Coping Styles and Defense Mechanisms Mediate Associations Between Exposure to Adverse Childhood Experiences and CPTSD Symptoms in Faroese Adolescents.

Background: The experience of several adverse childhood experiences (ACEs) has been shown to be associated with Post-Traumatic Stress Disorder (PTSD) and Disturbances in Self-Organization (DSO) symptoms among adolescents. Defense mechanisms and coping styles are psychological processes involved in the association of ACEs with PTSD and DSO symptoms. However, there is a lack of research on the joint association of these variables among Faroese adolescents. Aim: The aim of this study was to analyze the effect of exposure to ACEs on PTSD and DSO symptoms trough the indirect effect of defense mechanisms and coping styles in a sample of Faroese adolescents. Method: Six hundred and eighty-seven Faroese adolescents were recruited from 19 schools. Participants responded to validated self-report questionnaires. A multiple step mediation and a serial mediation methodology were conducted through structural equation modeling. Results: Exposure to ACEs was linked to PTSD and DSO symptoms through the indirect effect of immature defense mechanisms, emotional coping, and detachment coping. Exposure to ACEs was linked to PTSD symptoms through rational coping. Conclusions: The results suggest a mutual relationship between defense mechanisms and coping styles in coping with multiple adversity among adolescents.

A Latent Class Analysis of Adverse Life Events for Kenyan Adolescents.

Extant evidence indicates that exposure to adverse childhood experiences (ACE) tend to cluster among children and adolescents. Considering that adolescents from African countries present higher risk of being exposed to multiple ACE compared to other countries, the identification of victimization profiles in this population is clearly warranted. The aim of this study was to determine meaningful clusters of individuals with similar experiences of ACE in a sample of Kenyan adolescents. Latent class analysis (LCA) was conducted to identify latent classes of exposure to ACE. In addition, the relationships between the latent classes and gender, parental education, living arrangements and diagnosis of post-traumatic stress disorder (PTSD) were estimated. A three-class solution was found to be the best description of ACE, and the classes were labelled ''Low Risk'', ''Intermediate Risk'', and ''High Risk''. Compared with the Low-Risk class, the High-Risk class was found to be significantly more likely to have a diagnosis of PTSD and being a female may be an antecedent risk factor for high exposure to ACE. The Intermediate Risk class was significantly less likely to have parents with high school or college education. This paper indicates that Kenyan adolescents present higher risk of being exposed to multiple ACE and that trauma research may turn its focus on the individual as the unit of analysis rather than traumatic events.

Exploring Independent and Cumulative Effects of Adverse Childhood Experiences on PTSD and CPTSD a Study in Ugandan Adolescents.

Exposure to adverse childhood experiences (ACEs) is related to higher morbidity and mortality among adolescents. The present study analyzed the independent and cumulative effects of ACE exposure on the likelihood of PTSD and a CPSTD diagnosis in Ugandan adolescents. A sample of 401 schoolchildren participated in the study. The primary aim was to collect information on ACEs, PTSD, CPTSD, and attachment styles among adolescents living in different countries. It was found that exposure to 2-3 ACEs and exposure to 4-5 ACEs were significantly associated with PTSD diagnosis, while exposure to sexual abuse, bullying, threats of violence, and near-drowning were significantly related to CPTSD diagnosis. Fearful attachment style was significantly associated with PTSD diagnosis. The results propose that biological, psychological, and social issues interact and contribute to the differential prevalence of ACE, attachment styles, and PTSD/CPTSD. This study underscores the importance of addressing childhood-averse and traumatic experiences as a public health priority in Uganda.

Attachment Anxiety and Dissociation Mediate Associations Between Polytrauma and Somatization in Kenyan Adolescents.

