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Diminished parasympathetic reactivity is a physiological feature of posttraumatic stress disorder (PTSD). The objective of this study was to compare female PTSD patients with non-traumatized healthy women with respect to autonomic cardiovascular regulation during exposure to two stressors. Hospitalized PTSD patients (n = 52) and controls (n = 37) completed standardized laboratory-based stress testing including a mental arithmetic test and a standardized audiotape recording of a crying infant. Controls and PTSD patients both showed a significantly increased heart rate and reduced pre-ejection period from baseline rest to the arithmetic stressor. However, as judged from nonsignificant changes in baroreflex sensitivity, parasympathetic activation caused by the crying infant stressor was blunted in PTSD patients as compared to healthy individuals. Under the crying infant condition, a vagal dominance was observed only in controls, and not in PTSD patients. Our data demonstrate that, in PTSD patients, diminished parasympathetic reactivity is not restricted to trauma-related events but can also be observed in response to a social stimulus such as listening to a crying infant. This finding suggests that the altered vagal reactivity in PTSD patients reflects the physiological consequences of a generally disturbed autonomous response to emotionally relevant stressors. more...

In patients with complex posttraumatic stress disorder (complex PTSD; Herman, 1992) as well as in those with borderline personality disorder (BPD) traumata are often found anamnestically. Besides high comorbidity were found between both disorders. Thus it was examined whether internalizing and externalizing subtypes can be distinguished in chronic traumatized patients (N = 266) accounting for personality accentuations. Item parameters of a 2-class solution of the dichotomous Mixed Rasch Model were consistent with hypothesized patterns. χ²-tests indicated that patients subsumed to the internalizing group showed twice as much the diagnosis of complex PTSD. However an information criterion favored a one-class solution. Given that the analysis did not reveal 2 subtypes, a one-dimensional approach is suggested, that helps to describe internalizing and externalizing symptoms in chronic traumatized patients., (© Georg Thieme Verlag KG Stuttgart · New York.) more...

Present neuroimaging findings suggest two subtypes of trauma response, one characterized predominantly by hyperarousal and intrusions, and the other primarily by dissociative symptoms. The neural underpinnings of these two subtypes need to be better defined. Fourteen women with childhood abuse and the current diagnosis of dissociative amnesia or dissociative identity disorder but without posttraumatic stress disorder (PTSD) and 14 matched healthy comparison subjects underwent functional magnetic resonance imaging (fMRI) while finding their way in a virtual maze. The virtual maze presented a first-person view (egocentric), lacked any topographical landmarks and could be learned only by using egocentric navigation strategies. Participants with dissociative disorders (DD) were not impaired in learning the virtual maze when compared with controls, and showed a similar, although weaker, pattern of activity changes during egocentric learning when compared with controls. Stronger dissociative disorder severity of participants with DD was related to better virtual maze performance, and to stronger activity increase within the cingulate gyrus and the precuneus. Our results add to the present knowledge of preserved attentional and visuospatial mnemonic functioning in individuals with DD., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.) more...

Background: There is current controversy about the diagnostic overlap between personality disorders and trauma-related disorders., Patients and Methods: Applying a multicenter study design, trauma-related disorders were investigated via interview assessment in 136 patients with borderline personality disorder (BPD) in 5 specialized treatment centers. Additionally a spectrum of psychological symptoms and prevalence of lifetime traumatic experiences were assessed by questionnaire measures., Results: Diagnostic overlap between BPD and PTSD was found to be high (79%) as well as the overlap of BPD with complex PTSD (55%) and severe dissociative disorders (41%). Including neglect and emotional violence as trauma categories, an extremely high prevalence of lifetime traumatic experiences was reported (96%). Experiences of sexual violence were reported by 48% of all female and 28% of all male patients. Severe forms of physical violence were reported by 65% of all patients., Conclusions: BPD patients with severe psychopathology show a high comorbidity with trauma-related disorders including dissociative disorders. This association has to be taken into account when planning psychological treatment. more...

Since 1995 it is known that aversive and traumatic experiences in childhood, adolescence or adulthood correlate with measurable changes in the brain. Particularly, hippocampus-atrophies as well as reduction in amygdalae volumes have been investigated and documented. Furthermore, experiences of extreme form of early neglect have been associated with general reduction of brain volumes. Recent research documents neural correlates of dissociation. more...

Background: Individuals with posttraumatic stress disorder (PTSD) display reduced hippocampus size and impaired cognition. However, studies on individuals with borderline personality disorder (BPD) are rare, and studies on trauma-exposed patients with BPD but without PTSD are lacking., Methods: Twenty-four trauma-exposed women with BPD (10 with PTSD and 14 without) and 25 healthy controls underwent 3-dimensional structural magnetic resonance imaging of the amygdala and hippocampus and a clinical and neuropsychological investigation., Results: Compared with controls, patients with BPD and PTSD displayed significantly reduced amygdala (34%) and hippocampus (12%) size and significantly impaired cognition. Trauma-exposed patients with BPD but without PTSD also showed significantly reduced amygdala (22%) and hippocampus (11%) size but normal cognition. Amygdala and hippocampus size did not differ significantly between patients with and without PTSD., Limitations: The sample sizes of trauma-exposed groups are relatively small. A larger sample size may have revealed statistically significant differences in amygdala size between those with and without PTSD., Conclusion: Our results demonstrate strong amygdala size reduction in trauma-exposed patients with BPD with or without PTSD, much exceeding that reported for trauma-exposed individuals without BPD. Our data suggest that BPD is associated with small amygdala size. Furthermore, evidence is increasing that amygdala and hippocampus size reduction is not only due to PTSD, but also to traumatic exposure. more...

