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Biomedical subjects

Frank W Putnam

Publications and source records attributed to Frank W Putnam.

15 recordsLinked to original sources
PubMed2005

Sleep disturbances and childhood sexual abuse.

OBJECTIVE: This longitudinal, prospective study examined the relationship between childhood sexual abuse and later sleep problems in adolescence while taking into account cooccurring psychopathology that is closely related to sleep disruption [e.g., depression and posttraumatic stress disorder (PTSD)]. METHOD: Sleep disturbances in 147 females (78 sexually abused; 69 comparison) were assessed 10 years after disclosure of substantiated abuse. The follow-up protocol included self-report questions regarding typical sleeping patterns and sleep disturbances as well as measures of depression, PTSD, and lifetime victimization histories. RESULTS: Sleep disturbances correlated significantly with both depression and PTSD. Hierarchical regression analysis showed that sexually abused participants reported significantly greater rates of sleep disturbances than comparison participants above and beyond depression and PTSD. Sleep disturbances were related to revictimization rates independent of sexual abuse, depression, and PTSD. CONCLUSIONS: Assessments of sleep disturbances should be integrated into standard of care for adolescents who have experienced sexual abuse.

Adolescent↗
PubMed2005

Predictive validity in a prospective follow-up of PTSD in preschool children.

OBJECTIVE: To examine the predictive validity of an alternative to the DSM-IV for diagnosing posttraumatic stress disorder (PTSD) in preschool children and prospectively explore the course of PTSD symptomatology. METHOD: Sixty-two traumatized children, ages 20 months through 6 years, were assessed three times in 2 years with caregiver diagnostic interviews. RESULTS: PTSD diagnosis at visit 1 significantly predicted degree of functional impairment 1 and 2 years later and predicted PTSD diagnosis 2 years later but not 1 year later. The lack of 1-year diagnostic continuity may be explained by children with new traumas. Unexpectedly, overall PTSD symptoms did not remit over time, regardless of community treatment; however, reexperiencing symptoms decreased and avoidance/numbing symptoms increased with time, with avoidance/numbing symptoms increasing at a faster rate in children with PTSD at visit 1. The previous finding that arousal may cause emotional numbing was not replicated. Significantly more children were functionally impaired at visits 2 (48.9%) and 3 (74.3%) than were diagnosed with PTSD (23.4% and 22.9%, respectively). CONCLUSIONS: This study demonstrates predictive validity for the alternative method of diagnosing PTSD in preschool children. The unremitting course of PTSD symptomatology in preschool children and rates of impairment that are higher than rates of diagnosis indicate the need for efficacious treatment.

Child Behavior Disorders↗
PubMed2005

Shame, humiliation, and childhood sexual abuse: distinct contributions and emotional coherence.

Childhood sexual abuse (CSA) may produce powerful and enduring emotion reactions, including intense shame, anger, and humiliation. Whereas shame and anger have received considerable interest from researchers, less attention has been paid to humiliation or associated coherence among these emotions as it relates to the psychological adjustment in CSA survivors. In the current investigation, the authors coded shame, anger, and humiliation from narrative transcripts of CSA survivors as they either voluntarily disclosed an abuse experience or described a distressing nonabuse experience and from nonabused individuals as they described a distressing experience. Verbal humiliation was found to be significantly associated with nonverbal displays of shame. Coherence between verbal humiliation and facial shame among CSA nondisclosers was associated with increased symptoms of posttraumatic stress disorder.

Adolescent↗
PubMed2003

A prospective investigation of the impact of childhood sexual abuse on the development of sexuality.

The sexual attitudes and activities of 77 sexually abused and 89 comparison women (mean age = 20.41, SD = 3.38) were assessed 10 years after disclosure in a longitudinal, prospective study of the long-term effects of childhood sexual abuse. Abused participants were more preoccupied with sex, younger at first voluntary intercourse, more likely to have been teen mothers, and endorsed lower birth controlefficacy than comparison participants. When psychological functioning earlier in development was examined, sexual preoccupation was predicted by anxiety, sexual aversion was predicted by childhood sexual behavior problems, and sexual ambivalence (simultaneous sexual preoccupation and sexual aversion) was predicted by pathological dissociation. Findings also indicate that biological father abuse may be associated with greater sexual aversion and sexual ambivalence.

Adolescent↗
PubMed2003

Ten-year research update review: child sexual abuse.

OBJECTIVE To provide clinicians with current information on prevalence, risk factors, outcomes, treatment, and prevention of child sexual abuse (CSA). To examine the best-documented examples of psychopathology attributable to CSA. METHOD Computer literature searches of and for key words. All English-language articles published after 1989 containing empirical data pertaining to CSA were reviewed. RESULTS CSA constitutes approximately 10% of officially substantiated child maltreatment cases, numbering approximately 88,000 in 2000. Adjusted prevalence rates are 16.8% and 7.9% for adult women and men, respectively. Risk factors include gender, age, disabilities, and parental dysfunction. A range of symptoms and disorders has been associated with CSA, but depression in adults and sexualized behaviors in children are the best-documented outcomes. To date, cognitive-behavioral therapy (CBT) of the child and a nonoffending parent is the most effective treatment. Prevention efforts have focused on child education to increase awareness and home visitation to decrease risk factors. CONCLUSIONS CSA is a significant risk factor for psychopathology, especially depression and substance abuse. Preliminary research indicates that CBT is effective for some symptoms, but longitudinal follow-up and large-scale "effectiveness" studies are needed. Prevention programs have promise, but evaluations to date are limited.

