- 1 - Van der Kolk, Bessel A; Greenberg, Mark S; Boyd, Helene; Krystal, John H. Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of post traumatic stress. Biological Psychiatry (ISSN: 0006-5223), v. 20, no. 3, pp. 314-325 (1985). ABSTRACT: Chronic post traumatic stress has been described as a "physioneurosis" (Kardiner 1941), that is, a mental disorder with both psychological and physiological components. The behavioral sequelae of inescapable shock in animals and of massive psychic trauma in people show a striking parallel. Inescapable shock in animals leads to both transient catecholamine depletion and subsequent stress-induced analgesia. We postulate that the numbing and catatenoid reactions following trauma in humans correspond to the central nervous system (CNS) catecholamine depletion that follows inescapable shock in animals. We further explore the evidence for a human equivalent of "stress-induced analgesia" in animals, which is known to be mediated by endogenous opioids. Although reexposure to trauma may produce a paradoxical sense of calm and control due to endogenous opioid release, a cessation of traumatic stimulation will be followed by symptoms of opioid withdrawal and physiological hyperactivity mediated by CNS noradrenergic hypersensitivity. This hyperreactivity can, in turn, be temporarily modified by reexposure to trauma. This factor could account for voluntary reexposure to trauma in many traumatized individuals and would provide a complementary formulation to the conventional psychodynamic concept of attempted mastery of the psychosocial meaning of the trauma. [Author Abstract]

- 2 - Van der Kolk, Bessel A. Adolescent vulnerability to posttraumatic stress disorder. Psychiatry (ISSN: 0033-2747), v. 48, pp. 365-370 (November 1985). ABSTRACT: This study found that men who developed PTSD after combat in Vietnam tended to have been adolescents while in combat. They had formed an intense attachment to other men in their combat unit, which had been disrupted by the death of a buddy. This loss generally was followed by acts of revenge and subsequent feelings of a profound lack of control over their destiny. Adolescents use their peer group as an intermediary stage between dependency on their family and emotional maturity, and the army, particularly under battlefield conditions, maximizes the impact of peer group cohesion. For these younger men, the death of a friend was experienced as the dissolution of the once omnipotent group and as a narcissistic injury. Group psychotherapy for Vietnam veterans allows the partial re-creation of the peer group in the context in which the trauma occurred. The sharing and reliving of common experiences may facilitate entrance into the world of adult relationships, a process that was arrested by the trauma. [Author Abstract]

- 3 - Van der Kolk, Bessel A. Psychopharmacological issues in posttraumatic stress disorder. Hospital and Community Psychiatry (ISSN: 0022-1597), v. 34, no. 8, pp. 683-684, 691 (August 1983). ABSTRACT: Several psychopharmacological agents, including the benzodiazepines, propanolol, lithium carbonate, phenelzine, and amitriptyline, may have beneficial effects on the symptoms of PTSD. [Text, p. 691]

- 4 - Van der Kolk, Bessel A. The drug treatment of post-traumatic stress disorder. Journal of Affective Disorders (ISSN: 0165-0327), v. 13, no. 2, pp. 203-213 (1987). NT Review Article: 75 refs. ABSTRACT: Many individuals with a history of psychological trauma continue to react to current life stresses as a recurrence of the original trauma, even though they rarely make a conscious connection between present distress and past trauma. Their hyperreactivity, reliving experiences, and difficulty in modulating the intensity of their anxiety, aggression, and interpersonal attachments are sources of continuing stress to both themselves and their environment. Pharmacological treatments are often necessary to blunt the intensity of their response to subsequent stressors. Our knowledge about the drug treatment of PTSD is still very limited. Existing reports are pretty much limited to one particular population with chronic PTSD: Vietnam veterans. Even less is known about effective pharmacological management of acute PTSD. While many psychotropic agents have been proposed for the treatment of various symptoms of PTSD, carefully controlled studies are lacking to clarify the relative merits of particular psychotropic agents on the various post-traumatic symptoms. Impressions in open studies have utilized global ratings, rather than studied the effects on specific symptoms. The animal model of inescapable shock provides a good model for understanding the biological alterations produced by overwhelming trauma, and suggests a variety of pharmacological treatment interventions. Elucidation of traumatic childhood antecedents of certain forms of adult psychopathology will provide clearer links between existing knowledge about effective pharmacological management and the treatment of post-traumatic states. [Author Summary]

- 5 - Beck, James C; Van der Kolk, Bessel A. Reports of childhood incest and current behavior of chronically hospitalized psychotic women. American Journal of Psychiatry (ISSN: 0002-953X), v. 144, no. 11, pp. 1474-1476 (November 1987). ABSTRACT: Of the female patients (N = 26) on a state hospital unit who remained chronically institutionalized and actively psychotic despite psychopharmacologic and psychosocial treatment, 12 (46 percent) reported histories of childhood incest. These 12 patients were more likely than the others to engage socially with ward staff. A higher proportion had sexual delusions, affective symptoms, substance abuse, suspected organicity, and major mental problems, and they spent more time in seclusion than other patients. The authors acknowledge the difficulty of assessing the accuracy of reports of incest. They discuss the implications of a possible relationship between incest and severe, intractable psychotic disorder. [Author Abstract]

- 6 - Pitman, Roger K; Van der Kolk, Bessel A; Orr, Scott P; Greenberg, Mark S. Naloxone-reversible analgesic response to combat-related stimuli in posttraumatic stress disorder: a pilot study. Archives of General Psychiatry (ISSN: 0003-990X), v. 47, no. 6, pp. 541-544 (June 1990). ABSTRACT: We tested the hypothesis that exposure to a stimulus resembling the original traumatic event would induce naloxone-reversible analgesia in patients with PTSD. Eight medication-free Vietnam veterans with PTSD and eight veterans without PTSD, matched for age and combat severity, viewed a 15-minute videotape of dramatized combat under naloxone hydrochloride and placebo conditions in a randomized double-blind crossover design. In the placebo conditions, the subjects with PTSD showed a 30 percent decrease in reported pain intensity ratings of standardized heat stimuli after the combat videotape. No decrease in pain ratings occurred in the subjects with PTSD in the naloxone condition. The subjects without PTSD did not show a decrease in pain ratings in either condition. The results are consistent with the induction of opioid-mediated stress-induced analgesia in the patients with PTSD. [Author Abstract]

- 7 - Van der Hart, Onno; Brown, Paul; Van der Kolk, Bessel A. La traitement psychologique du stress post-traumatique de Pierre Janet = [Pierre Janet's psychological treatment of post-traumatic stress]. Annales Medico-Psychologiques (ISSN: 0003-4487), v. 147, no. 9, pp. 976-982 (November 1989). NT Presented at the meeting of the Societe Medico-Psychologique, 1989 May 22. Discussion is transcribed on pp. 980-982. Limited indexing applied. ABSTRACT: Pierre Janet's psychotherapeutic approach to post-traumatic stress consisted of the following stages: (1) stabilization; (2) exploration and modification of traumatic memories; (3) personality reintegration and rehabilitation. [Translation of Author Abstract]

