Anger, aggression, and self‐harm in PTSD and complex PTSD

Dyer, Kevin; Dorahy, Martin J.; Hamilton, Geraldine; Corry, Mary; Shannon, Maria; MacSherry, Anne; McRobert, Geordie; Elder, Rhonda; McElhill, Bridie

doi:10.1002/jclp.20619

Cited by 94 publications

(91 citation statements)

References 36 publications

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“…This is in line with transdiagnostic research on the importance of ruminative processes for psychopathology (Aldao, Nolen-Hoeksema, & Schweizer, 2010). The clinical implication of this finding is that anger, especially connected to ruminative processes, is a central treatment target for complex trauma (Dyer et al, 2009; Ehring & Ehlers, 2014). In reducing anger rumination, owing to its centrality, it may be assumed that other symptoms connected to it will also improve when rumination is decreased (Cramer et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

A network analysis of anger, shame, proposed ICD-11 post-traumatic stress disorder, and different types of childhood trauma in foster care settings in a sample of adult survivors

Glück

Knefel

2017

European Journal of Psychotraumatology

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Background: Anger and shame are aspects that are specifically associated with psychopathology and maladaptation after childhood abuse and neglect. They are known to influence symptom maintenance and exacerbation; however, their interaction is not fully understood. Objective: To explore with network analysis the association and interaction of prolonged, complex interpersonal childhood abuse and neglect in institutional foster care settings [institutional abuse (IA)] with anger, shame, and the proposed 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) post-traumatic stress disorder (PTSD) symptoms in adult survivors. Method: Adult survivors of IA (N = 220, mean age = 57.95 years) participated in the study and were interviewed using the Childhood Trauma Questionnaire, the International Trauma Questionnaire, the State–Trait Anger Expression Inventory, the Displaced Aggression Questionnaire, and shame-related items. To identify the most central aspects, we used a staged network analysis and centrality analysis approach: (1) on the scale level; (2) on the item/symptom level; and (3) with modularity analysis to find communities within the item-level network. Results: Trait anger, anger rumination, emotional abuse, and PTSD re-experiencing symptoms played the most important roles on a scale level and were then further analyzed on the item/symptom level. The most central symptom on the item level was anger rumination related to meaningful past events. The modularity analysis supported discriminant validity of the included scales. Conclusions: Anger is an important factor in the psychopathological processes following childhood abuse. Anger rumination is closely related to PTSD symptoms; however, anger is not a part of the proposed ICD-11 PTSD in the present study.

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Section: Discussionmentioning

confidence: 99%

A network analysis of anger, shame, proposed ICD-11 post-traumatic stress disorder, and different types of childhood trauma in foster care settings in a sample of adult survivors

Glück

Knefel

2017

European Journal of Psychotraumatology

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“…The most common traumatic experiences were: 1) "Troubles"-related trauma (e.g., bombing, torture; 93%); 2) non-sexual assault from stranger (65%); 3) serious accident (51%); 4) non-sexual assault from family member (46%); 5) imprisonment (44%); 6) military combat (44%); and 7) sexual contact as a minor (28%) . Based on the similarities between these sample characteristics and other studies conducted in this population (e.g., Dorahy et al, 2009;Dyer et al, 2009) The sample means and standard deviations for the attachment subscales, coping strategies, and alexithymia are in Table 1. …”

Section: Clinical Characteristicsmentioning

confidence: 95%

“…Ireland as a result of "The Troubles" sectarian conflict Dyer et al, 2009) Anecdotal observations suggest that complex trauma populations experience difficulties in developing adaptive coping strategies and forming an open, trusting therapeutic alliance (Pearlman & Courtois, 2005). This is perhaps unsurprising as Complex PTSD/trauma is primarily a relational disorder with antecedents in interpersonal trauma and consequences for interpersonal coping and social connectedness ).…”

Section: Ptsd/trauma Have Been Experienced Over the Past 35 Years In mentioning

confidence: 99%

“…Yet, at the same time, recovery from complex trauma often requires the individual to be in a healing relationship and empowered by that relationship (Herman, 1992). Survivors of complex trauma, therefore, may exhibit personality characteristics, emotional regulation styles and maladaptive coping strategies that are not only harmful to their overall wellbeing, but also prevent later recovery.The types of coping methods considered unhelpful or maladaptive within the complex trauma literature are varied, but are thought to include avoidance (e.g., safety behaviours, distraction), adverse emotional regulation strategies (e.g., self-harm, alcohol/substance misuse), dissociation, anger/aggression, and primitive defense mechanisms such as denial (Courtois, 2008;Dorahy et al, 2009;Dyer et al, 2009). Adaptive coping refers to use of strategies such as social/instrumental support, effective emotional processing and regulation (e.g., reflection, acceptance, cognitive flexibility), active problem-solving, and mature defense mechanisms (Hassija, Garvert, & Cloitre, 2015; Vaillant, 2011).…”

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confidence: 99%

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Client factors that predict the therapeutic alliance in a chronic, complex trauma sample.

