PTSD raises risk for obesity in women

Women with PTSD gain weight more rapidly than women without disorder Women with post-traumatic stress disorder (PTSD) gain weight more rapidly and are more likely to be overweight or obese than women without the disorder, find researchers at Columbia University's Mailman School of Public Health and Harvard School of Public Health. It is the first study to look at the relationship between PTSD and obesity over time. Results appear online in JAMA Psychiatry. One in nine women will have PTSD at sometime over the course of their lifetime—twice as often as men. Women are also more likely to experience extreme traumatic events like rape that carry a high risk for the disorder. "PTSD is not just a mental health issue," says study senior author Karestan Koenen, PhD, Mailman School associate professor of Epidemiology. "Along with cardiovascular disease and diabetes, we can now add obesity to the list of known health risks of PTSD." PTSD - Clinical Practice Guideline for Management of Post Traumatic Stress CEU Course "The good news from the study is that it appears that when PTSD symptoms abate, risk of becoming overweight or obese is also significantly reduced," says first author Laura D. Kubzansky, PhD, Professor of Social and Behavioral Sciences at Harvard School of Public Health. However, despite the growing evidence of potential far-reaching problems associated with PTSD, it's estimated that only half of women in the United States with the disorder are ever treated. "Hopefully, wider recognition that PTSD can also influence physical health will improve this statistic, leading to better screening and treatments, including those to prevent obesity," says Dr. Kubzansky. While it's known that women with PTSD have high rates of obesity, it has been unclear whether PTSD was actually driving the weight gain. To explore the issue, the researchers analyzed data collected from 50,504 women, aged 22-44 years, taking part in the Nurses' Health Study II between 1989 and 2009. Participants were asked about the worst trauma they experienced and if they had related post-traumatic stress symptoms. The threshold for PTSD was the persistence of four or more symptoms over a month or longer. Common symptoms include re-experiencing the traumatic event, feeling under threat, social avoidance, and numbness. Normal-weight women who developed PTSD during the study period had 36% increased odds of becoming overweight or obese compared with women who experienced trauma but had no symptoms of PTSD. The higher risk was evident even for women with sub-threshold symptoms levels and remained after adjusting for depression, which has also been proposed as a major risk factor for obesity. In women with PTSD that began prior to the study period, body mass index increased at a more rapid pace than women without PTSD. The observed effect of PTSD on obesity is likely stronger in the general population of women than in nurses, notes Dr. Koenen. "Nurses are great for studies because they report health measures like BMI with a high degree of accuracy. But they are also more health conscious and probably less likely to become obese than most of us, which makes these results more conservative than they would otherwise be." Symptoms of PTSD rather than the trauma itself seemed to be behind the weight gain. "We looked at the women who developed PTSD and compared them to women who experienced trauma but did not develop PTSD. On the whole, before their symptoms emerged, the rate of change in BMI was the same as the women who never experienced trauma or did experience trauma but never developed symptoms," says Dr. Kubzansky. How exactly does PTSD lead to weight gain? The biological pathway is unknown, but scientists have a number of guesses. One is through the over-activation of stress hormones. PTSD may lead to disturbances in functioning of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, each of which are involved in regulating a broad range of body processes, including metabolism. Another is through unhealthy behavior patterns that may be used to cope with stress. Ongoing research is looking at whether PTSD increases women's preference for processed foods and decreases their likelihood of exercising Social Worker Continuing Education ### Co-authors include Pula Bordelois, MPH, and Andrea Roberts, PhD, at Harvard School of Public Health; Hee Jin Jun, DrPH, at the Channing Division of Network Medicine at Brigham and Women's Hospital; Noah Blustone, BA, at Harvard Medical School and Boston University; and Magdalena Cerda, DrPH, at Columbia's Mailman School. The study was supported by grants from the National Institute of Mental Health to Dr. Koenen (MH078928 and MH093612). The authors declare no conflict of interest.

CWRU study finds mending ruptures in client-therapist relationship during PTSD treatment has positive benefits

In order for prolonged exposure therapy, an evidence-based psychotherapy for PTSD, to reach its full potential, any misperceptions or ruptures in trust and communication between therapist and client need fixing, according to a new Case Western Reserve University study. The study, reported in the Journal of Consulting and Clinical Psychology online article, “Patterns of Therapeutic Alliance: Rupture-Repair Episodes in Prolonged Exposure for PTSD,” is among the first to examine how ruptures in the relationship between the therapist and client can damage a patient’s treatment outcome. An alliance rupture may occur when there is a break in the therapist-client bond. For example, ruptures in the therapeutic relationship may occur when therapeutic progress stalls, negative feelings arise between the therapist and client, or when the work in therapy becomes challenging PTSD - Clinical Practice Guideline for Management of Post Traumatic Stress “We want therapists to know that a rupture in the therapeutic relationship isn’t a bad thing, as long as the therapist tends to it,” said Stephanie Keller, one of the study’s researchers and a Case Western Reserve doctoral student in clinical psychology. “However, if the rupture is not repaired, then your patient may not do as well in treatment.” The research study included 116 people who experienced a traumatic event such as childhood sexual or physical abuse, physical assault, or combat exposure, and had a primary diagnosis of PTSD. Participants engaged in a 10-session treatment program called prolonged exposure (PE) therapy. To help therapists chart progress and examine the therapeutic relationship, each client assessed his or her own PTSD symptoms and perception of their relationship with the therapist during treatment. This helped researchers to identify those clients who experience no ruptures in the therapeutic relationship (a stable relationship), clients who experienced a rupture that was subsequently repaired, and those with ruptures that went unrepaired LCSW Continuing Education The first PE session outlined what would happen over the course of treatment to set specific goals. Exposure-based exercises began in the second session, which included exposure to anxiety-provoking situations that served as trauma-reminders and talking about their traumatic experiences. In this sample, 28 percent of patients experiences a repaired rupture and 18 percent experienced a rupture, or dip in the therapeutic relationship, that was never repaired. An unresolved rupture in the therapist-client relationship became a predictor for a poorer outcome in treatment, Keller said. She also said more research is needed to figure out why these alliance ruptures occur and how to best repair them. The research was funded through a National Institute of Mental Health PTSD research project, directed by Norah Feeny, Ph. D. from Case Western Reserve University and Lori A. Zoellner, Ph. D. from the University of Washington. Other researchers contributing to the project were lead investigator and Case Western Reserve alumna AnnaMaria Aguirre McLauglin, and Eric A. Youngstrom, of the University of North Carolina at Chapel Hill.

