Eve Carlson is a Clinical Professor who focuses on fostering mental health after traumatic stress. She is a clinical psychologist and a researcher with the National Center for Posttraumatic Stress Disorder’s Dissemination and Training Division. Her primary interests are in measurement development and recovery after traumatic stress. She collaborates with faculty in Surgery (David Spain) and Medicine (Lisa Shieh) to study mental health of patients hospitalized after sudden, severe illness or injury, racial/ethnic disparities in traumatic stress risks and responses, screening for risk of mental health problems, and preventive mental health care. As PIs of a multi-center study funded by the National Institute on Minority Health and Health Disparities, Dr. Carlson and Dr. Spain and their collaborators have developed and validated a mental health risk screen for hospital patients admitted after sudden, severe illness or injury. Data from patients who identify as Asian American/Pacific Islander, Black, Latinx, Multiracial, and White were analyzed to select screen items, and the screen accurately predicts later mental health outcomes within these ethnic/racial groups. Our research has also found disparities across ethnic/racial groups in several traumatic stress risk factors and mental health responses. Dr. Carlson is Co-PI with Dr. Shieh of a study funded by Stanford RISE comparing mental health recovery in Latinx and non-Latinx COVID-19 patients to recovery in patients hospitalized with other sudden, severe illness.

Academic Appointments

  • Clinical Professor, Psychiatry and Behavioral Sciences

All Publications

  • Development and cross-validation of a veterans mental health risk factor screen. PloS one Carlson, E. B., Palmieri, P. A., Vogt, D., Macia, K., Lindley, S. E. 2023; 18 (2): e0272599


    BACKGROUND: VA primary care patients are routinely screened for current symptoms of PTSD, depression, and alcohol disorders, but many who screen positive do not engage in care. In addition to stigma about mental disorders and a high value on autonomy, some veterans may not seek care because of uncertainty about whether they need treatment to recover. A screen for mental health risk could provide an alternative motivation for patients to engage in care.METHOD: Data from samples of veterans and traumatic injury survivors were analyzed to identify mental health risk factors that are characteristics of individuals or stressors or of post-trauma, post-deployment, or post-military service resources, experiences, or responses. Twelve risk factors were strongly related to PTSD (r > .50): current PTSD, depression, dissociation, negative thinking, and emotional lability symptoms, life stress, relationship stress, social constraints, and deployment experiences of a difficult environment, concerns about life and family, perceived threat, and moral injury. Items assessing each of these risk factors were selected and their validity to prospectively predict PTSD and/or depression 6 months later was assessed in a new sample of 232 VA primary care patients.RESULTS: Twelve items assessing dissociation, emotional lability, life stress, and moral injury correctly classified 86% of those who later had elevated PTSD and/or depression symptoms (sensitivity) and 75% of those whose later symptoms were not elevated (specificity). Performance was also very good for 110 veterans who identified as members of ethnic/racial minorities.CONCLUSIONS: Mental health status was prospectively predicted in VA primary care patients with high accuracy using a screen that is brief, easy to administer, score, and interpret, and fits well into VA's integrated primary care. When care is readily accessible, appealing to veterans, and not perceived as stigmatizing, information about mental health risk may result in higher rates of engagement than information about current mental disorder status.

    View details for DOI 10.1371/journal.pone.0272599

    View details for PubMedID 36753482

  • Development of a Brief Version of the Dissociative Symptoms Scale and the Reliability and Validity of DSS-B Scores in Diverse Clinical and Community Samples ASSESSMENT Macia, K. S., Carlson, E. B., Palmieri, P. A., Smith, S. R., Anglin, D. M., Ippen, C., Lieberman, A. F., Wong, E. C., Schell, T. L., Waelde, L. C. 2022
  • Racial/ethnic differences in acute and longer-term posttraumatic symptoms following traumatic injury or illness. Psychological medicine Cruz-Gonzalez, M., Alegria, M., Palmieri, P. A., Spain, D. A., Barlow, M. R., Shieh, L., Williams, M., Srirangam, P., Carlson, E. B. 2022: 1-10


    BACKGROUND: Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness.METHODS: PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences.RESULTS: Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences.CONCLUSION: Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.

