Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-25T04:54:50.507Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive impairment and functioning in PTSD related to intimate partner violence

Published online by Cambridge University Press:  01 November 2009

ELIZABETH W. TWAMLEY ,
CAROLYN B. ALLARD ,
STEVEN R. THORP ,
SONYA B. NORMAN ,
SHADHA HAMI CISSELL ,
KELLY HUGHES BERARDI ,
ERIN M. GRIMES  and
MURRAY B. STEIN
ELIZABETH W. TWAMLEY*
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California Psychology Service, VA San Diego Healthcare System, San Diego, California
CAROLYN B. ALLARD
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California Psychology Service, VA San Diego Healthcare System, San Diego, California
STEVEN R. THORP
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California Research Service, VA San Diego Healthcare System, San Diego, California
SONYA B. NORMAN
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California Psychology Service, VA San Diego Healthcare System, San Diego, California
SHADHA HAMI CISSELL
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California Research Service, VA San Diego Healthcare System, San Diego, California
KELLY HUGHES BERARDI
Affiliation:
Psychology Service, VA San Diego Healthcare System, San Diego, California
ERIN M. GRIMES
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California Research Service, VA San Diego Healthcare System, San Diego, California
MURRAY B. STEIN
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California Psychiatry Service, VA San Diego Healthcare System, San Diego, California Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California
*
*Correspondence and reprint requests to: Elizabeth W. Twamley, Department of Psychiatry, University of California, San Diego, 140 Arbor Drive (0851), San Diego, CA 92103. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Posttraumatic stress disorder (PTSD) has been associated with neuropsychological impairments across multiple domains, but consensus regarding the cognitive profile of PTSD has not been reached. In this study of women with PTSD related to intimate partner violence (n = 55) and healthy, demographically similar comparison participants (NCs; n = 20), we attempted to control for many potential confounds in PTSD samples. All participants were assessed with a comprehensive neuropsychological battery emphasizing executive functioning, including inhibition, switching, and abstraction. NCs outperformed PTSD participants on most neuropsychological measures, but the differences were significant only on speeded tasks (with and without executive functioning components). The PTSD group’s mean performance was within the average range on all neuropsychological tests. Within the PTSD group, more severe PTSD symptoms were associated with slower processing speed, and more severe dissociative symptoms were associated with poorer reasoning performance. These results suggest that women with PTSD related to intimate partner violence demonstrate slower than normal processing speed, which is associated with the severity of psychiatric symptoms. We speculate that the cognitive slowing seen in PTSD may be attributable to reduced attention due to a need to allocate resources to cope with psychological distress or unpleasant internal experiences. (JINS, 2009, 15, 879–887.)

Keywords

Posttraumatic stress disorderTraumaStressNeuropsychologicalCognitionDomestic violence
Type
Symposia
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 6 , November 2009 , pp. 879 - 887
Copyright
Copyright © The International Neuropsychological Society 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders-Third Edition. Washington, DC: American Psychiatric Association.Google Scholar
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Beck Depression Inventory—Second Edition (BDI-II) manual. San Antonio: The Psychological Corporation.Google Scholar
Bernstein, D.P., Fink, L., Handelsman, L., & Foote, J. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. American Journal of Psychiatry, 151, 1132–1136.Google ScholarPubMed
Binder, L.M., Storzbach, D., Anger, W.K., Campbell, K.A., & Rohlman, D.S. (1999). Subjective cognitive complaints, affective distress, and objective cognitive performance in Persian Gulf War veterans. Archives of Clinical Neuropsychology, 14, 531–536.Google Scholar
Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.D., Charney, D.S., et al. . (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.Google Scholar
Bremner, J.D. (2006). The relationship between cognitive and brain changes in posttraumatic stress disorder. Annals of the New York Academy of Sciences, 1071, 80–86.Google Scholar