The experience of several potentially traumatic events (PTE) is a risk factor for higher somatization symptoms severity among adolescents. Attachment orientations and dissociation may influence the link between exposure to PTE and somatization symptoms severity. We analyzed the associations between direct exposure to PTE and somatization symptoms in Kenyan adolescents and explored the mediating role of attachment orientations and dissociation symptoms in the associations between direct exposure to PTE with somatization symptoms severity. A sample of 475 Kenyan adolescents completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modeling employing Preacher and Hayes' procedures (2008). Attachment anxiety and dissociation symptoms mediate the association between direct exposure to traumatic events and somatization symptoms. Higher exposure to traumatic events was significantly associated with higher attachment anxiety levels, which was associated with higher levels of dissociation symptoms, which was then associated with higher somatization symptoms severity. High levels of attachment anxiety and dissociation might aggravate somatization symptoms differently according to sex, which might be seen as a psychological distress mechanism subsequent to exposure to multiple PTE in African adolescents.

Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model.

BACKGROUND: Adolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms. METHODS: We analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008). RESULTS: Immature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters. CONCLUSIONS: Maladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.

Attachment mediates the impact of previous trauma on posttraumatic symptoms during the COVID-19 pandemic.

OBJECTIVE: There is some evidence that individuals previously been exposed to traumatic events may present higher vulnerability to PTSD because of the COVID-19 outbreak. Furthermore, exposure to traumatic events may cause changes in attachment orientations which might influence levels of PTSD symptoms (PTSS) in populations subjected to "stay-home" measures related to the COVID-19 outbreak. METHOD: The present study analyzed interrelations of number of traumatic events, attachment orientations, and PTSS during the COVID-19 in a group of Portuguese participants. The study comprised 2 time points: 3 days after the beginning of the lockdown (time 1) and 3 days before the end of the lockdown (time 2). Sample included 736 Portuguese participants who completed the questionnaires at both time points. Data were collected through a survey that included self-reported questionnaires. Structural equation modeling was conducted to examine if effect of number of traumatic events on PTSS at T2 was mediated attachment orientations at T1. RESULTS: Higher exposure to traumatic events was associated with higher levels of PTSS. Attachment anxiety at T1 partially mediated the effect of number of traumatic events on PTS at T2. CONCLUSION: Findings suggest that PTSS is a risk induced by the establishment of a total lockdown and that individuals with higher exposure to traumatic events and higher attachment anxiety levels present increased risk of higher levels of PTSS at the end of the lockdown. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Telework and Mental Health during COVID-19.

COVID-19 has come to change societal organization. Due to lockdowns, work typologies have been rethought and telework has gained strength. However, the impact of the constant use of information and communication technologies on the mental health of workers needs to be considered. We aimed to investigate the impact of different work conditions on mental health, to which end we disseminated an online questionnaire during lockdowns to assess imagined surveillance, mobile maintenance expectation, communication overload, feelings of entrapment, depression, anxiety, stress, and flourishing in four groups (employed in telework, employed on-site, employed in layoff, and unemployed). We computed mean comparisons and serial mediations. We show that depression and anxiety were more prevalent in women; parents flourished more than people without children; and people with a higher level of education feel more entrapment. Crucially, we show that telework was associated with imagined surveillance and communication overload, which mediated the association with mobile maintenance expectations and entrapment (which was exacerbated by parenthood), impacting mental health and the quality of life. However, this was also partially observed in the remaining work conditions. Finally, flourishing worked as a protector against mental health issues in all work conditions. We discuss this given the massification of digital migration.

Worldviews about the self mediate the impact of immature and mature defense styles on posttraumatic symptoms in bereaved parents.

The present study analyzed the mediating role of assumptive worldviews on the effect of defense mechanisms on post-traumatic stress symptoms (PTS) in bereaved parents. Sample included a convenience sample of 153 bereaved parents and a control group of 157 nonbereaved parents. Structural equation modeling was conducted to examine our hypotheses. Bereaved parents presented higher levels of PTS and more negative assumptions compared to nonbereaved participants. Worthiness of the self mediated the effect of both immature and mature defense styles on PTS levels, and neurotic defense style directly predicted PTS levels.

Attachment and social support mediate associations between polyvictimization and psychological distress in early Uganda and Kenya adolescents.