    View details for DOI 10.1017/S0033291722002112

    View details for PubMedID 35903010

  • Development and Validation of the Dissociative Symptoms Scale ASSESSMENT Carlson, E. B., Waelde, L. C., Palmieri, P. A., Macia, K. S., Smith, S. R., McDade-Montez, E. 2018; 25 (1): 84–98


    The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe levels of depersonalization, derealization, gaps in awareness or memory, and dissociative reexperiencing that would be relevant to a wide range of clinical populations. Structural analyses of data from four clinical and five nonclinical samples ( N = 1,600) yielded four factors that reflected the domains of interest and showed good fit with the data. Sample scores were consistent with expectations and showed very good internal consistency and temporal stability. Analyses showed consistent evidence of convergent and divergent validity, and posttrauma elevations in scores and in patients with posttraumatic stress disorder provided additional evidence of construct validity. Item response theory analyses indicated that the items assessed moderately severe dissociative experiences. Overall, the results provide support for the reliability and validity of DSS total and subscale scores in the populations studied. Further work is needed to evaluate the performance of the DSS relative to structured interview measures and in samples of patients with other psychological disorders.

    View details for DOI 10.1177/1073191116645904

    View details for Web of Science ID 000416007100007

    View details for PubMedID 27178761

  • Development and preliminary performance of a risk factor screen to predict posttraumatic psychological disorder after trauma exposure GENERAL HOSPITAL PSYCHIATRY Carlson, E. B., Palmieri, P. A., Spain, D. A. 2017; 46: 25–31


    We examined data from a prospective study of risk factors that increase vulnerability or resilience, exacerbate distress, or foster recovery to determine whether risk factors accurately predict which individuals will later have high posttraumatic (PT) symptom levels and whether brief measures of risk factors also accurately predict later symptom elevations.Using data from 129 adults exposed to traumatic injury of self or a loved one, we conducted receiver operating characteristic (ROC) analyses of 14 risk factors assessed by full-length measures, determined optimal cutoff scores, and calculated predictive performance for the nine that were most predictive. For five risk factors, we identified sets of items that accounted for 90% of variance in total scores and calculated predictive performance for sets of brief risk measures.A set of nine risk factors assessed by full measures identified 89% of those who later had elevated PT symptoms (sensitivity) and 78% of those who did not (specificity). A set of four brief risk factor measures assessed soon after injury identified 86% of those who later had elevated PT symptoms and 72% of those who did not.Use of sets of brief risk factor measures shows promise of accurate prediction of PT psychological disorder and probable PTSD or depression. Replication of predictive accuracy is needed in a new and larger sample.

    View details for PubMedID 28622811

    View details for PubMedCentralID PMC5656435

  • Contributions of risk and protective factors to prediction of psychological symptoms after traumatic experiences COMPREHENSIVE PSYCHIATRY Carlson, E. B., Palmieri, P. A., Field, N. P., Dalenberg, C. J., Macia, K. S., Spain, D. A. 2016; 69: 106–15


    Traumatic experiences cause considerable suffering and place a burden on society due to lost productivity, increases in suicidality, violence, criminal behavior, and psychological disorder. The impact of traumatic experiences is complicated because many factors affect individuals' responses. By employing several methodological improvements, we sought to identify risk factors that would account for a greater proportion of variance in later disorder than prior studies.In a sample of 129 traumatically injured hospital patients and family members of injured patients, we studied pre-trauma, time of trauma, and post-trauma psychosocial risk and protective factors hypothesized to influence responses to traumatic experiences and posttraumatic (PT) symptoms (including symptoms of PTSD, depression, negative thinking, and dissociation) two months after trauma.The risk factors were all significantly correlated with later PT symptoms, with post-trauma life stress, post-trauma social support, and acute stress symptoms showing the strongest relationships. A hierarchical regression, in which the risk factors were entered in 6 steps based on their occurrence in time, showed the risks accounted for 72% of the variance in later symptoms. Most of the variance in PT symptoms was shared among many risk factors, and pre-trauma and post-trauma risk factors accounted for the most variance.Collectively, the risk factors accounted for more variance in later PT symptoms than in previous studies. These risk factors may identify individuals at risk for PT psychological disorders and targets for treatment.

