Clinical, psychosocial and personality characteristics of traumatized female patients: some implications for person-centered psychiatry
Keywords:Patient-centered outcome measures, individual differences framework, person-centered psychiatry, personalised medicine, routine clinical practice, coping, personality, psychopathology, posttraumatic stress disorder, traumatized female patients, day clinic
AbstractBackground. There is increasing interest in chronic diseases across the world given their heavy morbidity and mortality. Chronically traumatized women, however, have been less studied than those with acute trauma.Research objectives. The purpose of the study was to describe clinical, psychosocial and personality characteristics of chronically traumatized women within a trauma-specialized day clinic aimed at female patients only, and then to consider their implications for improved clinical care.Method. This involved a cross-sectional study, using the following baseline Routine Outcome Monitoring (ROM) measures: Self-Rating Inventory for PTSD (SRIP), Symptom Checklist 90 (SCL-90), Temperament and Character Inventory (TCI), Utrecht Coping List (UCL). A total of 129 female patients (18-65 years of age) were included. The characteristics of patients studied were described concerning PTSD and non-PTSD groups: 100 female patients had PTSD (77.5%, total SRIP score ≥ 52), 29 female patients had no PTSD or partial PTSD (22.5%, total SRIP score <52). Both groups had been exposed to chronic trauma without differences regarding nature of trauma.Results. Patients with PTSD, compared to non-PTSD, reported more general psychopathology (SCL-90) and more passive coping (UCL), which was reflected in their personality traits (TCI). Linear regression analyses showed that total PTSD was positively associated with sleeping problems (SCL-90), avoidance and passive coping reactions (UCL), and Self-Transcendence (TCI Character scale). Self-Directedness (TCI Character scale) and Reward Dependence (TCI Temperament scale) were negatively associated with total PTSD symptoms.Discussion. The implications for treatment and person-centered care of broad characteristics of chronically traumatized women were outlined and discussed.Conclusions. Pathogenic implications of chronic trauma were elicited for female patients experiencing chronic trauma. Consideration of their contextualized profiles appears helpful for individualized care, one of the key elements of person-centered care.
American Psychiatric Association (APA) (2000). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Rev. Washington DC.
Gnanadesikan M, Novins DK, Beals J (2005). The relationship of gender and trauma characteristics to posttraumatic stress disorder in a community sample of traumatized Northern Plains American Indian adolescents and young adults. Journal of Clinical Psychiatry 66(9): 1176-1183.
Cohen H, Yehuda R (2011). Gender differences in animal models of posttraumatic stress disorder. Disease Markers 30: 141-150.
Robin RW, Chester B, Rasmussen JK, et al. (1997). Prevalence and characteristics of trauma and posttraumatic stress disorder in a Southwestern American Indian community. American Journal of Psychiatry 154: 1582-1588.
Tolin DF, Foa EB (2006). Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychological Bulletin 132(6): 959-992.
Keane TM, Marshall AD, Taft CT (2006). Posttraumatic Stress Disorder: etiology, epidemiology, and treatment outcome. Annual Review of Clinical Psychology 2: 161-197.
Nemeroff CB, Bremner JD, Foa EB, et al. (2006). Posttraumatic stress disorder: a state-of-the-science review. Journal of Psychiatric Research 40:
Breslau N (2009). The Epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma, Violence & Abuse 10(3): 198-210.
Bryant RA, Marosszeky JE, Crooks J, et al. (2000). Coping style and post-traumatic stress disorder following severe brain injury. Brain Injury 14: 175-180.
Hovens JG, Giltay EJ, Wiersma JE, et al. (2012). Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica 126(3): 198-207.
Breslau N, Davis GC, Peterson EL, et al. (1997). Psychiatric sequelae of posttraumatic stress disorder in women. Archives General Psychiatry 54: 81-87.
Breslau N, Kessler RC, Chilcoat HD, et al. (1998). Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Archives General Psychiatry 55: 626-632.