Bremner, J.D., Vermetten, E., Vythilingam, M., Afzal, N., Schmahl, C., Elzinga, B., et al. . (2004). Neural correlates of the classic color and emotional Stroop in women with abuse-related posttraumatic stress disorder. Biological Psychiatry, 55, 612–620.CrossRefGoogle ScholarPubMed
Breslau, N., Lucia, V.C., & Davis, G.C. (2004). Partial PTSD versus full PTSD: An empirical examination of associated impairment. Psychological Medicine, 34, 1205–1214.Google Scholar
Carrey, N.J., Butter, H.J., Persinger, M.A., & Bialik, R.J. (1995). Physiological and cognitive correlates of child abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1067–1075.Google Scholar
Crowell, T.A., Kieffer, K.M., Siders, C.A., & Vanderploeg, R.D. (2002). Neuropsychological findings in combat-related posttraumatic stress disorder. The Clinical Neuropsychologist, 16, 310–321.Google Scholar
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). D-KEFS examiner’s manual. San Antonio, TX: The Psychological Corporation.Google Scholar
DePrince, A.P., & Freyd, J.J. (1999). Review of truth in memory. American Journal of Clinical Hypnosis, 41, 281–283.Google Scholar
DePrince, A.P., & Freyd, J.J. (2004). Forgetting trauma stimuli. Psychological Science, 15, 488–492.Google Scholar
Evans, D.E., & Drobes, D.J. (2009). Nicotine self-medication of cognitive-attentional processing. Addiction Biology, 14, 32–42.Google Scholar
Everly, G.S., & Horton, A.M. (1989). Neuropsychology of posttraumatic stress disorder: A pilot study. Perceptual and Motor Skills, 68, 807–10.Google Scholar
First, M.B., Spitzer, R.L, Gibbon, M., & Williams, J.B.W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version (SCID-I). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Freyd, J.J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press.Google Scholar
Freyd, J.J., Klest, B., & Allard, C.B. (2005). Betrayal trauma: Relationship to physical health, psychological distress, and a written disclosure intervention. Journal of Trauma & Dissociation, 6, 83–104.Google Scholar
Freyd, J.J., Martorello, S.R., Alvarado, J.S., Hayes, A.E., & Christman, J.C. (1998). Cognitive environments and dissociative tendencies: Performance on the Standard Stroop task for high versus low dissociators. Applied Cognitive Psychology, 12, S91–S103.3.0.CO;2-Z>CrossRefGoogle Scholar
Garcia, E., Norman, S.B., Lang, A.J., Laffaye, C., Kennedy, C., & Stein, M.B. (2004). Relationship between cognitive complaints, cognitive deficits, and psychological distress in a sample of female survivors of intimate partner violence. Presented at the California Psychological Association Annual Meeting.Google Scholar
Geuze, E., Vermetten, E., de Kloet, C.S., Hijman, R., & Westenberg, H.G. (2009). Neuropsychological performance is related to current social and occupational functioning in veterans with posttraumatic stress disorder. Depression and Anxiety, 26, 7–15.CrossRefGoogle ScholarPubMed
Golier, J., & Yehuda, R. (2002). Neuropsychological processes in post-traumatic stress disorder. Psychiatric Clinics of North America, 25, 295–315.CrossRefGoogle ScholarPubMed
Green, M.F., Kern, R.S., Braff, D.L., & Mintz, J. (2000). Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the “right stuff”? Schizophrenia Bulletin, 26, 119–136.CrossRefGoogle ScholarPubMed
Grober, E., & Sliwinski, M. (1991). Development and validation of a model for estimating premorbid verbal intelligence in the elderly. Journal of Clinical and Experimental Neuropsychology, 13, 933–949.CrossRefGoogle Scholar
Gurvits, T.V., Lasko, N.B., Schachter, S.C., Kuhne, A.A., Orr, S.P., & Pitman, R.K. (1993). Neurological status of Vietnam veterans with chronic posttraumatic stress disorder. Journal of Neuropsychiatry and Clinical Neurosciences, 5, 183–188.Google ScholarPubMed
Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., & Castro, C.A. (2008). Mild traumatic brain injury in U.S. Soldiers returning from Iraq. New England Journal of Medicine, 358, 453–463.CrossRefGoogle ScholarPubMed
Horner, M., & Hamner, M. (2002). Neurocognitive functioning in posttraumatic stress disorder. Neuropsychology Review, 12, 15–30.CrossRefGoogle ScholarPubMed
Jackson, H., Philip, E., Nuttall, R.L., & Diller, L. (2004). Battered women and traumatic brain injury. In Kendall-Tackett, K.A. (Ed.), Health consequences of abuse in the family: A clinical guide for evidence-based practice Application and practice in health psychology (pp. 233–246). Washington, DC: American Psychological Association.Google Scholar
Kalechstein, A.D., Newton, T.F., & van Gorp, W.G. (2003). Neurocognitive functioning is associated with employment status: A quantitative review. Journal of Clinical and Experimental Neuropsychology, 25, 1186–1191.Google Scholar