    View details for PubMedID 27423351

    View details for PubMedCentralID PMC5381967

  • Advantages and psychometric validation of proximal intensive assessments of patient-reported outcomes collected in daily life QUALITY OF LIFE RESEARCH Carlson, E. B., Field, N. P., Ruzek, J. I., Bryant, R. A., Dalenberg, C. J., Keane, T. M., Spain, D. A. 2016; 25 (3): 507-516


    Ambulatory assessment data collection methods are increasingly used to study behavior, experiences, and patient-reported outcomes (PROs), such as emotions, cognitions, and symptoms in clinical samples. Data collected close in time at frequent and fixed intervals can assess PROs that are discrete or changing rapidly and provide information about temporal dynamics or mechanisms of change in clinical samples and individuals, but clinical researchers have not yet routinely and systematically investigated the reliability and validity of such measures or their potential added value over conventional measures. The present study provides a comprehensive, systematic evaluation of the psychometrics of several proximal intensive assessment (PIA) measures in a clinical sample and investigates whether PIA appears to assess meaningful differences in phenomena over time.Data were collected on a variety of psychopathology constructs on handheld devices every 4 h for 7 days from 62 adults recently exposed to traumatic injury of themselves or a family member. Data were also collected on standard self-report measures of the same constructs at the time of enrollment, 1 week after enrollment, and 2 months after injury.For all measure scores, results showed good internal consistency across items and within persons over time, provided evidence of convergent, divergent, and construct validity, and showed significant between- and within-subject variability.Results indicate that PIA measures can provide valid measurement of psychopathology in a clinical sample. PIA may be useful to study mechanisms of change in clinical contexts, identify targets for change, and gauge treatment progress.

    View details for DOI 10.1007/s11136-015-1170-9

    View details for Web of Science ID 000370796700003

    View details for PubMedID 26567018

  • Care and caring in the intensive care unit: Family members' distress and perceptions about staff skills, communication, and emotional support JOURNAL OF CRITICAL CARE Carlson, E. B., Spain, D. A., Muhtadie, L., McDade-Montez, L., Macia, K. S. 2015; 30 (3): 557-561


    Family members of intensive care unit (ICU) patients are sometimes highly distressed and report lower satisfaction with communication and emotional support from staff. Within a study of emotional responses to traumatic stress, associations between family distress and satisfaction with aspects of ICU care were investigated.In 29 family members of trauma patients who stayed in an ICU, we assessed symptoms of depression and posttraumatic stress disorder (PTSD) during ICU care. Later, family members rated staff communication, support, and skills and their overall satisfaction with ICU care.Ratings of staff competence and skills were significantly higher than ratings of frequency of communication, information needs being met, and support. Frequency of communication and information needs being met were strongly related to ratings of support (rs = .75-.77) and staff skills (rs = .77-.85), and aspects of satisfaction and communication showed negative relationships with symptoms of depression (rs = -.31 to -.55) and PTSD (rs = -.17 to -.43).Although satisfaction was fairly high, family member distress was negatively associated with several satisfaction variables. Increased understanding of the effects of traumatic stress on family members may help staff improve communication and increase satisfaction of highly distressed family members.

    View details for DOI 10.1016/j.jcrc.2015.01.012

    View details for Web of Science ID 000353400100023

    View details for PubMedID 25682345

  • Can Sudden, Severe Emotional Loss Be a Traumatic Stressor? JOURNAL OF TRAUMA & DISSOCIATION Carlson, E. B., Smith, S. R., Dalenberg, C. J. 2013; 14 (5): 519–28


    Aspects of the stressor criterion for posttraumatic stress disorder (PTSD) have been controversial since its inception, and the theoretical or empirical reasons for decisions about it have not been clear. To investigate whether sudden events involving severe emotional loss have the potential to precipitate PTSD, we assessed exposure to Criterion A stressors, sudden abandonment, sudden move or loss of home, and symptoms of PTSD and dissociation in a community sample of 427 adults. In regression analyses, models that included a severe emotional loss stressor accounted for a significant amount of additional variance in PTSD and dissociation symptoms beyond that accounted for by a model including only Criterion A stressors. The findings suggest that limiting Criterion A1 to events involving actual or threatened death or injury may be overly restrictive. Future research is needed to replicate these findings in a clinical sample and to prospectively examine the conditional probability of PTSD following these events.