- 8 - Van der Kolk, Bessel A; Blitz, Robert; Burr, Winthrop; Sherry, Sally; Hartmann, Ernest. Nightmares and trauma: a comparison of nightmares after combat with lifelong nightmares in veterans. American Journal of Psychiatry (ISSN: 0002-953X), v. 141, no. 2, pp. 187-190 (February 1984). NT Presented at the 135th annual meeting of the American Psychiatric Association, Toronto, 1982 May 15-21. For a study of a non-veteran population suffering from frequent nightmares using the same tests and interviews (allowing for comparison of populations), see: Ernest Hartmann, Diane Russ, Molly Oldfield, Ilana Sivan, and Steven Cooper, "Who has nightmares? The personality of the lifelong nightmare sufferer," Archives of General Psychiatry 44(1): 49-56 (January 1987) [03481]. ABSTRACT: In this study the chronic traumatic nightmares of men who had been in combat were found to differ from the lifelong nightmares of veterans with no combat experience in that they tended to occur earlier in the sleep cycle, were more likely to be replicas of actual events, and were more commonly accompanied by gross body movements. Traumatic nightmares may arise out of varying stages of sleep and are not confined to REM sleep alone. The group with lifelong nightmares showed evidence of thought disorder on the Rorschach. The men with PTSD had failed to psychologically integrate their traumatic experiences and used dissociation as a way of dealing with strong affects. [Author Abstract]

- 9 - Van der Kolk, Bessel A; Van der Hart, Onno. Pierre Janet and the breakdown of adaptation in psychological trauma. American Journal of Psychiatry (ISSN: 0002-953X), v. 146, no. 12, pp. 1530-1540 (December 1989). NT For comments on this paper, see Edward C. Norman, "Role of anger in posttraumatic stress," American Journal of Psychiatry 147(9): 1253 (September 1990) [01713], with a reply from van der Kolk and van der Hart; and Joseph D. Sullivan, "Janet and psychological trauma," American Journal of Psychiatry 147(7): 962-963 (July 1990) [02728], with a reply from van der Kolk and van der Hart. ABSTRACT: In this reappraisal of the work of Pierre Janet at the centenary of the publication of L'automatisme psychologique, the authors review his investigations into the mental processes that transform traumatic experiences into psychopathology. Janet was the first to systematically study dissociation as the crucial psychological process with which the organism reacts to overwhelming experiences and show that traumatic memories may be expressed as sensory perceptions, affect states, and behavioral reenactments. Janet provided a broad framework that unifies into a larger perspective the various approaches to psychological functioning which have developed along independent lines in this century. Today his integrated approach may help clarify the interrelationships among such diverse topics as memory processes, state-dependent learning, dissociative reactions, and posttraumatic psychopathology. [Author Abstract]

- 10 - Herman, Judith Lewis; Perry, J Christopher; Van der Kolk, Bessel A. Childhood trauma in borderline personality disorder. American Journal of Psychiatry (ISSN: 0002-953X), v. 146, no. 4, pp. 490-495 (April 1989). NT For a comment on this paper, see Charles L. Rich, "Verifying patients' reports of childhood abuse," American Journal of Psychiatry 146(10): 1358-1359 (October 1989) [01768]. ABSTRACT: Subjects with borderline personality disorder (N = 21) or borderline traits (N = 11) and nonborderline subjects with closely related diagnoses (N = 23) were interviewed in depth regarding experiences of major childhood trauma. Significantly more borderline subjects (81 percent) gave histories of such trauma, including physical abuse (71 percent), sexual abuse (68 percent), and witnessing serious domestic violence (62 percent); abuse histories were less common in those with borderline traits and least common in the subjects with no borderline diagnosis. These results demonstrate a strong association between a diagnosis of borderline personality disorder and a history of abuse in childhood. [Author Abstract]

- 11 - Norman, Edward C; Van der Kolk, Bessel A; Van der Hart, Onno. Role of anger in posttraumatic stress. American Journal of Psychiatry (ISSN: 0002-953X), v. 147, no. 9, pp. 1253 (September 1990). NT A letter from Norman commenting on van der Kolk and van der Hart, "Pierre Janet and the breakdown of adaptation in psychological trauma," American Journal of Psychiatry 146(12): 1530-1540 (December 1989) [01228], with a reply from van der Kolk and van der Hart.

- 12 - Rich, Charles L; Herman, Judith Lewis; Perry, J Christopher; Van der Kolk, Bessel A. Verifying patients' reports of childhood abuse. American Journal of Psychiatry (ISSN: 0002-953X), v. 146, no. 10, pp. 1358-1359 (October 1989). NT A letter from Rich commenting on Herman et al, "Childhood trauma in borderline personality disorder," American Journal of Psychiatry 146(4): 490-495 (April 1989) [01504], with a reply by Herman et al.

- 13 - Hobfoll, Stevan E; Spielberger, Charles D; Breznitz, Shlomo; Figley, Charles R; Folkman, Susan; Green, Bonnie Lepper; Meichenbaum, Donald; Milgram, Norman A; Sandler, Irwin N; Sarason, Irwin G; Van der Kolk, Bessel A. War-related stress: addressing the stress of war and other traumatic events. American Psychologist (ISSN: 0003-066X), v. 46, no. 8, pp. 848-855 (August 1991). NT This article was prepared as one of the charges of the American Psychological Association and Kent State University Applied Psychology Center Task Force on War-Related Stress. Stevan E. Hobfoll and Charles D. Spielberger are co-chairs of this task force, and the other authors are participants. ABSTRACT: A task force on war-related stress was convened to develop strategies for prevention and treatment of psychological, psychosocial, and psychosomatic disorders associated with the Persian Gulf War and other extreme stressors facing communities in general. The task force focused on the return home, reunion, and reintegration of service personnel with their families and work. Although the Persian Gulf War was won with relative ease, negative psychological sequelae may develop in some individuals because of the stress of war, family disruption, financial difficulty, and changes in family routines. Typical stress reactions and modes of coping that are usually unsuccessful or destructive were outlined, and suggestions were made for monitoring these. In addition, guidelines for successful coping were developed. Special attention was given to children's reactions and needs. Recommendations were made for outreach and intervention on the policy, systems (e.g., schools, businesses, governmental agencies), family, and individual levels. [Author Abstract]

