This page includes selected full-text articles about trauma -- versions of preprints, published articles, or chapters. Several other resources relevant to trauma, disasters, psychology, and neuroscience are available on the Resources Page, as well as the Links page.
Texts selected to appear here are all concerned with aspects of traumatic stress responses, PTSD, or its treatment, and are either full-length articles or lengthy summaries. The versions appearing here may have minor differences from the published version. Clearly, these works are copyright, and ownership resides with the respective authors (or their assignees). We are grateful for permission to present or link to these valuable resources in the trauma field. Please respect the copyright status of these creative works.
Article published in the electronic journal Traumatology, 3(1) (August 1997).
This theoretical review considers controversy in the traumatic-stress field as an inevitable consequence whenever philosophical assumptions differ between opposing sides. Two contemporary examples of controversies in traumatology surround adoption of EMDR (and other new clinical methods), and the final report of the American Psychological Association's Working Group on memories for childhood sexual abuse. Both examples are discussed within the framework of an historical rift between researchers and clinicians. The concomitant involvement of non-scientific issues (e.g., stereotyping) and approaches to consensus are also discussed.
Originally published in the American Journal of Psychiatry, 1997, 154(11), 1576-1581.
Brian Engdahl and colleagues interviewed a community sample of former prisoners-of-war (N = 262; WWII & Korea) living in the midwestern United States, comparing the incidence of posttraumatic stress disorder (PTSD) with other DSM Axis I disorders often found among trauma survivors. The most severely traumatized POW's had lifetime rates of 84% and current rates of 58% for PTSD; most of those with current PTSD were free from other Axis I disorders. Less than 10% of this sample was free of all PTSD symptoms. The authors conclude that PTSD is a normative and persistent consequence of exposure to severe trauma.
As published in the February 1999 issue of Journal of Consulting and Clinical Psychology, 67(1), 3-12.
Julian Ford, at the National Center for PTSD, reports on important differences and similaries between the Posttraumatic Stress Disorder (PTSD) and Disorders of Extreme Stress (DESNOS) diagnostic categories, in a sample of 84 male military combat veterans seeking inpatient PTSD treatment. In this chronic sample, with depression and personalitiy disorders used as covariates, the two disorders were found to be comorbid but distinct post traumatic syndromes. Ford concludes that the combination of early childhood and atrocity trauma may best be understood in terms of DESNOS. Implications are discussed for assessment, classification, research and treatment. 56 references.
As published in the October 1998 issue of the Journal of Traumatic Stress, 11(4), 743-761.
Julian Ford investigated early trauma and DESNOS as contributing factors in treatment outcome, in this study of adult chronic PTSD inpatients. Although early trauma is correlated with a diagnosis of DESNOS, the authors found that DESNOS was a stronger predictor of treatment non-responding in this patient population. Implications for treatment planning are discussed. 74 references.
Originally published in Marion F. Solomon & Daniel J. Siegel, Eds., (2003). Healing Trauma: Attachment, Trauma, the Brain, and the Mind. Pp. 221-281. New York: Norton. Web version posted here with permission of the author.
Diana Fosha summarizes research in affective neuroscience, attachment, and dyadic regulation, then introduces her Accelerated Experiential-Dynamic Psychotherapy (AEDP) approach to therapy, and discusses this method within the context of current research. Dyadic regulation of affective states, and the experience of intense emotion is illustrated through excerpts from two psychotherapy sessions; the power of affect is explored in development, psychopathology, and in psychotherapy. Dr. Fosha's chapter furthers the dialog between practice and clinically-relevant research. 111 references.
As published in the April 1998 online issue of Pediatrics, 101(4), p. e9.
William Friedrich and colleagues at the Mayo Clinic summarize the normative development of sexual behaviors in over 11,000 children between 2 and 12 years. Sexual behavior was related to the child's age, maternal education, family sexuality, family stress, family violence, and hours/week in day care. A broad range of sexual behaviors are exhibited by children who there is no reason to believe have been sexually abused.
Originally published in: Nature Neuroscience, 2002, 5(11), 1242-1247.