    View details for DOI 10.1080/15299732.2013.773475

    View details for Web of Science ID 000324670400003

    View details for PubMedID 24060034

  • Development and Initial Validation of the Structured Interview for Self-Destructive Behaviors JOURNAL OF TRAUMA & DISSOCIATION Carlson, E. B., McDade-Montez, E., Armstrong, J., Dalenberg, C., Loewenstein, R. J. 2013; 14 (3): 312–27


    This article describes the initial validation of the Structured Interview for Self-Destructive Behaviors (SI-SDB), a brief interview assessing suicidality, self-injury, substance abuse, disordered eating, and risky sexual behaviors. Self-destructive behaviors present clinical and practical challenges for mental health treatment providers. Participants were 217 psychiatric inpatients with a wide variety of diagnoses who completed the SI-SDB and other measures of psychiatric symptoms, trauma exposure, and other childhood experiences. Internal validity analyses revealed an internally consistent measure with 2 major factors. External validity analyses indicated that the Substance Abuse and Disordered Eating scales were predictive of related psychiatric diagnoses. All scales except Substance Abuse were significantly correlated with psychiatric symptoms and childhood abuse. These findings indicate that the SI-SDB is a valid means of assessing 5 significant domains of dangerous behaviors in clinical and research settings. Further research on the reliability of reports over time, interrater consistency, and convergent validity with longer measures of the SI-SDB domains is needed.

    View details for DOI 10.1080/15299732.2012.762822

    View details for Web of Science ID 000318279100006

    View details for PubMedID 23627480

    View details for PubMedCentralID PMC3656652

  • Chronic Psychological and Functional Sequelae After Emergent Hand Surgery JOURNAL OF HAND SURGERY-AMERICAN VOLUME Richards, T., Garvert, D. W., McDade, E., Carlson, E., Curtin, C. 2011; 36A (10): 1663-1668


    Several studies have shown that upper extremity trauma has serious, acute psychological effects after injury. This study's goal was to assess the psychological outcomes, including symptoms of major depression, posttraumatic stress disorder (PTSD), and other psychosocial variables, as well as the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) results, after severe hand trauma. We hypothesized that hand trauma would have persistent psychological sequelae long after the physical injury.We performed a cross-sectional survey of 34 patients who had emergency hand surgery at a Level 1 trauma center an average of 16 months (range, 7-32 mo) earlier. The hand disability measure was the QuickDASH, and the psychological measures included the Center for Epidemiologic Studies Depression Scale, the Screen for Posttraumatic Stress Symptoms, the Medical Outcomes Study Social Support Survey Form, the Social Constraints Survey (to assess interpersonal stressors), and the Perceived Stress Scale.The overall QuickDASH score was 27. The mean score for PTSD was 13 (above the clinical threshold for PTSD), and 29% of respondents had high levels of both depression and PTSD. High pain scores on the QuickDASH were strongly correlated with both depression and PTSD symptoms.This study found high levels of psychological distress in patients after hand trauma. Hand disability was strongly related to pain, depression, and PTSD symptoms. This study shows that the psychological sequelae of hand trauma can persist long after the physical injury.Therapeutic IV.

    View details for DOI 10.1016/j.jhsa.2011.06.028

    View details for Web of Science ID 000295855800015

  • Peer-Supported Mobile Mental Health for Veterans in Primary Care: A Pilot Study PSYCHOLOGICAL SERVICES Blonigen, D. M., Montena, A. L., Smith, J., Hedges, J., Kuhn, E., Carlson, E. B., Owen, J., Wielgosz, J., Possemato, K. 2022


    One in four veteran primary care patients suffers from a mental health condition; however, most do not receive any treatment for these problems. Mobile health (mHealth) can overcome barriers to care access, but poor patient engagement limits the effectiveness and implementation of these tools. Peers may facilitate patient engagement with mHealth. We designed a protocol for peers to support implementation of mobile mental health tools in primary care and tested the feasibility, acceptability, and clinical utility of this approach. Thirty-nine patients across two Veterans Affairs sites who screened positive for depression during a primary care visit and were not currently in mental health treatment were enrolled. Participants were scheduled for four phone sessions with a peer over 8 weeks and introduced to five mobile apps for a range of transdiagnostic mental health issues (stress, low mood, sleep problems, anger, and trauma). Pre/post phone interviews using quantitative and qualitative approaches assessed participants' self-reported app use, satisfaction with the intervention, symptom change (stress, anxiety, depression, insomnia), and progress with personal health goals. On average, patients reported using 3.04 apps (SD = 1.46). Per the Client Satisfaction Questionnaire, global satisfaction with the intervention was high (M = 25.71 out of 32, SD = 3.95). Pre to post participants reported significant improvements in their level of stress, based on a quantitative measure (p = .008), and 87% reported progress on at least one personal health goal. Findings support the feasibility, acceptability, and clinical utility of peer-supported mobile mental health for veterans in primary care. A randomized controlled trial of an adaptive version of this intervention is recommended. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

