Early trauma and schizophrenia onset: preliminary results of an outpatient cohort in Brazil

Abstract Objectives To assess the prevalence of early trauma in individuals with onset of schizophrenia (SZ) at early (≤ 18 years) and adult (> 18 years) ages (EOP and AOP, respectively) and explore relationships between the onset of disease and clinical variables including traumatic events and psychotic and mood symptoms. Methods Subjects with SZ (n = 71) and EOP and AOP were compared for history of psychological trauma, sexual abuse, and physical punishment using the Early Trauma Inventory Self Report - Short Form (ETISR-SF). They were also compared for history of comorbidities and affective disorders using the Diagnostic Interview for Psychosis and Affective Disorders, the Positive and Negative Syndrome Scale, the Liebowitz Social Anxiety Scale, and the Calgary Depression Scale for Schizophrenia. Coefficients were calculated for correlations between scale results and disease duration. Results Early trauma was significantly associated with an early onset psychotic episode (r = -0.315, p < 0.01). General trauma and depressive symptoms in adulthood were also associated (r = 0.442, p < 0.01), as were social anxiety symptoms and early trauma (r = 0.319, p < 0.01). Total ETISR-SF scores and the physical abuse item were significantly higher in EOP than in AOP. In the hierarchical regression, PANSS scores were best predicted by a model including the duration of disease and age of first psychotic episode (R = 0.303). Conclusions Our results support the hypothesis that early trauma, including physical abuse, may play a relevant role in schizophrenia symptoms, such as an earlier psychotic occurrence, as well as features of other psychiatric disorders, such as greater severity of social anxiety and depression.

O paradoxo da unidade na dualidade: elementos para a clí­nica dos casos-limite / La paradoja de la unidad en la dualidad: elementos para la clí­nica de los casos lí­mite / The paradox of unity in duality: elements for the clinic of borderline cases

O artigo irá aprofundar o debate acerca dos primórdios da constituição psíquica e sua relação com a etiologia dos casos-limite. Assim, apesar de não se tratar de um artigo sobre a infância, eixo principal desta revista, ele aporta a uma discussão teórica sobre a constituição psíquica e sobre a importância das interações iniciais da vida na etiologia dos casos-limite. Em seu primeiro eixo, discutiremos os primórdios do psiquismo como fonte de subsídios para uma clínica dos casos-limite, já que estes casos são compreendidos como marcados por traumas no âmbito das primeiras relações de objeto. Observa-se, na relação transferencial com estes pacientes, mecanismos de defesa verticais, como cisões, mais frequentemente do que mecanismos de defesa horizontais, como o recalque. O recalque foi o conceito central para a constituição da técnica psicanalítica clássica. Este fato faz com que nos defrontemos com a necessidade de refinamento da técnica analítica para abordar de forma mais eficaz estes casos que desafiam a técnica clássica. Neste sentido, estudaremos, no segundo eixo deste trabalho, a contratransferência sob uma perspectiva da intersubjetividade e da valorização da qualidade da relação analítica.

El artículo busca profundizar en el debate acerca de los principios de la constitución psíquica y su relación con la etiología de los casos dudosos. Aunque su tema no es sobre la infancia, línea principal de esta revista, plantea una discusión teórica sobre la constitución psíquica y la importancia de los primeros años de vida en la etiología de los casos límite. En su primer eje central, se exponen los principios del psiquismo como una fuente de subvenciones para una clínica de casos límite, puesto que estos son marcados por traumas en el contexto de las primeras relaciones de objeto. Se observa en la relación de transferencia con estos pacientes los mecanismos de defensa vertical como divisiones más frecuentes que mecanismos de defensa horizontal, como la represión. La represión fue el concepto central para el establecimiento de la técnica psicoanalítica clásica. Este hecho nos hace abordar la necesidad de refinamiento de la técnica analítica para exponer más eficazmente estos casos que desafían a la técnica clásica. En este sentido, en el segundo eje de este trabajo, vamos a estudiar la contratransferencia bajo una perspectiva de la intersubjetividad y la apreciación de la calidad de la relación analítica.