In this case control study of monozygotic twins discordant for trauma exposure, Mark Gilbertson and six colleagues investigate important questions about size of hippocampus and vulnerability to trauma. The authors found that severe PTSD twin pairs -- both trauma-exposed and unexposed -- had significantly smaller hippocampi. Their results indicate that pre-existing hippocampal volume constitutes an independent risk factor for development of trauma-related psychopathology, and show one way that individual differences in vulnerability for PTSD (given a traumatic exposure) may appear. About 50 references.
Originally appeared as a chapter in T. Williams (Ed.) Post-Traumatic Stress Disorders: a handbook for clinicians, pp. 1-18. Cincinatti, OH: Disabled American Veterans.
This version is a detailed summary of the published chapter, available on the internet for several years. Jim Goodwin gives a clear and well-written look at the long-term consequences of combat-stress for Vietnam veterans, and similarities and differences from other kinds of traumatic-stress reactions. Individual sections describe several PTSD symptoms particularly common within this population: depression, isolation, rage, alienation, survivor guilt, anxiety, nightmares, and intrusive thoughts.
Citation: Nijenhuis, E.R.S.; Van der Hart, O. & Steele, K. (2004). Trauma-related structural dissociation of the personality. Trauma Information Pages website, January 2004. Web URL: http://www.trauma-pages.com/a/nijenhuis-2004.php .
[This article is published here for the first time. Copyright by Ellert R. S. Nijenhuis; posted at www.trauma-pages.com with permission.]
Ellert Nijenhuis, writing with colleagues Onno van der Hart and Kathy Steele, presents the most detailed explanation of their theory of structural dissociation as a response to traumatization. Describing dissociation as a failure to synthesize and personify terrifying experiences, this article explores the evolutionary and trauma-related origins of this response, addresses the increasing complexity of structural dissociation into secondary and tertiary forms that may occur in cases of chronic abuse and neglect, and summarizes recent psychobiological research concerning the theory. This provides a detailed theoretical rationale for the authors' phase-oriented treatment approach. 159 references.
Originally appeared in Psychotherapy, 28 (1), 5-15. [Spring 1991] Republished first in Wilson & Raphael's (1993) International Handbook of Traumatic Stress Syndromes and later in Everly & Lating's (1995) Psychotraumatology.
This clinical article gives a detailed description of Frank Ochberg's approach towards therapy with trauma patients, and should be helpful to any clinicians working with this population. Individual sections discuss fundamental principles and techniques of posttraumatic therapy, including: education, discussing psychobiology, promoting holistic health, and psychotherapy. Two Appendices list proposed diagnostic criteria and symptoms for victimization disorder as a subcategory of traumatic stress.
Article published in the electronic journal Traumatology, 6(3), article 3 (October 2000).
In this article, Pat Ogden and Kekuni Minton describe their somatic (body) clinical approach to facilitate processing of unassimilated sensorimotor reactions to trauma; this sensorimotor sequencing, in turn, facilitates emotional and cognitive processing. Sensorimotor Psychotherapy requires that the clinician closely monitor sequential physical movements and sensations associated with motor impulses in the client -- muscular tension, trembling, changes in breathing, posture, and heart rate. The article describes physical defensive responses, "bottom-up" processing, and a modulation model; case examples illustrate the authors' clinical technique.
Citation: Perry, BD (1997). Incubated in Terror: Neurodevelopmental Factors in the 'Cycle of Violence' In: Children, Youth and Violence: The Search for Solutions (J Osofsky, Ed.). Guilford Press, New York, pp 124-148.
Bruce Perry, taking an evolutionary and developmental perspective, writes about the consequences for children exposed to violence and persistent fear. Effects on brain organization, cognitive and emotional neglect are described, and both clinical and public policy implications are considered. Includes about 80 references and 9 figures.
Web version of a chapter published as "The Memories of States" in J. Goodwin & R. Attias (Eds.) (1999). Splintered Reflections: images of the body in trauma. New York: Basic Books, pp. 9-38.