Terr LC (1991). Childhood traumas: an outline and overview. American Journal of Psychiatry 148: 10-20.
Sansone RA, Sansone LA, Gaither GA (2004). Multiple types of childhood trauma and borderline personality symptomatology among a sample of diabetic patients. Traumatology 10: 257-266.
Allan B, Lauterbach D (2007). Personality characteristics of adult survivors of childhood trauma. Journal of Traumatic Stress 20(4): 587-595.
Ozomaro U, Wahlestedt C, Nemeroff CB (2013). Personalized medicine in psychiatry: problems and promises. BMC Medicine 11:132. doi: 10.1186/1741-7015-11-132.
McKay R, Coombs T, Pirkis J (2012). A framework for the potential of routine outcome measurement to improve mental health care. Australas Psychiatry 20(2): 127-133.
De Beurs E, Den Hollander-Gijsman ME, Van Rood YR, et al. (2011). Routine outcome monitoring in the Netherlands: practical experiences with a web-based strategy for the assessment of the treatment outcome in clinical practice. Clinical Psychology and Psychotherapy 18: 1-12.
Carlier IVE, Meuldijk D, Van Vliet IM, Van Fenema E, Van der Wee NJ, Zitman FG (2012). Routine outcome monitoring and feedback on physical or mental health status: evidence and theory. Journal of Evaluation in Clinical Practice 18(1):104-110.
Carlier IVE, Schulte-Van Maaren Y, Wardenaar K, et al. (2012). Development and validation of the 48-item Symptom Questionnaire (SQ-48) in patients with depressive, anxiety and somatoform disorders. Psychiatry Research 200(2-3): 904-910.
Hovens JE, Van der Ploeg HM, Bramsen I, et al. (1994). The development of the self-rating inventory for posttraumatic stress disorder. Acta Psychiatrica Scandinavica 90: 172-183.
Hovens JE, Van der Ploeg HM, Bramsen I, et al. (2000). Test-retest reliability of the self-rating inventory for posttraumatic stress disorder. Psychological Report 87: 735-737.
Van Zelst WH, De Beurs E, Beekman ATF, et al. (2003) Criterion validity of the self-rating inventory for posttraumatic stress disorder (SRIP) in the community of older adults. Journal of Affective Disorders 76: 229-235.
Hovens JE, Bramsen I, Van der Ploeg HM (2002). Self-rating inventory for posttraumatic stress disorder: review of the psychometric properties of a new Dutch screening instrument. Perceptual and Motor Skills 94(3): 996-1008.
Degoratis LR, Lipman RS, Covi L (1973). SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacology Bulletin 9(1): 13-28.
Cloninger CR, Svrakic DM, Przybeck TR (1993). A psychobiological model of temperament and character. Archives General Psychiatry 50: 975-990.
Cloninger CR, Svrakic DM (1997). Integrative psychobiological approach to Psychiatric assessment and treatment. Psychiatry 60: 120-141.
Westbrook MT, Nordholm LA, McGee JE (1984). Cultural differences in reactions to patient behaviour: a comparison of Swedish and Australian health professionals. Social Science & Medicine 19(9): 939-9447.
Schreurs PJG, Van de Willige C, Tellogen B, et al. (1984). De Utrechtse Coping Lijst (UCL, The Utrecht Coping List). Tijdschrift voor Psychologie 12: 101-117.
Lazarus RS, Folkman S (1984). Stress, appraisal and coping. New York: Springer, 1984.
Turner H, Bryant-Waugh R, Peveler R, Bucks RS (2012). A psychometric evaluation of an English version of the Utrecht Coping List. European Eating Disorders Review 20(4): 339-342.
Demyttenaere K, Maes A, Nijs P, Odendael H, van Assche FA (1995). Coping style and preterm labor. Journal of Psychosomatic Obstetrics & Gynecology 16: 109-115.
Al-Saffar S, Borgå P, Hållström T (2002). Long-term consequences of unrecognised PTSD in general outpatient psychiatry. Social Psychiatry and Psychiatric Epidemiology 37(12): 580-585.
