A contextual approach to trauma experience: lessons from life events research

Article


Spence, R., Kagan, L. and Bifulco, A. 2019. A contextual approach to trauma experience: lessons from life events research. Psychological Medicine. 49 (9), pp. 1409-1413. https://doi.org/10.1017/s0033291719000850
TypeArticle
TitleA contextual approach to trauma experience: lessons from life events research
AuthorsSpence, R., Kagan, L. and Bifulco, A.
Abstract

There has been much debate over what constitutes trauma experience and how this is differentiated from other very negative life events in the diagnosis of PTSD. We believe the DSM implication that trauma events are uniquely different from other types of negative life events and are limited to a few specific types of predetermined event identified categorically hinders the utility of current trauma definitions in research and practice. Whilst we do not take issue with the standard definition of trauma events, a binary checklist-style approach to identifying such events has a potential for missing relevant experience. Instead, we argue that trauma events should be considered to be at one end of a continuum of threat/severity, with potential for more or less ‘threat to life’ in a range of domains. Furthermore, a wider assessment of events could elucidate a greater range of co-existing trauma events, those sub-threshold experiences related to phasing of trauma, and other unrelated negative life events which may contribute to context and impact. In this critique of definitions of trauma events we argue that the current definition of PTSD criterion-A events limits their utility in both research and clinical practice. Following intensive life event assessments such as the LEDS (Life Events and Difficulties Schedule) the application of dimensions underlying a cross spectrum of events includes loss (of person, role, plan or ideas about the self), danger (future loss/threat to security), humiliation (devaluation of self/rejection) and entrapment (sense of imprisonment) can be used to further categorise events or trauma, and specify their likely impact. Data is provided of the overlap of ‘markedly’ threatening negative events (using the LEDS) and those constituting trauma using a commonly used checklist in a high-risk community sample of women. This yielded high specificity (97%; CI = 95.60-97.71) but low sensitivity (41%; (95% CI = 27.57-54.97) with around a third rated on both. Most of the trauma events involved loss and danger categorisation and only in one instance humiliation. Other markedly threatening, non-trauma events, involved not only loss and danger but also humiliation and entrapment. We discuss how a more in-depth assessment of trauma events utilising these dimensions and with the new Computerised Life Events Assessment Record (CLEAR), could aid us in our understanding of trauma events and lead to more personalised treatment possibilities.

KeywordsPTSD; life events; trauma; LEDS; CLEAR
Research GroupCentre for Abuse and Trauma Studies (CATS)
PublisherCambridge University Press
JournalPsychological Medicine
ISSN0033-2917
Electronic1469-8978
Publication dates
Online30 Apr 2019
Print30 Jul 2019
Publication process dates
Deposited07 May 2019
Submitted07 Dec 2018
Completed19 Mar 2019
Accepted28 Mar 2019
Output statusPublished
Accepted author manuscript
Copyright Statement

This article has been published in a revised form in Psychological Medicine https://doi.org/10.1017/S0033291719000850. This version is free to view and download for private research and study only. Not for re-distribution or re-use. © Cambridge University Press 2019

