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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZMH1-ITV-D (01))
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Chavez, Mark
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University of Connecticut
Schools of Medicine
United States
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Ford, Julian D; Fraleigh, Lisa A; Albert, David B et al. (2010) Child abuse and autonomic nervous system hyporesponsivity among psychiatrically impaired children. Child Abuse Negl 34:507-15
Ford, Julian D; Connor, Daniel F; Hawke, Josephine (2009) Complex trauma among psychiatrically impaired children: a cross-sectional, chart-review study. J Clin Psychiatry 70:1155-63
Chapman, John F; Ford, Julian D (2008) Relationships between suicide risk, traumatic experiences, and substance use among juvenile detainees. Arch Suicide Res 12:50-61
Morina, Nexhmedin; Ford, Julian D (2008) Complex sequelae of psychological trauma among Kosovar civilian war victims. Int J Soc Psychiatry 54:425-36
Scoboria, Alan; Ford, Julian; Lin, Hsiu-ju et al. (2008) Exploratory and confirmatory factor analyses of the structured interview for disorders of extreme stress. Assessment 15:404-25
Henggeler, Scott W; Sheidow, Ashli J; Cunningham, Phillippe B et al. (2008) Promoting the implementation of an evidence-based intervention for adolescent marijuana abuse in community settings: testing the use of intensive quality assurance. J Clin Child Adolesc Psychol 37:682-9
Ford, Julian D; Stockton, Patricia; Kaltman, Stacey et al. (2006) Disorders of extreme stress (DESNOS) symptoms are associated with type and severity of interpersonal trauma exposure in a sample of healthy young women. J Interpers Violence 21:1399-416
Ford, Julian D; Russo, Eileen (2006) Trauma-focused, present-centered, emotional self-regulation approach to integrated treatment for posttraumatic stress and addiction: trauma adaptive recovery group education and therapy (TARGET). Am J Psychother 60:335-55
Ford, Julian D; Courtois, Christine A; Steele, Kathy et al. (2005) Treatment of complex posttraumatic self-dysregulation. J Trauma Stress 18:437-47
Ford, Julian D; Trestman, Robert L; Tennen, Howard et al. (2005) Relationship of anxiety, depression and alcohol use disorders to persistent high utilization and potentially problematic under-utilization of primary medical care. Soc Sci Med 61:1618-25