- 14 - Van der Kolk, Bessel A; Perry, J Christopher; Herman, Judith Lewis. Childhood origins of self-destructive behavior. American Journal of Psychiatry (ISSN: 0002-953X), v. 148, no. 12, pp. 1665-1671 (December 1991). ABSTRACT: Objective: Clinical reports suggest that many adults who engage in self-destructive behavior have childhood histories of trauma and disrupted parental care. This study explored the relations between childhood trauma, disrupted attachment, and self-destruction, using both historical and prospective data. Methods: 74 subjects with personality disorders or bipolar II disorder were followed for an average of 4 years and monitored for self-destructive behavior such as suicide attempts, self-injury, and eating disorders. These behaviors were then correlated with independently obtained self-reports of childhood trauma, disruptions of parental care, and dissociative phenomena. Results: Histories of childhood sexual and physical abuse were highly significant predictors of self-cutting and suicide attempts. During follow-up, the subjects with the most severe histories of separation and neglect and those with past sexual abuse continued being self-destructive. The nature of the trauma and the subjects' age at the time of the trauma affected the character and the severity of the self-destructive behavior. Cutting was also specifically related to dissociation. Conclusions: Childhood trauma contributes to the initiation of self-destructive behavior, but lack of secure attachments help maintain it. Patients who repetitively attempt suicide or engage in chronic self-cutting are prone to react to current stresses as a return of childhood trauma, neglect, and abandonment. Experiences related to interpersonal safety, anger, and emotional needs may precipitate dissociative episodes and self-destructive behavior. [Author Abstract]

- 15 - Sullivan, Joseph D; Van der Kolk, Bessel A; Van der Hart, Onno. Janet and psychological trauma. American Journal of Psychiatry (ISSN: 0002-953X), v. 147, no. 7, pp. 962-963 (July 1990). NT A comment by Sullivan on Van der Kolk and Van der Hart, ""Pierre Janet and the breakdown of adaptation in psychological trauma," American Journal of Psychiatry 146(12): 1530-1540 (December 1989) [01228], with a reply by Van der Kolk and Van der Hart.

- 16 - Moleman, Nico; Van der Hart, Onno; Van der Kolk, Bessel A. The partus stress reaction: a neglected etiological factor in postpartum psychiatric disorders. Journal of Nervous and Mental Disease (ISSN: 0022-3018), v. 180, no. 4, pp. 271-272 (April 1992). ABSTRACT: The following cases illustrate how intrusive recollections, numbing, dissociation, and other apparently trauma-related symptoms may occur in response to complicated deliveries that involved no direct threat to the life of mother or child. [Adapted from Text]

- 17 - Saxe, Glenn N; Van der Kolk, Bessel A; Berkowitz, Robert; Chinman, Gary; Hall, Kathryn; Lieberg, Gabriele; Schwartz, Jane. Dissociative disorders in psychiatric inpatients. American Journal of Psychiatry (ISSN: 0002-953X), v. 150, no. 7, pp. 1037-1042 (July 1993). NT Presented at the 144th annual meeting of the American Psychiatric Association, New Orleans, 1991 May 11-16. ABSTRACT: Objective: This study attempted to determine 1) the prevalence of dissociative disorders in psychiatric inpatients, 2) the degree of reported childhood trauma in patients with dissociative disorders, and 3) the degree to which dissociative experiences are recognized in psychiatric patients. Method: A total of 110 patients consecutively admitted to a state psychiatric hospital were given the Dissociative Experiences Scale. Patients who scored above 25 were matched for age and gender with a group of patients who scored below 5 on the scale. All patients in the two groups were then interviewed in a blind manner, and the Dissociative Disorders Interview Schedule, the Traumatic Antecedent [sic] Questionnaire, and the PTSD module of the Structured Clinical Interview for DSM-III-R, Nonpatient Version, were administered. Chart reviews were also conducted on all patients. Results: 15 percent of the psychiatric patients scored above 25 on the Dissociative Experiences Scale; 100 percent of these patients met DSM-III criteria for a dissociative disorder. These patients had significantly higher rates of major depression, PTSD, substance abuse, and borderline personality than did the comparison patients, and they also reported significantly higher rates of childhood trauma. Chart review data revealed that dissociative symptoms were largely unrecognized. Conclusions: A high proportion of psychiatric inpatients have significant dissociative pathology, and these symptoms are underrecognized by clinicians. The proper diagnosis of these patients has important implications for their clinical course. [Author Abstract]

- 18 - Van der Kolk, Bessel A. Group psychotherapy with posttraumatic stress disorder. Kaplan, Harold I; Sadock, Benjamin J (ed.). Comprehensive group psychotherapy , 3rd ed. (ISBN: 0-683-04534-2), pp. 550-560. Baltimore: Williams and Wilkins, (1993). ABSTRACT: This paper discusses theoretical issues (such as childhood trauma, the effects of trauma and the principles of group psychotherapy), and types of trauma-related group therapies, their techniques and pitfalls. [ALW]

- 19 - Van der Kolk, Bessel A; Fisler, Rita E. The biologic basis of posttraumatic stress. Primary Care: Clinics in Office Practice (ISSN: 0095-4543), v. 20, no. 2, pp. 417-432 (June 1993). NT Review Article: 227 refs. ABSTRACT: This literature review addresses the symptomatology of PTSD, the developmental level and the biology of the trauma response, the stress response, the psychobiology of PTSD, and implications for psychopharmacologic treatment. [ALW]

- 20 - Herzog, David B; Staley, Janet E; Carmody, Susan; Robbins, Wendi M; Van der Kolk, Bessel A. Childhood sexual abuse in anorexia nervosa and bulimia nervosa: a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry (ISSN: 0890-8567), v. 32, no. 5, pp. 962-966 (September 1993). ABSTRACT: Objectives: The aims of this pilot study were to determine the feasibility and scientific merit of coordinating a large-scale investigation of childhood sexual abuse (CSA) in outpatient-eating disordered women and to evaluate the usefulness and potential adverse effects of a semistructured trauma interview. Method: The sample was randomly selected from subjects participating in a naturalistic longitudinal study of anorexia nervosa (AN) and bulimia nervosa (BN). The refusal rate was 26 percent. 20 women with DSM-III-R AN/BN were assessed with the traumatic antecedents interview (TAI); a brief semistructured follow-up interview was administered over the telephone 3 to 8 weeks after the first interview. Subjects also completed the Dissociative Experiences Scale (DES). Results: 13 subjects (65 percent) reported CSA, and those with more comorbidity reported CSA more frequently. Subjects with a history of CSA had significantly higher scores on the DES. Minimal adverse consequences to the TAI were noted. Conclusions: The high compliance rate, high prevalence of CSA, and high DES scores among our pilot sample support the merit of studying CSA in a larger sample. [Author Abstract] KEY WORDS: anorexia nervosa; bulimia nervosa; childhood sexual abuse.