BACKGROUND: There is strong evidence that the experience of several potentially traumatic events (polyvictimization) is a risk factor for posttraumatic stress disorder (PTSD) and psychological distress among adolescents. The identification of the variables that influence the link between polyvictimization and PTSD and other psychiatric symptoms is warranted. OBJECTIVE: We analyzed the associations between polyvictimization, PTSD symptoms (PTSS) and psychiatric symptoms in Kenya and Uganda adolescents, and explored the mediating roles of attachment orientations and perceived social support in the associations between polyvictimization, PTSS and psychiatric symptoms among adolescents from lower-middle-income countries (LALMIC). PARTICIPANTS AND SETTING: A sample of 481 Kenyan adolescents (M = 16.28; SD = 1.878) and a sample of 408 Uganda adolescents (M = 15.95; SD = 1.377) completed validated self-report questionnaires. METHODS: Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008). RESULTS: Polyvictimization was related to higher PTSS and psychiatric symptoms. Importantly, polyvictimization was significantly linked to high attachment anxiety, which was linked with low perceived social support, which in turn was linked with high PTSS levels and psychiatric symptoms. CONCLUSIONS: High levels of attachment anxiety might be connected with lack of perceived social support, which might be seen as a possible psychological distress mechanism subsequent to exposure to polyvictimization in adolescence from LALMIC.

Pathways Between Combat Stress and Physical Health Among Portuguese War Veterans.

In this study, I explored the experience of both physical and psychological chronic illnesses among a sample of Portuguese war veterans. Twenty suffered from chronic posttraumatic stress disorder (PTSD; unrecovered) and 20 had remission from PTSD (recovered), and all participants suffered from a chronic physician-diagnosed medical disorder. Two semistructured interviews were conducted. Analysis of the interviews was conducted using the Thematic and Categorical Analysis. Unrecovered participants reported higher moral injury, discrepancy between pre- and postwar identity, medication side effects, and lower repertoire of coping strategies, and verbalized that treatment care plan triggers posttraumatic symptoms. Recovered participants reported stronger moral repair, sense of continuity between pre- and postwar identity, and wider repertoire of coping strategies, well-being. Veterans' adjustment to chronic physician-diagnosed medical disorders is related to the accommodation of war traumatic experiences within existing self-schemas to restore a sense of continuity between veterans' pre- and postwar identity.

Mental strategies as mediators of the link between attachment and PTSD.

The authors analyzed the relationship between attachment dimensions (avoidance and anxiety) and posttraumatic stress disorder (PTSD) symptoms through the mediation of the mental strategies organization, that is, behavioral and intrapsychic strategies used to cope with traumatic events and symptoms, among a sample of war veterans. Sample was composed of Portuguese war veterans (N = 60): 30 veterans suffered from chronic PTSD (nonrecovered) and 30 veterans had remission from PTSD (recovered). Assessment of mental strategies was retrieved from 1 interview assessed by 3 judges, and attachment patterns and PTSD symptoms were assessed through self-report measures. Path coefficients of direct and total effects were estimated. Results showed lower mental strategies organization and higher attachment anxiety among nonrecovered participants. Indirect effect of attachment anxiety on PTSD symptoms through mental strategies was significant when no variable was entered as covariate. Indirect effect of attachment avoidance on PTSD symptoms through mental strategies organization was not significant. The authors discussed that the development of more mature mental strategies play a central role in working with veterans to cope with posttraumatic symptoms. (PsycINFO Database Record

Portuguese War Veterans: Moral Injury and Factors Related to Recovery From PTSD.

This study explored the factors to which a sample of Portuguese war veterans attributed their recovery from posttraumatic stress disorder (PTSD). Participants were a sample of veterans (N = 60) with mental sequelae of the Portuguese Colonial War: 30 suffered from chronic PTSD (unrecovered) and 30 veterans with remission from PTSD (recovered). Two semistructured interviews were conducted. Analysis of the interviews was conducted using the Thematic and Categorical Analysis. Results showed that unrecovered participants reported higher postwar betrayal, appraisal of hostile societal homecoming, social stigmatization, lack of personal resources (mental fatigue and restriction of coping strategies), and reduced perceived social support. Recovered participants verbalized some capability for self-awareness of their own mental states and/or awareness of others' mental states (mentalization ability), a wider repertoire of coping strategies, and higher perceived social support. The authors discussed that recovery from PTSD among veterans can be related to the assimilation of moral injury by developing higher mentalization abilities.

The effects of combat exposure, abusive violence, and sense of coherence on PTSD and depression in Portuguese colonial war veterans.

