Regional Conferences

Talking About Trauma and Dissociation in All Corners of the World

Joan Haliburn, MD, and Kate McMaugh

Hobart, Tasmania

Some might argue that it is a challenge to organise and present a conference in an island off the southern coast of … another island, quite literally on the edges of the world. But ISSTD is keen to reach all corners of the globe and we were fortunate that members Joan Haliburn MD and Jan Ewing PhD, were prepared to organise and lead a regional conference in Hobart, Tasmania last month. It just turns out that this conference was highly successful!

Joan and Jan were delighted to report that more than 100 people attended the conference. This comprised local health professionals as well as people who made the trek across the Bass Strait from all over Australia and New Zealand, and even one person from the US, who was holidaying in Australia. There were psychiatrists, psychologists, social workers, school counsellors and welfare workers, all interested in recent developments in the field of trauma and dissociation.

Jan reports that the audience, which varied from new graduates through to highly experienced clinicians, were all keen to add to their knowledge, skills and confidence in working with their wounded clients. She adds, “They were all enthusiastic and highly engaged. There was a palpable commitment to healing in the air, which was quite moving at times.”

Both presentations were well received with lots of questions and requests for references. Joan and Jan both report that there have been numerous emails since the conference from interested people, with all sorts of questions. At least half a dozen took ISSTD membership forms and we hope they have completed and sent them in!

Conference Venue

As is typical for this island state, Hobart put on a show for delegates – that is, showing them all four seasons in two days. While weather was fine and sunny on Friday, but it was cold and blustery on Saturday with a threat of a snow storm. Naturally we hope all interstate visitors heeded weather warnings and packed accordingly. The conference was complimented by great catering and a sensational venue in a new conference centre overlooking Bellerive Oval, dedicated to famous cricketers like Don Bradman and Ricky Ponting.

Organisers would like to thank local Clinical Psychologist, Serena King, who helped out enormously. Her support and assistance (including staffing the reception desk and providing free taxi services) was greatly appreciated!

We are happy to say that the Hobart Regional Conference was a resounding success from all points of view.

2019 Annual Conference

2019 Annual Conference Plans to Delight Attendees with Fine Array of Pre-Conference Workshops

Christine Forner

The 36th Annual conference, to be held in NYC in March, 2019, will offer a complete array of Pre-Conference workshops featuring some of the world’s leading trainers and thinkers in the field.

The Pre-Conference sessions have been set up to provide clinicians and researchers full day, in depth sessions of cutting-edge information. A lot of time goes into the preparation of these days and the Annual Conference Committee hopes that the information within these sessions rejuvenates, educates, and excites our attendees.

The list of Pre-Conference sessions include:


  • Sandra Baita: Shame, Avoidance and Rejection in the Clinical Work with Dissociative Children and adolescents
  • D. Michael Coy and Jennifer Madere: Integrating the Multidimensional Inventory of Dissociation into Clinical Practice .
  • Heather Hall and Michael Salter: Dissociative Disorders and Public Health
  • Rochelle Sharpe Lohrasbe: Harmonizing Body and Mind – Sensorimotor Psychotherapy, Trauma, and Dissociation
  • Billie Pivnick, Jill Bellinson, Moderated by Joan Turkus: Remembering the Vanishing Forms of 9/11: Ruptures, Ripples, and Reflections


  • Kathy Steele, Dolores Mosquera, Suzette Boon: Integration Failures Across Diagnostic Categories in Traumatized Individuals
  • Ken Benau and Sarah Krakauer: Pride and Shame in Psychotherapy with Relational Trauma and Dissociative Disorders
  • Rick Kluft: Putting Ideas and Techniques to Work in the Treatment of DID: A Case Study-Driven Approach
  • Adah Sachs and Michael Salter: Organized Abuse: The Criminology of Sexual Exploitation and Therapeutic Approaches
  • Christine Forner and Mary-Anne Kate: Dissociation 101: A Comprehensive Exploration into the Field of Dissociation and Complex Trauma

As you can see, there are a variety of topics that cover issues with children, adolescents and adults. There is the updated Dissociation 101, which is designed to educate people who are beginning to work with complex trauma and dissociation. There will be a special course designed to explore, learn about and understand the impact of trauma and terror; this will include information regarding 9/11. There is a workshop on understanding how to use, and apply to clinical practice, the Multidimensional Inventory of Dissociation. There is a session that examines dissociation as a public health crisis, and another that examines organised sexual exploitation, with input from both criminology and therapeutic perspectives.

Some of the most asked-for sessions are those which address difficult clinical issues. We have attempted to make sure that the pre-conference workshops have a heavy emphasis on this. In addition to the above workshops, we also have sessions which examine: the differentiation of the various types of integration failures that occur with different disorders, something that is sure to assist with complex case formulation; the difficult and ubiquitous issues of pride and shame in therapy; as well as the practice of specific clinical techniques such as sensorimotor psychotherapy. Of course, we look forward to hearing the clinical wisdom of Rick Kluft, shared through a unique case-presentation format.

As a member of the conference committee since 2011, I have had the great vantage point of seeing the variety of sessions offered every year. We are working hard to include discussions that have been requested of us. If any Members have a great idea or a suggestion of a Pre-Conference lecturer or topic please send word to the conference committee. We will work towards including it in future conferences.

If you have never made the investment of attending the Pre-Conferences, I highly recommend you consider attending. During these courses, all participants get a chance to intimately connect with experienced clinicians, researchers and innovators within the field of trauma and dissociation, most of whom have been doing this challenging work for decades. These classes are set up to be intimate, and full of content that you may not get anywhere else, all designed to advance your clinical practice, broaden your thinking, and challenge your research

Kid's Korner

“I go in the closet in my head.” – Trauma and Dissociation in Children Living with Domestic Violence

Na’ama Yehuda, MSC, SLP

Eli, age seven, lives with his younger sister Marianne, age four, and their mother Lisa, in New York City. They had lived in a domestic violence shelter for a year, and before that with his stepfather, Mark, till Lisa fled with the kids following repeated violence. Huddled in his bed, Eli had often heard his stepdad beating his mother. He’d wait helplessly till she sought refuge in the children’s room once Mark stormed out. She’d sob herself to sleep on the floor by his bed as he lay awake, worrying his stepdad would return and hit her more.

Mark was the only father Eli knew. His biological father left shortly after he was born. Eli adored his stepdad. He loved it when Mark took him to the park and showed him “how to build muscles” on the monkey-bars. He also hated Mark for hurting his mother, and felt guilty for admiring the very strength that brutalized her. When one night his bruised mother took him, still in pajamas, to a “hotel for mommies,” Eli wanted to go back home. He cried and screamed and it made his mother cry. One of the shelter’s women told Eli he was being “selfish” and that if he “wanted to grow up to be a decent man” he would “stop hurting his mom.”Eli felt confused. Was he hurting his mommy like his stepdad hurt her? Sometimes his stepdad would apologize in the morning and say “he didn’t know his own strength.” Did Eli also not know his own strength? Did he hurt his mommy without meaning to?

