non-reporters. Finally, negative self-concept (theorized as a putative consequence of cognitive deficits) was implicated in both networks. When comparing the networks according to global strength, we did not find significant differences. Conclusions: Our findings contribute to the literature examining the interrelatedness of eating pathology and cognition and extend these findings by considering the role of trauma exposure. While our networks shared features of overvaluation of weight/shape and negative self-concept, they differed according to cognitive-affective concomitants. This information holds clinical utility in advancing assessment and intervention for individuals with eating psychopathology. Full article

This study analyzes the award-winning documentary film Searching for Rodakis, directed by Kerem Soyyilmaz, produced in 2023. The aim of this study is the historic comprehension and analysis of this filmic narrative in the field of social–semiotic literacy and its utilization in historical studies for approaching issues of conflict in modern history, otherness, collective experience and trauma, and collective memory. The research material is the documentary Searching for Rodakis (produced by Denmark, Turkey 2023; screenplay/director, Kerem Soyyilmaz; duration, 57’), which received the following awards: Adana Golden Boll FF 2023 Turkey | Best Documentary, Thessaloniki International Doc. Festival 2023 Greece, Greek Film Festival Los Angeles 2023 USA, and Istanbul Documentary Days 2023 Turkey. As regards the historic context, the year of production, 2023, coincides with the 100th anniversary of the signing of the Treaty of Lausanne, where Turkey’s current borders were set and the “population exchange” legally sealed, i.e., the violent expulsion of 400,000 Muslims, citizens of Greece, many of whom spoke only Greek, and 200,000 Orthodox citizens of Turkey, who in the majority spoke Turkish. At the same time, the Treaty of Lausanne ratified and finalized the expulsion of approximately one million Orthodox who were forced to leave the Ottoman Empire, as well as 120,000 Muslims who had fled Greece since the beginning of the Balkan Wars (1912–1913). About two million people were deported and lost their citizenship and property, in the context of “national homogeneity” (which connotes an ethnic cleansing), with the official states ignoring the criticisms of lawyers and academics who spoke of violations of constitutional rights. Mohammedan Greeks, estimated at around 190,000 as early as 1914, based on ecclesiastical statistics in the Pontus region, did not receive attention from the provisions of the Treaty of Lausanne, even though linguistically and culturally (origin, customs, culture and traditions) they did not differ in any way from the Orthodox Greeks. In Turkey, there was general indifference to the thousands of desperate people who arrived, with the exception of a few academics and the Lausanne Exchange Foundation. The filmic scenario is as follows: as a Greek tombstone of unknown origin is discovered underneath the floorboards in an old village house in Turkey, an almost forgotten story from the country’s creation unravels—the forced population exchange between Greece and Turkey in 1923. The engraved Greek letters tell of a woman, Chrysoula Rodaki, who died in 1887. Thus the search for her descendants begins. It leads director Kerem Soyyilmaz to local archives, where his own family’s role in history is laid bare; to abandoned ghost towns, and through the memories of older villagers—all while Soyyilmaz meets massive support for his quest from Greeks on the other side of the border. The stone becomes a portal to the past—and for a while, the trauma becomes redeemed when the previous owners of the village house return. Searching for Rodakis is a movie that reconnects people, culture, and the stories that were discarded in order to build a strong, nationalist state—told through the director’s personal experiences. The research questions, as they arise from the cinematographic material itself, are as follows: How is the historical memory of traumatic events of the previous century, such as the exchange of populations according the Treaty of Lausanne, recorded in the cinematographic narrative? What are the historical sources? To what extent did the origin, ethnicity, and geographical location of the narrators as participants influence the preservation of historical memory and the historical research? What are the criteria of the approach of the creator, and what are the criteria of the participants? Methodologically, we apply historic and socio-semiotic analyses in the field of public and digital history. The results: The types of historical sources found in filmic public discourse include the oral narration of testimonies, of experiences and of memories, as well as the director’s historical research in state archives, the material cultural objects, and the director’s digital research. Thus, historic thematic categories occur, such as the specific persons and actions in Turkey/Greece, actions on-site and in online research, and the types of historical sources, such as oral testimonies, research in archives, and objects of material culture. Sub-themes such as childhood, localities and kinship also emerge. These cinematic recordings of biographical oral narratives as historical and sociological material help us understand the political ideologies of the specific period, between the years 1919 and 1923. The multimodal film material is analyzed to provide testimonies of oral and digital history; it is utilized to approach the historical reality of “otherness”, seeking dialogue in cross-border history in order to identify differences, but above all the historic and cultural similarities against sterile stereotypes. The historic era and the historic geography of the Greek and Turkish national histories concern us for research and teaching purposes a hundred years after the Treaty of Lausanne which set the official borders of the countries. Full article