In this chapter, Dr. Perry explores how the brain "stores and retrieves physiologic states, feelings, behaviors and thoughts from traumatic events", and illustrates these issues with several case examples of traumatized children and adolescents. Concluding sections focus on vulnerable children and the law, and on transgenerational memory in society and culture. Four figures and 59 references are included in this online version.
Citation: Perry, B.D. (2001b). The neurodevelopmental impact of violence in childhood. In Schetky D & Benedek, E. (Eds.) Textbook of child andadolescent forensic psychiatry. Washington, D.C.: American Psychiatric Press, Inc. (pp. 221-238). This is an edited (web) version of the chapter from the author's ChildTrauma Academy website.
Bruce Perry discusses five neural systems involved in regulating a child's response to threat: the Reticular Activating System, Locus Coeruleus, Hippocampus, Amygdala, and Hypothalamic-Pituitary-Adrenal Axis, and then describes the clinical presentation and altered neurobiology of children exposed to violence. Heartrate data and gender differences are presented from children at the Branch Davidian' s Ranch Apocalypse compound. Includes about 70 references, 3 figures and 2 tables.
Article published in Infant Mental Health Journal, 16(4), 271-291.
Bruce Perry and his colleagues argue that infants and young children may be more vulnerable to traumas than adults -- that they are not resilient, but malleable. They consider neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization, and conclude that the more plastic developing brain may be more vulnerable to disruptions related to these responses. Evolutionary advantages of gender differences in responses to trauma (hyperarousal by males; dissociation in females) are considered briefly, and clinical implications are discussed. Includes about 70 references.
Published in Psychophysiology, 32, 301-318.
Stephen Porges introduces his Polyvagal Theory to explain differing functions of two primary medullary source nuclei of the vague: the nucleus ambiguus (NA) and the dorsal motor nucleus (DMNX), responsible for respiratory sinus arrhythmia (RSA) and heart rate, respectively. He speculates that mammalian brainstem organization may be characterized by a ventral vagal complex (including NA) related to processes associated with attention, motion, and emotion. Various medical disorders may stem from competition between DMNX and NA. 105 refs.
Originally appeared in the Journal of Applied Social Psychology, 1990, 20(20), 1695-1703.
In this methodological article, John Reid describes some common problems inherent when research with trauma victims and control subjects is initiated after disastrous events. He then proposes that long-term longitudinal studies may help shed light on these problems when subjects experience traumatic events during their research participation (e.g., crime, divorce, or natural disaster). Difficulties in collaboration with ongoing longitudinal/developmental studies during disaster situations are discussed, and suggestions offered.
Originally published in the Lancet, 1918, 1, 173-177 (2 February 1918).
In this classic article, W. H. R. Rivers writes about suppression and dissociation of traumatic combat experiences by World War I veterans, and his clinical observations that avoidance of traumatic memories -- the recommended treatment of the time -- interfered with recovery from "shell shock" or "war neurosis". This historical article is significant in the development of our scientific and clinical views about trauma responses and effective treatment. Dr. Rivers views on the effective treatment of what we now call PTSD were far ahead of his time, and issues addressed in this 1918 article remain controversial today.
Full text of the book, originally published in 1920 by Cambridge University Press in England, courtesy of Christopher Green's Classics in the History of Psychology website.
In this book, Dr. Rivers explores theoretical aspects of his clinical experiences, at Maghull and Craiglockhart War Hospitals, treating "shell shock" and "war neuroses" among soldiers traumatized in WWI combat. His insight that avoidance of traumatic experiences does not assist recovery was prescient, and he saw dissociation as one type of suppression -- thus distinguishing distinct avoidance strategies. Rivers discusses self-preservation and "danger instincts" stirred during trauma in conjunction with Freud's ideas about the unconscious; this placed psychotherapy, especially for the traumatic form of "psycho-neuroses", within the theoretical framework of biology.
Published in Applied Psychophysiology and Biofeedback, 2001, 26(1), 73-91.
