This application for a Career Development Award in Patient-Oriented Research (K-23) is intended to provide the applicant with intensive mentoring, expert consultation, formal advanced coursework, and the opportunity to conduct preliminary scientific studies to prepare him to be an independent investigator who will implement a productive program of funded studies addressing the treatment and clinical course of a complex variant of post-traumatic stress disorder (PTSD) known as Disorders of Extreme Stress Not Otherwise Specified (DESNOS). The award will prepare the applicant to serve as the principal investigator on a R01 grant proposal for a multi-site, multi-year, randomized, clinical trial of treatment for DESNOS. DESNOS was described in the DSM-IV as some of the associated features of PTSD, although more recent evidence indicates that DESNOS and PTSD may be distinct disorders (Ford, 1999). DESNOS has been linked in independent studies (van der Kolk et al., 1996; Ford, 1999) to exposure to developmentally-adverse interpersonal trauma (DAIT). DESNOS represents a potential public health problem, as it has been found to be associated with impaired emotion processing capacities and extreme post-traumatic intrusive symptomatology (Ford, 1999), treatment refractoriness (Ford & Kidd, 1998), and high utilization of crisis psychiatric care (Ford, 1999). However, DESNOS is not necessarily the best conceptual model to represent the structure and course of the sequelae of DAIT. There is a need for replicated prospective, psychometric, structural, and construct validation studies that examine the structure of the diverse (yet often overlapping) features of DESNOS and other sequelae of DAIT (e.g., PTDS, depression, substance abuse, Axis II disorders) and empirically define the constructs, nomological network, and measurement methods that best represent the sequelae of DAIT. There also is a need for development and controlled empirical evaluation of replicable (i.e., manualized) treatment for the sequelae of DAIT. The proposed studies will prepare the applicant to replicate and extend his prior work on DAIT and DESNOS to people with severe mental illness (SMI), a population at high risk for DAIT and PTSD (Mueser et at., 1998). Didactic studies will address the sequelae of DAIT in the context of: (a) perinatal through adolescent psychological development and developmental psychopathology; (b) information/emotion processing and relational/interpersonal models of trauma, psychopathology and psychotherapy, (d) psychometric theory and instrument development; (e) psychotherapy and health services outcome research methodology; and (f) multivariate biostatistical theory and methods. The research program will include pilot studies within a SMI population of (a) psychometric and structural evaluation of DAIT and its adult sequelae in people with SMI; and (b) development and pilot evaluation of manualized therapist, client, and treatment fidelity protocols for SMI patients who are survivors of DAIT.
