Adolescent Psychiatry - Volume 7, Issue 4, 2017

Background: Complex trauma involves prolonged or repeated exposure during critical developmental windows or transitions (including adolescence) to intentional interpersonal victimization that is inescapable and causes profound insecurity. Developmental Trauma Disorder is a clinical framework for describing heterogeneous sequelae of complex trauma. Objective: To review the conceptual, diagnostic, clinical, and scientific issues and evidence with regard to the nature and sequelae of complex trauma in adolescence. Method: Variants of posttraumatic stress disorder in adulthood that foreshadow Developmental Trauma Disorder are described, including Disorders of Extreme Stress Not Otherwise Specified and Enduring Personality Change Associated with Catastrophic Experiences. The clinical and developmental rationale for Developmental Trauma Disorder, and results of research supporting the clinical utility of Developmental Trauma Disorder as a distinct diagnostic construct and an integrative parsimonious framework for clinical assessment and treatment, are described with a focus on adolescence. Emergent empirically supported psychotherapy models designed to enhance self-regulation in youth with complex trauma histories are described. Results and Conclusion: Complex trauma and Developmental Trauma Disorder provide a self-regulation framework that can advance research and clinical psychiatric assessment and treatment of highly complex trauma-related forms of adolescent psychopathology.

Background: Individuals with eating disorders often report histories of childhood sexual abuse, but no direct relationship has been elucidated. Studies have examined sexual, physical and emotional abuse as factors contributing to the pathogenesis of eating disorders. Objective: Clinical studies and vignettes of eating disorder patients with histories of abuse or neglect are discussed, as are personality and family traits, genetics, and neurobiological changes that mediate this relationship. Methods: MedlinePlus, PsycINFO, PsychiatryOnline, and PubMed were searched, using filters for full-text clinical studies in English between 1996-2016. Studies were only included if they were published in peer-reviewed journals, scholarly books, or clinical manuals; used reliable validated scales or structured interviews; and involved subjects who experienced abuse before age eighteen. Methodological issues and efforts aimed to overcome them are discussed. Results: Within an eating disorder population, patients with histories of childhood abuse are more likely to purge, self-harm, and have psychiatric comorbidity. Childhood abuse is more often reported by bulimics than anorexics. Purging anorexics report childhood abuse more often than restricting anorexics. Rates of childhood abuse are comparable in ED populations and general psychiatric populations. Conclusion: Childhood abuse is a non-specific risk factor for eating disorders. Eating disorder patients who report childhood abuse are more likely to purge, self-harm, or have psychiatric comorbidities, thus treatment of these patients must address trauma. Many biopsychosocial factors contribute to outcomes of childhood abuse victims, and further research is needed in order to understand the link between adversity in childhood and subsequent eating pathology.

Background: The federal approach to disaster management in the United States encourages public participation to build resilient communities. Many children are affected by disasters and they now are recognized as potential participants in disaster management activities. Objective: The objective of this paper is to present a theoretical rationale and approach for involving youth in enhancing community resilience for disasters. Methods: This paper is based on a review of the literature on a range of topics including disaster management, personal and community resilience, adolescent development, and youth programming. A framework for community resilience intervention and youth involvement is presented. Results: Public participation in building community resilience is essential to build trust, ensure that activities address local needs and reflect community values, instill a sense of ownership, and improve the likelihood that activities are successfully implemented. Youth represent a major constituent in any community. This review affirms that they possess the knowledge, skills, initiative, and ability to make meaningful contributions to their communities. Youth also benefit developmentally from participation in community enhancement processes. A recommended framework for formal intervention to enhance community resilience relies on a team problem-solving approach that builds on assessment, goals, and action planning. Conclusion: As major constituents in their communities, youth should be engaged in community enhancement processes. Not only do youth and their communities benefit from the consequences of improved community resilience, youth benefit developmentally from participation in intervention processes. Communities have both a reason and a responsibility to involve them.

Background and Scope of the Problem. High prevalence rates of deaths by accidents, suicides, and homicides, coupled with expanding social networks, place adolescents at significant risk for traumatic bereavement occasioned by the traumatic deaths of their friends, romantic partners, and family members. Conceptual Analysis. This conceptual paper focuses on the interplay between posttraumatic stress symptoms and grief reactions that can arise following traumatic bereavement in adolescence. We begin with a review of “building block” key concepts needed to construct a scientifically sound and clinically useful theory of traumatic bereavement in adolescence. We briefly review earlier conceptual contributions and discuss the utility of unpacking and distinguishing between trauma exposure and bereavement as theorized causal risk factors, and posttraumatic stress reactions and grief reactions as their respective primary causal consequences. Multidimensional Grief Theory. We introduce multidimensional grief theory as a useful framework for conceptualizing a broad range of grief reactions, both adaptive and maladaptive, in traumatically bereaved adolescents. We use the theory to explore the interplay between posttraumatic stress and grief reactions, including ways in which each set of reactions may exacerbate the other and contribute to adverse outcomes. Implications for Evidence-based Assessment. We conclude with recommendations for trauma- and bereavement-informed risk screening, clinical assessment, and case formulation of potential consequences of traumatic bereavement in adolescence across multiple psychosocial domains. These domains include posttraumatic stress and grief reactions, school functioning, suicide ideation and behavior, risk-taking behavior, and developmental progression.

Background/Objective: About 16% of documented cases of maltreatment take place in adolescence, a developmental period which carries unique vulnerability. Studies investigating the impact of physical abuse find negative outcomes in cognitive functioning and academic performance, both in the short and long term. The present study aims to examine the impact of documented adolescent physical abuse on adolescent and adult academic functioning. Methods: This longitudinal study is comprised of two waves of data following a cohort of individuals who were physically abused in adolescence and a non-abused comparison group. We assessed academic and occupational achievement of 145 young adults (67 abused, 78 non-abused) via academic records, standardized achievement test scores, parental academic achievement, IQ, and teacher ratings of internalizing and externalizing behaviors at time 1 and the highest academic degree, current work status, history of job loss at time 2 (10-14 years later). Results: School performance of the abused participants at time 1 showed lower grades and achievement scores, more teacher-rated problems, and more special school services than the comparison group. At the second time, the abused group completed significantly fewer years of schooling and was more likely to have lost a job. Grades at the first time, gender, parents' education, and an abuse status by IQ interaction were significant predictors of the number of years of schooling at the second time. Conclusion: This study highlights the pervasive impact that adolescent physical abuse can have on academic functioning and documents how these difficulties can set the stage for continuing challenges in young adulthood.

Background: There are significant gaps in our understanding of vulnerable and grandiose narcissism in adolescents and whether it is associated with psychosocial difficulties as well as risk factors such as child maltreatment. Objective: The aim of this study was to examine vulnerable and grandiose narcissism in adolescents and young adults. Method: 570 participants (ages 14-21) from the community completed an online survey. Vulnerable and grandiose narcissism were assessed with the Pathological Narcissism Inventory, while psycho-social difficulties were assessed with the Child Behaviour Checklist and maltreatment with the Childhood Experiences of Care and Abuse Questionnaire. Results: Gender-specific age trends were identified, with narcissism appearing to decrease with age for females, while increasing for males into early adulthood. For females, vulnerable and grandiose narcissism was associated with maltreatment and partially mediated the relationship between abuse and neglect and internalizing and externalizing difficulties. Conclusion: These findings underscore the importance of considering the relationship between childhood maltreatment experiences and suggest that the relationship between such experiences and adolescent psychosocial difficulties may be partially accounted for by the negative impact that maltreatment has on narcissism.

Background: After disasters that produce extensive damage and community disruption, many youth experience persisting psychological distress. Current recommendations are for stepped intervention, including broad resilience building, then screening and when warranted, evidence-based interventions. Schools are a logical site for reaching youth but often lack resources and expertise to provide sufficient post-disaster care. In addition, youth recovery has been shown to be impeded if supporting adults are overwhelmed by their own post-disaster stress. Objective: The objective of this project was to demonstrate the effectiveness of a multi-tiered post-disaster intervention for youth delivered entirely in schools through collaboration of a major health system and two highly impacted school districts. Methods: Two years after Superstorm Sandy, a team from the Northwell Health System implemented a 3-tiered intervention to youth, families and school staff in two school communities. A broad menu of education and resiliency-building activities was presented to youth preK to 12 with outreach education and support for teachers and parents. This set the stage for formal screening and triaging of the youth who were offered on-site evidence-based treatments (CBITS and TF-CBT) and/or pharmacological consultation. Results: The resilience building activities were well received and widely utilized. The on-site interventions were effective in reducing post-disaster distress. Conclusion: Results support the importance of school/mental health agency partnerships that provide both resilience building and evidence based trauma interventions in schools in the aftermath of major disasters.

Background: Childhood maltreatment represents a major and preventable risk factor for psychiatric difficulties. However, the majority of studies treat maltreatment experiences as if they occur alone, but evidence suggests co-occurrence of maltreatment is the norm rather than the exception. Little is known regarding consequences of particular types and combinations of childhood maltreatment in adolescence. Objective: To identify classes of maltreatment types and combinations using a personcentered approach (Latent Class Analysis) and then to examine whether adolescents who experienced specific types and combinations of maltreatment reported more borderline personality traits, self-injury or internalizing and externalizing difficulties. Methods: Participants included 327 adolescents and young adults aged 12 to 21 recruited from schools, colleges and a university and who completed a series of online questionnaires. Results: Four subgroups of maltreatment were identified including sexual abuse, physical abuse, neglect co-occurring with physical and sexual abuse, as well as parental antipathy cooccurring with neglect and physical abuse. With regard to personality disorder traits, adolescents who experienced sexual abuse endorsed significantly more difficulties, as did adolescents who experienced antipathy. With regard to self-injury, adolescents who experienced sexual abuse, as well as those who experienced neglect were at higher risk. With regard to internalizing and externalizing difficulties, adolescents who experienced sexual abuse reported more internalizing difficulties, whereas those who experienced antipathy and neglect reported more internalizing and externalizing difficulties. Conclusion: Awareness of specific types and co-occurring maltreatment as risk factors for personality difficulties and self-injury has implications for improving trauma informed treatment.