Objective: Trauma-exposed individuals with post-traumatic stress disorder (PTSD) display reduced amygdala and hippocampal size and impaired cognition. However, studies on trauma-exposed individuals with dissociative amnesia (DA) or dissociative identity disorder (DID) are lacking., Method: Twenty-three young women who had experienced severe childhood sexual/physical abuse, diagnosed with DA/DID or PTSD, and 25 healthy control subjects were subjected to 3D structural magnetic resonance imaging of amygdala and hippocampus and a clinical and neuropsychological investigation., Results: Compared with controls, trauma-exposed subjects with PTSD (n = 10) displayed significantly reduced amygdala and hippocampal size and significantly impaired cognition. By contrast, trauma-exposed subjects with DA or DID (n = 13) displayed normal amygdala and hippocampal size and normal cognition., Conclusion: We report for the first time volumetric results in subjects with DA/DID without PTSD as comorbid diagnosis. Our results indicate preserved amygdala and hippocampal size and preserved cognition in subjects with these disorders. more...

Different patients need different treatment, when in-door psychotherapy is the indication. Also, in the course of psychotherapeutic treatment a change of setting might be useful or necessary. It is shown how this knowledge can be put into work in a psychiatric-psychotherapeutic state hospital with obligatory service, using an integrated group of several specialized wards. more...

Objectives: In the present study we examined the facial affective behaviour of acute adult-onset traumatized patients versus childhood-onset traumatized patients. Furthermore, we analyzed whether a decrease in emotional numbing results from a reduction of symptoms. We used amnestic tendencies as a moderator variable., Methods: The facial affective behaviour was coded with the Emotional Facial Acting Coding System, an instrument for the registration of facial movements with emotional relevance. The facial affective behaviour of the patient's first and last EMDR sessions was compared., Results: Childhood-onset and acute adult-onset traumatized patients showed the same reduction of overall facial activity. We found significantly higher psychic complaints (global severity index) (SCL-90-R) in childhood-onset traumatized patients and no difference in amnestic tendencies (FDS) between the two groups. Childhood-onset traumatized patients showed higher values of derealisation (FDS)., Conclusions: The facial affective reduction remains constant over time. Also childhood-onset traumatized patients developed more psychic complaints and greater derealisation. more...

Recent evidence suggests that borderline personality disorder (BPD) is related to reduced size of the parietal lobe. Dissociative symptoms occur in the majority of individuals with BPD. Structural magnetic resonance imaging (3D-MRI) was used to assess volumes of the superior (precuneus, postcentral gyrus) and inferior parietal cortices in 30 young women with BPD who had been exposed to severe childhood sexual and physical abuse and 25 healthy control subjects. Compared with control subjects, BPD subjects had significantly smaller right-sided precuneus (-9%) volumes. The left postcentral gyrus of BPD subjects with the comorbid diagnosis of dissociative amnesia (DA) or dissociative identity disorder (DID) was significantly increased compared with controls (+13%) and compared with BPD subjects without these disorders (+11%). In BPD subjects, stronger depersonalization was significantly related to larger right precuneus size. Possibly, larger precuneus size in BPD is related to symptoms of depersonalization. Increased postcentral gyrus size in BPD may be related to the development of DA or DID in the presence of severe childhood abuse. more...

In a naturalistic outcome study, the authors evaluated the results of a specific psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder and concomitant borderline personality disorder, self-mutilating behavior, and depression. At admission, the frequency of self-mutilating behavior and the amount of inpatient treatment (an average of 68 days annually) of the sample was high, characterizing this patient group as "previously therapy resistant." Treatment outcome was assessed both at the end of treatment and in a 1-year follow-up. In comparison with a treatment-as-usual control group, the treatment program brought about significant and stable improvements both in trauma-specific symptoms (e.g. dissociation, intrusion, avoidance) and in general psychiatric symptoms (e.g., general symptom distress, frequency of self-mutilating behavior, number of hospitalizations). The frequency of inpatient treatments (hospitalizations) decreased dramatically (< 10 days annually; effect size: d = 2.88). more...

Individuals with borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) often experience dissociative symptoms. Evidence is increasing that stress-related hyperglutamatergic states may contribute to dissociative symptoms and neurodegeneration in temporo-parietal cortical areas. Seventeen young women with BPD who had been exposed to severe childhood physical/sexual abuse and presented with pronounced dissociative symptoms underwent (18)fluoro-2-deoxyglucose positron emission tomography (FDG-PET). Nine healthy, matched volunteers served as comparison subjects. Borderline subjects displayed reduced FDG uptake (as analyzed by SPM) in the right temporal pole/anterior fusiform gyrus and in the left precuneus and posterior cingulate cortex. Impaired memory performance among borderline subjects was significantly correlated with metabolic activity in ventromedial and lateral temporal cortices. Our results demonstrate regional hypometabolism in temporal and medial parietal cortical regions known to be involved in episodic memory consolidation and retrieval. Currently, the precuneus/posterior cingulate cortex is modeled as part of a network of tonically active brain regions that continuously gather information about the world around and within us. Decreased resting metabolic rate of these regions may reflect dissociative symptoms and possibly also identity disturbances and interpersonal difficulties of individuals with BPD. more...

Background: Evidence is accumulating that suggests borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) are related to small hippocampal size. Psychotic symptoms are frequent in both disorders. Psychotic spectrum disorders are known to be related to abnormalities of temporoparietal cortices., Methods: Using structural magnetic resonance imaging (3D-MRI), parietal cortex and hippocampal volumes were assessed in 30 young women with BPD who had been exposed to severe childhood sexual and physical abuse and in 25 healthy control subjects., Results: Compared with control subjects, BPD subjects had significantly smaller right parietal cortex (-11%) and hippocampal (-17%) volumes. The parietal cortex of borderline subjects showed a significantly stronger leftward asymmetry when compared with control subjects. Stronger psychotic symptoms and schizoid personality traits in borderline subjects were significantly related to reduced leftward asymmetry. Stronger trauma-related clinical symptoms and neuropsychologic deficits were significantly related to smaller hippocampal size., Conclusions: Our results are consistent with previous findings of small hippocampal size in BPD and PTSD. Reduced right parietal cortex size in individuals with BPD may reflect a neurodevelopmental deficit of the right hemisphere. more...

Actual results of brain research show that we might have more than one system to cope with distress. The most archaic one might be the system freeze/dissociation. The second one is the system attachment/relationship/herd/support. Articles by Allan N. Schore show that the central regulation of the self, the affects, and the interpersonal relations are impaired permanently by relational traumata/attachment traumata during early childhood. Jaak Panksepp differentiates the distress systems panic versus fear. On the one side we find the cluster panic--periaqueductal gray PAG--lateral septum--gyrus cinguli--glutamate--opioids--attachment--parasympathetic autonomic nerve system--trophotorphic state--hypometabolism--freeze reaction--dissociation, on the other side the cluster fear--enemy--sympathetic autonomic nerve system--ergotrophic state--hypermetabolism--fight and flight--cognition and learning. It can be helpful for therapy strategies to differentiate these systems. more...

Emotions can be assessed by means of different diagnostic methods, for example, by self-report instruments, ratings of facial expressions, or by projective techniques. This study presents an alternative approach: a computerized investigation of verbally expressed emotions by means of the Affective Dictionary Ulm (ADU; Dahl, Hölzer, & Berry, 1992), which was applied to responses in the Holtzman Inkblot Technique (HIT; Holtzman, 1988; Holtzman, Thorpe, Swartz, & Herron, 1961). A normal group (n = 30), patients with neurotic disorders (n = 30), borderline patients (n = 30), acute schizophrenics (n = 25), and chronic schizophrenics (n = 25) were compared in regard to verbally expressed emotions. According to the results, patients with neurotic disorders did not differ from the normal group in regard to verbally expressed emotions. Borderline patients expressed fear and emotions in general significantly more frequently than all other diagnostic groups. Furthermore, borderline patients differed in regard to specific emotions from patients with neurotic disorders, acute schizophrenics, and chronic schizophrenics. Acute schizophrenics did not differ from the normal group in regard to the expression of emotions, whereas chronic schizophrenics expressed anger, fear, anxiety, and emotions in general significantly less frequently than normals. By a discriminant analysis using verbally expressed emotions as predictors of the diagnosis, hit rates between 87% and 100% could be achieved. Furthermore, hypotheses about correlations between emotions on the one hand and internalized primitive object relations and bizarre-idiosyncratic thinking were tested empirically. Significant correlations could be demonstrated. These results support the validity of assessing emotions through a lexical content analysis of the HIT by use of the ADU. more...

Within the group of in-patients the patients exhibiting self-injurious behavior (SIB) have a significantly more disturbed body image--as assessed by the Holtzman Inkblot Technique (HIT)--than the patients who do not have this symptomatology. The more disturbed the body image, the higher the frequency of SIB. The method of self-injury most frequently reported is cutting the skin of the extremities, followed by burning the skin with cigarettes or open flames. This behavior serves the purpose of alleviating diffuse internal tension, of directing aggression inward, i.e. toward the self, and of terminating depersonalization states. During the act of self-mutilation, the perception of pain is lessened appreciably or inactivated. 48 percent of the female patients in this group suffered sexual abuse during childhood. more...