Girls with ADHD more prone to self-injury, suicide as they enter adulthood

Visible symptoms can go undercover, UC Berkeley psychologists find Girls with Attention Deficit Hyperactivity Disorder (ADHD) – and their families – often look forward to the likely decline in visible symptoms such as fidgety or disruptive behavior as they mature into young women. However, new findings from UC Berkeley caution that, as they enter adulthood, girls with histories of ADHD are more prone to internalize their struggles and feelings of failure – a development that can manifest itself in self-injury and even attempted suicide LPC continuing education "Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood," said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood. "Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD females are profound," he added. The study is published today (Tuesday, August 14) in the Journal of Consulting and Clinical Psychology. Its results are consistent with earlier findings by the UC Berkeley team that, as girls with ADHD grow older, they show fewer visible symptoms of the disorder, but continue to suffer in hidden ways. The findings challenge assumptions that girls can "outgrow" ADHD, and underscore the need for long-term monitoring and treatment of the disorder, Hinshaw said. The longitudinal study, which began when the girls were ages 6 to 12, is funded by grants from the National Institute of Mental Health. Since 1997, Hinshaw and his team have tracked a racially and socio-economically diverse group of girls with ADHD in the San Francisco Bay Area through early childhood summer camps, adolescence and now early adulthood. In addition to this new study, many others have been published by the team about the girls every five years. In the United States, more than 5 million children ages 3-17 – approximately one in 11 – have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. ADHD is characterized by poor concentration, distractibility, hyperactivity, impulsiveness and other symptoms that are inappropriate for the child's age. Evidence-based treatment includes stimulant medications and various forms of behavior therapy. The new UC Berkeley study, assessing the girls 10 years after it began, examined 140 of them, ages 17-24, comparing their behavioral, emotional and academic development to that of a demographically similar group of 88 girls without ADHD. It also gauged the symptoms of two major ADHD subtypes: Those who entered the study with poor attention alone versus those who had a combination of inattention plus high rates of hyperactivity and impulsivity. The study's major finding was that the group with combined inattention and hyperactivity-impulsivity during childhood was by far the most likely to manifest self-injury and suicide attempts in early adulthood. In fact, the study pointed out, more than half of the members of this subgroup were reported to have engaged in self-injurious behavior, and more than one-fifth had attempted suicide, Hinshaw said. "A key question is why, by young adulthood, young women with ADHD would show a markedly high risk for self-harm … Impulse control problems appear to be a central factor," the study said. In the first study on this group, published in 2002, the 6- to- 12-year old girls attended five-week camps where they were closely monitored as they partook in art and drama classes and outdoor activities. Those taking ADHD medication volunteered to go off the drug treatment for much of the summer camp study. The counselors and staff observing all the participants did not know which of them had been diagnosed with ADHD. That study found that girls with ADHD were more likely to struggle academically and to be rejected by their peers, compared to the comparison peer group. The five-year follow-up study, when the girls were 12 to 17 and experiencing early to mid-adolescence, found that the fidgety and impulsive symptoms tended to subside in the early teen years, but that the learning gap between girls with ADHD and their non-ADHD peers had widened, and eating disorders and substance abuse had surfaced. For the latest study, in which 95 percent of the original sample of girls participated, the researchers conducted intensive interviews with the subjects and their families. Those interviews include personal reports on behaviors such as self-harm and suicide attempts, drug use, eating habits and driving behavior. Researchers also measured key cognitive functions such as executive planning skills, which include goal-setting and monitoring, planning and keeping on task despite distractions. While many girls in the study showed improvement in ADHD symptoms during the 10-year period, certain problems persisted and new ones emerged, suggesting that careful monitoring and treatment are essential, Hinshaw said. "The overarching conclusion is that ADHD in girls portends continuing problems, through early adulthood," the study concluded. "Our findings argue for the clinical impact of ADHD in female samples, the public health importance of this condition on girls and women, and the need for ongoing examination of underlying mechanisms, especially regarding the high risk of self-harm in young adulthood." That said, Hinshaw added, "ADHD is a treatable condition, as long as interventions are monitored carefully and pursued over a number of years." ### In addition to Hinshaw, authors and researchers of the study are Elizabeth Owens, Christine Zalecki, Emily Schrodek and Erika Swanson at UC Berkeley; Suzanne Perrigue Huggins at the University of Maryland and Adriana Montenegro-Nevado at Palo Alto University