The article will deepen the debate about the beginnings of psychic constitution and its relation to the etiology of borderline cases. So, although this is not an article about childhood, main axe of this journal, it brings a theoretical discussion about the psychic constitution and the importance of the early interactions of life in the etiology of borderline cases. In the first axe, early objects relationships and the reorganization of the initials attachments as a source of subsidies for a clinic of borderline cases will be discussed. These cases are understood as marked by early trauma in the context of the first object relationships. It is noted, in relation to transference with these patients, vertical defense mechanisms, such as splitting, emerge more frequently than horizontal defense mechanisms, such as repression. The repression was the central concept for the establishment of classical psychoanalytic technique. This fact makes us tackle the need for refinement of analytical technique for approaching more effectively these cases that challenge the classical technique. In this sense, we will study, in the second axis of this paper, the countertransference under a intersubjectivity perspective and the appreciation of the quality of the analytical relationship.

Reliability and Validity of the Early Trauma Inventory Self Report-Short Form among Korean Adolescents

OBJECTIVES: Experiencing early childhood trauma is related to multiple psychiatric problems in adolescents and adulthood. This study aimed to examine the reliability and validity of the Korean version of the Early Trauma Inventory Self Report-Short Form (ETISR-SF) among Korean adolescents. METHODS: A total of 86 adolescents aged 12–17 years (mean age 14.50±1.35 years, range 12–17) were assessed using the ETISR-SF. Other instruments, including the Children's Depression Inventory (CDI), the revised Children's Manifest Anxiety Scale (RCMAS), and the List of Threatening Experiences Questionnaire (LTE-Q), were used to assess clinical symptoms. After 2 months, 51 of the 86 participants were evaluated using the ETISR-SF to assess test-retest reliability. RESULTS: The Cronbach's coefficient alpha for the ETISR-SF was high (0.803). Adolescents with depressive disorder showed higher ETISR-SF scores compared to healthy controls. The ETISR-SF scores were correlated higher with the scores on the LTE-Q (r=0.485) than with the scores on the CDI or RCMAS (r=0.165 and 0.347, respectively). CONCLUSION: The ETISR-SF was temporally stable, showing acceptable reliability (r=0.776). These findings suggest that the Korean version of the ETISR-SF appears to be a reliable and valid instrument for the measurement of reported childhood trauma.

Clinical Characteristics of Panic Disorder with Comorbid Major Depressive Disorder

OBJECTIVES: The objective of this study was to investigate the differences in sociodemographic and clinical characteristics, temperaments, and quality of life between panic disorder (PD) patients with and without major depressive disorder (PD+MDD and PD−MDD patients, respectively). METHODS: We compared 411 PD−MDD and 219 PD+MDD patients. All patients who were drug-free for at least 1 month were assessed at initial outpatient visits before the administration of medication. The following instruments were used for assessment: the NEO Personality Inventory-Neuroticism (NEO-N) ; the Temperament and Character Inventory-Harm Avoidance (TCI-HA) ; the State-Trait Anxiety Inventory (STAI) ; the Intolerance of Uncertainty Scale-Short (IUS); the Anxiety Sensitivity Index-Revised (ASI-R); the Beck Depression Inventory (BDI) ; the Beck Anxiety Inventory (BAI); the Penn State Worry Questionnaire (PSWQ) ; the Generalized Anxiety Disorder for 7 item (GAD-7) ; the Albany Panic and Phobia Questionnaire (APPQ) ; the Panic Disorder Severity Scale (PDSS) ; the Early Trauma Inventory Self Report-Short Form (ETISR-SF) ; the Scale for Suicidal Ideation (SSI) ; the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) ; the Sheehan Disability Scale (SDS) ; and the Short Form health survey (SF-36). RESULTS: Compared to the PD−MDD patients, the PD+MDD patients were younger and more likely to be unmarried. They showed higher rates of unemployment, lower levels of education and income, younger age of onset, more previous suicide attempts, a greater incidence of agoraphobia, and more previous treatments. The PD+MDD patients showed significantly higher scores on the NEO-N, the TCI-HA, the STAI, the IUS, the ASI-R, the BDI, the BAI, the PSWQ, the GAD-7, the APPQ, the PDSS, the ETISR-SF, and the SSI. In addition, the PD+MDD patients showed significantly lower quality of life than did the PD−MDD patients. In contrast with previous studies, we observed no significant differences between the two groups in terms of gender, duration until treatment, and psychiatric comorbidities. CONCLUSIONS: This study showed that the PD+MDD patients have more early trauma experiences, higher levels of anxiety-related temperaments, more severe panic and depressive symptoms, and lower quality of life than the PD−MDD patients.