Hong X, Currier GW, Zhao X, et al. (2009). Posttraumatic stress disorder in convalescent severe acute respiratory syndrome patients: a 4-year follow-up study. General Hospital Psychiatry 31: 546-554.
Najarian LM, Sunday S, Labruna V, Barry I (2011). Twenty-year follow-up of adults traumatized during childhood in Armenia. Journal of Affective Disorders 135(1-3): 51-55.
Vrana SR, Hughes JW, Dennis MF, et al. (2009). Effects of posttraumatic stress disorder status and covert hostility on cardiovascular responses to relived anger in women with and without PTSD. Biological Psychology 82: 274-280.
Orth U, Wieland E (2006). Anger, hostility and posttraumatic stress disorder in trauma-exposed adults: a meta-analysis. Journal of Consulting & Clinical Psychology 74: 698-706.
Linley PA, Joseph S (2004). Positive change following trauma and adversity: a review. Journal of Traumatic Stress 17: 11-21.
Buurman BM, Mank APM, Beijer HJM, Olff M (2011). Coping with serious events at work: a study of traumatic stress among nurses. Journal of American Psychiatric Nurses Association 17(5): 321-329.
McGee ZT, Davis BL, Brisbane T, et al (2001). Urban stress and mental health among African-American youth: assessing the link between exposure to violence, problem behavior, and coping strategies. Journal of Cultural Diversity 8: 94-104.
Gill JM, Page GG (2006). Psychiatric and physical health ramifications of traumatic events in women. Issues in Mental Health Nursing 27: 711-734.
Matud MP (2004). Gender differences in stress and coping styles. Personality and Individual Differences 37: 1401-1415.
Olff M, Langeland W, Draijer N (2007). Gender differences in posttraumatic stress disorder. Psychological Bulletin 133: 183-204.
Yoon SJ, Jun CS, An HY, et al (2009). Patterns of temperament and character in patients with posttraumatic stress disorder and their association with symptom severity. Comprehensive Psychiatry 50(3): 226-231.
North CS, Abbacchi A, Cloninger CR (2012). Personality and posttraumatic stress disorder among directly exposed survivors of the Oklahoma City bombing. Comprehensive Psychiatry 53(1): 1-8.
Daud A, Klinteberg af B, Rydelius P (2008). Trauma, PTSD and personality: the relationship between prolonged traumatization and personality impairments. Scandinavian Journal of Caring Sciences 22: 331-340.
Kira IA (2001). Taxonomy of trauma and trauma assessment. Traumatology 7(2): 81-95.
Karwantz A, Troop NA, Rabe-Hesketh S, et al (2003). Personality disorders and Personality dimensions in anorexia nervosa. Journal of Personality Disorders 17(1): 73-85.
Carlier IVE, Gersons BPR (1995). Partial Posttraumatic Stress Disorder: the issue of psychological scars and the occurrence of PTSD symptoms. Journal of Nervous & Mental Disease 183(2): 107-109.
Zlotnick C, Johnson J, Najavits LM (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavior Therapy 40: 325-336.
Pietrzak RH, Goldstein RB, Southwick SM, Grant BF (2011). Medical comorbidity of full and partial posttraumatic stress disorder in US adults: results from wave 2 of the national epidemiologic survey on alcohol and related conditions. Psychosomatic Medicine 73: 697-707.
Dell’Osso L, Carmassi C, Massimetti G, et al. (2011). Full and partial PTSD among young adult survivors 10 months after the L’Aquila 2009 earthquake: gender differences. Journal of Affective Disorders 131: 79-83.
Friedman MJ, Resick PA, Bryant RA, Brewin CR (2011). Considering PTSD for DSM-5. Depression and Anxiety 28: 750-769.
Herman JL (1992). Complex PTSD. Journal of Traumatic Stress 5: 377-391.