Eli stopped fussing, but he still missed his stepdad. There were no dads in the shelter, only whiny babies, toys big kids wouldn’t share, and mommies with scared eyes and scary bruises. He didn’t like it there. He couldn’t go to his own school. He couldn’t see his friends or go to the park where he’d played catch with Mark. Instead, he had school in the shelter and played at the playroom where the carpet smelled funny. Eli tried to be good but still his mommy cried at night. Maybe he was hurting her by his thoughts of wanting to go home? He didn’t know how to stop wanting to go home.

Even when they finally left the shelter they didn’t go home. His mommy said their new apartment was “home, sweet home,” but it wasn’t. It wasn’t even near the park and he had a new school with different everything. Also, his mommy was scared again. She had a lot of locks on the door, and slept on the floor by his bed again. Like before. She cried even though Mark wasn’t there to hit her. Eli tried to take care of his mommy but he didn’t know how. He was doing it all wrong. He didn’t know what to do.

When I met Eli, he was repeating Kindergarten and showed difficulty with attending, comprehending, and meeting academic demands. Teachers reported he could be talkative but mostly seemed to be “in his own little world” and frequently complained of stomach-aches, asking for his mother to take him home. His occasional explosive aggression led to questions about whether he needed a more restrictive environment “for the protection of everyone involved.” Both Eli and Marianne had attended a therapeutic play group at the shelter, and the counselor there noted that Eli had “tended to keep to himself” and was “always with one ear to the door, listening his mom was okay.” The little boy hadn’t been aggressive toward others at the shelter, but the counselor wasn’t surprised to hear “some of that rage bubbled up eventually.”

“Lions are strong,” Eli emphasized. “They eat the deer.”
We had just finished reading a story about forest animals and their needs, and he seemed disappointed that no one got eaten.
“Yes,” he added, smacking his palm on the closed book. “Later, he’ll beat her up and then he’ll eat her. He can kill her …”
He shuddered and looked up at me and appeared a lot younger than seven.
“That sounds very scary,” I noted gently.
He pointed to the deer on the cover of the book. “Can she hide?” he asked.
I nodded and pointed in the direction of a napkin. I wanted to give him space to go where he needed. It was obvious this wasn’t about deer and lions.
Eli took in a trembling breath.
“I hide.” He whispered and reached for my hand. “I hide inside the closet in my mind.”

It’s what he did when mommy was being hurt and when she cried and when he missed his stepdad and when he didn’t know what to do: he went inside the closet inside his mind. Not the real closet, where people can find you, but a better one, in his head: A closet where only he could open the doors, where no bad sounds or smells got in. It wasn’t scary in his closet, just quiet. But sometimes he forgot to open the doors and pay attention and the teachers said he wasn’t a good listener and kids said he was stupid. His mommy told him that if she kept missing work to take him home from school she’d lose her job and they’d lose their apartment. But he worried about her. He heard her tell a friend on the phone that she was scared Mark would shoot her at work. Like on TV. He wanted mommy to take him home so she won’t be at work where Mark can come. And sometimes he thought he heard scary Mark coming so he’d jump out of his closet fast and hit but then people told him he was being bad, too. It made him want to go back in the closet inside his head but he needed to look after his mother. He was “the man of the house” now. He didn’t know what to do.

Exposure to domestic violence hurts children (Edleson 1999, Sousa et al 2011). Witnessing violence impacts children as much—and sometimes more—than being hit. It is unbearable to a child to be helpless to save the caregiver they need, and it can be even worse when the one harming the caregiver is also someone the child depends on. Children often convince themselves that the violence—and its prevention—is somehow theirs to control (Levendovksi et al 2003, Sousa et al, 2011). In a child’s mind, if only they were better, quieter, and less needy, the people they rely on would not become terrified or terrifying.

The very words that accompany domestic violence can be confusing. Did mom “ask for it?” Did stepdad “only hit her because he loved her?” Does saying “I’m sorry” mean it didn’t happen? Unable to make sense of what is happening around them, children—like Eli retreating into his “closet inside his mind”—might shut-down and dissociate. They can appear unemotional and numb, stop attending, and fall behind socially and at school. They might mirror the aggression they’d seen. Very often children feel guilty if they love the person who hurts the other person they love, and guilty for hating the person they love for hurting another person they love. They rarely have the words or space to describe any of this. Children who apply dissociation to cope with terror and helplessness may also shut down at reminders of the trauma, reinforcing dissociation and resulting in children who are less available for processing information and utilizing available support (Siegel 2012, Silberg 2013, Wieland 2011, Yehuda 2005, 2016).

Even after a parent flees domestic violence, strain often continues, and children might mirror it in ways that reflect not only past trauma, but also current issues. A parent who escaped domestic violence can still be vulnerable. They might still be scared. They might have limited financial, social, and emotional resources. Children sense this, and may hide their own difficulties to protect the parent from distress. When feelings of resentment, anger, worry, or grief inevitably overwhelm them, the children can feel doubly guilty. Unfortunately, just as Eli was scolded at the shelter, children might be chided if they misbehave and be told “there’s already enough to deal with.” They might dissociate to avoid added shame and helplessness. They might become hyper-aware of the parent’s mood and try to accommodate it (Ostrowski et al 2007, Lyons-Ruth & Block 1996).

A loss of home—even the mere risk of it—can be overwhelming and preoccupying, leaving children anxious, wary, worried, angry, or withdrawn. The parent may be managing depression, posttraumatic stress, financial insecurity, and grief; all of which can inadvertently reinforce unhealthy dynamics. This is why it is crucial anyone who works with families fleeing domestic violence, understands children’s behaviors and the functions they serve.

Domestic violence hurts children. While children don’t always communicate their distress verbally, they almost always do so in their behaviors: In aggression and acting out, in shutting down, in falling behind, in what they won’t talk about, in what they do or cannot do (Silberg 2013, Waters 2005, 2016, Yehuda 2005, 2011, 2016). It is paramount we hear them, for our reaction may become the measure of whether they believe help is available.

Eli’s mother was depressed, but she was also determined to keep her children safe and to minimize the impact of trauma on their future. She entered counseling to deal with her own unresolved history, and enrolled Eli in a therapeutic playgroup. She became more involved in his therapy with me, and learned to support his narrative when he spoke of his feelings, including difficult ones about the violence he’d witnessed. Together, at his request, we made a visual representation of the “closet inside his mind” using a shoebox that the two of them painted to fit his inner representation. Eli was able to put his “big feelings” into the closet-box for safe keeping so that he can attend better at school. He was delighted when his mother made a small blanket for his closet “so even the biggest feelings can be cozy and safe.”

With his mother less frightened and himself less alone, Eli was able to let in play, instruction, joy, and praise. His explosive aggression ceased, and he was catching up on language, academics, and friendships.

“Remember when I told you about my closet in my mind?” he said at one of our sessions. “I don’t need to hide there anymore. It’s old and it’s too small for me,” he added without judgment. “I was little, but now I can speak up and if I get scared I can go to mommy or the teacher … or you. I don’t need that closet. The bad memories can rest there.”

Edleson, J.L. (1999). Children’s witnessing of adult domestic violence, Journal of Interpersonal Violence, 14:839-870.

Levendosky, A.A., Huth-Bocks, A.C., Shapiro, D.L., Semel, M.A. (2003). The impact of domestic violence on the maternal–child relationship and preschool-age children’s functioning, Journal of Family Psychology, 17(3):275–287.

Lyons-Ruth, K., Block, D., (1996). The disturbed caregiving system: Relations among childhood trauma, maternal caregiving, and infant affect and attachment, Infant Mental Health Journal, 17(3):257-275,

Ostrowski, S.A., Norman, M.A., Christopher, C., Delahanty, D.L. (2007). Brief report: The impact of maternal Posttraumatic Stress Disorder symptoms and child gender on risk for persistent Posttraumatic Stress Disorder symptoms in child trauma victims, Journal of Pediatric Psychology, 32(3):338–342.

Siegel, D.A. (2012). The Developing Mind: How relationships and the brain interact to shape who we are, 2nd Edition, New York: The Guilford Press.

Silberg J.L. (2013). The Child Survivor: Helping Developmental Trauma and Dissociation, New York: Routledge Publishers.

Sousa. C., Herrenkohl, T.I., Moylan, C.A., Tajima A.E., Klika, J.B., Herrenkohl, R.C., Russo, M.J. (2011) Longitudinal study on the effects of child abuse and children’s exposure to domestic violence, parent–child attachments, and antisocial behavior in adolescence, Journal of Interpersonal Violence, 26(1):111–136.

Waters, F. (2005). When treatment fails with traumatized children. . .Why? Journal of Trauma and Dissociation, 6:1–9.

Waters, F. (2016). Healing the Fractured Child: Diagnosis and treatment of youth with dissociation, Springer, New York.

Wieland, S. (Ed.) (2011). Dissociation in Traumatized Children and Adolescents: Theory and clinical interventions, Psychological Stress Series, Routledge Publishers.

Yehuda, N. (2005). The language of dissociation. Journal of Trauma and Dissociation, 6:9–29.

Yehuda, N. (2011). Leroy (7 Years Old)—“It Is Almost Like He Is Two Children”: Working with a dissociative child in a school setting, in Wieland’s (Ed.) Dissociation in Traumatized Children and Adolescents: Theory and clinical interventions, New York: Routledge, Psychological Trauma Series.

Yehuda, N. (2016) Communicating Trauma: Clinical presentations and interventions with traumatized children, Routledge, New York.

Kid’s Korner is a regular feature of ISSTD News, published every January, April, July

and October.

If you have an idea for an article for Kid’s Korner please contact Kate McMaugh at:

Letter From The President

Increasing Diversity: ISSTD Rising to the Challenge

Kevin Connors, MS, MFT

September is Student and Emerging Professional Month here at ISSTD, a month where we highlight and celebrate the work of this important member component.

I am particularly proud of the work done by incoming President Christine Forner in establishing and developing this vital group. Today this group is an active part of the ISSTD landscape with 200 Student and Emerging Professional Members. After many years of dynamic leadership, Christine has invited Christianna Flynn-Christianson to serve as co-chair of the Student and Emerging Professional Committee.

Many members of this group are contributing to our Society in numerous meaningful ways. Abigail Percifield and Stergio Skatharoudis contribute regularly to our Annual Conference Committee helping to plan and shape the future of how ISSTD educates and encourages new clinicians and researchers. Shelly Hua and Rachel Friedman are vital parts of the team transitioning ISSTD into the 21st Century with our move to a new, more accessible website and the more flexible and dynamic Higher Logic Community platform. David Seagull and Abigail Percifield are active on our membership committee, with Abigail now serving as co-chair.

Most committees and task forces now actively seek out student members to contribute to the dialogue. The dialogue on the Student and Emerging Professionals Forum is among the most active discussion groups ISSTD has running. This year, 2018, we begin to have a bit more balance with a significant drop in the average age of Board Members.

Where did this all begin? Many years ago, serving as the ISSTD Vice-President, I had the honor of attending a special luncheon held during the annual conference. The luncheon was a gathering of Past Presidents invited to share their wisdom and insights as to how to face the challenges confronting our Society.

In the middle of the luncheon, Rick Kluft stood up and asked us to look around the room. He asked us to reflect on what was wrong with the scenario laid out before us. Several long seconds of silence passed. He pointed out, in the quiet, most articulate language that Rick is so well known for, that the average age in the room was well past the age when most people retired. No one in a leadership position was under the age of 55. He noted that we had no input from anyone coming up in the field. We were deaf to the needs, concerns, and issues confronting anyone seeking to enter into the study of trauma and dissociation

A few short months later there was an unexpected opening on the Board of Directors. Recognizing the validity and value of Rick Kluft’s observation, a young, relatively new member of ISSTD was appointed to fill that opening: This was our incoming President Christine Forner. As I’ve already described, one of Christine’s first suggestions was the Student and Emerging Professionals Committee and ISSTD has been richer for this ever since.

However, I am mindful of Rick Kluft’s comment still. It was echoed by Catherine Classen at our last Town Hall Meeting when she looked around the room and noted the lack of diversity among attending members.

We still have work to do in growing and developing our Society.

We are recognizing and responding in some important ways. The theme of our 36th Annual Conference, held in New York City from late March to April 1st 2019, is the World Congress on Complex Trauma. To address and heighten awareness of international perspectives on trauma and dissociation, we have assembled a panel of experts from around the globe to broaden our understanding.

The distinguished panel includes:

  • Argentina – Sandra Baita
  • Spain – Dolores Mosquera
  • India – Adithy
  • Turkey – Vedat Sar
  • South Africa – Christa Kruger
  • Canada – Gabor Mate

Adding further insight into the need to embrace diversity in our field is the work of Heather Hall, MD and Michael Salter, PhD, co-chairs of the ISSTD Public Health Task Force. They will present a pre-conference workshop focusing on treating and hopefully preventing complex trauma and dissociation. They examine how “the risk and impact of Complex Trauma and Dissociation (CTD) is shaped by a range of social, economic and political inequalities.” They go on to note that “access to treatment and opportunities for recovery from CTD are also inequitably distributed” across similar socio-political and economic lines. Their findings and recommendations will shape ISSTD efforts and hopefully find their way to informing policy makers at all levels.

And… We still have work to do in growing and developing our Society.

How can we expand our network of clinicians and researchers to be more inclusive and embrace diversity? How can we extend our ability to reach and teach others so that quality mental health care informed by the understandings of complex trauma and dissociation that ISSTD brings can be available to more people in all the corners of the world and at all socio-economic levels?

We saw one area where we needed to grow. We rose to the challenge and now have an active and growing group of students and emerging professionals. We see our next challenge. Will you help us meet that one too?

Let’s roll up our sleeves and get to work.


Please help support our $35 for the 35th campaign. This important campaign raises funds to grow and support student member opportunities and activities and to provide for our much needed website updates and improvements as well.

You can help by making a donation of any size by visiting the 35 for the 35th webpage on the ISSTD website. One time and monthly installment payment options are available.

Thanks for helping grow ISSTD!

News You Can Use

News You Can Use

Kate McMaugh, Editor, ISSTD News

Tara Tulley at ISSTD Annual Conference, San Francisco

ISSTD Member Tara Tulley, LCSW, LDEM has spoken on a podcast for Rational Faiths about her experience of organised abuse within the Mormon Community. Tara speaks of her personal experience of organised abuse within her LDS family and the wider community, as well as the journey that lead her to become a social worker, treating other survivors of abuse.

Tara and the other speakers discuss issues that survivors in Mormon communities face, and the difficulties LDS survivors face when they disclose the abuse. The Podcast also discussed the Pace Memorandum, the science of memory and the impact of lingering misconceptions left behind in the wake of the FMS advocacy.

Tara explains that this advocacy is part of activism efforts in Utah to empower survivors and to spread awareness about the hidden abuse and human trafficking that occurs in Utah. Tara also explains that this is not a discussion that is against the LDS church or implicating them directly, but rather to help people understand the abuse that can occur within the experience of growing up in a Mormon home and culture around being a Mormon survivor. For those interested the podcast can be accessed here.

Welcome ISSTD’s New Members in August!

Roslyn Badcock
Randy Brazie
Elizabeth Conroy
Megan de Souza
Leslie Deutsch
Karen Druce
Michelle Epstein
Linda Guhe
Fredlee Kaplan
Megan Maloney
Kathleen Maxey
Gilda Ogawa
Shingo Oshima
Janine Petrass
Michelle Rhodes
Robert Solomon
Christie VonVille
Jill Bellinson
Laura Dekle
Santiago Delboy
Jennifer Dritt
Eliza Fernandes
Ian Fowler
Susan Gutwill
Amy Sinjem
Jeanna Smith
Cynthia Wilson
Agnes Wohl
Mehtap Anderson
Catherine Fries
Dianna Hansen
Jessica Wansart
Fiona Fairbrother
Anu Abu-Rus
Sharon Schonteich
Christine Shaw
Robyn Yaxley
Lori Kucharski

Do You Have News ISSTD Members Can Use?
We need your help to make NYCU a great feature, full of news and connecting us all!
Do you have a book or journal article coming out that you wish to share? Have you received an award for your work in the field? Have you been part of developing a new website or training course? If so, we want to hear from you! Don’t be shy, submit your news to us so that we can share with other members.

Submission Deadline: 20th of the month
Send to ISSTD Editor, Kate McMaugh:

Clinical E-Journal

JTD and Frontiers Table of Contents (September 2018)

Journal of Trauma & Dissociation

Check out the entire library online of the Journal of Trauma & Dissociation – your member benefit – now!

Table of Contents
Volume 19, Issue 1
Volume 19, Issue 2
Volume 19, Issue 3
Volume 19, Issue 4
Volume 18, Issue 5

Are you interested in auto publication alerts?
To set up a quick and each way to get a ‘new content alerts’ for JTD, go to the JTD page at Taylor & Francis and click the ‘Alert me’ button under the graphic of the JTD.

For full access to the entire library of the Journal of Trauma & Dissociation (your member benefit) visit the Member’s Only section of the ISSTD website and log in with your member username & password. Need help to access? Call ISSTD Headquarters at 703-610-9037, or email for assistance.

Frontiers in the Psychotherapy of Trauma & Dissociation

Table of Contents


  • Healing Emotional Affective Responses to Trauma (HEART): A Christian Model of Working with Trauma (Benjamin B Keyes, PhD, EdD)
  • Eye Movement Desensitization and Reprocessing (EMDR) in Complex Trauma and Dissociation: Reflections on Safety, Efficacy and the Need for Adapting Procedures (Anabel González, MD, PhD)
  • Cross-Cultural Trauma Work With a Tribal Missionary: A Case Study (Heather Davediuk Gingrich, PhD)
  • The Potential Relevance of Maladaptive Daydreaming in the Treatment of Dissociative Disorder in Persons with Ritual Abuse and Complex Inner Worlds (Colin A. Ross, M.D.)
  • Neuroaffective Embodied Self Therapy (NEST): An Integrative Approach to Case Formulation and EMDR Treatment Planning for Complex Cases (Sandra L. Paulsen, Ph.D.)
  • The Case of the Shaking Legs: Somatoform Dissociation and Spiritual Struggles (Alfonso Martinez-Taboas, Ph.D.)
  • Treatment Outcomes Across Ten Months of Combined Inpatient and Outpatient Treatment In a Traumatized and Dissociative Patient Group (Colin A. Ross, M.D., Caitlin Goode, M.S., and Elizabeth Schroeder, B.A.)
  • Maladaptive Daydreaming: Ontological Analysis, Treatment Rationale; a Pilot Case Report (Eli Somer, Ph.D.)


  • Editorial: How Close Encounters of the Completely Unanticipated Kind Led Me to Becoming Co-Editor of Frontiers (A. Steven Frankel, Ph.D., J.D.)
  • Editorial: Sources for Psychotherapy’s Improvement and Criteria for Psychotherapy’s Efficacy (Andreas Laddis, M.D.)
  • Trying to Keep It Real: My Experience in Developing Clinical Approaches to the Treatment of DID (Richard P. Kluft, M.D., Ph.D.)
  • Expanding our Toolkit through Collaboration: DIR/Floortime and Dissociation-Informed Trauma Therapy for Children (Joyanna Silberg, Ph.D. and Chevy Schwartz Lapin, MA)
  • From Passion to Action: A Synopsis of the Theory and Practice of Enactive Trauma Therapy (Ellert R.S. Nijenhuis, Ph.D.)

To access articles, log into the Member’s Corner area of the website and click on the Frontiers link in the upper right corner. New articles will be posted monthly on the fourth Tuesday of the month as they become available. Frontiers is a member-only benefit.

Committee Spotlight

Student and Emerging Professional (SEP) Committee

Christine Forner, MSW, Chair, SEP Committee | Photos by Prof Warwick Middleton, MD

This has been another good year for our student and emerging professional (SEP) members. The three major highlights over the year are the annual conference, the launching of the SEP Discussion Forum and the Special Events offered for SEP members.

SEP Committee Chair, Christine Forner MSW, speaks with Board Member Dana Ross, MD and ISSTD Fellow Colin Ross MD, with another unknown participant, SEP Lunch Annual Conference, 2018.

Some highlights from the annual conference include the lunch meeting, the poster sessions, the networking of students and senior members, the book give away and more. We always have an excellent lunch where students and emerging professionals get together with senior members of the society to have a casual discussion. This is a great opportunity to meet and network with experienced clinicians and researchers in the field of complex trauma and dissociation. During the lunch we had our annual SEP book give away. Every year we hand out about 20 books written by some amazing authors. There were a lot of laughs and a great chance for students and emerging professionals to ask questions and meet others who share a common clinical or research area of interest

I would encourage students to take advantage of the poster sessions. This is an excellent chance to get your information out there. It is also important for students and emerging professionals to know that you don’t have to have a completed research project to be part of a poster presentation. A poster presentation can be a literature review or another form of clinical or research based information sharing. This is an excellent opportunity to show case your area of interest, bring in new ideas and to add the credit to your CV.

Misty Brigham (blue shirt) and other SEP members chat with ISSTD Fellow, Dr Rich Chefetz MD, SEP Lunch, Annual Conference 2018

We would also like to inform others that it is possible to room-share with others at the annual conferences. It is possible for up to four individuals to share a room so that the costs are kept down. It would be amazing if we could have a large student and emerging professional contingency at the annual conferences. The contacts and education that our students have received in the past is invaluable. In this edition of ISSTD News we have two student members, Mary-Anne Kate and Christianna Flynn-Christianson, share their stories of how valuable it has been to connect with senior professionals at the conferences.

We started a forum for students and emerging professionals in the middle part of the year. So far we have began a discussion of a PDF that was generously provided to us from Dr. Colin Ross. This forum is set up so that students have a place to develop a community, to ask research or clinically relevant questions, and to have a place that is a community of like minded individuals. It can be lonely being a professional in this field and the forum is here to help others feel like they have an academic and clinically sound home. I encourage you all to dive in and start a discussion. This forum is set up to be the place where students and emerging professionals can have a safe and educational space for connections, questions and assistance.

Abigail Percival (centre) with other SEP Members at the SEP lunch, Annual Conference 2018

We are also in the process of vamping up the student and emerging professional committee. Our goal is to have a vibrant committee dedicated to the needs of our SEP members. In this process we are looking for SEP leaders. These individuals tend to have a lot of exposure and opportunities with the ISSTD. Many of the members of the committee have gone on to be full board members and practitioners and researchers who are already making impactful contributions to the field of trauma and dissociation. If you are interested in getting your feet wet with a leadership role, please send word and we will add you to the group. Or if you have needs, requests, ideas and suggestions on things that you feel would be an important contribution, again, please send a note. This month in ISSTD News the volunteer spotlight actually features one such SEP member who has volunteered in a lot of ways for ISSTD. Click here to read about her journey and the benefits of volunteering.

We are also offering a full day live Webinar on Dissociation 101. This course can help you with an excellent foundation of information to take with you into your academics and your career. Learning about dissociation, what it might actually be, what is happening neurobiologically, the history of the field and how to best treat these issues can help your career have longevity. Register for the webinar here.

Please join us, as we grow. As usual we are also always looking for individuals to help us with marketing. We need a few people each year that can help get the word out about our annual conferences. If you are in the Tri-State area, looking to help and looking for a few perks that come from helping out, we would love to hear from you. Please contact me here:

Students & Emerging Professionals

ISSTD Membership Supports SEP Member to Follow her Passion

Kate McMaugh, Editor, ISSTD News

Christianna Flynn-Christianson

Student member of ISSTD, Christianna Flynn-Christianson has developed an early career interest in the assessment and treatment of Complex Trauma and Dissociative Disorders. In this interview she speaks of the benefits she gains from her ISSTD Membership which enables her to focus on her particular areas of interest, something that is not adequately covered in general psychology training, even at the doctoral level.

Tell us a bit about yourself.

My name is Christianna Flynn-Christianson and am originally from Suffolk, Virginia, currently living in Chicago, Illinois since 2012. I am a nature enthusiast and enjoy hiking in forest preserves, national parks, and anywhere else with a decent trail. I just returned from a lovely trip to rural Ireland (Counties Wexford and Wicklow), where my husband and I spent two weeks with my family, who lives in County Wicklow for about a month a year. I much prefer a good trail in the country to the pub atmosphere, though I did enjoy some Irish folk music during my stay as well. I also enjoy swimming in Lake Michigan in Chicago and the cycling, walking and running along the Lakefront path near my home. On occasion, I will compete in local sprint triathlons or running races just to keep fit.

Can you tell us a bit about your studies?

I am currently starting my third year at Adler University in the Clinical Psychology, Psy.D. program. Previously, I obtained a Master’s degree in Psychology with an emphasis on Social Psychology as well as a Master’s degree in Counseling Psychology from The Chicago School of Professional Psychology. I am currently a Licensed Professional Counselor working at an inpatient psychiatric hospital outside Chicago. Previous supervised clinical experience included a one year practicum at American Indian Health Services, where I did counseling with a diverse group of American Indian patients from various tribes, most of whom were trauma survivors. I also worked as a case manager with an organization which helps transition institutionalized individuals to independent living.

I just completed my diagnostic practicum at an inpatient psychiatric hospital with a population of predominantly children and adolescents. Currently, I am awaiting the start of my therapy practicum at a college counseling center known for excellent supervision and multicultural competency. I have also completed basic level one clinical hypnosis training and look forward to completing my intermediate training in the Fall. I have clinical and research interests in Complex PTSD, DID, trauma and resiliency in the transgender and gender nonconforming community, and clinical hypnosis.

How did you hear about ISSTD? What led you to join ISSTD as a SEP member?

I heard about ISSTD through my dissertation chair, Dr. Janna Henning, at Adler University. I met with her during my first semester and expressed an interest in becoming competent to serve the needs of individuals with Dissociative Identity Disorder.

I had noticed during both master’s programs and already in my first year of doctoral training that attitudes and information provided in classroom instruction and clinical supervision had predominantly been grounded in sensationalized myths and misinformation, seemingly biased against viewing DID as a legitimate diagnosis. By this time, I had already interacted both clinically and relationally with multiple individuals who had shared their how difficult it was to get connected with a therapist competent in working with patients with DID.

Dr. Henning was the first individual I had encountered who understood my concerns about the way the field seemed to view both DID as a diagnostic phenomenon and the impact this had on patient care. She recommended I read ISSTD’s Guidelines for Treating Dissociative Identity Disorder in Adults. Admittedly, I waited until my first day of diagnostic practicum, where I was somehow given a case where the psychiatrist listed DID as a rule out. I was paired with an individual who was gratefully open to the idea and she and I both read the Guidelines to complete the case.

In this experience, I learned how difficult it is as a student to obtain adequate clinical supervision on diagnosing individuals with DID. While the DSM-5 does have some useful information to aid in the process, I found the Guidelines to be much more robust and helpful in navigating the nuances of diagnosing. I was so impressed with the Guidelines that I visited the website and later registered for the 2018 conference, which was conveniently located in Chicago.

I joined as a student and emerging professionals member because I am interested in increasing competence in our field, particularly among newer clinicians who may be open to learning what the research actually says about DID.

How have you found your experience in ISSTD? What has the SEP membership been like for you?

In my first conference experience with ISSTD, I was taken aback by how grounded and friendly people were. I found people at the conference to be open-minded and validating of my experiences in the field. It was particularly meaningful for me to have dialogue with both workshop facilitators and first-time attendees about attitudes in the field, therapy approaches and additional training opportunities. I was moved by the Dissociation 101 workshop and learning about the history of ISSTD, and I think I started to understand how and why the field views DID in such polarized ways.

Since the 2018 ISSTD conference, I attended the Complex Issues in C-PTSD and DID treatment online workshop and hope to attend additional workshops soon. As someone invested and passionate about bringing services to this community, it has been transformative for me to have access to more support, research and resources that are directly relevant to my clinical interests. I am grateful to have found ISSTD during my doctoral program because clinical practica tend to be geared toward shaping generalists, rather than specialists. While it is currently more difficult to pursue specialized clinical practica that would grant me the ability to gain meaningful clinical experience in working with DID and C-PTSD on a longer term basis, I view this time as an important opportunity to build my clinical toolkit so that when I am able to pursue more specialized positions, I have attended conferences and workshops and have built a network of supportive colleagues.

What are your hopes for your future career directions?

As I look around the field, I am aware of the gap in services for individuals who have already suffered unspeakable trauma who have profound difficulty locating competent providers who can help them heal. I could see myself starting in a trauma specialist unit with inpatient psychiatric patients to continue to develop clinical competency, and transitioning to community mental health, where I could work to meet the needs of individuals who have few options. I also plan to teach graduate school, hopefully in a PsyD program, where I can ensure that information about DID and C-PTSD is accurate and grounded in research.

In supervision, I plan to advocate for more emphasis on thorough clinical interviewing, provide training on diagnostic tools for trauma and dissociation, and helping trainees better understand the etiology of DID. Over time, I also hope to become increasingly more involved with ISSTD’s special interest groups and continue to participate in annual conferences. One area I’d like to work on is increasing student participation with ISSTD. After noticing the challenges with supervision and education about trauma and dissociation, I know students will benefit from exposure to ISSTD to increase their knowledge in these areas.

Regional Conferences

First ever ISSTD Conference in New Zealand | Haere Mai o Otautahi (Welcome to Christchurch)

Diane Clare, Chair, Conference Coordinating Committee

View to Aoraki (Mount Cook), New Zealand

ISSTD is excited to announce that from November 22nd-24th, 2019, it will offer its very first regional conference in New Zealand. Save the date as this conference promises to be something special.

The people of Christchurch, New Zealand would like to offer a warm welcome to ISSTD members and all conference attendees from around the world, with the Maori welcome: “Haere Mai o Otautahi”.

The theme of this bi-national New Zealand – Australia Regional Conference is ‘Changing Landscapes: Innovations and Challenges in the Treatment of Trauma and Dissociation.’

Lake Tekapo, New Zealand

This theme has been chosen to reflect not just the changing landscapes of our professional field, but of Otautahi (Christchurch) itself. This beautiful city, located in the South Island of New Zealand, was devastated by the combined damage of earthquakes in September 2010, February 2011, and all the subsequent and multiple aftershocks. One hundred and eighty five people lost their lives in February 2011.

Today the historic and scenic city is recovering from the devastation of this trauma to the land and its people. The Nation as a whole, traumatised by the experience, is also healing. The city is now largely re-built with modern, more earthquake-resilient structures and is as beautiful as ever. Recently a decision has been made to restore the iconic Cathedral and an eco friendly version has been serving Christchurch in the meantime.

Christchurch’s temporary eco-Cathedral, known locally as the ‘Cardboard Cathedral’.

Come and celebrate this journey and regeneration as we explore trauma and recovery across a packed three-day program. We offer a pre-conference workshop day followed by two days of conference. Like the beautiful scenery, the program is rich and varied, offering something for everyone. We are delighted to welcome many international presenters, as well as Australians and New Zealanders.



Pre-conference workshops:
Michael Coy & Jennifer Madere – Assessment with the MID.6
Christine Forner & Mary-Anne Kate – Dissociation 101
Naomi Halpern – Snow White Model
Warwick Middleton – Perpetrator-victims and Organised Abuse
Rochelle Sharpe – Sensorimotor Approaches

Conference Program:
As part of our culture the people of the Ngai Tahu iwi (the people of Otautahi/Christchurch) will welcome us to their land with a Powhiri (cultural welcome)

Day 1 Plenaries (titles to be confirmed):

Tram, Christchurch

Martin Dorahy (Past President ISSTD) An Overview of Current Research on DID
Christine Forner (President ISSTD 2019) – Meditation and Dissociation
Michael Salter – Constructions of Complex Trauma: Implications for Women’s Wellbeing and Safety from Violence
Kathy Steele – Advances in the Treatment of Complex Dissociative Disorders
Panel discussion: Dissociation/Psychosis/BPD interface. Warwick (moderator), Matt Ball, Joan Haliburn, Rick Hohfeler & David Leonard.

After hearing these speakers please join us for a conference dinner.

Restored Fountain, Christchurch

Day 2 workshops:
Diane Clare – Alternatives to Self Harm program and the APEX model.
Martin Dorahy & Rick Hohfeler – Shame and Dissociation.
Lisa Danylchuk – Yoga for Complex Trauma.
Joan Haliburn – Fractured Youth: Attachment Abuse and Psychopathology.
Kiri Lawson-Te-Aho – Maori Perspectives on Colonisation and Trauma.
Speaker to be confirmed- Aboriginal Perspectives of Trauma.
Pam Stavropolous and Cathy Kezelman: Blue Knot Guidelines for Working with Complex Trauma.
Kathy Steele – Models of Dissociation.
TDU/Belmont – Mary-Anne Kate, Mary Williams, Lenaire Seager.

At the close of the conference join with the Ngai Tahu iwi as we close with a Poroporoaki (farewell).

But after the conference…

Lyttelton Bay, near Christchurch

Don’t let your experience of New Zealand end here! This tiny nation of just over four million people is one of the world’s most scenic and pristine travel destinations, offering a diversity of holiday experiences.

Travelling though New Zealand, you may recognise some of the extraordinary landscape, as this is the home of the ‘Lord of the Rings’ movies. However, you don’t have to be a Hobbit to enjoy this gorgeous location. Take a few extra days to experience dolphin watching, kayaking, mountain-biking, or bush-walking on the South Island. Consider visiting glaciers or go to Fiordland further south of Christchurch. If you like a bit more adventure, try Queenstown, which offers jet boat rides, skiing, river rafting, hiking and biking, or go bungy jumping where it all began. If you like something more genteel try wine-tasting (New Zealand wines are great!), spa treatments or alfresco dining.

While you are with us, consider a visit to the North Island. Rotorua is one of the world’s most active geothermic ‘hotspots’. Here you can enjoy bathing in hot springs, see bubbling mud pools and watch geysers spouting.

Full conference abstracts, speaker bios, venue details, and more information will be found on the Conference Website which will be live in early 2019. These pictures will offer a taste of what you can expect to see in and around Christchurch.

Publications of Interest

Suicide, Trauma, and Dissociation

Lynn Hazard, LCSW, POI Editor

Lynn Hazard, POI Editor

This quarter’s POI theme is suicide associated with trauma and/or dissociation. This is an important theme for me, after having lost two family members in less than one year to suicide – both having had histories of childhood trauma. Professionals and survivors need to be aware of the increased risks for, along with the correlations between, trauma and suicide. When someone can face the past, learn to appreciate themselves for having survived, and develop ways to self-regulate and integrate, then a path is opened to true healing. Please take care of yourselves and, if this issue distresses you, please contact your professional supports or contact the suicide prevention services in your country

Firoozabadi, A., Jahromi, L.R., and Yaghmaie, S. (2018). Prevalence of dissociative experiences in those referred to emergency psychiatric centers after attempting suicide. Journal of Hospital Practice and Research, 3(1):22-27. DOI: 10.1517/hpr.2018.05

Background: Dissociation is a symptom that can be related to traumatic childhood events. Dissociation in some cases is categorized in a distinct subgroup from other psychiatric disorders. Objective: The purpose of this study was to investigate the prevalence of dissociative experiences in patients who have attempted suicide and who have referred to an emergency psychiatric center. Methods: This was a cross-sectional epidemiological study in which dissociative experiences were evaluated in 98 patients who referred to Ibn Sina and Hafez hospitals after attempting suicide. In addition to determining the prevalence of these experiences, the relationship between the symptoms and variables such as sex, age, marital status, education, and suicide risk was determined. Results: There was significant difference in the level of disappointment between married and single patients (P=0.047). The mean disappointment score for the overall population was 11.92, which is in the normal range. There was no significant relationship between dissociation score and level of disappointment (P=0.933). The prevalence of dissociative experiences was found to decrease as the age of the patients increased (P=0.006). There was no significant difference between rate of suicide as reflected in the measurement of disappointment and dissociative symptoms There was no significant relationship between DES score and other variables. Conclusion: One cause of psychological pressure in deciding to attempt suicide is family conflict. Many individuals who attempt suicide did not have a thought-out desire to take their lives, but attempted it impulsively in response to a periodic stressor.

Ford, J.D., Chark, R., Modrowski, C.A., & Kerig, P.K. (2018). PTSD and dissociation symptoms as mediators of the relationship between polyvictimization and psychososical and behavioral problems among justice-involved adolescents. Journal of Trauma & Dissociation, 19(3):325-346. Download at

Polyvictimization (PV) has been shown to be associated with psychosocial and behavioral impairment in community and high risk populations, including youth involved in juvenile justice. However, the mechanisms accounting for these adverse outcomes have not been empirically delineated. Symptoms of posttraumatic stress disorder (PTSD) and dissociation are documented sequelae of PV and are associated with a wide range of behavioral/emotional problems. This study used a cross-sectional research design and bootstrapped multiple mediation analyses with self-report measures completed by a large sample of justice-involved youth (N=809, ages 12-19 years old, 27% female, 46.5% youth of color) to test the hypotheses that PTSD and dissociation symptoms mediate the relationship between PV and problems with anger, depression/anxiety, alcohol/drug use, and somatic complaints after controlling for the effects of exposure to violence and adversities related to juvenile justice involvement. As hypothesized, PTSD symptoms mediated the relationship of PV with all outcomes except alcohol/drug use problems (which had an unmediated direct association with PV). Partially supporting study hypotheses, dissociation symptoms mediated the relationship between PV and internalizing problems (i.e., depression anxiety; suicide ideation). Implications are discussed for prospective research demarcating the mechanisms linking PV and adverse outcomes in juvenile justice and other high risk populations.

Xie, P., Wu, K., Zheng, Y., et. al. (2017). Prevalence of childhood trauma and correlations between childhood trauma, suicidal ideation, and social supports inpatients with depression, bipolar disorder, and schizophrenia in southern China. Journal of Affective Disorders, Vol. 228:41-48. Download at

Background: Childhood trauma has long-term adverse effects on physical and psychological health. Previous studies demonstrated that suicide and mental disorders were related to childhood trauma. In Chine, there is insufficient research available on childhood trauma in patients with mental disorders. Methods: Outpatients were recruited from a psychiatric hospital in southern China, and controls were recruited from local communities. The demographic questionnaire, the Childhood Trauma Questionnaire – Short Form (CTQ-SF), and the Social Support Rating Scale (SSRS) were completed by all participants, and the Self-rating Idea of Suicide Scale (SIOSS) were completed only by patients. Prevalence rates of childhood trauma were calculated. Druskal-Wallis test and Dunnet test were used to compare CTQ-SF and SSRS scores between groups. Logistic regression was used to control demographic characteristics ad examine relationships between diagnosis and CTQ-SF and SSRS scores. Spearman’s rank correlation test was conducted to analyze relationships between suicidal ideation and childhood trauma and suicidal ideation and social support. Results: The final sample comprised 229 patients with depression, 102 patients with bipolar, 216 patients with schizophrenia, and 132 health controls. In our sample, 55.5% of the patients with depression, 61.8% of the patients with bipolar disorder, 47.2% of the patients with schizophrenia, and 20.5% of the healthy people reported at least one type of trauma. In patient groups, physical neglect (PN) and emotional neglect (EN) were most reported, and sexual abuse (SA) and physical abuse (PA) were least reported. After controlling for demographic characteristics, mental disorders were associated with higher CTQ-SF scores and lower SSRS scores. CTQ-SF scores and number of trauma types were positively correlated with the SIOSS score. Negative correlations existed between SSRS scores and SIOSS score. Limitations: Our sample may not be sufficiently representative. Some results might have been interfered by demographic characteristics. The SIOSS was not completed by controls. Data from self-report scales were not sufficiently objective. Conclusions: In southern China, childhood trauma is more severe and more prevalent in patients with mental disorders (depression, bipolar and schizophrenia) than healthy people. Among patients with mental disorders in southern China, suicidal ideation is associated with childhood trauma and poor social support.

Xiang Ng, Q., Zheng Jie Yong, B., Yin Xian Ho, C., Yutong Lim, D., & Yeo, W-S. (2018). Early Life sexual abuse is associated with increased suicide attempts: an update meta-analysis. Journal of Psychiatric Research, Vol. 99:129-141.
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Suicide is an emerging, yet preventable global health issue associated with significant mortality. Identification of underlying risk factors and antecedents may inform preventive strategies and interventions. This study serves to provide an updated meta-analysis examining the extent of association of early life sexual abuse with suicide attempts Use the keywords [early abuse OR childhood abuse OR sexual OR rape OR molest* OR violence OR trauma OR PTSD] AND [suicide* OR premature OR unnatural OR deceased OR died OR mortality], a preliminary search on PubMed, Ovid, PsychINFO, Web of Science and Google Scholar databases yielded 12,874 papers published in English between 1-Jan-1988 and 1-June-2017. Of these, only 47 studies were included in the final meta-analysis. The 47 studies (25 cross-sectional, 14 cohort, 6 case-control and 2 twin studies) contained a total of 151,476 subjects. Random-effects meta-analysis found early life sexual abuse to be a significant risk factor for suicide attempts, compared to baseline population (pooled OR 1.89, 95% CI: 1.66 to 2.12, p<0.001). Subgroup analyses of cross-sectional and longitudinal studies showed similar findings of increased risk as they yielded ORs of 1.98 (95% CI: 1.70 to 2.25, p<0.001) and 1.65 (95% CI: 1.37 to 1.93, p<0.001), respectively. In both cross-sectional and longitudinal studies, childhood sexual abuse was consistently associated with increased risk of suicide attempts. The findings of the present study provide strong grounds for funding public policy planning and interventions to prevent sexual abuse and support its victims. Areas for future research should include preventive and treatment strategies and factors promoting resilience following childhood sexual abuse. Future research on the subject should have more robust controls and explore the differential effects of gender and intra- versus extra-familial sexual abuse.

Stein, M.B., Campbell-Sills, L., Ursano, R.J., et. al. (2018). Childhood maltreatment and lifetime suicidal behaviors among new soldiers in the US Army: results from the Army study to assess risk and resilience in service members (Army STARRS). The Journal of Clinical Psychiatry [01 Mar 2018, 79(2)]. DOI: 10.4088/JCP.16m10900.

Understanding suicide risk is a priority for the US military. We aimed to estimate associations of childhood maltreatment with pre-enlistment suicidal behaviors in new Army soldiers. Cross-sectional survey data from 38,237 soldiers reporting for basic training from April 2011 through November 2012 were analyzed. Scales assessing retrospectively reported childhood abuse and neglect were derived and subjected to latent class analysis, which yielded 5 profiles: No Maltreatment, Episodic Emotional Maltreatment, Frequent Emotional/Physical Maltreatment, Episodic Emotional/Sexual Abuse, and Frequent Emotional/Physical/Sexual Maltreatment. Discrete-time survival analysis was used to estimate associations of maltreatment profiles with suicidal behaviors (assessed with modified Columbia-Suicide Severity Rating Scale), adjusting for sociodemographic and mental disorders. Nearly 1 in 5 new soldiers was classified as experiencing childhood maltreatment. Relative to No Maltreatment, all multivariate maltreatment profiles were associated (P values <0.001) with elevated odds of lifetime suicidal ideation (adjusted odds rations [AORs] = 3.10-4.93), plan (AORs = 3.75-10.77), attempt (AORs = 3.60-15.95), and onset of plan among those with ideation (AORs = 1.40-3.10). Several profiles also predicted attempts among those with plans (AORs = 2.01-2.47), and Frequent Emotional/Physical/Sexual Maltreatment predicted unplanned attempts among ideates (AOR = 5.32). Adjustment for mental disorders attenuated but did not eliminate these associations. Childhood maltreatment is strongly associated with suicidal behavior among new soldiers, even after adjusting for intervening mental disorders. Among soldiers with lifetime ideation, certain maltreatment profiles are associated with elevated odds of subsequently planning and/or attempting suicide. Focus on childhood maltreatment might reveal avenues for risk among new soldiers.

Bjorkenstam, E., Hjern, A., Bjorkenstam, C., et. al. (2018). Association of cumulative childhood adversity and adolescent violent offending with suicide in early adulthood. Journal of the American Medical Association Psychiatry, 75(2):185-193.
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Importance: Childhood adversity (CA) is associated with an increased risk of suicide in young adulthood that might be explained by maladaptive trajectories during adolescence. Although adolescent violent offending is linked with suicide, little is known about its role in the association between CA and suicide. Objective: To examine whether adolescent violent offending mediates the association between CA and suicide in early adulthood. Design, Setting, and Participants: This population-based, longitudinal cohort study with a follow-up time spanning 5 to 9 years included 476,103 individuals in Sweden between 1984 and 1988. The study population was prospectively followed up from 20 years of age until December 31, 2013, with respect to suicide. Data analysis was performed from January 1, 1984 to December 31, 2013. Exposures: Resisted-Based CAs included parental death, parental substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Adolescent violent offending was defined as being convicted of a violent crime between the ages of 15 and 19 years. Main Outcomes and Measures: Estimates of risk of suicide after 20 years of age (from 2004 if born in 1984 and from 2008 if born in 1988) until the end of 2013 were calculated as incidence rate rations (IRRs) with 95% CIs using Poisson regression analysis. Adjustments were made for demographics and psychiatric disorder. In addition, binary mediation analysis with logistic regression was used. Results: A total of 476,103 individuals (231,699 [48%] female) were included in the study. Those with a conviction for violent offending had been exposed to all CAs to a greater extend that those with no violent offending. Cumulative CA was associated with risk of suicide in non convicted (adjusted IRR, 2.4; 95% CI, 1.5-3.9) and convicted youths, who had a higher risk of suicide (adjusted IRR, 8.5; 95% CI, 4.6-15.7). Adolescent violent offending partly mediated the association between CA and suicide. Conclusions and Relevance: Individuals with a history of CA who also engaged in violent offending in adolescence have a high risk of suicide. Interventions to prevent externalizing behavior during childhood and increased support to youths with delinquent behavior may have the potential to prevent suicide related to CA.

Bromet, E.J., Nock, M.K., & Saha, S. (2017). Association between psychotic experiences and subsequent suicidal thoughts and behaviors: a cross-national analysis from the World Health Organization world mental health surveys. Journal of the American Medical Association Psychiatry 74(11):1136-1144.
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Importance: Community-based studies have linked psychotic experiences (PEs) with increased risk of suicidal thoughts and behaviors (STBs). However, it is not knows if these associations vary across the life course or if mental disorders contribute to these associations. Objective: To examine the temporal association between PEs and STBs across the life span as well as the influence of mental disorders (antecendent to the STBs) on these associations. Design, Setting, and Participants: A total of 33,370 adult respondents across 19 countries from the World Health Organization World Mental Health Surveys were assessed for PEs, STBs (ie. Ideation, plans, and attempts), and 21 DSM-IV mental disorders Discrete-time survival analysis was used to investigate the association of Pas with subsequent onset of STBs. Main Outcomes and Measures: Prevalence and frequency of STBs and Yes, and odds ratios and 95% CIs. Results: of 33,370 included participants, among those with PEs (n=2488), the lifetime prevalence (SE) of suicidal ideation, plans, and attempts was 28.5% (1.3), 10.8% (0.7), respectively. Respondents with 1 or more PEs had 2-fold increased odds of subsequent STBs after adjusting for antecedent or intervening mental disorders (suicidal ideation: odds ratio, 2.2: 95% CI, 1.8-2.6; suicide plans: odds ratio, 2.1; 95%CI, 1.7-2.6; and suicide attempts: odds ratio, 1.9; 95% CI, 1.5-2.5). There were significant does-response relationships of number of PE types with subsequent STBs that persisted after adjustment for mental disorders. Although Yes were significant predictors of subsequent STBs onset across all life stages, associations were strongest in individuals 12 years and younger. After adjustment for antecedent mental disorders, the overall population attributable risk proportions for lifetime suicidal ideation, plans, ad attempts associated with temporally prior PEs were 5.3%, 5.7%, and 4.8% respectively. Conclusions and Relevance: Psychotic experiences are associated with elevated odds of subsequent STBs across the life course that cannot be explained by antecedent mental disorders. These results highlight the importance of including information about PEs in screening adjustments designed to predict STBs.

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