Mediating effects of personality traits between early trauma and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder / 中国心理卫生杂志

Objective:To explore the tri-relationship among the different types of early trauma,personality traits and obsessive-compulsive symptoms,and to analysis the mediating effects of maladaptive personality traits between early trauma and obsessive-compulsive symptoms.Methods:A total of 147 obsessive-compulsive patients were selected.The Yale-Brown obsessive-compulsive scale (Y-BOCS) was used to measure the degree of obsessive-compulsive symptoms,the Early Trauma Inventory Short Form (ETI-SF) was used to measure the early trauma experience,the NEO Five-Factor Inventory (NEO-FFI) was used to measure the personality characteristics.Results:The emotional abuse subscale scores of ETI-SF were positively correlated with the total scores of Y-BOCS (r =0.19;P ＜0.05),the neuroticism scores of NEO-FFI were positively correlated with the total scores of Y-BOCS (r =0.31,P ＜0.001),while the agreeableness scores of NEO-FFI were negatively correlated with the total scores of Y-BOCS (r =-0.18,P ＜0.05).The pathway analysis showed the indirect effects from emotional abuse to Y-BOCS via neuroticism were 0.107 (95％ CI:0.04-0.19,P ＜ 0.05),the neuroticism play a completely mediated role.Conclusion:Early emotional abuse may be positively correlated with obsessive-compulsive symptoms,while the neuroticism may play a completely mediating role between the early emotional abuse and obsessive-compulsive symptoms.

Early emotional trauma in alcohol-dependent men: prevalence, associations and predictive value

Abstract Background Several studies have indicated that early emotional traumas (EET) are highly prevalent in alcohol-dependent individuals, and that these traumas work as risk factors for the development of this disorder. Objective The aim of the current study is to evaluate the EET associations and predictive value regarding active alcohol dependence among male individuals from a developing country. Methods The sample consisted of two groups. The first was composed by adult male individuals diagnosed as alcohol dependents (AG, N = 110), and the second with no alcohol abuse and/or dependence diagnosis (CG, N = 110). Both groups were evaluated using Structured Clinical Interview based on the Diagnostic and Statistical Manual of Mental Disorders; Early Emotional Trauma Inventory; and a sociodemographic questionnaire. Results All trauma subtypes (general, physical, emotional and sexual) were more prevalent among AG than CG. However, only traumas categorized as general and emotional worked as risk factor for alcoholism development and they increased the chances to develop this disorder by 1.45 and 1.23 times, respectively. Discussion EETs are important factors that should be taken into account in interventions that aim to prevent, minimize and/or treat this clinical condition and its impact and/or severity, especially in countries such as Brazil.

Eraly trauma experience is associated with obsessive-compulsive disorder / 中华行为医学与脑科学杂志