    View details for DOI 10.1037/ser0000709

    View details for Web of Science ID 000853574700001

    View details for PubMedID 36107676

  • Psychometric properties of the dissociative symptoms scale (DSS) in Italian outpatients and community adults. Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD) Schimmenti, A. n., Sideli, L. n., La Barbera, D. n., La Cascia, C. n., Waelde, L. C., Carlson, E. B. 2020: 1–9


    This study investigated the psychometric properties of the Dissociative Symptoms Scale (DSS) among Italian adults from outpatient and community samples. The DSS is a self-report measure of clinically relevant dissociation in adults. An Italian translation of the DSS was administered with measures of lifetime traumatic experiences, psychoform dissociation, and somatoform dissociation to 175 psychiatric outpatients and 423 individuals from the community. The DSS scores for outpatient and community adults were significantly different and showed good internal reliability, good convergent and construct validity, and a four-factor structure (depersonalization and derealization, gaps in awareness and memory, sensory misperceptions, and cognitive and behavioral reexperiencing) that was consistent with findings from previous research. Therefore, our results support previous research showing that the DSS can be used as a screening measure to assess clinically relevant dissociative experiences.

    View details for DOI 10.1080/15299732.2020.1760170

    View details for PubMedID 32396059

  • The Dynamic Relations Among Peritraumatic Posttraumatic Stress Symptoms: An Experience Sampling Study During Wartime JOURNAL OF TRAUMATIC STRESS Gelkopf, M., Pickman, L., Carlson, E. B., Greene, T. 2019; 32 (1): 119–29


    The associations among peritraumatic posttraumatic stress symptoms (P-PTSS) in the immediate aftermath of trauma exposure, including those in the posttraumatic stress disorder clusters of intrusions, avoidance, negative cognitions and mood (NCM), and arousal, might indicate mechanisms through which enduring PTSD develops. During a period of war, exposed participants (N = 181) were sent twice-daily questionnaires for 30 days via smartphone. We repeatedly assessed the predictive associations between the P-PTSS clusters over time. We performed a multilevel pathway analysis built of multiple triple sequence responses (6,221 cases) on each of the four P-PTSS clusters at a mean time lag of 12 hr (Model A) and 24 hr (Model B) for 181 participants, 85 of whom had been diagnosed with a serious mental illness. Arousal predicted intrusion in Models A and B, bA = 0.08, 95% CI [0.03, 0.12], p < .001 and bB = 0.03, 95% CI [0.00, 0.07], p = .051, respectively; and NCM in Models A and B, bA = 0.09, 95% CI [0.05, 0.12], p < .001 and bB = 0.06, 95% CI [0.03, 0.09], p < .001, respectively. Intrusion predicted arousal in Model B, bB = 0.05, 95% CI [0.01, 0.08], p = .010. NCM predicted arousal, bA = 0.10, 95% CI [0.05, 0.14], p < .001, and avoidance bA = 0.05, 95% CI [0.00, 0.11], p = .052, in Model A. Avoidance did not predict any other cluster. Arousal seemed to be acting as a hub, strengthening feedback loops to and from NCM and intrusion.

    View details for DOI 10.1002/jts.22374

    View details for Web of Science ID 000459491900012

    View details for PubMedID 30720893

  • Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. European journal of psychotraumatology Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., Bryant, R. A. 2014; 5


    There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when the latter is comorbid with PTSD.To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD.A latent class analysis (LCA) was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD.THE LCA REVEALED FOUR DISTINCT CLASSES OF INDIVIDUALS: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness.Findings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning.

    View details for DOI 10.3402/ejpt.v5.25097

    View details for PubMedID 25279111

    View details for PubMedCentralID PMC4165723

  • Reality versus fantasy: reply to Lynn et al. (2014). Psychological bulletin Dalenberg, C. J., Brand, B. L., Loewenstein, R. J., Gleaves, D. H., Dorahy, M. J., Cardeña, E., Frewen, P. A., Carlson, E. B., Spiegel, D. 2014; 140 (3): 911-920