Van der Kolk BA, Pelcovitz D, Roth S, et al. (1996). Dissociation, somatization, and effect dysregulation: complexity of adaption to trauma. American Journal of Psychiatry 153(7): 83-93.
Roth S, Newman E, Pelcovitz D, et al. (1997). Complex PTSD in victims exposed to sexual and physical abuse. Journal of Traumatic Stress 10: 539-555.
Pelcovitz D, Kolk van der B, Roth S, et al. (1997). Development of a criteria set and a structured interview for disorders of extreme stress (DESNOS). Journal of Traumatic Stress 10: 3-16.
Ford JD, Stockton P, Kaltman S, Green BL. (2006). Disorders of extreme stress (DESNOS) symptoms are associated with type and severity of interpersonal trauma exposure in a sample of healthy young women. Journal of Interpersonal Violence 21(11): 1399-1416.
Cloitre M (2009). Effective psychotherapies for posttraumatic stress disorder: a review and critique. CNS Spectrums 14: 32-43.
Muenzenmaier K, Spei E, Gross DR (2010). Complex posttraumatic stress disorder in men with serious mental illness: a reconceptualization. American Journal of Psychotherapy 64(3): 257-268.
Cloitre M, Stovall-McClough KC, Nooner K, et al. (2010). Treatment for PTSD related to childhood abuse: a randomized controlled trail. American Journal of Psychiatry 167: 915-924.
Baars EW, Van der Hart O, Nijenhuis ERS, et al. (2011). Predicting stabilizing treatment outcomes for complex posttraumatic stress disorder and dissociative identity disorder: an expertise-based prognostic model. Journal of Trauma & Dissociation 12: 67-87.
Polusny MA, Dickinson KA, Murdoch M, Thuras P (2008). The role of cumulative sexual trauma and difficulties identifying feelings in understanding female veterans’ physical health outcomes. General Hospital Psychiatry 30: 162-170.
Springer KW, Sheridan J, Kuo D, Carnes M (2007). Long-term physical and mental health consequences of childhood physical abuse: results from a large population-based sample of men and women. Child Abuse & Neglect 31: 517-530.
Cloitre M, Courtois CA, Charuvastra A, et al. (2011). Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. Journal of Traumatic Stress 24(6): 615-627.
Ford DJ, Courtois CA, Steele K, et al. (2005). Treatment of complex posttraumatic self-regulation. Journal of Traumatic Stress 5(18): 437-447.
Van der Kolk BA, Courtois CA (2005). Editorial comments: complex developmental trauma. Journal of Traumatic Stress 5(18): 385-388.
Bergeron M, Hébert M (2006). Évaluation d’une intervention de groupe d’approche féministe auprès de femmes victims d’agression sexuelle. Child Abuse & Neglect 30: 1143-1159.
Cohen NJ (2008). Using feminist, emotion-focused, and developmental approaches to enhance cognitive-behavioral therapies for posttraumatic stress disorder related to childhood sexual abuse. Psychotherapy Theory, Research, Practice, Training 45(2): 227-246.
Tarter RE, Kirisci L, Ridenour T, Bogen D (2012). Application of person-centered medicine in addiction. The International Journal of Person Centered Medicine, 2(2): 240-249.
Zatzick DF, Kang SM, Hinton WL, Kelly RH, Hilty DM, Franz CE, Le L, Kravitz RL (2001). Posttraumatic concerns: A patient-centered approach to outcome assessment after traumatic physical injury. Medical Care, 39(4): 327-339.
Salvador-Carulla L, Mezzich JE (2012). Person-centred medicine and mental health. Epidemiology and Psychiatric Sciences, 21: 131-137.
Mezzich JE (2007). Psychiatry for the person: Articulating medicine’s science and humanism. World Psychiatry 6: 65-67.
Mezzich JE, Christodoulou GN, Fulford KWM (2011). Introduction to the conceptual bases of psychiatry for the person. The International Journal of Person Centered Medicine, 1(1): 121-124.