Dr. Robert Scaer examines dissociation and PTSD from the perspective of a neurologist. In this speculative article, he describes dissociation in terms of the freeze/immobility response observed in animals facing overwhelming threat. He also proposes a model of PTSD linked to autonomic dysregulation -- and maintained by kindling, dorsal vagal tone and endorphinergic rewards -- contributing to further dissociation. Finally, the autonomic dysregulation underlying dissociation and PTSD is discussed in the context of a diverse set of chronic diseases of unknown origin. 74 references.
Published in Infant Journal of Mental Health, 2001, 22, 7-66.
In the first part of a two-part review, Allan Schore reviews psychoneurobiological mechanisms underlying infant mental health and successful adaptation. He integrates attachment data on dyadic affective communications, developmental neuroscience research on the right brain and stress psychophysiology, and developmental psychopathology perspectives on psychopathogenesis. This provides an overview of healthy development: connecting attachment theory, stress regulation, and infant mental health. Schore also describes the neurobiology of a secure attachment, and development of the right brain, early limbic system, and orbital frontolimbic regions, suggesting that normal orbitofrontal and right brain development is connected to adaptive mental health. 379 references.
Published in Infant Journal of Mental Health, 2001, 22, 201-269.
In the second part of his two-part interdisciplinary review, Allan Schore focuses on severe attachment failures, impairments in early development of the right brain's stress coping systems, and maladaptive infant mental health -- suggesting direct connections between traumatic attachment, inefficient right brain regulatory functions, and both maladaptive infant and adult mental health. He describes the neurobiology of infant trauma, neuropsychology of a disorganized / disoriented attachment pattern (associated with abuse and neglect), trauma-induced impairments of a regulatory system in the orbitofrontal cortex, links between orbitofrontal dysfunction and a predisposition to posttraumatic stress disorders, neurobiology of the dissociative defense, effects of early relational trauma on enduring right hemispheric function, and offers some implications for early intervention. 450 references.
Published in Australian and New Zealand Journal of Psychiatry, 36, 9-30.
In a review article written specifically for clinical and research traumatologists, Allan Schore sketches developmental precursors of complex PTSD and dissociative symptoms in the effects of early relational trauma on the developing central and autonomic nervous system. Early traumatic attachments negatively impact right brain development, producing structural changes that lead to inefficent stress coping mechanisms -- the core of posttraumatic stress disorders in infants, children, and adults. Schore makes a strong case that early intervention prevention programs can reduce intergenerational transmission of trauma-related disorders across the lifespan. 246 references.
Originally published in the Journal of Trauma and Dissociation, 1, 83-104.
Fredric Schiffer, M.D., reviews literature and hypothesizes that psychological traumas are associated more with one cerebral hemisphere than the other, and concludes that the ultimate aim of psychiatric care then becomes the teaching of the mental entity associated with this troubled hemisphere that it is now safer and more valued than it had been at the time of the trauma. He summarizes anecdotal evidence indicating that lateralized sensory stimulation can be used as an effective adjunct to psychotherapy, and describes the practical application of this theory to psychotherapy. PDF format; 50 references.
Originally published in: Journal of Trauma and Dissociation, 2(4), 79-116.
Kathy Steele and colleagues address the issue of dependency in chronically traumatized patients -- individuals often diagnosed with Bipolar Personality, Complex PTSD, or Dissociative Disorders. They first discuss the concept of dependency, exploring its origins in attachment difficulties and questioning prevailing beliefs before describing its relationship to structural dissociation and countertransference in psychotherapy. Then, using the theory of structural dissociation, the authors offer practical strategies to help clinicians manage insecure dependency within the therapy context. 129 references.
This is a version of an important chapter from Valent's 1998 book, From Survival to Fulfillment: A framework for the life-trauma dialectic, published in Philadelphia by Bruner/Mazel.
Paul Valent describes eight survival strategies in response to trauma -- "stress responses which include specific adaptive and maladaptive, biological, psychological and social constituents". Valent's survival strategies evolved as discrete phylogenetic templates to aid survival following specific stressors. Together, survival strategies offer a framework for categorizing classes of traumatic responses and events beyond PTSD's typical fight or flight responses. When trauma responses are unsuccessful, this framework may also help clarify differences important in treatment.
Originally published in A. Shalev, R. Yehuda & A. McFarlane (Eds.) International Handbook of Human Response to Trauma, pp. 233-248.
Onno van der Hart and Danny Brom present an overview of relevant literature on amnesia among survivors of the Holocaust. Following Janet's (1893/1901) continuum of localized-, selective-, and generalized amnesia, they describe several cases of survivors' trauma-induced amnesia of the Holocaust (with or without dissociative re-experiencing). In conclusion, the authors discuss reasons for the lack of research attention to this complex issue, possible causes of amnesia among Holocaust survivors, and the absence of delayed recall in this population. 57 references.
Originally published in Dissociation,1992, 6(2/3), 162-180. [Posted here with permission of the authors and Journal Editor.]
Onno van der Hart and Paul Brown review the use of "abreaction" in treating traumatic memories from Breuer and Freud through World Wars I and II, Vietnam, and in contemporary times. After tracing the historical and theoretical roots of two contradictory models concerning the nature and treatment of traumatic memories (dissociation/integration and abreaction/repression), the authors critically re-evaluate abreaction, and conclude that Janet's model of dissociation provides a preferable basis for phase-oriented treatment of the more complex traumatic-stress disorders. 103 references.
Originally published in Dissociation,1989, 2(1), 3-16. [Posted here with permission of the authors and Journal Editor.]
Onno van der Hart and Barbara Friedman review Pierre Janet's writings on hysteria and dissociation over a 30-year period, summarizing their central concepts. Janet was an important figure in early studies on dissociation and hysteria before hypnosis fell into disrepute, but his writings, many in French, are not well known in the US. Seven books are reviewed here; they focus primarily on classification and case descriptions. 94 references.
Originally published in Dissociation, 1997, 10(2), 91-103. [Posted here with permission of the authors and Journal Editor.]
Disturbances in a sense of reality and time are especially dramatic in trauma-induced disorders, including dissociative identity disorder (DID). Observing that therapeutic change involves reorganizing the patient's experience of reality and time, Onno van der Hart and Kathy Steele describe therapeutic approaches that can assist this reorganization, within their phase-oriented treatment model. They integrate Pierre Janet'scontributions regarding time disturbances with more contemporary work relating time disturbances to trauma, and offer case examples. 52 references.
Originally published in Dissociation,1993, 6(2/3), 162-180. [Posted here with permission of the authors and Journal Editor.]
Onno van der Hart and colleagues integrate Pierre Janet's dissociation theory with contemporary trauma-based models of therapy. They begin by describing multiple personality disorder (now DID) as a disorder of non-realization, and then explore the nature of traumatic memories and the dissociative reactions they evoke, before presenting a phase-oriented treatment model for trauma-focused therapy with dissociative patients. Their non-abreactive treatment approach is appropriate for resolution of traumatic memories in adult survivors of chronic childhood abuse. 118 references.
Originally published in the Journal of Trauma and Dissociation, 2000, 1(4), 33-66. [Reprinted here with permission of the author, Editors of the Journal of Trauma and Dissociation, and Haworth Press.]
Onno van der Hart and colleagues explore traumatic dissociation from descriptive, structural and functional perspectives. This article deepens our understanding of dissociation -- including perceptual, sensory, and motoric (somatoform) symptoms along with the cognitive (psychoform) symptoms in the DSM. Quotes from early writers dramatically illustrate various positive and negative dissociative symptoms in WWI combat soldiers. The authors emphasize the dissociative nature of somatoform symptoms seen in contemporary PTSD patients, and relate early observations by Charles S. Myers and by Pierre Janet to recent work by Ellert Nijenhuis and others. 111 references.
This article first appeared in Psychiatric Clinics of North America, 12, (2), 389-411.
Repetition of traumatic experiences can occur on behavioral, emotional, physiologic, and neuroendocriniologic levels, but invariably causes suffering. In this 1989 article, Bessel van der Kolk describes the diversity of traumatic re-enactments, and addresses relationships to social attachment and separation, traumatic bonding, state-dependent learning, addiction to trauma, sex differences, and biological responses to trauma. Treatment implications are also discussed. 147 references.
This is a version of an article first published in the Harvard Review of Psychiatry, 1994, 1(5), 253-265.
Bessel van der Kolk reviews memory for traumatic events in this article. He discusses limbic system involvement in stress responses, psychobiological and developmental factors influencing how traumatic memories may be consolidated in the brain, and neuroendocrine abnormalities associated with PTSD. This article provides an excellent and very clear description of many aspects of memory for traumatic events, and it includes extensive references. Two tables and two figures are not available in this version. Includes 134 references.
This is a version of their article published in the Journal of Traumatic Stress, 1995, 8(4), 505-525.
In this article, Bessel van der Kolk and Rita Fisler review differences between memories of traumatic vs. stressful events and summarize evidence implicating dissociation as an important mechanism in the formation of PTSD. The authors also present results from an exploratory interview study, indicating that subjects (N=46) with PTSD initially retrieve traumatic memories as fragmentary dissociated elements (such as visual, olfactory, or affective experiences), followed by gradual emergence of a personal narrative (explicit memory). Includes 78 references.
This paper originally appeared in the American Journal of Psychiatry, 153(7), Festschrift Supplement, 83-93.
This article reports results from the DSM-IV Field Trial for PTSD demonstrating a complex PTSD syndrome in people traumatized at an early age, or suffering from prolonged interpersonal trauma. Dissociation, somatization, and affect dysregulation represent a chronic adaptation to emotional trauma, and characterize complex PTSD (e.g., DESNOS). Clinicians should understand how complex trauma must be treated differently from acute or "simple" PTSD. The authors discuss implications for treatment and for PTSD diagnostic criteria. Includes four tables and about 90 references.
Originally appeared in American Journal of Psyciatry, 146 (12), 1530-1540 (December 1989).
In this article, Drs. Bessel van der Kolk and Onno van der Hart revisit the work of Pierre Janet, focusing particularly on his views regarding dissociation as a process that can transform overwhelming traumatic experiences into psychopathology. Specific attention is given to the processing and encoding of memory, and Janet's therapeutic principles. 100 references.
Originally appeared in S. Hobfoll & M. de Vries (Eds.), Extreme stress and communities: Impact and intervention (NATO Asi Series. Series D, Behavioural and Social Sciences, Vol 80). Norwell, MA: Kluwer Academic.
This article considers PTSD as a biological disorder, and discusses the roles of developmental level, memory, and dissociation in its formation. Bessel van der Kolk and his colleagues review the symptomatology of PTSD in detail, and describe three principle components of treatment, before turning to specific tasks guiding psychotherapeutic interventions including group therapy and psychopharmacological approaches. Two Tables summarize symptoms of simple PTSD and additional features associated with the proposed diagnosis of complicated PTSD. Includes about 70 references.
Originally appeared in Biological Psychiatry, 1993, 33, 479-486.
In this commentary article, Rachel Yehuda and Seymour Antelman propose five criteria that should be fulfilled by any animal model of PTSD. They describe an animal model based on time-dependent sensitization (TDS), and discuss alternative models involving learned helplessness and inescapable shock. Comparing these models with respect to their proposed five criteria for this disorder, the authors conclude that the TDS model best fits characteristics of PTSD. About 50 references.
Originally appeared in American Journal of Psychiatry, 1995, 152(12), 1705-1713.
Rachel Yehuda and Sandy McFarlane explore historical and social forces that have influenced our conception of trauma as a cause of PTSD, and they discuss current research findings with respect to these original conceptions. They conclude that we in the field must address contradictions between recent research and our previous conceptions of the PTSD disorder. Review article with 123 references.
Pre-publication text version of Chapter 37 (pp. 639-655) Originally published in: Y. Danieli (Ed.) International Handbook: Multigenerational Legacies of Trauma. New York: Plenum Press, 1998.
In this draft chapter (a second revision, lacking the 5 figures), Rachel Yehuda and colleagues briefly review literature describing the effects of the Holocaust on its survivors and their offspring. They then describe three different approaches to studying PTSD symptoms in Holocaust survivors and adult offspring of Holocaust survivors, and report preliminary results from three in-progress studies. About 60 references.