    We respond to Lynn et al.'s (2014) comments on our review (Dalenberg et al., 2012) demonstrating the superiority of the trauma model (TM) over the fantasy model (FM) in explaining the trauma-dissociation relationship. Lynn et al. conceded that our meta-analytic results support the TM hypothesis that trauma exposure is a causal risk factor for the development of dissociation. Although Lynn et al. suggested that our meta-analyses were selective, we respond that each omitted study failed to meet inclusion criteria; our meta-analyses thus reflect a balanced view of the predominant trauma-dissociation findings. In contrast, Lynn et al. were hypercritical of studies that supported the TM while ignoring methodological problems in studies presented as supportive of the FM. We clarify Lynn et al.'s misunderstandings of the TM and demonstrate consistent superiority in prediction of time course of dissociative symptoms, response to psychotherapy of dissociative patients, and pattern of relationships of trauma to dissociation. We defend our decision not to include studies using the Dissociative Experiences Scale-Comparison, a rarely used revision of the Dissociative Experiences Scale that shares less than 10% of the variance with the original scale. We highlight several areas of agreement: (a) Trauma plays a complex role in dissociation, involving indirect and direct paths; (b) dissociation-suggestibility relationships are small; and (c) controls and measurement issues should be addressed in future suggestibility and dissociation research. Considering the lack of evidence that dissociative individuals simply fantasize trauma, future researchers should examine more complex models of trauma and valid measures of dissociation.

    View details for DOI 10.1037/a0036685

    View details for PubMedID 24773506

  • Psychotic-like Experiences, Symptom Expression, and Cognitive Performance in Combat Veterans With Posttraumatic Stress Disorder. journal of nervous and mental disease Lindley, S. E., Carlson, E. B., Hill, K. R. 2014; 202 (2): 91-96


    Apparent psychotic symptoms are often associated with posttraumatic stress disorder (PTSD), but these symptoms are poorly understood. In a sample of 30 male Vietnam combat veterans with severe and chronic PTSD, we conducted detailed assessments of psychotic symptom endorsement, insight, symptom severity, neurocognitive function, and feigning. Two thirds of the subjects endorsed a psychotic item but did not believe that the experiences were real. Those endorsing psychotic items were higher in PTSD severity, general psychopathology, and dissociation but not depression, functional health, cognitive function, or feigned effort. Severity of psychotic symptoms correlated with dissociation, combat exposure, and attention but not PTSD, depression, or functional health. Those endorsing psychotic items scored higher on a screen but not on a detailed structured interview for malingering. Endorsement of psychotic experiences by combat veterans with PTSD do not seem to reflect psychotic symptoms or outright malingering.

    View details for DOI 10.1097/NMD.0000000000000077

    View details for PubMedID 24469519

  • Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis European Journal of Psychotraumatology Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., Bryant, R. A. 2014; 5: 25097


    There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when the latter is comorbid with PTSD.To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD.A latent class analysis (LCA) was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD.THE LCA REVEALED FOUR DISTINCT CLASSES OF INDIVIDUALS: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness.Findings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning.

    View details for DOI 10.3402/ejpt.v5.25097

    View details for PubMedCentralID PMC4165723

  • Traumatic Stressor Exposure and Post-Traumatic Symptoms in Homeless Veterans MILITARY MEDICINE Carlson, E. B., Garvert, D. W., Macia, K. S., Ruzek, J. I., Burling, T. A. 2013; 178 (9): 970–73


    To better understand potential risk factors for post-traumatic stress disorder (PTSD) and homelessness in veterans, we studied trauma exposure and responses in archival data on 115 homeless veterans.Rates of exposure to military and a variety of civilian high magnitude stressor (HMS) and persistent post-traumatic distress (PPD) events and symptoms of post-traumatic stress were assessed. The relationships between frequency of different trauma types and symptoms of post-traumatic stress were examined.Exposure to both HMS and PPD events were extremely high in this sample, with particularly high exposure to adult (82%) and childhood (62%) interpersonal violence HMS events and HMS events during military service (53%). Exposure to both military and civilian PPD events was associated with significantly higher levels of PTSD symptoms than exposure to no PPD events or only civilian PPD events, and almost all HMS event types were significantly correlated with both PTSD and dissociation symptoms.Post-traumatic symptoms and military and civilian traumatic stressors of all types should be assessed in homeless veterans because they may be contributing to poor social and occupational functioning.