Awareness↗
PubMed2003

New findings on alternative criteria for PTSD in preschool children.

OBJECTIVE: An alternative set of criteria for posttraumatic stress disorder (PTSD) for preschool children was analyzed for validity. METHOD: Sixty-two traumatized children and 63 healthy controls, aged 20 months through 6 years, were assessed. The traumatic experiences included motor vehicle collisions, accidental injuries, abuse, and witnessing violence. The number of symptoms required for clusters C and D and the utility of proposed symptoms were systematically analyzed. RESULTS: No cases met the DSM-IV algorithm for PTSD. Cluster B was endorsed 67.9% of the time. The proportion of cases meeting the cluster C threshold was 2% when three symptoms were required, 11% when two symptoms were required, and 39% when one symptom was required. The rate of cluster D was 45% when two symptoms were required and 73% when one symptom was required. Four novel symptoms did not substantially add to the diagnostic validity of the criteria. The optimal algorithm (one cluster B symptom, one cluster C symptom, and two cluster D symptoms) diagnosed PTSD at a rate of 26%. Measures of comorbid symptoms concurrently provided convergent validation to support this revised algorithm. CONCLUSION: Revisions to the DSM-IV PTSD criteria continue to be supported so that highly symptomatic young children can be diagnosed.

Algorithms↗
PubMed2003

Revictimization and self-harm in females who experienced childhood sexual abuse: results from a prospective study.

Lifetime trauma histories were ascertained for females with confirmed histories of childhood sexual abuse and comparison females participating in a longitudinal, prospective study. Abused participants reported twice as many subsequent rapes or sexual assaults (p = .07), 1.6 times as many physical affronts including domestic violence (p = .01), almost four times as many incidences of self-inflicted harm (p = .002), and more than 20% more subsequent, significant lifetime traumas (p = .04) than did comparison participants. Sexual revictimization was positively correlated with posttraumatic stress disorder symptoms (PTSD), peritraumatic dissociation, and sexual preoccupation. Physical revictimization was positively correlated with PTSD symptoms, pathological dissociation, and sexually permissive attitudes. Self-harm was positively correlated with both peritraumatic and pathological dissociation. Competing theoretical explanations for revictimization and self-harm are discussed and evaluated.

Adaptation, Psychological↗
PubMed2003

Predicting the willingness to disclose childhood sexual abuse from measures of repressive coping and dissociative tendencies.

Although it is generally agreed that the verbal disclosure of past childhood sexual abuse (CSA) experiences can be beneficial, CSA survivors are often reluctant to reveal such experiences. Bonanno et al. found that women with documented CSA histories who did not disclose abuse when provided an opportunity to do so were more likely to show nonverbal expressions of shame and polite smiling, relative to disclosing CSA survivors or nonabused controls. Disclosing CSA survivors, in contrast, showed greater facial expressions of disgust. The current study extended this paradigm by showing that among the same participants, CSA disclosure was associated with chronic dissociative experiences, whereas nondisclosure was associated with repressive coping. Further, repressive coping and dissociative experiences were inversely related and showed opposite patterns of facial expressions and adjustment. Repressors expressed greater negative and positive emotion and were relatively better adjusted, whereas dissociators expressed little emotion and had relatively poorer adjustment.

Adaptation, Psychological↗
PubMed2002

Pharmacotherapy for survivors of childhood trauma.

Research over the past decade and a half has established the efficacy of pharmacotherapy as an important adjunctive treatment for trauma in conjunction with either cognitive behavior therapy or psychoanalytic psychotherapy. Medication is often effective in reducing post-traumatic stress symptoms as well as treating a number of commonly comorbid conditions such as depressive and anxiety disorders. The current medications of choice are the selective serotonin reuptake inhibitors (SSRI), which are beneficial for posttraumatic reexperiencing, hyperarousal, and avoidant symptoms. Other medication classes including non-SSRI antidepressants, mood stabilizers, anticonvulsants, and anti-adrenergic agents have shown efficacy for some trauma symptoms. Because beneficial responses may be slow to appear, pharmacotherapy of trauma requires a medication trial of adequate length and dose to determine effectiveness. Partial responders may require the addition of a second class of medication. Positive responders should be maintained on medication for at least 6 months after remission of acute PTSD and at least 12 months after remission of chronic PTSD. The initial successes of pharmacotherapy for trauma are spurring further research and more effective medications can be anticipated in the foreseeable future.

Adult↗
PubMed2002

When the face reveals what words do not: facial expressions of emotion, smiling, and the willingness to disclose childhood sexual abuse.

For survivors of childhood sexual abuse (CSA), verbal disclosure is often complex and painful. The authors examined the voluntary disclosure-nondisclosure of CSA in relation to nonverbal expressions of emotion in the face. Consistent with hypotheses derived from recent theorizing about the moral nature of emotion, CSA survivors who did not voluntarily disclose CSA showed greater facial expressions of shame, whereas CSA survivors who voluntarily disclosed CSA expressed greater disgust. Expressions of disgust also signaled sexual abuse accompanied by violence. Consistent with recent theorizing about smiling behavior, CSA nondisclosers made more polite smiles, whereas nonabused participants expressed greater genuine positive emotion. Discussion addressed the implications of these findings for the study of disclosure of traumatic events, facial expression, and the links between morality and emotion.

Adolescent↗