- 21 - Van der Kolk, Bessel A. The body keeps the score: memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry (ISSN: 1067-3229), v. 1, no. 5, pp. 253-265 (January-February 1994). NT Review Article: 134 refs. ABSTRACT: Ever since people's responses to overwhelming experiences have been systematically explored, researchers have noted that a trauma is stored in somatic memory and expressed as changes in the biological stress response. Intense emotions at the time of the trauma initiate the long-term conditional responses to reminders of the event, which are associated both with chronic alterations in the physiological stress response and with the amnesias and hypermnesias characteristic of PTSD. Continued physiological hyperarousal and altered stress hormone secretion affect the ongoing evaluation of sensory stimuli as well. Although memory is ordinarily an active and constructive process, in PTSD failure of declarative memory may lead to organization of the trauma on a somatosensory level (as visual images or physical sensations) that is relatively impervious to change. The inability of people with PTSD to integrate traumatic experiences and their tendency, instead, to continuously relive the past are mirrored physiologically and hormonally in the misinterpretation of innocuous stimuli as potential threats. Animal research suggests that intense emotional memories are processed outside of the hippocampally mediated memory system and are difficult to extinguish. Cortical activity can inhibit the expression of these subcortically based emotional memories. The effectiveness of this inhibition depends, in part, on physiological arousal and neurohormonal activity. These formulations have implications for both the psychotherapy and the pharmacotherapy of PTSD. [Author Abstract]

- 22 - Van der Kolk, Bessel A; Fisler, Rita E. Childhood abuse and neglect and loss of self-regulation. Bulletin of the Menninger Clinic (ISSN: 0025-9284), v. 58, no. 2, pp. 145-168 (Spring 1994). NT This article is based on a presentation at the 15th annual Menninger Winter Psychiatry Conference, Park City, Utah, 1993 March 7-12. ABSTRACT: Secure attachments with caregivers play a critical role in helping children develop a capacity to modulate physiological arousal. Loss of ability to regulate the intensity of feelings and impulses is possibly the most far-reaching effect of trauma and negelct. It has been shown that most abused and neglected children develop disorganized attachment patterns. The inability to modulate emotions gives rise to a range of behaviors that are best understood as attempts at self-regulation. These include aggression against others, self-destructive behavior, eating disorders, and substance abuse. The capacity to regulate internal states affects both self-definition and one's attitude toward one's surroundings. Abused children often fail to develop the capacity to express specific and differentiated emotions: Their difficulty putting feelings into words interferes with flexible response strategies and promotes acting out. Usually, these behaviors coexist, which further complicates diagnosis and treatment. Affective dysregulation can be mitigated by safe attachments, secure meaning schemes, and pharmacological interventions that enhance the predictability of somatic responses to stress. The ability to create symbolic representations of terrifying experiences promotes taming of terror and desomatization of traumatic memories. [Author Abstract]

- 23 - Van der Kolk, Bessel A; Herron, Nan; Hostetler, Ann. The history of trauma in psychiatry. Psychiatric Clinics of North America (ISSN: 0193-953X), v. 17, no. 3, pp. 583-600 (September 1994). NT Review Article: 95 refs. ABSTRACT: The authors trace the history of psychiatric trauma from Homer to DSM-IV. [ALW]

- 24 - Saxe, Glenn N; Chinman, Gary; Berkowitz, Robert; Hall, Kathryn; Lieberg, Gabriele; Schwartz, Jane; Van der Kolk, Bessel A. Somatization in patients with dissociative disorders. American Journal of Psychiatry (ISSN: 0002-953X), v. 151, no. 9, pp. 1329-1334 (September 1994). ABSTRACT: Objective: This study attempted to determine the prevalence of somatic symptoms, somatization disorder, and medical interventions in patients with dissociative disorders. Method: 14 psychiatric inpatients with a DSM-III dissociative disorder were matched for age and gender with a comparison group of inpatients who reported few dissociative symptoms. All subjects were interviewed in a blind manner with the Dissociative Disorders Interview Schedule (this semistructured interview schedule includes a section on somatization disorder), and their hospital charts were reviewed to determine somatic symptoms and medical histories. Results: 64 percent of the patients with dissociative disorders met DSM-III criteria for somatization disorder and reported an average of 12.4 somatic symptoms. None of the comparison patients met DSM-III criteria for somatization disorder, and these patients reported an average of 3.1 somatic symptoms. These differences between the two groups were significant. Significant differences were also found in the number of medical hospitalizations and consultations between the two groups. A significant correlation was found between the degree of dissociation and degree of somatization in patients with dissociative disorders. Conclusions: The authors conclude that somatization disorder is a frequent and serious comorbid disorder among patients with dissociative disorders. [Author Abstract]

- 25 - Van der Kolk, Bessel A; Dreyfuss, Daniel; Michaels, Michael; Shera, David; Berkowitz, Robert; Fisler, Rita E; Saxe, Glenn N. Fluoxetine in posttraumatic stress disorder. Journal of Clinical Psychiatry (ISSN: 0160-6689), v. 55, no. 12, pp. 517-522 (December 1994). NT For a comment on this article, see: Jay S. Cohen, "Provide fluoxetine information vital to clinicians," Journal of Clinical Psychiatry 56(12): 591 (December 1995) [07140]. ABSTRACT: Background: This study was designed to establish the efficacy of the serotonin reuptake blocker fluoxetine in the treatment of PTSD. Method: 64 subjects (22 women and 42 men; 31 veterans and 33 nonveterans) with PTSD entered a 5-week randomized double-blind trial comparing fluoxetine (N = 33) and placebo (N = 31). Results: By Week 5 fluoxetine, but not placebo, significantly reduced overall PTSD symptomatology, as assessed by the Clinician-Administered PTSD Scale (CAPS) score. Changes were most marked in the arousal and numbing symptom subcategories. Non-VA patients responded much better than VA patients. Fluoxetine was an effective antidepressant independent of its effects on PTSD. Conclusion: Fluoxetine is an effective pharmacotherapeutic agent for treating PTSD and its associated features, particularly in patients without chronic treatment histories. [Author Abstract]

- 26 - Van der Kolk, Bessel A; Hostetler, Anne; Herron, Nan; Fisler, Rita E. Trauma and the development of borderline personality disorder. Psychiatric Clinics of North America (ISSN: 0193-953X), v. 17, no. 4, pp. 715-730 (December 1994). ABSTRACT: Topics Treated: PTSD and borderline personality disorder (intrusive recollections, re-enactment, and dissociation); studies on childhood trauma and borderline personality disorder (developmental arrest and fixation on the trauma; treatment implications).

- 27 - Baker, D G; Diamond, Bruce I; Gillette, Greg; Hamner, Mark B; Katzelnick, D; Keller, T; Mellman, Thomas A; Pontius, Edward B; Rosenthal, M; Tucker, P; Van der Kolk, Bessel A; Katz, Richard J. A double-blind, randomized, placebo-controlled, multi-center study of brofaromine in the treatment of post-traumatic stress disorder. Psychopharmacology (ISSN: 0033-3158), v. 122, no. 4, pp. 386-389 (December 1995). ABSTRACT: A large multi-center, double-blind, parallel trial to assess the efficacy of brofaromine in the treatment of PTSD failed to show a significant difference between the brofaromine and placebo treatment groups. The placebo response rate in this study was higher than that in previously published double-blind, placebo-controlled studies of PTSD. [Author Abstract] KEY WORDS: Brofaromine; MAOI; PTSD; psychopharmacology.

