Benjamin Iffland

Frequency of child maltreatment in a representative sample of the German population

BackgroundRepresentative data about the frequency of child maltreatment is needed in order to estimate the extent of the problem in the wider population as well as to provide the basis for interpretation of frequency rates in clinical samples. However, previous representative studies on the frequency of child maltreatment in Germany and other countries were limited as they focused on the assessment of physical and sexual abuse whilst emotional forms of maltreatment were ignored. In addition, previous studies applied scales that had not been validated against external criteria.MethodsIn a cross-sectional study, standardized questionnaires were administered to a representative sample of the German population. Maltreatment in childhood and adolescence was assessed using the German version of the Childhood Trauma Questionnaire. Empirically derived threshold values for the five different types of child maltreatment including emotional maltreatment were applied to determine presence of abuse and neglect.ResultsComplete data was available from N = 2,500 subjects. Prevalence rates were 13.9% for emotional neglect, 10.2% for emotional abuse, 12.0% for physical abuse, 48.4% for physical neglect, and 6.2% for sexual abuse. Differences between sexes were found for the frequency of sexual abuse.ConclusionsAlthough our analysis has found lower rates of child maltreatment than previous reports that used less well validated criteria, the results of this study confirm that child abuse, with its many different facets, is a significant problem in Germany.

Emotional but not physical maltreatment is independently related to psychopathology in subjects with various degrees of social anxiety: a web-based internet survey.

BackgroundPrevious studies reported that social phobia is associated with a history of child maltreatment. However, most of these studies focused on physical and sexual maltreatment whilst little is known about the specific impact of emotional abuse and neglect on social anxiety. We examined the association between emotional maltreatment, including parental emotional maltreatment as well as emotional peer victimization, and social anxiety symptoms in subjects with various degrees of social anxiety.MethodsThe study was conducted as a web-based Internet survey of participants (N = 995) who had social anxiety symptoms falling within the high range, and including many respondents who had scores in the clinical range. The assessment included measures of child maltreatment, emotional peer victimization, social anxiety symptoms and general psychopathology.ResultsRegression and mediation analyses revealed that parental emotional maltreatment and emotional peer victimization were independently related to social anxiety and mediated the impact of physical and sexual maltreatment. Subjects with a history of childhood emotional maltreatment showed higher rates of psychopathology than subjects with a history of physical maltreatment.ConclusionsAlthough our findings are limited by the use of an Internet survey and retrospective self-report measures, data indicated that social anxiety symptoms are mainly predicted by emotional rather than physical or sexual types of victimization.

The Trauma of Peer Abuse: Effects of Relational Peer Victimization and Social Anxiety Disorder on Physiological and Affective Reactions to Social Exclusion

Background: Social exclusion elicits emotional distress, negative mood, and physiological stress. Recent studies showed that these effects were more intense and persisting in socially anxious subjects. The present study examined whether the abnormal reactions of socially anxious subjects can be traced back to previous experiences of relational peer victimization during childhood and adolescence. Methods: Participants (N = 74) were patients with a diagnosis of social anxiety disorder as well as healthy controls. The patient and control groups were subdivided into two subgroups according to the subject’s reports about previous relational peer victimization. Immediate and delayed physiological (skin conductance level and heart rate) and affective reactions to a simulated social exclusion in a ball-toss game (Cyberball) were recorded. Results: Overall, subjects’ immediate reactions to social exclusion were an increase in skin conductance and a reduction of positive affect. Regardless of the diagnostic status, subjects with a history of relational peer victimization showed a more intense self-reported affective change that was accompanied by a blunted skin conductance response. However, the mood of the subjects with a history of peer victimization recovered during a 15 min waiting period. A diagnosis of social anxiety disorder did not affect the reactions to social exclusion on any measure. Conclusion: Findings indicate that stress reactions to social exclusion depend more on previous experiences of peer victimization than on a diagnosis of social anxiety disorder. The findings indicate that memories of negative social experiences can determine the initial stress reaction to social threats.

Peer victimization predicts psychological symptoms beyond the effects of child maltreatment

Experiences of peer victimization have been repeatedly associated with psychological symptoms and disorders. However, as peer victimization is correlated with child maltreatment occurring within the family, it remains unclear whether the pathological effect of peer victimization is an artifact that can be attributed to previous aversive events. To separate the effects of peer victimization from child maltreatment, we studied both event types as well as psychological symptoms in a mixed clinical sample of ambulant and psychiatric patients (N=168), a self-selected community sample recruited through the internet (N=995), and a student sample (N=272). Hierarchical regression analyses showed that, after controlling for child maltreatment, peer victimization accounted for an incremental proportion of the variance of different symptom dimensions in each sample. These results indicate that peer victimization is an independent predictor of psychopathology.

The trauma of peer victimization: Psychophysiological and emotional characteristics of memory imagery in subjects with social anxiety disorder

The study investigated the role of an associative information network as a mechanism underlying the relation of peer victimization and social anxiety disorder (SAD). A sample of N = 80 was divided according to diagnosis (SAD vs. no diagnosis) and amount of peer victimization (low vs. high). Responses to memory of a personally experienced aversive social situation and to imagining a standardized negative social situation were assessed. In terms of skin conductance level, subjects with SAD and peer victimization were more reactive to the memory script than the other three groups while responses to the standardized script did not vary. As to heart rate, there were no differences between the groups. Emotional responses presented with an inconsistent pattern. The results provide a first indication that associative memory structures resulting from aversive social experiences might play a role in the development and maintenance of SAD, but further research is needed.

Neutral is negative enough – Peer Victimization influences cardiac, facial-muscular and experiential reactions to both negative evaluative and neutral social stimuli

Physiological stress responses vary as a function of adverse childhood experiences. However, previous studies concentrate on familial sources of childhood adversity. Potential long-term effects of peer victimization on physiology and affective responses are less known. This study examined cardiac, facial-muscular, and experiential responses to social evaluative stimuli in ninety-four healthy subjects with various degrees of experienced peer victimization. In a social conditioning task, peer victimization was associated with similarly attenuated cardiac and facial-muscular responses to negative and neutral stimuli, while differentiated physiological responses to negative and neutral stimuli were found in subjects without peer victimization. Overall, increased ratings of arousal, valence and disapproval for negative compared to neutral stimuli were found. Contrary to the physiological response, peer victimization was associated with more negative ratings of negative stimuli one month after acquisition. The results suggest that the physiological and experiential reactivity towards both negative and neutral social stimuli is affected by the experience of peer victimization. Peer victimization causes generalized autonomic dysregulation and memory recall biases during social learning impeding adequate response preparation to social stressors.

Do self-reports provide valid information about driving fitness in seniors?

Aging goes along with cognitive deficits even in healthy seniors. Some of these deficits (e.g. processing speed) are closely related to driving fitness. Consequently, driving fitness also decreases with advancing age. As neurodegenerative disorders further deteriorate cognitive performance in seniors, driving fitness is particularly challenged in this population. Nevertheless, the official driving guidelines for neurodegenerative disorders are rather vague in Germany. This is insofar surprising because neurodegenerative disorders are associated with severe cognitive decline and necessarily lead to a complete loss of driving fitness eventually. Still, there are the same standards for people with Alzheimer’s disease, for example, as for healthy seniors. These standards include self-examination and precautionary measures meaning that German seniors are self-responsible for their driving fitness and have to take precautions if necessary. Noteworthy, Alzheimer’s disease is often associated with a reduced insight into the illness (anosognosia) including a valid judgment of own cognitive abilities (Vogel et al., 2004). As a consequence, many demented people often still drive despite severe driving-related cognitive deficits. Certainly, these drivers pose a high risk for themselves and the driving public which makes their identification an important necessity. Commonly, practical driving lessons are regarded as the gold standard to identify impaired drivers. However, practical driving lessons require immense financial, personnel and temporal resources which go beyond daily clinical routines. An alternative option might be the utilization of questionnaires in which drivers furnish particulars about their driving behaviour. One example is the Driver Behaviour Questionnaire (DBQ; Reason et al., 1990). In the DBQ, traffic lapses, errors and violations within the last 12months are enquired. Previous findings showed that the number of self-reported traffic offences was positively correlated with the number of self-induced accidents (de Winter and Dodou, 2010). However, the validity of self-reports appears to be at least questionable. In the context of a bigger project including 42 driving seniors (mean age= 70.3 +/ 9.1 years) who consulted our memory clinic to clarify possible cognitive deficits, we therefore examined the association between self-reported driving behaviour, driving-related cognitive performance and global cognition. Self-reported driving behaviour was assessed with the 24-item version of the DBQ (Parker et al., 1995), global cognitive functioning with the mini-mental state examination and driving-related cognitive functions with the Corporal test system (Berg and Schubert, 1999). The Corporal test system is a neuropsychological test battery permitted by law to assess driving-related cognitive domains such as diffuse attention, focused spatial attention and divided spatial attention. Contrary to previous findings, conservative nonparametric correlation analyses revealed positive correlations between the Corporal total score and the number of reported DBQ violations (τ=0.50, p=0.003) and between the mini-mental state examination score and the number of reported DBQ violations (τ=0.39, p=0.027). All other correlations failed to reach statistical significance but showed similar patterns (mostly positive correlations). These results indicate that driving seniors with better driving-related cognitive performance and higher global cognitive status in general reported more traffic offences. A plausible reason for these unexpected results may be that seniors with higher cognitive abilities are able to provide more valid judgments of their own fitness to drive (Vogel et al., 2004). An alternative explanation could be that seniors with mild cognitive deficits are aware of possible driving-related constraints and make false statements for fear of losing their driving license. Either way, the present results suggest that self-reports of driving seniors should be interpreted with caution and that the evaluation of driving fitness should be based upon objective measures. Besides practical driving lessons, such measures could involve specific cognitive tests or a multifactorial selection of risk factors as suggested by several working groups.

Trauma and Memory

Abstract During a traumatic event, mainly emotional, sensory, and perceptual information is stored in an interconnected neural network. This network can be activated by environmental stimuli and internal cues later at any given time. An activation of the entire network is thought to be a flashback, which is one of the cardinal symptoms of post-traumatic stress disorder (PTSD). Additionally, the PTSD symptom of avoidance can be seen as a consequence of the activation of the trauma network. In contrast to the extensive memory of sensory-perceptual information, memories of traumatic events are characterized by a disconnectedness from temporal and spatial information about the general event and cannot be clearly positioned in a lifetime period. Furthermore, traumatic stress and the distribution of stress hormones during a traumatic event cause strong structural and functional alterations of brain structures involved in memory processing, like the hippocampus and the amygdala.