Objective To compare the difference of early trauma experience between early-onset and late-onset obsessive-compulsive disorder(OCD),and the kinds of early trauma in the cause of OCD. Methods Three hundred and twenty-six patients with obsessive-compulsive disorder and 480 healthy con-trols were enrolled. Early Trauma Inventory-Short Form ( ETI-SF) was applied to assess the early trauma ex-perience,compare the difference of early trauma experience between early-onset ( n=138) and late-onset ( n=188) OCD,and the kinds of early trauma in the cause of OCD. Results There were significant differences in the early trauma experience between obsessive-compulsive disorder group and control group((3.90±3.61) vs (1.88±2.61), P<0.01).Scores of physical((1.12±1.38) vs (0.71±1.23), P=0.001),emotional((1.58± 1.71) vs (0.42±1.01), P<0.01),and sexual abuse((0.27±0.59) vs (0.09±0.36), P=0.001),and a gener-al traumatic experience((0.94±1.17) vs (0.66±1.09), P<0.01) were significant difference between patients and controls. Except sexual abuse((0.30±0.66) vs (0.24±0.67), P=0.42),there were significant differ-ences in the early trauma between early-onset and late-onset OCD((5.12±3.58) vs (3.01±3.38), P<0.01), especially emotional abuse((2.18±1.76) vs (1.12±1.53), P<0.01).247(75.8%) OCD patients and 79(57. 9%) healthy controls experienced early trauma(χ2=21.48, P<0.01). Experiencing one kind of early trau-ma,the prevalence of OCD was 39.1%,two kind was 61.0%,three kind of early trauma was 65.8%,and ex-periencing four or more kind of early trauma,the prevalence of OCD was up to 84.4%. Conclusion OCD patients have much more early trauma,especially early-onset OCD. Experiencing more kind of early trauma, and the prevalence of OCD higher may associated with the development of obsessive-compulsive disorder. It is important to consider the role of childhood trauma in the prevention and treatment of OCD.

Comparison of Early Trauma History between Young/Middle Adulthood Patients and Earlier/Later Older Adulthood Patients with Panic Disorder

OBJECTIVE: To investigate the early trauma history between young/middle adulthood patients and earlier/later older adulthood patients with panic disorder (PD). METHODS: 216 patients with PD and 76 healthy controls (HCs) were included for analysis. Patients with PD were operationally dichotomized into two groups of young/middle adulthood (age below 50 years) and earlier/later older adulthood (age 50 years or over) to compare the early trauma history between two groups. Data of sociodemographic factors, self-reported shortened form of the Early Trauma Inventory (ETI), and the Albany Panic and Phobia Questionnaire (APPQ) were analyzed. RESULTS: Patients with PD showed higher scores of ETI than HCs. Young/middle adulthood PD showed statistically significantly higher levels of general trauma (t=-2.088, p=0.041), physical abuse (t=-2.456, p=0.014), emotional abuse (t=-3.690, p=0.000), and total scores of trauma (t=-3.534, p=0.001) except sexual abuse. In the young/middle adulthood PD group, ETI scores were significantly correlated with APPQ scores while no significant correlation with ETI was found in earlier/later older adulthood PD. CONCLUSION: These results show that PD is statistically associated with early trauma history and that early trauma history is more significantly related with PD in young/middle adulthood than earlier/later older adulthood. These findings suggest that the age factor should be considered in clinical practice for patients with PD.

Sofrimento narcísico: diálogo com um jovem colega / Narcissistic suffering: dialogue with a younger colleague / Sufrimiento narcisista: diálogo con un joven colega

Na forma de diálogo com um jovem colega, a autora procura apresentar o sofrimento narcísico tanto de um ponto de vista clínico quanto teórico. Entende que esse sofrimento está ligado às dificuldades na constituição do eu, que se fragiliza porque é obrigado a recorrer a defesas primárias - clivagens e identificações com o agressor - para sobreviver ao trauma precoce. Para além das definições clássicas de trauma, a autora sugere que este pode se originar em um vínculo primário com características tanáticas: a figura materna ataca inconscientemente o eu da criança por meio de identificações projetivas. Por fim, mostra como a fragilidade narcísica se manifesta na clínica por meio de um funcionamento psicótico, no qual se articulam falhas diversas na constituição das funções egoicas, dificuldade em manter a integridade das fronteiras do eu e ataques do supereu cruel contra o eu...

In this paper, written as a dialogue with a younger colleague, the author presents narcissistic suffering both from a clinical and theoretical point of view. She understands that this suffering relates to problems in the constitution of the ego, which is weakened by primary defenses - splitting and identification with the aggressor - used for surviving early trauma. In addition to classical definitions of trauma, the author suggests that it may originate within a primary bond with tanatic features, when mother communicates with her child through projective identifications. Finally, she shows how narcissistic fragility manifests in the clinic by means of psychotic functioning, in which we can recognise impaired ego functions, difficulty in maintaining ego boundaries, and cruel superego attacks against the ego...

En forma de diálogo con un joven colega, la autora visa presentar el sufrimiento narcisista tanto desde el punto de vista clínico como teórico. Considera que este sufrimiento está vinculado a las dificultades en la constitución del yo, que se debilita porque se ve obligado a recurrir a defensas primitivas para sobrevivir a un trauma precoz. Además de las definiciones clásicas de trauma, la autora sugiere que éste puede originarse en un vínculo primario con características tanáticas donde la figura materna ataca inconscientemente el yo del niño a través de identificaciones proyectivas. Finalmente, muestra como la fragilidad narcisista se manifiesta en la clínica a través de un funcionamiento psicótico en el cual se reconoce la articulación entre defectos en la constitución de las funciones egoicas, dificultad de mantener la integridad de las fronteras del yo y ataques del superyo cruel contra el yo...

The Relationships between Early Trauma, Dissociation, and Alexithymia in Alcohol Addiction

OBJECTIVE: Addiction is often considered a dissociative behavior that is related to alexithymia and developmental trauma. The study aims were to explore the relationships between early trauma, alexithymia, and dissociation. METHODS: A total of 117 (males=60; females=57) alcohol-addicted individuals and 117 healthy individuals (males=60; females=57) were administered a series of self-report questionnaires that assess traumatic experiences, alexithymia, and pathological dissociation. RESULTS: Correlation analyses indicated significant correlations between alexithymia, dissociation, and trauma and a significant difference between the target and control groups, with higher alexithymia and dissociation scores in the target group. CONCLUSION: These findings suggest that trauma, alexithymia, and dissociation are predictors of alcohol addiction.

O a posteriori transferencial dos traumas do início da vida / The a posteriori transferencial of traumas of the beginning of the life

O a posteriori é uma das únicas noções psicanalíticas que permitem compreender os mecanismos da mudança psíquica. Muitas vezes confundida com uma simples significação de retrospectiva, trata-se, de fato, de noção complexa que envolve a concepção psicanalítica da temporalidade e a teoria do trauma. Em que medida o tratamento psicanalítico, a experiência da transferência, é capaz de pôr em jogo novamente os traumas do início da vida, de produzir sobre estes um efeito de a posteriori, e permitir mudança psíquica em relação às camadas mais primitivas do psiquismo?.

The transferential a posteriori of early traumas. The a posteriori is one of the few psychoanalytic concepts to allow understanding the mechanisms of psychic change. Often mistaken as a simple meaning hindsight, it is actually a complex concept that involves the psychoanalytic conception of temporality and the theory of trauma. To what extent is psychoanalysis, the experience of transference, able to bring early traumas into play, to produce a hindsight effect and to allow psychic change related to the most primitive layers of psyche?.

Trauma precoce e transtornos de humor em jovens / Early trauma and mood disorders in youngsters

OBJETIVO: Verificar vivências precoces de abuso e negligência na infância entre jovens com transtorno bipolar (TB), transtorno depressivo maior (TDM) e controles populacionais. MÉTODO: Estudo de caso-controle aninhado a um estudo transversal de base populacional. A confirmação do diagnóstico foi realizada por meio de entrevista clínica estruturada para transtornos de eixo I do DSM-IV (SCID) e os eventos traumáticos foram verificados pelo Questionário sobre traumas na infância (CTQ). RESULTADOS: A amostra foi composta por 231 jovens, sendo 95 indivíduos no grupo controle, 82 com TDM e 54 com TB (32 do tipo I e 22 do tipo II). A prevalência de trauma na infância foi de 42,2%, sendo 54,7% entre aqueles com TB, 62,2% entre os jovens com TDM e 18,1% entre o grupo controle. Os jovens com TB ou TDM apresentaram maiores médias no CTQ total e entre seus componentes quando comparados aos jovens do grupo controle, exceto o componente abuso sexual, em que se observou diferença estatística apenas entre o grupo controle e o grupo de jovens com transtorno bipolar. CONCLUSÃO: O relato de vivências traumáticas precoces foi mais presente entre os jovens com transtornos de humor do que na população geral, confirmando o que a literatura traz sobre o tema. Nesse sentido, as vivências de trauma na infância parecem contribuir para o aparecimento dos transtornos de humor.