- 28 - Van der Kolk, Bessel A; Pelcovitz, David; Roth, Susan H; Mandel, Francine S; McFarlane, Alexander Cowell; Herman, Judith Lewis. Dissociation, somatization, and affect dysregulation: the complexity of adaptation to trauma. American Journal of Psychiatry (ISSN: 0002-953X), v. 153, no. 7 Festschrift Supplement, pp. 83-93 (July 1996). NT This paper is part of a "Festschrift in Honor of John C. Nemiah, M.D.". ABSTRACT: OBJECTIVE: A century of clinical research has noted a range of trauma-related psychological problems that are not captured in the DSM-IV framework of PTSD. This study investigated the relationships between exposure to extreme stress, the emergence of PTSD, and symptoms traditionally associated with "hysteria," which can be understood as problems with stimulus discrimination, self-regulation, and cognitive integration of experience. METHOD: The DSM-IV field trial for PTSD studied 395 traumatized treatment-seeking subjects and 125 non-treatment-seeking subjects who had also been exposed to traumatic experiences. Data on age at onset, the nature of the trauma, PTSD, dissociation, somatization, and affect dysregulation were collected. RESULTS: PTSD, dissociation, somatization, and affect dysregulation were highly interrelated. The subjects meeting the criteria for lifetime (but not current) PTSD scored significantly lower on these disorders than those with current PTSD, but significantly higher than those who never had PTSD. Subjects who developed PTSD after interpersonal trauma as adults had significantly fewer symptoms than those with childhood trauma, but significantly more than victims of disasters. CONCLUSIONS: PTSD, dissociation, somatization, and affect dysregulation represent a spectrum of adaptations to trauma. They often occur together, but traumatized individuals may suffer from various combinations of symptoms over time. In treating these patients, it is critical to attend to the relative contributions of loss of stimulus discrimination, self-regulation, and cognitive integration of experience to overall impairment and provide systematic treatment that addresses both unbidden intrusive recollections and these other symptoms associated with having been overwhelmed by exposure to traumatic experiences. [Author Abstract]

- 29 - Rauch, Scott L; Van der Kolk, Bessel A; Fisler, Rita E; Alpert, Nathaniel M; Orr, Scott P; Savage, Cary R; Fischman, Alan J; Jenike, Michael A; Pitman, Roger K. A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery. Archives of General Psychiatry (ISSN: 0003-990X), v. 53, no. 5, pp. 380-387 (May 1996). NT Presented in part at the 10th annual meeting of the International Society for Traumatic Stress Studies, Chicago, 1994 November 8. ABSTRACT: BACKGROUND: Previous studies have used symptom provocation and positron emission tomography to delineate the brain systems that mediate various anxiety states. Using an analogous approach, the goal of this study was to measure regional cerebral blood flow changes associated with PTSD symptoms. METHODS: 8 patients with PTSD, screened as physiologically responsive to a script-driven imagery symptom provocation paradigm, were exposed sequentially to audiotaped traumatic and neutral scripts in conjunction with positron emission tomography. Heart rate and subjective measures of emotional state were obtained for each condition. Statistical mapping techniques were used to determine locations of significant brain activation. RESULTS: Increases in normalized blood flow were found for the traumatic as compared with control conditions in right-sided limbic, paralimbic, and visual areas; decreases were found in left inferior frontal and middle temporal cortex. CONCLUSIONS: The results suggest that emotions associated with the PTSD symptomatic state are mediated by the limbic and paralimbic systems within the right hemisphere. Activation of visual cortex may correspond to the visual component of PTSD reexperiencing phenomena. [Author Abstract]

- 30 - Van der Kolk, Bessel A. The biological response to psychic trauma. Ochberg, Frank M (ed.). Post-traumatic therapy and victims of violence (ISBN: 0-87630-490-0), pp. 25-38. New York: Brunner/Mazel, (1988). (Brunner/Mazel psychosocial stress series, 11). NT An expanded version of this chapter, under the title "The drug treatment of post-traumatic stress disorder," first appeared in the Journal of Affective Disorders 13: 203-213 (1987). ABSTRACT: Topics treated: etiological models of PTSD; physiological sequelae of traumatization; the animal model of inescapable shock; the psychopharmacological treatment of post-traumatic stress; conclusion.

- 31 - Van der Kolk, Bessel A. The trauma spectrum: the interaction of biological and social events in the genesis of the trauma response. Journal of Traumatic Stress (ISSN: 0894-9867), v. 1, no. 3, pp. 273-290 (July 1988). ABSTRACT: When Kardiner first described the full syndrome of what is now called PTSD in 1941, he called the trauma response a "physioneurosis," that is, a mental disorder which affects both the soma and the psyche. Now, more than 40 years later much knowledge has been gained about the biological effects of traumatization. Based on the studies of disruptions of attachment bonds in non-human primates, the animal model of inescapable shock, and numerous studies of traumatized children and adults, we are beginning to understand the nature of the biological changes which underlie the psychological response to trauma. This paper will explore (1) the nature of the biological alterations in response to traumatization, (2) how these biological shifts depend on the maturation of the central nervous system (CNS), cognitive processes, and the social matrix in which they occur, (3) and how these alterations can influence psychopathological and interpersonal processes. [Author Abstract] KEY WORDS: PTSD; psychobiology; attachment; hyperarousal; memory; addiction to trauma.

- 32 - Van der Kolk, Bessel A; Ducey, Charles P. The psychological processing of traumatic experience: Rorschach patterns in PTSD. Journal of Traumatic Stress (ISSN: 0894-9867), v. 2, no. 3, pp. 259-274 (July 1989). NT For a comment on this paper, see Leo Cohen and Corine de Ruiter, "The Rorschach and PTSD revisited: critique of Van der Kolk and Ducey's (1989) 'The psychological processing of traumatic experience: Rorschach patterns in PTSD,'" Journal of Traumatic Stress 4(3): 407-417 (July 1989) [11035]. ABSTRACT: The Rorschach records of 13 Vietnam veterans with PTSD were compared with 11 matched combat controls and were analyzed for both content and structural features. These Rorschachs showed an unmodified reliving of traumatic material and revealed the biphasic cognitive processing of traumatic experiences of rigidly defended, affective numbing versus overwhelmed intrusive reliving. They demonstrated how trauma and its concomitant affects persist with little modification over time and confirm the clinical impression that people with severe PTSD have an impaired capacity for affect modulation. The lack of integration of the traumatic experience accounts for extreme reactivity to environmental stimuli: the initially overwhelming external event, through lack of assimilation, is perpetuated internally and continues to exert disorganizing effects on the psyche. The authors discuss the claims that the presence of mute, unsymbolized, and unintegrated experiences causes reenactment of the trauma, until the victim learns to put into words both the associated facts and the feelings. [Author Abstract] KEY WORDS: PTSD; Rorschach; psychological testing; dissociation; cognitive processes; compulsion to repeat; psychotherapy; impulsivity.

- 33 - Van der Kolk, Bessel A; Brown, Paul; Van der Hart, Onno. Pierre Janet on post-traumatic stress. Journal of Traumatic Stress (ISSN: 0894-9867), v. 2, no. 4, pp. 365-378 (October 1989). ABSTRACT: One hundred years ago, in 1889, Pierre Janet published L'Automatisme Psychologique, his first work to deal with how the mind processes traumatic experiences. Janet claimed that vehement emotions interfere with proper appraisal and appropriate action. Failure to confront the experience fully leads to dissociation of the traumatic memories and their return as fragmentary reliving experiences: feeling states, somatic sensations, visual images, and behavioral reenactments. A century later, Janet still provides an unsurpassed framework for integrating current knowledge about the psychodynamic, cognitive, and biological effects of human traumatization. [Author Abstract] KEY WORDS: Janet; PTSD; dissociation; memory; history of psychiatry; cognitive psychology.

- 34 - Van der Hart, Onno; Brown, Paul; Van der Kolk, Bessel A. Pierre Janet's treatment of post-traumatic stress. Journal of Traumatic Stress (ISSN: 0894-9867), v. 2, no. 4, pp. 379-395 (October 1989). NT Reprinted in: George S. Everly and Jeffrey M. Lating (ed.), Psychotraumatology: key papers and core concepts in post-traumatic stress (New York: Plenum Press, 1995), pp. 195-210 [12569]. ABSTRACT: Pierre Janet's therapeutic approach to traumatized patients was the first attempt to create a systematic, phase-oriented treatment of post-traumatic stress. Janet viewed the trauma response basically as a disorder of memory which interfered with effective action. Relying heavily on the use of hypnosis, he taught that the treatment of post-traumatic psychopathology consisted of forming a stable therapeutic relationship; retrieving and transforming traumatic memories into meaningful experiences; and taking effective action to overcome learned helplessness. Most of his observations and recommendations are as challenging today as when he first made them, starting a century ago. [Author Abstract] KEY WORDS: PTSD; dissociation; hypnosis; Janet; history of psychiatry.

- 35 - Van der Kolk, Bessel A. The psychological consequences of overwhelming life experiences. Van der Kolk, Bessel A ([ed.]). Psychological trauma (ISBN: 0-88048-233-8), pp. 1-30. Washington: American Psychiatric Press, (1987). ABSTRACT: Topics treated: The clinical symptomatology of PTSD; The trauma response as a biphasic response; Etiological models of PTSD; Fixation on the trauma; Integration or dissociation; Loss of capacity to modulate anxiety and aggression; Helplessness and loss of control; Vulnerability; Factors affecting the duration and severity of the trauma response; Resolution; Trauma in children; Child physical abuse; Incest; Learning disabilities following childhood abuse; Abuse and neurological abnormalities; The victim to patient process: trauma and psychiatric illness; Conclusions.

- 36 - Van der Kolk, Bessel A. The separation cry and the trauma response: developmental issues in the psychobiology of attachment and separation. Van der Kolk, Bessel A ([ed.]). Psychological trauma (ISBN: 0-88048-233-8), pp. 31-62. Washington: American Psychiatric Press, (1987). ABSTRACT: Topics treated: Studies on imprinting; Attachment and separation in nonhuman primates: lessons from Harlow's heirs; Affiliative behavior and the brain; Neuroanatomical correlates of affiliative behavior; Conclusion.

- 37 - Van der Kolk, Bessel A; Greenberg, Mark S. The psychobiology of the trauma response: hyperarousal, constriction, and addiction to traumatic reexposure. Van der Kolk, Bessel A ([ed.]). Psychological trauma (ISBN: 0-88048-233-8), pp. 63-87. Washington: American Psychiatric Press, (1987). NT Review Article: 101 refs. ABSTRACT: Topics treated: PTSD as a "physioneurosis": the loss of ability to moderate arousal; The psychological consequences of the inability to modulate physiological arousal; The animal model of inescapable shock; Hyperarousal, constriction, and altered catecholamine receptor sensitivity; Stress and drugs uncover long-term physiological posttraumatic alterations: kindling and behavioral sensitization; Intrusive reexperiencing in PTSD: flashbacks and nightmares; Trauma and endogenous opioid peptides; Addiction to trauma; The reciprocal relationship between opioid and noradrenergic systems; Treatment implications of the animal model of inescapable shock; The psychopharmacological treatment of posttraumatic stress; Conclusions.

- 38 - Fish-Murray, Caroline C; Koby, Elizabeth V; Van der Kolk, Bessel A. Evolving ideas: the effect of abuse on children's thought. Van der Kolk, Bessel A ([ed.]). Psychological trauma (ISBN: 0-88048-233-8), pp. 89-110. Washington: American Psychiatric Press, (1987). ABSTRACT: Children's understanding of their inner and outer world changes qualitatively as they grow up. In this chapter we will explore how a child tries to make sense of experiences of abuse, loss, and neglect over time. We will attempt to combine ideas from the fields of dynamic personality and cognitive development to contribute to a deeper understanding of how trauma impairs cognition, an understanding that will be needed for more effective diagnosis and treatment. [Author]

- 39 - Herman, Judith Lewis; Van der Kolk, Bessel A. Traumatic antecedents of borderline personality disorder. Van der Kolk, Bessel A ([ed.]). Psychological trauma (ISBN: 0-88048-233-8), pp. 111-126. Washington: American Psychiatric Press, (1987). ABSTRACT: PTSD is often undiagnosed in cases in which secrecy or stigma prevent recognition of the traumatic origins of the disorder. Such patients often improve dramatically when the connection between symptoms and trauma is recognized and appropriate treatment is instituted. We believe that some of the negative therapeutic reactions so frequently observed in borderline patients might be avoided by early and appropriate recognition of the relationship between the patient's current symptomatology and its origins in a traumatic history. [Author]

- 40 - Van der Kolk, Bessel A. The role of the group in the origin and resolution of the trauma response. Van der Kolk, Bessel A ([ed.]). Psychological trauma (ISBN: 0-88048-233-8), pp. 153-171. Washington: American Psychiatric Press, (1987). ABSTRACT: Topics treated: The loss of communality following trauma; The role of the group in surviving extreme conditions; Adolescent individuation and group formation; Adolescence, military service, and trauma; Treatment implications: individual versus group psychotherapy.

- 41 - Van der Kolk, Bessel A; Kadish, William. Amnesia, dissociation, and the return of the repressed. Van der Kolk, Bessel A ([ed.]). Psychological trauma (ISBN: 0-88048-233-8), pp. 173-190. Washington: American Psychiatric Press, (1987). ABSTRACT: Reports the case of a patient hospitalized at the Massachusetts Mental Health Center for psychiatric episodes who began in 1984 to make references to the Coconut Grove nightclub fire of 1942. At that time the patient was a 55-year-old single woman who had no memory of having been in the fire herself, but whose dissociated reexperiences and reenactments of fire-related incidents had caused repeated psychiatric hospitalizations. [Adapted from text]

