Thursday, December 29, 2016

Trauma & Delusions

Most people who work with older men with histories of trauma notice that delusions are commonplace. There is no medication available to treat delusions so I wonder what can be done? 

The literature has found a connection between trauma, dissociation and delusions. In the illness conceptualization of my ancestors, dissociation could be called, soul loss. 

Soul loss is when a part of our soul checks out during a traumatic event. 

Both soul loss and dissociation seem to serve as a form of protection during the traumatic event.

Shamans are entrusted to recover these cast-off soul parts and bring them home for integration and patient wholeness.

I don't yet know or understand the connection between dissociation and delusions - but we are building to bridge that gap. 

Mostly, I just want to know how my dear friends can be helped.



JAMES SCOTT, DAVID CHANT, GAVIN ANDREWS, GRAHAM MARTIN, JOHN McGRATH
Association between trauma exposure and delusional experiences in a large community-based sample

Introduction & Background

Community-based surveys have found that otherwise well individuals endorse items related to psychotic symptoms (Eaton et al, 1991van Os et al, 2000). 

Previous studies have shown an association between psychotic symptoms and exposure to trauma.

An Australian study identified an increased likelihood of delusional experiences associated with certain demographic variables, including:

  • male gender, 
  • younger age, 
  • unemployment, 
  • migrant status (but only those from non-English-speaking backgrounds), 
  • urban residence, 
  • lower income, 
  • lower educational achievement and 
  • living alone (Scott et al, 2006). 

Cannabis dependence and alcohol dependence were also found to be associated with delusional experiences (Degenhardt & Hall, 2001). 


A number of studies have now shown an association between traumatic events in childhood and psychotic symptoms (Janssen et al, 2004Spauwen et al, 2006). 


We had the opportunity to further examine the association between exposure to trauma, post-traumatic stress disorder (PTSD) and delusional experiences in a large, representative community-based Australian sample. 


Results 


Exposure to any traumatic event but without the development of PTSD was associated with increased endorsement of delusional experiences and there was a significant dose–response relationship between the number of types of traumatic events and endorsement of such experiences. The association between PTSD and delusional experiences remained significant after adjusting for factors associated with psychotic symptoms.

Discussion

Based on the largest sample to date, we found that individuals who had been exposed to a traumatic event were more likely to report delusional experiences. There was a dose–response relationship between the variables of interest: those who reported exposure to a greater number of different types of traumatic events were more likely to report delusional experiences. Furthermore, those who had developed PTSD after exposure to traumatic events were also more likely to report delusional experiences. The association between trauma, PTSD and delusional experiences persisted after controlling for factors known to be associated with psychotic symptoms. The association remained significant for each type of trauma examined, including those more likely to occur in childhood (sexual molestation) and those of adult life (direct combat).

Trauma, PTSD and psychotic symptoms

A number of community-based studies from different countries have shown an association between exposure to trauma and psychotic symptoms. Previous community surveys have shown an association between child abuse and psychotic symptoms (Ross et al, 1994Janssen et al, 2004Whitfield et al, 2005Shevlin et al, 2007). Another study has shown an association between PTSD and positive psychotic symptoms (Sareen et al, 2005). Two further studies have reported psychotic symptoms associated with traumatic events other than child abuse (Bebbington et al, 2004Spauwen et al, 2006).
We found that delusional experiences were associated with all types of trauma. The association was especially strong in those who had reported rape. Bebbington et al (2004) reported a strong association between childhood sexual abuse and psychotic disorder, whereas Spauwen et al(2006) found the association was most strong in people who had exposure to a natural catastrophe.
To the best of our knowledge, this is the first study to show that PTSD complicating exposure to trauma increases the likelihood of endorsement of delusional experience compared with trauma exposure without PTSD. We suggest that people with PTSD have had more adverse psychological adjustments to traumatic events. Our study also found a significant dose–response relationship between exposure to traumatic events (as assessed by the number of different types of traumatic events) and increased likelihood of endorsing delusional experiences. This is consistent with the study of Spauwen et al (2006), who found increased psychotic symptoms in people exposed to a greater number of traumatic events.

Pathways of causality

Although cross-sectional surveys such as this study do not allow us to untangle the web of causation underpinning this association, several potential pathways warrant consideration. Delusional experiences could reflect a final common pathway for a wide range of adverse exposures such as substance misuse, trauma or other general stressors (e.g. migrant status, lack of significant other, unemployment). In other words, delusional experiences may be diffuse, non-specific ‘surface markers’ that emerge from a wide variety of biological and/or environmental risk factors (Degenhardt & Hall, 2001van Os & McGuffin, 2003Scott et al, 2006).
From a different perspective, delusional experiences associated with trauma could be viewed as dissociative phenomena (van der Kolk et al, 1996). Other researchers have noted the close links between trauma, dissociation and psychotic symptoms (Startup, 1999). Although conceptually distinct, in the absence of a detailed clinical interview, delusional experience as an expression of dissociation may be phenomenologically indistinguishable from delusions reported in the prodrome of psychosis. The symptomatic overlap of these syndromes and the growing body of evidence linking trauma and psychotic symptoms suggests that the taxonomy of these symptoms warrants closer scrutiny.
It is also feasible that exposure to trauma in susceptible individuals might be a risk-modifying factor (a component cause) for psychosis, through as yet unidentified mechanisms. For example, a number of authors postulate that dysregulation of the hypothalamic–pituitary–adrenal axis with elevated cortisol levels could contribute to the hippocampal changes that are associated with the onset of psychosis (Read et al, 2001Corcoran et al, 2003). Exposure to chronic stress and elevated cortisol levels are associated with hippocampal changes (Sapolsky, 1996) and reduced hippocampal volume is a relatively consistent finding in imaging studies of schizophrenia (Wright et al, 2000). Thus, trauma might lead to altered stress hormones, which might then ‘ catalyse’ the neurobiological mechanisms contributing to the onset of psychosis. Other mechanisms linking stress (e.g. ‘social defeat’) to risk of psychosis through dysregulation of dopaminergic pathways have also been proposed (Selten & Cantor-Graae, 2005)
Empirical support for trauma as a causal factor for psychosis is inconsistent. One prospective study showed no increase in rates of schizophrenia in adults who had been ascertained by child protection services as sexually abused in childhood (Spataro et al, 2004). However, there were significant limitations in this study, identified by both the authors and others (Read & Hammersley, 2005). In contrast, two studies have prospectively found an increased incidence of psychotic symptoms in those who reported exposure to traumatic events (Janssen et al, 2004Spauwen et al, 2006). The notion that traumatic events cause delusions is lent some weight by the dose–response relationship identified in this study and in a previous study (Spauwen et al, 2006). Although there is now clear evidence of an association between traumatic events, PTSD and psychotic symptoms (Bebbington et al, 2004Janssen et al, 2004Sareen et al, 2005Spauwen et al, 2006), the explanation for this association requires further investigation.

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