Koenen, K.C., Moffitt, T.E., Roberts, A.L., Martin, L.T., Kubzansky, L., Harrington, H., et al. . (2009). Childhood IQ and adult mental disorders: A test of the cognitive reserve hypothesis. American Journal of Psychiatry, 166, 50–57.Google Scholar
Kongs, S.K., Thompson, L.L., Iverson, G.L., & Heaton, R.K. (2000). Wisconsin Card Sorting Test–64 card version (WCST-64). Odessa, FL: Psychological Assessment Resources.Google Scholar
Leskin, L.P., & White, P.M. (2007). Attentional networks reveal executive function deficits in posttraumatic stress disorder. Neuropsychology, 21, 275–284.Google Scholar
Nelson, L.A., Yoash-Gantz, R.E., Pickett, T.C., & Campbell, T.A. (2009). Relationship between processing speed and executive functioning performance among OEF/OIF veterans: Implications for postdeployment rehabilitation. Journal of Head Trauma Rehabilitation, 24, 32–40.Google Scholar
Marvel, C.L., & Paradiso, S. (2004). Cognitive and neurological impairment in mood disorders. Psychiatric Clinics of North America, 27, 19–36.Google Scholar
Perez, C.M., & Widom, C.S. (1994). Childhood victimization and long-term intellectual and academic outcomes. Child Abuse and Neglect, 18, 617–633.Google Scholar
Rey, A. (1941). L’examen psychologique dans les cas d’encephalopathie traumatique (Les problems). Archives de Psychologie, 28, 215–285.Google Scholar
Saigh, P.A., Mroueh, M., & Bremner, J.D. (1997). Scholastic impairments among traumatized adolescents. Behavior Research and Therapy, 35, 429–436.Google Scholar
Samuelson, K.W., Neylan, T.C., Metzler, T.J., Lenoci, M., Rothlind, J., Henn-Haase, C., et al. . (2006). Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse. Neuropsychology, 20, 716–726.CrossRefGoogle ScholarPubMed
Schneiderman, A.I., Braver, E.R., & Kang, H.K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167, 1446–1452.CrossRefGoogle ScholarPubMed
Seedat, S., Stein, M.B., & Forde, D.R. (2003). Prevalence of dissociative experiences in a community sample: Relationship to gender, ethnicity, and substance use. Journal of Nervous and Mental Disease, 191, 115–120.Google Scholar
Sheehan, D.V. (1983). The anxiety disease. New York: Scribner’s.Google Scholar
Shucard, J.L., McCabe, D.C., & Szymanski, H. (2008). An event-related potential study of attention deficits in posttraumatic stress disorder during auditory and visual Go/NoGo continuous performance tasks. Biological Psychology, 79, 223–233.Google Scholar
Spreen, O., & Strauss, S. (1998). A compendium of neuropsychological tests: Administration, norms, and commentary (2nd ed.). New York: Oxford University Press.Google Scholar
Stein, M.B., Hanna, C., Vaerum, V., & Koverola, C. (1999). Memory functioning in adult women traumatized by childhood sexual abuse. Journal of Traumatic Stress, 12, 527–534.Google Scholar
Stein, M.B., Kennedy, C.M., & Twamley, E.W. (2002). Neuropsychological function in female victims of intimate partner violence with and without posttraumatic stress disorder. Biological Psychiatry, 52, 1079–1088.Google Scholar
Stein, M.B., Walker, J.R., Hazen, A.L., & Forde, D.R. (1997). Full and partial posttraumatic stress disorder: Findings from a community survey. American Journal of Psychiatry, 154, 1114–1119.Google Scholar
Twamley, E.W., Doshi, R.R., Nayak, G.V., Palmer, B.W., Golshan, S., Heaton, R.K., et al. . (2002). Generalized cognitive impairments, ability to perform everyday tasks, and level of independence in community living situations of older patients with psychosis. American Journal of Psychiatry, 159, 2013–2020.Google Scholar
Twamley, E.W., Hami, S., & Stein, M.B. (2004). Neuropsychological function in college students with and without posttraumatic stress disorder. Psychiatry Research, 126, 265–274.Google Scholar
Vasterling, J.J., Brailey, K., Constans, J.I., & Sutker, P.B. (1998). Attention and memory dysfunction in posttraumatic stress disorder. Neuropsychology, 12, 125–133.Google Scholar
Vasterling, J.J., Duke, L.M., Brailey, K., Constans, J.I., Allain, A.N. Jr., & Sutker, P.B,. (2002). Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons. Neuropsychology, 16, 5–14.CrossRefGoogle ScholarPubMed
Vasterling, J.J., Proctor, S.P., Amoroso, P., Kane, R., Heeren, T., & White, R.F. (2006). Neuropsychological outcomes of army personnel following deployment to the Iraq war. Journal of the American Medical Association, 296, 519–529.Google Scholar
Waller, N., Putnam, F., & Carlson, E. (1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1, 300–321.CrossRefGoogle Scholar
Weathers, F.W., Keane, T.M., & Davidson, J.R. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13, 132–156.CrossRefGoogle Scholar
Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (1993). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar