Abstract
Objective
To empirically investigate whether or not symptoms of posttraumatic stress disorder (PTSD) are essential for transferring the negative effects of trauma on the severity of severe mental illness (SMI) as recently suggested by an interactive model.
Methods
About 122 inpatients with either schizophrenia or major affective disorder were administered the Posttraumatic Diagnostic Scale, the Symptom Checklist and the Toronto Alexithymia Scale.
Results
At least one trauma was reported by 83 participants (68%) and 28 patients (23%) reported symptoms of current PTSD. Those SMI subjects with current PTSD sympoms had significantly more psychopathological distress and alexithymic features than those with a trauma exposure but without PTSD symptoms and those patients without any traumatic experiences.
Discussion
In line with prior research, our data indicate that patients with SMI have frequently been exposed to traumatic events and that a third suffers from current posttraumatic stress symptoms. Despite some methodological limitations our findings support the interactive model, which posits that a comorbid PTSD increases the symptom severity of SMI. More attention should be directed at assessing trauma and PTSD in SMI patients and at developing therapeutic interventions.
Similar content being viewed by others
References
Allen JG (2001) Traumatic relationships and serious mental disorders. Wiley, New York
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. American Psychiatric Press, Washington, DC
Bach M, Bach D, de Zwaan M, Serim M, Bohmer F (1996) Validation of the German version of the 20-item Toronto Alexithymia Scale in normal persons and psychiatric patients. Psychother Psychosom Med Psychol 46:23–28
Bagby RM, Parker JD, Taylor GJ (1994a) The twenty-item Toronto Alexithymia Scale-I. Item selection and cross—validation of the factor structure. J Psychosom Res 38:23–32
Bagby RM, Taylor GJ, Parker JD (1994b) The Twenty-item Toronto Alexithymia Scale-II. Convergent, discriminant, and concurrent validity. J Psychosom Res 38:33–40
Bernstein EM, Putnam FW (1986) Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 174:727–735
Bremner JD, Marmar CR (eds) (1998) Trauma, memory, and dissociation. American Psychiatric Press, Washington, DC
Brunner R, Parzer P, Schmitt R, Resch F (2004) Dissociative symptoms in schizophrenia: a comparative analysis of patients with borderline personality disorder and healthy controls. Psychopathology 37:281–284
Carlson EB, Putnam FW (1993) An update on the Dissociative Experience Scale. Dissociation 6:16–27
Cascardi M, Mueser KT, DeGiralomo J, Murrin M (1996) Physical aggression against psychiatric inpatients by family members and partners. Psychiatr Serv 47:531–533
Cedro A, Kokoszka A, Popiel A, Narkiewicz-Jodko W (2001) Alexithymia in schizophrenia: an exploratory study. Psychol Rep 89:95–98
Derogatis L (1983) Symptom Checklist-90-R Clinical Psychometric Research, Baltimore
Foa EB, Cashman L, Jaycox L, Perry K (1997) The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychol Assess 9:445–451
Franke GH (2002) Die Symptom-Checkliste von Derogatis Deutsche Version. Beltz, Weinheim
Frueh BC, Buckley TC, Cusack KJ, Kimble MO, Grubaugh AL, Turner SM, Keane TM (2004) Cognitive-behavioral treatment for PTSD among people with severe mental illness: a proposed treatment model. J Psychiatr Pract 10:26–38
Gearon JS, Kaltman SI, Brown C, Bellack AS (2003) Traumatic life events and PTSD among women with substance use disorders and schizophrenia. Psychiatr Serv 54:523–528
Goodman LA, Dutton MA, Harris M (1997) The relationship between violence dimensions and symptom severity among homeless, mentally ill women. J Trauma Stress 10:51–70
Goodman LA, Salyers MP, Mueser KT, Rosenberg SD, Swartz M, Essock SM, Osher FC, Butterfield MI, Swanson J (2001) Recent victimization in women and men with severe mental illness: prevalence and correlates. J Trauma Stress 14:615–632
Goodman LA, Thompson KM, Weinfurt K, Corl S, Acker P, Mueser KT, Rosenberg SD (1999) Reliability of reports of violent victimization and posttraumatic stress disorder among men and women with serious mental illness. J Trauma Stress 12:587–599
Grabe HJ, Rainermann S, Spitzer C, Gansicke M, Freyberger HJ (2000) The relationship between dimensions of alexithymia and dissociation. Psychother Psychosom 69:128–131
Grabe HJ, Spitzer C, Freyberger HJ (2004) Alexithymia and personality in relation to dimensions of psychopathology. Am J Psychiatry 161:1299–1301
Greenfield SF, Strakowski SM, Tohen M, Batson SC, Kolbrener ML (1994) Childhood abuse in first-episode psychosis. Br J Psychiatry 164:831–834
Hepp U, Gamma A, Milos G, Eich D, Ajdacic-Gross V, Rossler W, Angst J, Schnyder U (2006) Prevalence of exposure to potentially traumatic events and PTSD: The Zurich Cohort Study. Eur Arch Psychiatry Clin Neurosci 256:151–158
Honkalampi K, Koivumaa-Honkanen H, Antikainen R, Haatainen K, Hintikka J, Viinamaki H (2004) Relationships among alexithymia, adverse childhood experiences, sociodemographic variables, and actual mood disorder: a 2-year clinical follow-up study of patients with major depressive disorder. Psychosomatics 45:197–204
Krystal H (1988) Integration and self-healing: affect, trauma, alexithymia. Analytic Press, Hillsdale
McFarlane AC, Bookless C, Air T (2001) Posttraumatic stress disorder in a general psychiatric inpatient population. J Trauma Stress 14:633–645
Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher C, Vidaver R, Auciello P, Foy DW (1998) Trauma and posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol 66:493–499
Mueser KT, Rosenberg SD, Goodman LA, Trumbetta SL (2002) Trauma, PTSD, and the course of severe mental illness: an interactive model. Schizophr Res 53:123–143
Mueser KT, Salyers MP, Rosenberg SD, Goodman LA, Essock SM, Osher FC, Swartz MS, Butterfield MI (2004) Interpersonal trauma and posttraumatic stress disorder in patients with severe mental illness: demographic, clinical, and health correlates. Schizophr Bull 30:45–57
Neria Y, Bromet EJ, Sievers S, Lavelle J, Fochtmann LJ (2002) Trauma exposure and posttraumatic stress disorder in psychosis: findings from a first-admission cohort. J Consult Clin Psychol 70:246–251
Otto MW, Perlman CA, Wernicke R, Reese HE, Bauer MS, Pollack MH (2004) Posttraumatic stress disorder in patients with bipolar disorder: a review of prevalence, correlates, and treatment strategies. Bipolar Disord 6:470–479
Pagani M, Hogberg G, Salmaso D, Tarnell B, Sanchez-Crespo A, Soares J, Aberg-Wistedt A, Jacobsson H, Hallstrom T, Larsson SA, Sundin O (2005) Regional cerebral blood flow during auditory recall in 47 subjects exposed to assaultive and non-assaultive trauma and developing or not posttraumatic stress disorder. Eur Arch Psychiatry Clin Neurosci 255:359–365
Resnick SG, Bond GR, Mueser KT (2003) Trauma and posttraumatic stress disorder in people with schizophrenia. J Abnorm Psychol 112:415–423
Ritsner M (2003) The attribution of somatization in schizophrenia patients: a naturalistic follow-up study. J Clin Psychiatry 64:1370–1378
Rosenberg SD, Drake RE, Mueser K (1996) New directions for treatment research on sequelae of sexual abuse in persons with severe mental illness. Commun Ment Health J 32:387–400
Rosenberg SD, Mueser KT, Friedman MJ, Gorman PG, Drake RE, Vidaver RM, Torrey WC, Jankowski MK (2001) Developing effective treatments for posttraumatic disorders among people with severe mental illness. Psychiatr Serv 52:1453–1461
Spitzer C, Brandl S, Rose HJ, Nauck M, Freyberger HJ (2005) Gender-specific association of alexithymia and norepinephrine/cortisol ratios. A preliminary report. J Psychosom Res 59:73–76
Spitzer C, Freyberger HJ, Stieglitz RD, Carlson EB, Kuhn G, Magdeburg N, Kessler C (1998) Adaptation and psychometric properties of the German version of the Dissociative Experience Scale. J Trauma Stress 11:799–809
Spitzer C, Haug HJ, Freyberger HJ (1997) Dissociative symptoms in schizophrenic patients with positive and negative symptoms. Psychopathology 30:67–75
Switzer GE, Dew MA, Thompson K, Goycoolea JM, Derricott T, Mullins SD (1999) Posttraumatic stress disorder and service utilization among urban mental health center clients. J Trauma Stress 12:25–39
Taylor G (2000) Recent developments in alexithymia theory and research. Can J Psychiatry 45:134–142
van der Kolk BA, McFarlane AC, Weisaeth L (1996) Traumatic stress. Guilford Press, New York
Wise TN, Mann LS, Mitchell JD, Hryvniak M, Hill B (1990) Secondary alexithymia: an empirical validation. Compr Psychiatry 31:284–288
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Spitzer, C., Vogel, M., Barnow, S. et al. Psychopathology and alexithymia in severe mental illness: the impact of trauma and posttraumatic stress symptoms. Eur Arch Psychiatry Clin Neurosci 257, 191–196 (2007). https://doi.org/10.1007/s00406-006-0669-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-006-0669-z