OBJECTIVE: To verify early experiences of childhood abuse and neglect among young with bipolar disorder (BD), major depression (MDD), and controls. METHOD: Case-control study nested to a population-based cross-sectional study. The diagnosis was performed via the structured clinical interview for DSM-IV Axis I Disorders (SCID). Traumatic events were analyzed using the Portuguese version - Questionário sobre Traumas na Infância (CTQ) - based on the Childhood Trauma Questionnaire. RESULTS: The sample comprised 231 adolescents with 95 individuals in the control group, 82 with MDD and 54 with BD (32 of type I and 22 type II). The prevalence of trauma or violence in childhood was 42.2%; among those, 54.7% had BD, 62.2% had MDD and 18.1% were in the control group. Young people with BD or MDD obtained higher means in total CTQ and among their components when compared with those in the control group. DISCUSSION: Reports on early traumatic experiences were more frequent among young people with mood disorders than in the general population, corroborating the literature on the subject. In this sense, the traumatic experiences during childhood seemed to contribute to the onset of the disorder.

The Early Trauma Inventory Self Report-Short Form: Psychometric Properties of the Korean Version

OBJECTIVE: Experiencing traumatic events in childhood is related to various psychiatric problems in adulthood, and a comprehensive tool for measuring childhood trauma is necessary in this field. This study aimed to examine the psychometric properties, and factor structure of the Korean version of the Early Trauma Inventory Self Report-Short Form (ETISR-SF). ETISR-SF measures the childhood trauma, including physical, and emotional sexual abuse, as well as general traumas. METHODS: A clinical and nonclinical samples comprising of 97 subjects from a local community, and 207 patients with the ETISR-SF, were assessed. Other tools, including the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) were used to assess clinical symptoms. Additional data from 69 college students was used to examine the test-retest reliability. RESULTS: The original four-factor model was supported by the confirmatory factor analysis scale [chi2 (351, n=304)=3374.025, p<0.001, TLI=0.969, CFI=0.972, RMSEA=0.030]. The ETISR-SF was found to be a reliable instrument (Cronbach's alpha=0.869). Comparison of the ETISR-SF scores discriminated the clinical group from that of the control group. The measure showed good convergent and divergent validity, in that the scores were correlated higher with the scores on the CTQ-SF (0.691) than with the scores on the BDI or BAI (0.424, 0.397 respectively). The ETISR-SF was found to be temporally stable, showing the moderate to high correlation (0.844). CONCLUSION: These findings suggest that the Korean version of the ETISR-SF appears to be a reliable and valid instrument for the measurement of reported childhood trauma.

Association study between early trauma experience and obsessive-compulsive disorder / 中华行为医学与脑科学杂志

Objective To investigate the association between early trauma experiences and obsessivecompulsive disorder (OCD). Methods One hundred and eighty-five patients who met with OCD diagnosis of DSM-Ⅳ and one hundred and thirty-two healthy controls were recruited. Early trauma experience of all participants was assessed with Early Trauma Inventory-Short Form (ETI-SF) ,and severity of symptoms of OCD patients was evaluated with Yale-Brown Obsessive-Compulsive Severity Scale (Y-BOCS). Results When compared with controls, OCD group showed significantly higher in ETI-SF total score (3.55 ± 3.29 vs 1.51 ± 1.98, P ＜ 0. 01 ) and had greater in general trauma (0.89 ± 1.10 vs 0. 43 ±0.77, P＜0.01 ) ,physical abuse (0.98 ± 1.31 vs 0.65 ±1.04, P=0. 016),emotional abuse(1.43 ±1.61 vs 0.38 ±0.89, P＜0. 01),and sexual abuse(0.24 ±0.59 vs 0.06 ±0.30, P＜0. 01 ). Female OCD patients reported more sexual abuse than male patients(0.33 ±0.69 vs0. 16 ± 0.45, P = 0.049) . There was a negative correlation between onset age of obsessive symptoms and early trauma experiences(P ＜ 0. 01 ), except sexual abuse experiences (P = 0. 10). Conclusion OCD patients have much more childhood traumas, and the more trauma experiences are,the earlier onset of OCD is, which may associated with the development of obsessive-compulsive disorder.