- 42 - Greenberg, Mark S; Van der Kolk, Bessel A. Retrieval and integration of traumatic memories with the "painting cure". Van der Kolk, Bessel A ([ed.]). Psychological trauma (ISBN: 0-88048-233-8), pp. 191-215. Washington: American Psychiatric Press, (1987). ABSTRACT: This chapter will demonstrate how special cognitive resources outside the verbal realm can be reawakened and utilized, first to uncover and recall traumatic events, and then to transform the meaning of the trauma with resulting psychological growth. Images, scenes, bodily sensations and emotions related to the trauma can be retrieved. This reversal of dissociation affords the patient an opportunity to recall significant autobiographical episodes and integrate the trauma into his or her personal history. In this process, the patient can transcend the trauma and cease the compulsion to repeat and reenact it. Most of the chapter is a case report describing a 30-year-old married woman referred for psychotherapy after she described crippling insecurities, compulsive behaviors, and unusual somatic symptoms to her endocrinologist. [Adapted from text]

- 43 - Van der Kolk, Bessel A; Ducey, Charles P. Clinical implications of the Rorschach in post-traumatic stress disorder. Van der Kolk, Bessel A (ed.). Post-traumatic stress disorder: psychological and biological sequelae (ISBN: 0-88048-053-X), pp. 29-42. Washington: American Psychiatric Press, (1984). (Clinical insights). ABSTRACT: During times of pronounced autonomic activation, either behavioral disturbances or intolerable intrusive traumatic memories will allow for a ready diagnosis of PTSD. However, when controls predominate and intrusive events are warded off, emotional constriction, chronic passivity, and a vague sense of victimization may be the only apparent sequelae of the trauma, usually missed by the diagnostician who is not alert to the possibility. Among people who fall in the latter category, the diagnosis of PTSD cannot be made with any degree of certainty, until intrusive phenomena start recurring. This is often the case in older veterans around retirement age, in whom nightmares about traumatic events in World War II (WWII) resume when they are faced with the loss of the structure and purpose that their jobs provided. In one survey, about half of WWII combat veterans who were around retirement age had a recurrence of intrusive recollections or nightmares. On rare occasions, evidence of continuing preoccupation with the trauma may be absent from a patient's conscious mental life and yet be manifested on psychological testing, particularly the Rorschach. [Text, p. 31]

- 44 - Van der Kolk, Bessel A; Boyd, Helene; Krystal, John H; Greenberg, Mark S. Post-traumatic stress disorder as a biologically based disorder: implications of the animal model of inescapable shock. Van der Kolk, Bessel A (ed.). Post-traumatic stress disorder: psychological and biological sequelae (ISBN: 0-88048-053-X), pp. 123-134. Washington: American Psychiatric Press, (1984). (Clinical insights). ABSTRACT: The laboratory model of inescapable shock is unique in providing an animal model of a human psychiatric syndrome, allowing for controlled measurements of behavioral, physiological, and biochemical alterations subsequent to overwhelming stress. [Introduction]

- 45 - Pitman, Roger K; Orr, Scott P; Van der Kolk, Bessel A; Greenberg, Mark S; Meyerhoff, James L; Mougey, Edward H. Analgesia: a new dependent variable for the biological study of posttraumatic stress disorder. Wolf, Marion E; Mosnaim, Aron D (ed.). Posttraumatic stress disorder: etiology, phenomenology, and treatment , 1st ed. (ISBN: 0-88048-299-0), pp. 140-147. Washington: American Psychiatric Press, (1990). ABSTRACT: Despite its appellation, understanding of the psychiatric condition PTSD has as yet benefited little from insights into the biology of the stress response obtained with experimental work with animals. In this chapter, we will present evidence suggesting that a well-recognized dependent variable in animal stress research - pain sensibility - may prove useful in characterizing the stress response in combat-related PTSD. [Adapted from Text, p. 141]

- 46 - Van der Kolk, Bessel A; Greenberg, Mark S; Orr, Scott P; Pitman, Roger K. Endogenous opioids, stress induced analgesia, and posttraumatic stress disorder. Psychopharmacology Bulletin (ISSN: 0048-5764), v. 25, no. 3, pp. 417-421 (1989). ABSTRACT: The hypothesis that the animal model of inescapable shock is an appropriate model for PTSD predicts that re-exposure to a traumatic stressor will precipitate opioid-mediated stress-induced analgesia in people with PTSD. Eight Vietnam veterans with PTSD and eight matched veterans without PTSD viewed a combat videotape under naloxone and placebo conditions in a randomized double-blind crossover design. In the placebo conditions, but not after naloxone, the PTSD subjects reported a 30 percent decrease in pain intensity ratings of standardized heat stimuli after the combat videotape. Point biserial correlations revealed that change in pain perception was the most highly correlated with PTSD of all variables tested, including biochemical, physiological, and self-report. These results suggest that a centrally mediated opioid response to traumatic stimuli is an important feature of PTSD. Possible implications of this finding for the psychobiology of PTSD are discussed. [Author Abstract]

- 47 - Ducey, Charles P; Van der Kolk, Bessel A. The psychological processing of traumatic experience: reply to Cohen and de Ruiter. Journal of Traumatic Stress (ISSN: 0894-9867), v. 4, no. 3, pp. 425-432 (July 1991). NT A reply to Leo Cohen and Corine de Ruiter, "The Rorschach and PTSD revisited: critique of Van der Kolk and Ducey's (1989) 'The psychological processing of traumatic experience: Rorschach patterns in PTSD,'" Journal of Traumatic Stress 4(3): 407-417 (July 1989) [11035]. This correspondence is continued by Ruiter and Cohen, "Psychological processing of criticism: reaction to Ducey and van der Kolk," Journal of Traumatic Stress 5(1): 143-148 (January 1992) [11145]. ABSTRACT: A critique of our Rorschach research on the experience, symbolization, and psychological processing of trauma makes some valid points, but overlooks both the study's exploratory, hypothesis-generating nature and our integration of historical, clinical, psychotherapeutic, and empirical perspectives. Our examination of the relationship of trauma to inner symbolization and to emotional responsiveness to the environment reveals the critics' narrow understanding of the Rorschach and misconceptions regarding trauma. Further research cited replicates but also challenges our initial findings. [Author Abstract] KEY WORDS: PTSD; Rorschach; psychological testing; dissociation; cognitive processes; affective experience.

- 48 - Lindy, Jacob D; Van der Kolk, Bessel A. Notes from Moscow (1990): some thoughts on the politics of PTSD during perestroika. Journal of Traumatic Stress (ISSN: 0894-9867), v. 4, no. 3, pp. 439-443 (July 1991). ABSTRACT: Describes the authors' reactions to the International Symposium on Medico-Psychological Problems of Natural Disasters and Catastrophes, held in Moscow in September 1990. [FAL]

- 49 - Van der Kolk, Bessel A; Van der Hart, Onno. The intrusive past: the flexibility of memory and the engraving of trauma. American Imago (ISSN: 0065-860X), v. 48, no. 4, pp. 425-454 (Winter 1991). ABSTRACT: Citing the findings of Janet and others, the authors discuss the proposition that traumatic memories are unassimilated scraps of overwhelming experiences, which need to be integrated with existing mental schemes, and be transformed into narrative language. [ALW]