Reynolds¹,

Simms²,

Webb³

et al. 2017

Traumatology

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This project was completed as a PhD dissertation by the first name author. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. AbstractThis investigation aimed to examine how specific client characteristics of individuals with chronic, complex trauma are associated with the type coping strategies they employ and the quality of the therapeutic alliance. Fifty-nine adult participants with diagnostic levels of posttraumatic stress disorder (PTSD) and who attended therapy for complex trauma in Northern Ireland were obtained via opportunity sampling. Participants completed self-report measures of client attachment style, alexithymia, coping strategies, and the therapeutic alliance. Preoccupied attachment factors such as "Need for Approval" and "Preoccupation with Relationships" were related to use of maladaptive coping strategies. In contrast, the adaptive coping strategies of "Acceptance" and "Instrumental Support" were significant predictors of a positive therapeutic alliance, whereas established psychological and traumatogenic factors (e.g., attachment, number of traumatic events) did not significantly predict the therapeutic alliance. The findings have implications for understanding the relationship between client characteristics and the therapeutic alliance within complex trauma populations, as well as developing protocols to assist this process.Keywords: Therapeutic Alliance, complex trauma, client factors, coping CLIENT FACTORS, THERAPEUTIC ALLIANCE, AND TRAUMA 3 Client characteristics, coping strategies, and the therapeutic alliance in a chronic, complex trauma sample Defined broadly as the collaborative and affective bond between therapist and client, the therapeutic alliance has long been considered an essential element of the therapeutic process. Research has consistently found a substantive relationship between the alliance and therapeutic effectiveness, regardless of therapeutic orientation, presenting problem, or problem severity (Goldsmith, Lewis, Dunn, & Bentall, 2015;Martin, Garske, & Davis, 2000). The capacity to engage in an effective therapeutic alliance, however, is thought to require concomitant implementation of certain coping strategies by clients (e.g., reflection, active coping, openness), which can prove challenging (Stiles, Agnew-Davies, Hardy, Barkham, & Shapiro, 1998).One clinical group in which this area of study is particularly relevant is individuals who have experienced chronic, complex or childhood trauma. Herman (1992) proposed the concept of 'Complex PTSD', or 'Complex Trauma' as it is also known, to describe the multifaceted clinical presentation of individuals experiencing protracted, recurring trauma, particularly of an interpersonal nature (e.g., childhood sexual abuse, sectarian violence).Compared to clients with a discrete or 'simple' PTSD presentation, individuals with complex PTSD have a more severe and comprehensive sympt...

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“…The perpetration of violence often co-presents with victimisation (Malik, Sorensen, & Aneshensel, 1997), and PTSD has been shown to be related to aggression (Dyer et al, 2009; Jakupcak et al, 2007). This association may result from an underlying dysregulation of emotion (Weiss, Tull, Viana, Anestis, & Gratz, 2012) and impulse which may cause aggression, or individuals who suffer from numbing symptoms related to PTSD may utilise aggression in order to up-regulate themselves.…”

Section: Introductionmentioning

confidence: 99%

Associations between societal disapproval and changes in symptoms of PTSD and appetitive aggression following treatment among high-risk South African males

Sommer

Hinsberger

Holtzhausen

et al. 2017

European Journal of Psychotraumatology

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Background: In violent communities, social rejection as a person with victim–offender attributes is associated with more intense symptoms of posttraumatic stress disorder (PTSD) and a higher propensity towards violence, i.e. appetitive aggression. Successful community reintegration encompassing adequate social acknowledgment of individuals with both a history of violence exposure and perpetration may be necessary to enhance the treatment effects of interventions addressing PTSD and aggression. Objective: In this study, the effects of treatment and post-treatment traumatic events, violent offenses, and social acknowledgment (with sub-dimensions of general disapproval, family disapproval, and recognition as a person with both a history of violence exposure and commission) on changes in PTSD symptom severity and appetitive aggression from baseline to 8-month follow-up were investigated. Method: Data were collected from 54 males recruited through a Cape Town offender reintegration programme for an intervention study targeting trauma and aggression (n = 28 treatment; n = 26 wait-list). Changes in PTSD symptom severity after treatment were assessed with the PTSD Symptom Scale-Interview, changes in appetitive aggression with the Appetitive Aggression Scale (AAS), post-treatment traumatic events with an adapted version of the Child’s Exposure to Violence Checklist, offenses with an adapted checklist from the AAS, and social acknowledgment with an adapted form of the Social Acknowledgment Questionnaire. Results: Path analyses revealed negative relationships between ongoing societal disapproval and changes in PTSD symptom severity and appetitive aggression at 8-months, controlling for age. All other variables were non-significant, except for treatment, which was associated with PTSD symptom reduction. Conclusions: As a complementary strategy to effective psychotherapeutic treatment, increased social acknowledgment may contribute significantly to the alleviation of PTSD symptoms and appetitive aggression. Psychological interventions should, therefore, not neglect the impact of societal factors on treatment effects.

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Anger, aggression, and self‐harm in PTSD and complex PTSD

Cited by 94 publications

References 36 publications

A network analysis of anger, shame, proposed ICD-11 post-traumatic stress disorder, and different types of childhood trauma in foster care settings in a sample of adult survivors

A network analysis of anger, shame, proposed ICD-11 post-traumatic stress disorder, and different types of childhood trauma in foster care settings in a sample of adult survivors

Client factors that predict the therapeutic alliance in a chronic, complex trauma sample.

Associations between societal disapproval and changes in symptoms of PTSD and appetitive aggression following treatment among high-risk South African males

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