Digital Object Identifier (DOI)https://doi.org/10.1017/s0033291719000850
Web of Science identifierWOS:000474922400001
LanguageEnglish
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Bifulco, A., Bernazzani, O., Moran, P. and Ball, C. 2000. Lifetime stressors and recurrent depression: preliminary findings of the Adult Life Phase Interview (ALPHI). Social Psychiatry and Psychiatric Epidemiology. 35 (6), pp. 264-275. https://doi.org/10.1007/s001270050238
Motherhood as a vulnerability factor in major depression: the role of negative pregnancy experiences
Bernazzani, O. and Bifulco, A. 2003. Motherhood as a vulnerability factor in major depression: the role of negative pregnancy experiences. Social Science & Medicine. 56 (6), pp. 1249-1260. https://doi.org/10.1016/S0277-9536(02)00123-5
Malaysian moslem mothers' experience of depression and service use
Abdul Kadir, N. and Bifulco, A. 2010. Malaysian moslem mothers' experience of depression and service use. Culture, Medicine, and Psychiatry. 34 (3), pp. 443-467. https://doi.org/10.1007/s11013-010-9183-x
Exploring psychological abuse in childhood. I: developing a new interview scale
Moran, P., Bifulco, A., Ball, C., Jacobs, C. and Benaim, K. 2002. Exploring psychological abuse in childhood. I: developing a new interview scale. Bulletin of the Menninger Clinic. 66 (Summer), pp. 213-240.
Childhood experiences of care and abuse (CECA): validierung der Deutschen version des fragebogenund korrespondierenden Interview sowie Ergebnisse einer Untersuchung von Zusammenhangen belastenader Kindheitserlebnisse mit suizdalen Verhaltensweisen
Kaess, M., Parzer, P., Mattern, M., Resch, F., Bifulco, A. and Brunner, R. 2011. Childhood experiences of care and abuse (CECA): validierung der Deutschen version des fragebogenund korrespondierenden Interview sowie Ergebnisse einer Untersuchung von Zusammenhangen belastenader Kindheitserlebnisse mit suizdalen Verhaltensweisen. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie. 39 (4), pp. 243-252. https://doi.org/10.1024/1422-4917/a000115
Investigating police practice in the UK: achieving best evidence in work with young victims of abuse
Davidson, J. and Bifulco, A. 2009. Investigating police practice in the UK: achieving best evidence in work with young victims of abuse. Pakistan Journal of Criminology. 1 (3), pp. 19-46.
Childhood experience and sexual offending: the use of the Childhood Experience of Care and Abuse (CECA) interview in forensic psychology research and practice
Bifulco, A. 2006. Childhood experience and sexual offending: the use of the Childhood Experience of Care and Abuse (CECA) interview in forensic psychology research and practice. in: Pham, T. (ed.) L'évaluation diagnostique des agresseurs sexuels Belgium Mardaga Pierre.
Early adversity and depression
Bifulco, A. 2009. Early adversity and depression. in: Ingram, R. (ed.) The International Encyclopedia of Depression New York Springer Publishing Company.
Multi-agency working: Implications for an early-intervention social work team
Moran, P., Jacobs, C., Bunn, A. and Bifulco, A. 2007. Multi-agency working: Implications for an early-intervention social work team. Child & Family Social Work. 12 (2), pp. 143-151. https://doi.org/10.1111/j.1365-2206.2006.00452.x
Teenage pregnancy, attachment style, and depression: a comparison of teenage and adult pregnant women in a Portuguese series
Figueiredo, B., Bifulco, A., Pacheco, A., Costa, R. and Magarinho, R. 2006. Teenage pregnancy, attachment style, and depression: a comparison of teenage and adult pregnant women in a Portuguese series. Attachment & Human Development. 8 (2), pp. 123-138. https://doi.org/10.1080/14616730600785686
Solutions on Stress (SOS): programmes, packages and products for helping teenagers
Bunn, A., Bifulco, A., Lorenc, A. and Robinson, N. 2007. Solutions on Stress (SOS): programmes, packages and products for helping teenagers. Young Consumers: Insight and Ideas for Responsible Marketers. 8 (1), pp. 29-35. https://doi.org/10.1108/17473610710733758
Exploring psychological abuse in childhood: II. Association with other abuse and adult clinical depression
Bifulco, A., Moran, P., Baines, R., Bunn, A. and Stanford, K. 2002. Exploring psychological abuse in childhood: II. Association with other abuse and adult clinical depression. Bulletin of the Menninger Clinic. 66 (3), pp. 241-258.
The childhood experience of care and abuse questionnaire (CECA.Q): validation in a community series
Bifulco, A., Bernazzani, O., Moran, P. and Jacobs, C. 2005. The childhood experience of care and abuse questionnaire (CECA.Q): validation in a community series. British Journal of Clinical Psychology. 44 (4), pp. 563-581.
The Vulnerable Attachment Style Questionnaire (VASQ): an interview-based measure of attachment styles that predict depressive disorder
Bifulco, A., Mahon, J., Kwon, J., Moran, P. and Jacobs, C. 2003. The Vulnerable Attachment Style Questionnaire (VASQ): an interview-based measure of attachment styles that predict depressive disorder. Psychological Medicine. 33 (6), pp. 1099-1110. https://doi.org/10.1017/S0033291703008237
Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder
Bifulco, A., Moran, P., Jacobs, C. and Bunn, A. 2009. Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder. Attachment & Human Development. 11 (1), pp. 69-85. https://doi.org/10.1080/14616730802500826
Child victims of sexual abuse: children's experience of the investigative process in the criminal justice system
Davidson, J., Bifulco, A., Thomas, G. and Ramsay, M. 2006. Child victims of sexual abuse: children's experience of the investigative process in the criminal justice system. Practice: Social Work in Action. 18 (4), pp. 247-263. https://doi.org/10.1080/09503150601025253
Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety
Bifulco, A., Kwon, J., Jacobs, C., Moran, P., Bunn, A. and Beer, N. 2006. Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Social Psychiatry and Psychiatric Epidemiology. 41 (10), pp. 796-805. https://doi.org/10.1007/s00127-006-0101-z
Childhood adversity, parental vulnerability and disorder: examining intergenerational transmission of risk
Bifulco, A., Moran, P., Ball, C., Jacobs, C., Baines, R., Bunn, A. and Cavagin, J. 2002. Childhood adversity, parental vulnerability and disorder: examining intergenerational transmission of risk. Journal of Child Psychology and Psychiatry. 43 (8), pp. 1075-1086. https://doi.org/10.1111/1469-7610.00234
The Attachment Style Interview (ASI): a support-based adult assessment tool for adoption and fostering practice
Bifulco, A., Jacobs, C., Bunn, A., Thomas, G. and Irving, K. 2008. The Attachment Style Interview (ASI): a support-based adult assessment tool for adoption and fostering practice. Adoption and Fostering. 32 (3), pp. 33-45. https://doi.org/10.1177/030857590803200306
Adult Attachment Style. II: Its relationship to psychosocial depressive-vulnerability
Bifulco, A., Moran, P., Ball, C. and Lillie, A. 2002. Adult Attachment Style. II: Its relationship to psychosocial depressive-vulnerability. Social Psychiatry and Psychiatric Epidemiology. 37 (2), pp. 60-67. https://doi.org/10.1007/s127-002-8216-x
Adult attachment style. I: Its relationship to clinical depression
Bifulco, A., Moran, P., Ball, C. and Bernazzani, O. 2002. Adult attachment style. I: Its relationship to clinical depression. Social Psychiatry and Psychiatric Epidemiology. 37 (2), pp. 50-59. https://doi.org/10.1007/s127-002-8215-0
Assessing psychosocial risk in pregnant/postpartum women using the Contextual Assessment of Maternity Experience (CAME)
Bernazzani, O., Marks, M., Bifulco, A., Siddle, K., Asten, P. and Conroy, S. 2005. Assessing psychosocial risk in pregnant/postpartum women using the Contextual Assessment of Maternity Experience (CAME). Social Psychiatry and Psychiatric Epidemiology. 40 (6), pp. 497-508. https://doi.org/10.1007/s00127-005-0917-y
Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder
Bifulco, A., Moran, P., Jacobs, C. and Bunn, A. 2009. Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder. Attachment & Human Development. 11 (1), pp. 69-85. https://doi.org/10.1080/14616730802500826
Concordance between mother and offspring retrospective reports of childhood adversity
Fisher, H., Bunn, A., Jacobs, C., Moran, P. and Bifulco, A. 2011. Concordance between mother and offspring retrospective reports of childhood adversity. Child Abuse and Neglect. 35 (2), pp. 117-122. https://doi.org/10.1016/j.chiabu.2010.10.003
The longitudinal psychometric properties of the EAS temperament survey in adolescence
Spence, R., Owens, M. and Goodyer, I. 2013. The longitudinal psychometric properties of the EAS temperament survey in adolescence. Journal of Personality Assessment. 95 (6), pp. 633-639. https://doi.org/10.1080/00223891.2013.819513
Item response theory and validity of the NEO-FFI in adolescents
Spence, R., Owens, M. and Goodyer, I. 2012. Item response theory and validity of the NEO-FFI in adolescents. Personality and Individual Differences. 53 (6), pp. 801-807. https://doi.org/10.1016/j.paid.2012.06.002
Understanding adult attachment in family relationships: assessment and intervention
Bifulco, A. and Thomas, G. 2012. Understanding adult attachment in family relationships: assessment and intervention. Routledge.
Clinical and economic outcomes from the UK pilot psychiatric services for personality-disordered offenders
Fortune, Z., Barrett, B., Armstrong, D., Coid, J., Crawford, M., Mudd, D., Rose, D., Slade, M., Spence, R., Tyrer, P. and Moran, P. 2011. Clinical and economic outcomes from the UK pilot psychiatric services for personality-disordered offenders. International Review of Psychiatry. 23 (1), pp. 61-69. https://doi.org/10.3109/09540261.2010.545989
An evaluation of new services for personality-disordered offenders: staff and service user perspectives
Fortune, Z., Rose, D., Crawford, M., Slade, M., Spence, R., Mudd, D., Barrett, B., Coid, J., Tyrer, P. and Moran, P. 2010. An evaluation of new services for personality-disordered offenders: staff and service user perspectives. International Journal of Social Psychiatry. 56 (2), pp. 186-195. https://doi.org/10.1177/0020764009105281