    View details for DOI 10.7205/MILMED-D-13-00080

    View details for Web of Science ID 000340805500012

    View details for PubMedID 24005545

  • Positive affect, childhood adversity, and psychopathology in psychiatric inpatients EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY Etter, D. W., Gauthier, J. R., McDade-Montez, E., Cloitre, M., Carlson, E. B. 2013; 4


    Low positive affect is closely related to common pathological responses to childhood adversity, including posttraumatic stress disorder (PTSD) and depression, but little is known about how the characteristics of early adversity experiences might be related to positive affect in adulthood.This study aimed to explore whether low positive affect is related to specific childhood adversities, including abuse, neglect, caretaker dysfunction, and low childhood social support.Using structured interviews and self-report measure data collected from 173 adult psychiatric inpatients, this study examined the relationship between positive affect and symptoms of psychopathology, as well as how the number of types of abuse experienced, severity of adversity types (physical abuse and sexual abuse), childhood environment (childhood social support, neglect, and caretaker dysfunction), and number of non-abuse traumas related to positive affect.Positive affect was significantly negatively related to several symptoms of psychopathology, including depression, dissociation, self-destructive behavior, PTSD, and global psychopathology. Individuals who experienced both physical and sexual abuse reported significantly less positive affect than those with only physical or no abuse experiences. Lower positive affect was predicted by lower childhood social support and greater severity of sexual abuse, with both factors accounting for unique variance in positive affect.These results suggest that individuals who experience multiple types of early adversity, more severe sexual abuse experiences, and less social support are at risk of psychological difficulties. Given the relatively strong association between positive affect and childhood social support, interventions to foster social support may be a means of increasing positive affect among individuals exposed to childhood adversity.

    View details for DOI 10.3402/ejpt.v4i0.20771

    View details for Web of Science ID 000332100000001

    View details for PubMedID 23946881

    View details for PubMedCentralID PMC3742840

  • Dissociation in PTSD DISSOCIATION AND THE DISSOCIATIVE DISORDERS: DSM-V AND BEYOND Waelde, L. C., Silvern, L., Carlson, E., Fairbank, J. A., Kletter, H., Dell, P. F., ONeil, J. A. 2011: 447–56
  • Monitoring mental health treatment acceptance and initial treatment adherence in veterans Veterans of Operations Enduring Freedom and Iraqi Freedom versus other veterans of other eras 89th Annual Conference of the Association for Research in Nervous and Mental Disease Lindley, S., Cacciapaglia, H., Noronha, D., Carlson, E., Schatzberg, A. WILEY-BLACKWELL. 2010: 104–113


    Identifying factors that influence mental health outcomes in veterans can aid in the redesign of programs to maximize the likelihood of early resolution of problems. To that end, we examined demographic and clinical process data from 2,684 veterans who scored positive on a mental health screen. We investigated this data set for patterns and possible predictors of mental health referral acceptance and attendance. The majority of patients had not received mental health treatment within the last two years (76%). Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) were more likely to accept a mental health referral for depression but were equally likely to attend a mental health visit as other era veterans. Decreased acceptance was associated with provider type and contact method, clinic location, depression only, and specific age ranges (65-74). Among those who accepted a referral, decreased attendance was associated with clinic location, depression only, and retirement. No variables predicted OEF/OIF acceptance/attendance. In conclusion, our findings illustrate the importance of close, continual monitoring of clinical process data to help reveal targets for improving mental health care for veterans.

    View details for Web of Science ID 000284742000014

    View details for PubMedID 20955332

  • Posttraumatic stress and aggression among veterans in long-term care 19th Annual Conference of the International-Society-for-Traumatic-Stress-Studies Carlson, E. B., Lauderdale, S., Hawkins, J., Sheikh, J. I. SAGE PUBLICATIONS INC. 2008: 61–71


    Because stresses associated with long-term care settings may exacerbate distress and aggression related to past trauma, we investigated self-report and staff reports of posttraumatic stress disorder symptoms and staff observations of verbal and physical aggression in 32 elderly males who were patients in a long-term care unit for veterans. Feelings of anger and irritability were reported by 47% of patients; levels of anger and irritability were significantly correlated with observed aggressive behaviors (r = 0.43, P < .02); and observed aggressive behaviors were significantly more frequent among those reporting past traumatic stressors (t = 2.84, P < .008). Patient-reported posttraumatic stress disorder symptoms were significantly correlated with the frequency of past traumatic stressors (r = 0.48, P < .006). Observer-reported posttraumatic stress disorder symptoms and patient reports of anger were strongly correlated (r = 0.73, P < .001). No patient or staff reports were related to level of cognitive function. These findings are consistent with the hypothesis that posttraumatic symptoms can contribute to aggressive behaviors in elderly, medically ill, and cognitively impaired patients.

