Needing to shout to be heard? Affective dysregulation, caregiver under-responsivity, and disconnection between vocal signalling and autonomic arousal in infants from chaotic households

Higher levels of household chaos have been related to increased child affect dysregulation during later development. To understand why this relationship emerges, we used miniature wearable microphones and autonomic monitors to obtain day-long recordings in home settings from a cohort of N=74 12-month-old infants and their caregivers from the South-East of the UK. Our findings suggest a disconnect between what infants communicate and their physiological arousal levels, that are likely to reflect what they experience. Specifically, in households which families self-reported as being more chaotic, infants were more likely to produce negative affect vocalisations such as cries at lower levels of arousal. This disconnection between signalling and autonomic arousal was also present in a lab still face procedure, where infants from more chaotic households showed reduced change in facial affect and slower physiological recovery despite equivalent change in arousal during the still face episode. Finally, we found that this disconnect between what infants communicate and their physiological arousal levels may influence the likelihood of a caregiver responding. Implications for understanding the mechanisms underlying the relationship between household chaos, emotion dysregulation and caregiver under-responsivity are discussed.

Psychometric evaluation of the Affect Regulation Checklist: Clinical and community samples, parent-reports and youth self-reports

The Affect Regulation Checklist (ARC) was designed to capture affect dysregulation, suppression, and reflection. Importantly, affect dysregulation has been established as a transdiagnostic mechanism underpinning many forms of psychopathology. We tested the ARC psychometric properties across clinical and community samples and through both parent-report and youth self-report information. Clinical sample: participants included parents (n=814; Mage=43.86) and their child (n=608; Mage=13.98). Community sample: participants included parents (n=578; Mage=45.12) and youth (n=809; Mage=15.67). Exploratory structural equation modeling supported a three-factor structure across samples and informants. Dysregulation was positively associated with all forms of psychopathology. In general, suppression was positively associated with many forms of psychopathology, and reflection was negatively associated with externalizing problems and positively associated with internalizing problems.

Complex Posttraumatic Stress Disorder and Rehabilitation Counseling

PurposeComplex posttraumatic stress disorder (CPTSD) is a multifaceted disorder, and the specific diagnostic criteria developed by the World Health Organization (WHO), which highlight symptoms of CPTSD (i.e., affect dysregulation, negative self-concept, disturbed relationships), that occur along with PTSD symptoms speak to this. Understanding the disorder itself and its ramifications is essential as our society is exposed to seemingly more and more traumatic and long-lasting events, all of which may lead to an increase in the number of overall cases. CPTSD is characterized by changes in three primary areas of the brain – hippocampus, amygdala, and medial prefrontal cortex (mPFC)– which are usually smaller in individuals with CPTSD, and there are certain subsets of individuals who have an increased likelihood of developing this disorder (e.g., individuals with physical and psychiatric disabilities, children exposed to long-term trauma).MethodThe authors conducted a scoping literature review on CPTSD, treatment approaches for individuals with CPTSD, and rehabilitation implications.ResultsTreatment for CPTSD is generally more extensive than treatment for PTSD and should be made available for those in need. There is a dearth of research on this topic in the rehabilitation literature; however, disability research has consistently shown that employment plays a huge role in successful recovery among individuals with psychiatric disabilities, which includes CPTSD.ConclusionIn order to ensure client success, rehabilitation counselors, educators, and researchers must understand the complexities associated with CPTSD and then how to best go about incorporating this information into individual plans for employment and our classrooms as well as making research in this area a priority for the field.

A New Integrative Model For The Co-Occurrence of Non-Suicidal Self-Injury Behaviours and Eating Disorder Symptoms

Objective: The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed whether insecure attachment and maladaptive schemas were related to NSSI and ED symptoms through affect dysregulation, impulsivity, self-esteem, and body dissatisfaction. Method:123 ED patients and 531 individuals from the community completed an online survey, which included measures assessing the variables of interest. Results: The model was a good fit for the ED group, however only a revised model reached an acceptable fit for the community sample. In the community group, impulsivity was a shared predictor for NSSI and bulimic symptoms, whereas affect dysregulation was a unique predictor for NSSI in both the ED and community groups. No other variables were shared by NSSI and ED symptoms in the two groups. Both attachment and maladaptive schemas were implicated in the pathways leading to ED and NSSI symptoms in the clinical ED and the community sample. The variance explained for NSSI and drive for thinness were highest for the clinical ED sample (29% and 57% respectively). Conclusion: Common factors may underlie NSSI and ED symptoms, however, these factors may become more specific and less prevalent as a function of disorder severity.

Roles of Family Stress, Maltreatment, and Affect Regulation Difficulties on Adolescent Mental Health During COVID-19

Purpose: This study examines the indirect effect of affect dysregulation and suppression on the associations between family stress from confinement, maltreatment, and adolescent mental health during COVID-19. We examined both adolescent and caregiver perspectives to yield a more well-rounded understanding of these associations. Methods: Using both adolescent (N = 809, Mage = 15.66) and caregiver (N = 578) samples, exposure to physical and psychological maltreatment, family stress from confinement, affect dysregulation, suppression, and youth externalizing and internalizing symptoms were measured in the summer of 2020, following three months of stay at home orders due to COVID-19. Results: We found that affect dysregulation partially accounted for the associations between family stress and psychological maltreatment on both internalizing and externalizing symptoms for youth and parent report. Suppression partially accounted for the associations between family stress and maltreatment on internalizing and externalizing symptoms in the youth sample, but only for internalizing symptoms in the caregiver sample. Conclusion: Understanding the family predictors of adolescents’ mental health concerns, and their underlying mechanisms, affect dysregulation and suppression, can help us target mental health interventions during and following the COVID-19 pandemic.

PTSD diagnoses and treatments: closing the gap between ICD-11 and DSM-5

SUMMARYThe diagnostic status of ‘complex’ post-traumatic stress disorder (PTSD) remains controversial. The revisions to PTSD diagnostic criteria in ICD-11 and DSM-5 take opposing positions on how best to conceptualise post-traumatic presentations that include affect dysregulation, interpersonal difficulties and negative self-concept. ICD-11 carved out a separate category of complex PTSD (CPTSD) that is distinct from PTSD, whereas DSM-5 expanded PTSD to encompass such symptoms. Each approach carries problematic implications for clinical care. ICD-11 creates a dichotomy but the criteria themselves suggest a difference in severity rather than category. Furthermore, separating CPTSD perpetuates expectations that a ‘simple’ PTSD can be easily treated with brief trauma-focused therapy. DSM-5 complicates the PTSD diagnosis, but does not revise treatment recommendations. Both ICD and DSM need to recognise that most patients with PTSD do not reflect the clinical trial samples and do not fully recover with brief manualised therapies. Treatment guidelines should be developed that address the multiple needs and challenges of all patients with PTSD.