Traumatology

Animal models conceptualize anxiety as a response to potential danger while fear is a response to present danger. The way humans experience anxiety involves our capacity for higher thinking while the human experience of fear appears to be much the same as the animal model. This article examines these differences at both a phenomenological and neurological level and highlights implications for the treatment of conditioned fear in PTSD. The stimuli for human fear are sensory-perceptual, while the stimuli for most forms of anxiety are conceptual-linguistic. Individuals in a state of fear/terror undergo a radical shift from top-down to bottom-up processing in which access to conceptual-linguistic thought processes is severely restricted and the frontal regions of the cortex are no longer able to override impulses from brain stem and midbrain regions. Conditioned fear involves actual neurological changes in the limbic system. To overcome a traumatic memory, the individual must (1) gain some level of access to the bottom-up state in order to habituate or extinguish the conditioned fear response, and (2) also achieve access to the top-down state in order to process the fear experience and establish explicit memory. Effective treatments for trauma vary in regard to the degree to which they require the client to enter the bottom-up state, but all activate the fear state and eventually facilitate top-down processing.

This study examined the effects of vicarious exposure to the September 11 terrorist attacks in an academic community, just after the three-month period that delineates acute from chronic post-traumatic stress. An entire academic community of 1693 students, faculty, and staff was surveyed electronically regarding their perceived stress symptoms and coping behaviors. The survey yielded a 37 percent response rate. About 76 percent showed one or more substantial symptoms of stress, and 32 percent showed three or more. The most prominent symptom clusters involved persistent avoidance and persistent arousal. Respondents primarily relied on coping through optimism, reassessing priorities and relationships, giving and receiving support, and becoming better informed on terrorism-related topics. Differences in symptoms and coping preferences were found based on sex, group (student, faculty, staff), and exposure to previous crisis. This study indicates that despite time and distance from the site of the terrorism, all segments of a college community continue to experience some degree of distress. Such distress can interfere with academic performance, personal health, and relationship stability. Rather than rely on formal support service delivery, most appear to rely on established interpersonal relationships. This suggests that providing support to vicarious victims in the future might emphasize training for friends and family, rather than relying on established service delivery systems.

Studied the association between features of DSM-IV personality disorders, temperament, character and attachment styles among 109 second-generation offspring of victims of World War II. The majority of these patients, all born after 1945, have been insecurely attached. An dynamic integration of descriptive and structural data, taken from a combination of personality features and drawn from an object relation perspective points to the presence of narcissistic personality pathology in this population. It is concluded that the main focus in any psychotherapeutic treatment of these patients should be their fragile sense of self. However, although self-pathology seems to be the central issue in these patients, they cannot be considered a homogeneous group. In accordance with what is known about narcissistic pathology, two types of narcissistic patients are identified: the oblivious and the hypervigilant. Implications for treatment are discussed.