    View details for DOI 10.1177/0891988707311557

    View details for Web of Science ID 000253457700009

    View details for PubMedID 18287172

  • A randomized, double-blind, placebo-controlled trial of augmentation topiramate for chronic combat-related posttraumatic stress disorder JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Lindley, S. E., Carlson, E. B., Hill, K. 2007; 27 (6): 677-681


    Topiramate, a novel anticonvulsant, has been reported to rapidly reduce symptoms of posttraumatic stress disorder (PTSD) in an open-label trial. The present study was designed as a test of topiramate's efficacy as adjunctive therapy in a 7-week, randomized, double-blind, placebo-controlled trial.Forty male veterans with PTSD in a residential treatment program were randomized to flexible-dose topiramate or placebo augmentation. The primary outcome measures were PTSD symptom severity and global symptom improvement.Baseline Clinician-Administered PTSD Scale scores were 62.1 +/- 13.9 for placebo and 61.0 +/- 22.2 for topiramate. There was a high dropout rate from the study (55% topiramate; 25% placebo), with 40% of topiramate and 10% of placebo dropping because of adverse events (AEs). No significant treatment effects of topiramate versus placebo were observed for the primary treatment outcomes. Subjects reporting central nervous system-related AEs and with higher baseline severity of depression were more likely to discontinue because of AEs.Primary outcome measures failed to demonstrate a significant effect for topiramate over placebo; however, high dropout rate in the treatment group prohibits definitive conclusions about the efficacy of topiramate in this population.

    View details for DOI 10.1097/jcp.0b013e31815a43ee

    View details for Web of Science ID 000251181600017

    View details for PubMedID 18004136

  • Aging and panic disorder - Phenomenology, comorbidity, and risk factors AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Sheikh, J. I., Swales, P. J., Carlson, E. B., Lindley, S. E. 2004; 12 (1): 102-109


    The authors compared young and older adults with panic disorder (PD) to investigate differences in panic-associated phenomenology, psychiatric comorbidity, and risk factors.Patients in the older group (age 60 and above) were further subdivided into early- and late-onset groups and compared. Phenomenology (number of panic symptoms, severity of anxiety, physiological symptoms, panic-associated cognitions, and overall severity of PD); comorbidity (depressive and anxiety disorders); and risk factors (family history of anxiety and life stressors) were assessed in 167 outpatients with PD.Older patients reported fewer panic symptoms, less anxiety and arousal, less severe PD, lower levels of depression, and higher levels of functioning. Furthermore, within the older-patient group, late-onset patients were found to report less distress during panic attacks in relation to body sensations and panic-related cognitions and emotions. Multiple-regression analysis of the entire sample showed that chronological age and age at onset of PD distinctly predicted different domains of panic phenomenology.PD was consistently less severe in older patients across multiple domains, and a later age at onset was associated with less distress due to body sensations, cognitions, and emotions during panic attacks.

    View details for Web of Science ID 000188001000014

    View details for PubMedID 14729565



    The Dissociative Experiences Scale has proved a reliable and valid instrument to measure dissociation in many groups, but its capacity to distinguish patients with multiple personality disorder from patients with other psychiatric disorders has not yet been conclusively tested.A discriminant analysis was performed to classify 1,051 subjects as having or not having multiple personality disorder. Another discriminant analysis was performed on a subgroup of 883 subjects more closely representing patients in a typical psychiatric facility in terms of base rates of dissociative disorders. A cutoff score of 30 was also used to classify subjects, and Bayes's theorem, which allows for the calculation of the positive predictive value and the negative predictive value of a screening test, was applied.According to discriminant analysis of the total study group, the scale's sensitivity was 76% and its specificity was also 76%; according to discriminant analysis of the more representative subgroup, the scale's sensitivity was 76% and its specificity was 85%. Use of the cutoff score of 30 produced similar results. Results of the application of Bayes's theorem showed that 17% of the subjects scoring 30 or higher would actually have multiple personality disorder and 99% of those scoring less than 30 would not have multiple personality disorder.These results indicate that the Dissociative Experiences Scale performs quite well as a screening instrument to identify subjects with multiple personality disorder. In addition, the consistency of responses to scale items across centers indicates that the symptoms reported by patients with multiple personality disorder are highly similar across diverse geographic centers. This consistency supports the reliability and validity of the diagnosis of multiple personality disorder across centers.

    View details for Web of Science ID A1993LL39800007

    View details for PubMedID 8317572