David Pelcovitz

Complex PTSD in Victims Exposed to Sexual and Physical Abuse: Results from the DSM-IV Field Trial for Posttraumatic Stress Disorder

Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.

Development of a criteria set and a structured interview for disorders of extreme stress (SIDES)

Data regarding the development of a structured interview measuring alterations that may accompany extreme stress are presented. A list of 27 criteria often seen in response to extreme trauma and not addressed by DSM-IV criteria for posttraumatic stress disorder (PTSD) were generated based on a systematic review of the literature and a survey of 50 experts. A structured interview for disorders of extreme stress (SIDES) measuring the presence of these criteria was administered to 520 subjects as part of the DSM-IV PTSD field trials. Inter-rater reliability as measured by Kappa coefficients for lifetime Disorders of Extreme Stress was .81. Internal consistency using coefficient alpha ranged from .53 to .96. Results indicate that the SIDES is a useful tool for investigation of response to extremes stress.

Identification of PTSD in Cancer Survivors

The authors measured the rate and determinants of posttraumatic stress disorder (PTSD) in a group of cancer survivors. Patients who had a history of cancer diagnosis with at least 3 years since diagnosis, receiving no active treatment, such as chemotherapy or radiation, were interviewed (N = 27). Patients, who were part of the DSM-IV PTSD field trial, were compared with a community-based control group matched for age and socioeconomic status. One member of the survivor group (4%) and no members of the control group met criteria for current PTSD (NS). Six of the survivors (22%) and no control subjects met lifetime criteria (P < 0.02). Cancer patients have a higher rate of PTSD than found in the community. Symptoms closely resemble those of individuals who have experienced other traumatic events.

Post-Traumatic Stress Disorder in Physically Abused Adolescents

OBJECTIVE In an investigation of the prevalence of post-traumatic stress disorder (PTSD), other Axis I psychiatric disorders, and social and behavioral difficulties, 27 physically abused adolescents were compared with 27 nonabused controls who were recruited through random-digit dialing procedures. METHOD The Structured Clinical Interview for Diagnosis (PTSD module), Kiddie-Schedule for Affective Disorders and Schizophrenia, and Youth Self-Report were administered to all subjects; mothers were interviewed regarding their adolescents behavior using the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children and Child Behavior Checklist. RESULTS The three physically abused adolescents who received a diagnosis of PTSD on the PTSD module of the Structured Clinical Interview for Diagnosis reported their PTSD symptoms were in reaction to extrafamilial sexual assaults and not to physical abuse. In contrast, the abused adolescents showed significantly higher prevalence rates of depression, conduct disorder, internalizing and externalizing behavior problems, and social deficits. CONCLUSIONS Findings suggest that physically abused adolescents may be more at risk for behavioral and social difficulties than for PTSD.

Posttraumatic stress disorder and family functioning in adolescent cancer

Twenty three adolescents with a history of cancer, 27 physically abused adolescents, and 23 healthy, nonabused adolescents were administered structured posttraumatic stress disorder (PTSD) interviews and self-report questionnaires regarding family functioning. Thirty five percent of adolescent cancer subjects met criteria for lifetime PTSD as compared to only 7% of the abused adolescents: 17% of the cancer subjects and 11% of the abuse subjects met criteria for current PTSD. Adolescents with cancer viewed their mothers and fathers as significantly more caring and more protective than the comparison and abused adolescents. Cancer subjects who met criteria for lifetime PTSD save their families as significantly more chaotic than those who did not have PTSD. Eighty three percent of cancer subjects who had lifetime PTSD also had mothers who had PTSD.

Posttraumatic Stress Disorder in Mothers of Pediatric Cancer Survivors

Prevalence of posttraumatic stress disorder (PTSD) in 24 mothers of pediatric cancer survivors was compared with its prevalence among 23 mothers of healthy children. Significantly more mothers of pediatric cancer survivors were diagnosed with lifetime PTSD. Significant differences were also found in lifetime arousal, as well as current and lifetime reexperience and avoidance symptom clusters. Significant difference existed in the distribution of the number of prediagnosis high-magnitude events experienced by the mothers diagnosed with current PTSD as compared with the prediagnosis experience of the mothers who were not diagnosed with current PTSD. Illness severity, level of perceived family and extrafamilial social support, and Symptom Checklist-90-Revised global severity index scores did not significantly differ in the PTSD-positive and PTSD-negative groups.

Relocation after a disaster: posttraumatic stress disorder in Armenia after the earthquake

OBJECTIVE To explore the relationship between exposure to the earthquake in Armenia on December 7, 1988, and relocation from the disaster zone, and the subsequent development of posttraumatic stress disorder (PTSD), depression, and behavioral difficulties in children. METHOD The PTSD module of the Diagnostic Interview for Children and Adolescents-Revised and the Depression Self-Rating Scale were administered to 25 children, aged 11 through 13 years, who had high exposure to the earthquake and remained in the earthquake city. They were compared with a demographically similar group of 24 children exposed to the earthquake who were relocated to another city after the earthquake and 25 nonexposed children. For each child the mothers responded to the Child Behavior Checklist and the teachers responded to the Teachers Report Form. RESULTS The hypothesis that relocated children would present with less PTSD, depression, and behavioral problems was not confirmed. Both groups of children with high exposure to the earthquake, one remaining in the earthquake city and one relocating, demonstrated significantly higher rates of PTSD, depression, and behavioral difficulties than the comparison group. There were no differences between the relocated children and those who remained in the earthquake zone. CONCLUSION Children who were relocated after a natural disaster did no worse than children who remained in the disaster zone. Relocation should be considered as an alternative after catastrophic natural disasters in situations where resources are so limited that rebuilding cannot take place for an indefinite period of time.

The effect of relocation after a natural disaster

Twenty-five women remaining in a city devastated by an earthquake were compared with 24 relocated survivors and 25 comparison women. The women were administered a structured PTSD interview, the Hamilton Depression Scale, and SCL-90-R. The women in both exposed groups showed significantly more symptoms of avoidance, arousal, and total PTSD than the comparison group. The women in the relocated city had significantly higher depression scores than the women in the earthquake city. On the SCL-90-R, relocated women were most symptomatic and comparison group women were least symptomatic. Relocation after a disaster appears to be associated more with risk for depression than with PTSD in situations where recovery is delayed following the trauma.

Obsessive-Compulsive Symptomatology in Children with Tourette's Syndrome

Abstract This study compared 25 children with Tourettes disorder with a group of 25 children comparable in age, sex, race, socioeconomic status and school achievement with respect to obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS). Data from the children, their parents, and teachers were gathered using a structured diagnostic interview, a parent and teacher questionnaire and a childrens obsessional inventory. Significantly, more children in the Tourettes group were diagnosed as having OCD. Parents and teachers reported Tourettes children as having significantly more OCS. Tourettes children diagnosed as OCD reported significantly more obsessive symptomatology than the comparison group.

Parent and teacher assessment of children's behavior in child maltreating families

This study is an assessment of the amount of intellectual and behavioral dysfunction found in children from families in which child maltreatment has occurred. It reports differences in the information obtained from parents and teachers. The clinical implications of the results suggest the incorporation of parent training in developmental issues in programs which treat maltreating families and the use of teachers for more accurately assessing all the children in these families.