- 50 - Van der Kolk, Bessel A; Saporta, Jose. The biological response to psychic trauma: mechanisms and treatment of intrusion and numbing. Anxiety Research (ISSN: 0891-7779), v. 4, no. 3, pp. 199-212 (1991). NT Review Article: 80 refs. ABSTRACT: The recognition that trauma is qualitatively different from stress and results in lasting biological changes goes back to the dawn of contemporary psychiatry. The conditioning of biological emergency responses following traumatic experiences may account for the biphasic trauma response, and the accompanying memory disturbances. The past decade has seen rapid advances in our understanding of the underlying biology of this "physioneurosis". In addition to classically conditioned physiological reactions, changes now have been demonstrated in the startle response in people with PTSD and in central nervous system catecholamine, serotonin, and endogenous opioid systems. This paper reviews the research data which have demonstrated changes in these systems and explores how these biological changes may be related to the characteristic hyper-reactivity, loss of neuromodulation, numbing of responsiveness, dissociative states, and memory disturbances seen in PTSD. There is growing evidence that trauma has different biological effects at different stages of primate human, development. This article relates these findings to the studies which have demonstrated clear linkages between childhood trauma, and a variety of psychiatric disorders, including borderline personality disorder, and a range of self-destructive behaviors. [Author Abstract] KEY WORDS: PTSD; psychobiology; arousal; memory; self-destructive behavior; psychopharmacology.

- 51 - Van der Kolk, Bessel A; Saporta, Jose. Biological response to psychic trauma. Wilson, John P; Raphael, Beverley (ed.). International handbook of traumatic stress syndromes (ISBN: 0-306-43795-3), pp. 25-33. New York: Plenum Press, (1993). (Plenum series on stress and coping). NT Review Article: 95 refs. ABSTRACT: Topics Treated: Background; Symptomatology of PTSD; Effects of developmental level on psychobiological effects of trauma; Trauma and the limbic system; Neuromodulation of arousal: noradrenergic versus serotonergic pathways; Stress response and the psychobiology of PTSD; Memory disturbances in PTSD; Sleep studies; Psychosomatic reactions; Implications for the psychopharmacological treatment of PTSD; Conclusions.

- 52 - Saporta, Jose; Van der Kolk, Bessel A. Psychobiological consequences of severe trauma. Basoglu, Metin (ed.). Torture and its consequences: current treatment approaches (ISBN: 0-521-39299-3), pp. 151-181. Cambridge: Cambridge University Press, (1992). NT Review Article: 179 refs. ABSTRACT: Saporta and van der Kolk provide a detailed review of the literature on the psychobiology of traumatic stress response syndromes and discuss the treatment implications of recent findings in this area. The authors aim to introduce the reader to the complex interaction between biological, psychological, and social factors that converge and perpetuate the long term consequences of trauma. After a brief discussion of four primary features of trauma - incomprehensibility, disrupted attachment, traumatic bonding, and inescapability - the authors review three animal models for PTSD: inescapable stress, forced isolation, and disruption of attachments in nonhuman primates. Also reviewed are the role of endogenous opioids in trauma responses and the psychobiology of reliving and reenactment. The chapter ends with a discussion of treatment implications. [Introduction]

- 53 - Van der Kolk, Bessel A. Post-traumatic stress disorder: psychological and biological sequelae. (ISBN: 0-88048-053-X). Washington: American Psychiatric Press, (1984). (Clinical insights). NT This monograph is based on material presented at the 136th annual meeting of the American Psychiatric Association. Selected chapters are indexed individually [10793-10800]. ABSTRACT: Examines psychological and physiological factors underlying PTSD. [FAL]

- 54 - Van der Kolk, Bessel A. Psychological trauma. (ISBN: 0-88048-233-8). Washington: American Psychiatric Press, (1987). NT Selected chapters are indexed individually [10570-10579]. ABSTRACT: This book considers the impact of experiences that overwhelm both psychological and biological coping mechanisms. The effects of trauma on emotional and cognitive processes, underlying biological changes, and resulting psychopathology are reviewed. A large number of research findings from a variety of theoretical perspectives are presented and their treatment implications examined. Childhood trauma is particularly significant because uncontrollable terrifying experiences may have their most profound effects when the central nervous system and cognitive functions have not yet fully matured, leading to a global impairment that may be manifested in adulthood in psychopathological conditions. Although long-term prospective studies of traumatized children are not yet available, retrospective studies are reviewed to examine the impact of early psychological trauma on the development of mental illness.

- 55 - Van der Hart, Onno; Brown, Paul; Van der Kolk, Bessel A. Pierre Janet's treatment of post-traumatic stress. Everly, George S; Lating, Jeffrey M (ed.). Psychotraumatology: key papers and core concepts in post-traumatic stress (ISBN: 0-306-44783-5), pp. 195-210. New York: Plenum Press, (1995). (Plenum series on stress and coping). NT Reprinted from: Journal of Traumatic Stress 2(4): 379-395 (October 1989) [10522]. ABSTRACT: Pierre Janet's therapeutic approach to traumatized patients was the first attempt to create a systematic, phase-oriented treatment of post-traumatic stress. Janet viewed the trauma response basically as a disorder of memory which interfered with effective action. Relying heavily on the use of hypnosis, he taught that the treatment of post-traumatic psychopathology consisted of forming a stable therapeutic relationship; retrieving and transforming traumatic memories into meaningful experiences; and taking effective action to overcome learned helplessness. Most of his observations and recommendations are as challenging today as when he first made them, starting a century ago. [Author Abstract] KEY WORDS: PTSD; dissociation; hypnosis; Janet; history of psychiatry.

- 56 - Van der Kolk, Bessel A; Fisler, Rita E. Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study. Journal of Traumatic Stress (ISSN: 0894-9867), v. 8, no. 4, pp. 505-525 (October 1995). ABSTRACT: Since trauma arises from an inescapable stressful event that overwhelms people's coping mechanisms, it is uncertain to what degree the results of laboratory studies of ordinary events are relevant to the understanding of traumatic memories. This paper reviews the literature on differences between recollections of stressful and of traumatic events. It then reveiws the evidence implicating dissociation as the central pathogenic mechanism that gives rise to PTSD. A systematic exploratory study of 46 subjects with PTSD indicated that traumatic memories were retrieved, at least initially, in the form of dissociated mental imprints of sensory and affective elements of the traumatic experience: as visual, olfactory, affective, auditory, and kinesthetic experiences. Over time, subjects reported the gradual emergence of a personal narrative that can be properly referred to as "explicit memory." The implications of these findings for understanding the nature of traumatic memories are discussed. [Author Abstract] KEY WORDS: trauma; memory; dissociation; posttraumatic stress disorder

- 57 - Pelcovitz, David; Van der Kolk, Bessel A; Roth, Susan H; Mandel, Francine S; Kaplan, Sandra; Resick, Patricia A. Development of a criteria set and a structured interview for disorders of extreme stress (SIDES). Journal of Traumatic Stress (ISSN: 0894-9867), v. 10, no. 1, pp. 3-16 (January 1997). ABSTRACT: 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 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 extreme stress. [Author Abstract] KEY WORDS: Posttraumatic stress; assessment; traumatic events; disorders of extreme stress; SIDES.