We analyzed the effects of 3 war components-combat exposure (CES), observation of abusive violence (OBS), and participation in abusive violence (PARTC)-and sense of coherence (SOC) on the development of both posttraumatic stress disorder (PTSD) and depression among a sample of war veterans. We also analyzed the role of SOC as a mediator of the effects of CES, OBS, and PARTC on both depression and PTSD symptoms. Sample was composed of 120 Portuguese Colonial War veterans. A binomial logistic regression analysis was performed to determine the effects of these variables on depression and PTSD diagnosis. Mediation test was performed by conducting several hierarchical regression analyses. Results showed that OBS and PARTC, and lower levels of SOC were associated with increased odds for exceeding the clinical cutoff scores for diagnosis of depression. All variables were associated with increased odds for exceeding the clinical cutoff scores for diagnosis of PTSD. In mediation analysis, at first step, PARTC was not a significant predictor of both PTSD and depression symptoms, and PARTC did not enter in subsequent analysis. SOC was a full mediator of the effects of OBS and CES on both depression and PTSD symptoms. We propose that treatment of war veterans should aim the reconciliation of traumatic incongruent experiences in veterans' personal schemas to strengthen veterans' sense of coherence, especially for those exposed to acts of abusive violence.

O estudo de caso como metodologia de investigação psicanalítica / Case study as a methodology for psychoanalytic research

Registram-se divergências epistemológicas relativas ao estudo de caso como método adequado à validação da teoria psicanalítica entre uma posição que compreende a investigação psicanalítica como o estudo dos significados e método apropriado à investigação das teorias psicanalíticas e uma abordagem que privilegia a adoção de um caráter científico, baseando-se na integração de metodologias de investigação apoiada em lógicas de relações probabilísticas de causalidade. A investigação psicanalítica, de acordo com modelos de causalidade, parece não considerar a especificidade do seu campo de estudo, o inconsciente, requerendo uma abordagem específica de investigação. Neste trabalho os autores propõem a utilização do estudo de caso como metodologia de investigação psicanalítica científica, através da realização de supervisão clínica e da análise da contratransferência como metodologias geradoras de evidência científica para a teoria psicanalítica(AU)

Epistemological differences regarding case study as an appropriate validation method of psychoanalytic theory have been observed, from a position that understands psychoanalytic research as the study of meanings, and the appropriate method to research psychoanalytic theories; and an approach that favors the adoption of a scientific character, based on the integration of research methodologies supported on logics of probabilistic causal relations. The psychoanalytic investigation, according to causal models, does not seem to consider the specificity of its study field, the unconscious, requiring a specific approach to research. In this work the authors propose the use of case study as a methodology for psychoanalytic scientific research, by means of clinical supervision and the analyses of countertransference as methodologies that generate scientific evidence for the psychoanalytic theory(AU)

Existen diferencias epistemológicas en relación con el estudio de caso como método apropiado para validar la teoría psicoanalítica, entre una posición que comprende la investigación psicoanalítica como el estudio de los significados y el método adecuado para la investigación de las teorías psicoanalíticas y un enfoque a favor de la adopción de un carácter científico, basado en la integración de metodologías de investigación basándose en relaciones de causalidad lógica probabilística. La investigación psicoanalítica de acuerdo con modelos de causalidad no parece tener en cuenta la especificidad de su campo de estudio, el inconsciente, que requiere un método específico para su investigación. En este trabajo los autores proponen el uso del estudio de caso como metodología de la investigación psicoanalítica científica, mediante la realización de la supervisión clínica y el análisis de la contratransferencia como metodologías que generan evidencia científica para la teoría psicoanalítica(AU)

Cross-cultural adaptation of the Operationalized Psychodynamic Diagnosis (OPD-2) in Portugal / Adaptação transcultural do Diagnóstico Psicodinâmico Operacionalizado (OPD-2) em Portugal

Background: The Operationalized Psychodynamic Diagnosis (OPD-2) is internationally established as one of the major instruments available for clinical diagnosis and scientific research, being frequently used as an auxiliary tool in the selection of therapeutic interventions. Aims: 1) To describe the methodological aspects of the adaptation of the OPD-2 into Portuguese (Portugal and Brazil). 2) To assess inter-rater agreement for the different axes of the instrument when scoring clinical interviews. Method: The cross-cultural adaptation involved translation of the instrument by different independent translators, whose versions were compared in discussion groups in order to develop a final Portuguese version. In the presence of discrepancies regarding the translation of original concepts, the authors of the original instrument were contacted for clarification. Five interviews were used to assess inter-rater agreement. Each subject participated in two interviews, conducted by an experienced clinical psychologist. The interviews were recorded, transcribed and then analyzed by the principal investigator and by three independent examiners. Results: Axis IV (Structure) presented the highest inter-rater agreement (78%). Axes I (Experience of illness and prerequisites for treatment) and III (Conflict) showed the lowest inter-rater agreement results (66 and 57.7%, respectively). Conclusions: Our results point in the same direction as previous studies conducted in other countries. In our sample, the OPD-2 presented an acceptable inter-rater agreement; however, further studies are needed to assess the instrument's reliability (AU)

Introdução: O Diagnóstico Psicodinâmico Operacionalizado (OPD-2) constitui-se internacionalmente como um dos principais instrumentos de diagnóstico clínico e de investigação científica, sendo frequentemente utilizado como uma ferramenta auxiliar na seleção de intervenções terapêuticas. Objetivos: 1) Descrever os aspetos metodológicos do processo de adaptação transcultural do OPD-2 para a língua portuguesa (Portugal e Brasil). 2) Avaliar a concordância inter-avaliadores para os diferentes eixos do instrumento na cotação de entrevistas clínicas. Método: A adaptação transcultural envolveu a tradução do instrumento por vários tradutores independentes. As versões resultantes foram confrontadas em grupos de discussão para a redação da versão final do instrumento em português. Na presença de divergências relacionadas à tradução de alguns conceitos originais, os autores do instrumento original foram contactados para esclarecimento. Para a avaliação da concordância inter-avaliadores, foram utilizadas entrevistas de cinco sujeitos. Cada um dos sujeitos participou de duas entrevistas, conduzidas por uma psicóloga com experiência clínica. As entrevistas foram gravadas, transcritas e posteriormente analisadas pela investigadora principal e por três examinadores independentes. Resultados: O eixo IV (Estrutura) apresentou a maior concordância inter-avaliadores (78%). Os eixos I (Vivência da doença e pré-requisitos para o tratamento) e III (Conflitos) obtiveram a menor concordância inter-avaliadores (66 e 57,7%, respectivamente). Conclusão: Nossos resultados apontam na mesma direção de estudos anteriores realizados em outros países. Na nossa amostra, o instrumento obteve razoável concordância inter-avaliadores, porém novos estudos são necessários para investigar a confiabilidade do instrumento (AU)

Cross-cultural adaptation of the Operationalized Psychodynamic Diagnosis (OPD-2) in Portugal.

BACKGROUND: The Operationalized Psychodynamic Diagnosis (OPD-2) is internationally established as one of the major instruments available for clinical diagnosis and scientific research, being frequently used as an auxiliary tool in the selection of therapeutic interventions. AIMS: 1) To describe the methodological aspects of the adaptation of the OPD-2 into Portuguese (Portugal and Brazil). 2) To assess inter-rater agreement for the different axes of the instrument when scoring clinical interviews. METHOD: The cross-cultural adaptation involved translation of the instrument by different independent translators, whose versions were compared in discussion groups in order to develop a final Portuguese version. In the presence of discrepancies regarding the translation of original concepts, the authors of the original instrument were contacted for clarification. Five interviews were used to assess inter-rater agreement. Each subject participated in two interviews, conducted by an experienced clinical psychologist. The interviews were recorded, transcribed and then analyzed by the principal investigator and by three independent examiners. RESULTS: Axis IV (Structure) presented the highest inter-rater agreement (78%). Axes I (Experience of illness and prerequisites for treatment) and III (Conflict) showed the lowest inter-rater agreement results (66 and 57.7%, respectively). CONCLUSIONS: Our results point in the same direction as previous studies conducted in other countries. In our sample, the OPD-2 presented an acceptable inter-rater agreement; however, further studies are needed to assess the instrument's reliability.