Sunteți pe pagina 1din 14

Aleksandar Dimitrijevic, PhD 1 Originalni naučni rad Assistant Professor, Department of Psychology, UDK: 159.944.4: 616.89-008.1 Faculty of Philosophy, University of Belgrade Primljeno: 11.5.2015. Substitute Professor, DOI: 10.2298/SOC1502286D International Psychoanalytic University, Berlin


ABSTRACT Throughout the history of mental health care field, trauma was prescribed different and frequently opposing roles. In psychoanalysis, the attitude toward trauma was ambiguous: it was considered a crucial factor, but at the same time its role could happen to be minimized. In biological psychiatry, it is seen as a dominant cause of some disorders and completely irrelevant for the others.

In this paper, two issues are discussed: frequency of traumatic events in general

population and among persons with mental disorders; and hypothesized intrapsychic mechanisms that lead to detrimental consequences of trauma on mental health.

It is advocated that prevention of early, especially attachment, trauma should be

the focus of our work in dealing with mental disorders.

KEYWORDS: trauma, mental disorder, attachment, mentalization

SAŽETAK Tokom razvoja zaštite mentalnog zdravlja, trauma je često dobijala različite, pa čak i suprotstavljene uloge. U psihoanalizi je smatrana ključnim faktorom nastanka mentalnih poremećaja, ali je u isto vreme mogla biti i zanemarena, dok je u biološkoj psihijatriji prihvaćena za glavni uzrok nekih poremećaja ali i kao potpuno nevažna za druge.

U ovom tekstu ću diskutovati dva pitanja: učestalost traumatskih događaja u

opštoj populaciji i među osobama s mentalnim poremećajima, te pretpostavljene intrapsihičke mehanizme koji vode do nepoželjnih posledica traume po mentalno zdravlje.

Na osnovu svih podataka može se zaključiti da bi prevencija ranih trauma, a posebno trauma u odnosima vezanosti, trebalo da bude fokus u našem radu s osobama koje pate od mentalnih poremećaja. KLJUČNE REČI trauma, mentalni poremećaj, vezanost, mentalizacija

Aleksandar Dimitrijevic: Trauma as a neglected etiological factor of mental disorders


History of trauma in the mental health care field

A long debate about the role of trauma started with French psychiatrists of

the XIX century and Freud (e.g.: Ellenberger, 1970; Hacking, 1998; Makari, 2008). While Freud believed that actual trauma is a necessary trigger for neurosis, his opinion about the infantile trauma changed. Initially, he found infantile trauma to be of utmost importance, because it would define the fixation point and thus

the symptoms of the disorder (e.g., Bonomi, 2015). In a letter to Wilhelm Fliess, however, on October 15, 1897, Freud introduced the conception of what will come to be known the Oedipus complex: it was children’s fantasy that defined the root of the disorder and not the actual traumatic events (Masson, 1985, p. 272). The shift was so dramatic that it was labeled „the assault on truth“ about the molestation of children in the conservative Vienna (Masson, 1992).

It had not been until the second half of the 1920s that this view was

challenged. In two of his last papers, Sandor Ferenczi tried to bring trauma back to the centre of attention. He described developmental and clinical details

related to problems faced by the unwanted children, who are traumatized by simply not being welcomed with enough love and care (1929), as well as reactions of children to adult experiences they cannot represent in their immature minds (1933). These ideas were rejected by Freud, to the level that Ferenczi was declared psychotic and his papers forgotten/forbidden for about half a century (Bonomi, 2004).

It seems that the concept of trauma has been polarizing psychoanalysts

during the entire century, constantly considered as opposite to the concept of inner fantasy. On one side were Melanie Klein and her followers, who thought that what mattered were mental drives, representations, anxieties, and defense mechanisms, while social „objects“ (like actual parents) were outside the field of their interest. Opposite to them, the Independents, most explicitly Donald Winnicott and John Bowlby, studied the importance of interpersonal relationships and consequences of trauma (Dimitrijevic, 2011a). They started with a joint paper that recommended the evacuation of whole families from 1939 London, so that children are not separated from their parents (Bowlby et al., 1939), and kept studying trauma, albeit in different ways: Winnicott worked as pediatrician and psychoanalyst, while Bowlby founded attachment theory as a special form of object-relations theory, closer to natural sciences than to psychoanalytic hermeneutics (Issroff, 2005). Out of this grew many hypothesized types of trauma, several proposed underlying mechanisms, many forms of treatment. By 1967, Anna Freud claimed that the concept of trauma has become empty due to overuse. Although that was still the time when psychodynamic model dominated psychiatry, especially in the US, the situation there was much different. It now looks curious that the widely used Kaplan’s „Synopsis of Psychiatry“ has up to the 1980 edition relied on a 1955 study that had claimed incest occurred in just one out of one million American families (after Ross, 1996, pp. 6–7). And although current estimates are more realistic, the division in approaches resembles that inside psychoanalysis.


SOCIOLOGIJA, Vol. LVII (2015), N° 2

Namely, since the third revision, published in 1980, the „Diagnostic and Statistical Manual“ does not include discussions about possible causes of mental disorders and this principle is included even in the generic definition offered at the Manual’s beginning. Without going into details of the possible critique of this, it should be emphasized that there is one clear exemption to this rule. The same DSM-III included (in the new category „Anxiety Disorders“) „Post- Traumatic Stress Disorders (PTSD)“, explicitly defined by their cause, and that cause was trauma. One can reason that behind this is the now omnipresent biological model of mental disorders (in all cases but PTSD, the causes is in the dis-balance of neurotransmitters), which suits the pharmacological industry, and that the role of trauma, and thus of more psychological models, is limited to just one disorder (Lewis, 2006). The best, and possibly the only, way to tell who is right and who is wrong would be to see what research tells us about the incidence of trauma in general population and in samples of persons with mental disorders. Luckily, we have more and more solid data about this.

Incidence of trauma

So, is trauma very


as we


to believe,



it be




everywhere around us? And: is it more frequent in the lives and growing up of the persons with mental disorders? We can decide on these issues now based on several large-scale epidemiological studies, mostly done in the United States. In general, it seems that high incidence of early individual trauma seems not to be disputed in contemporary scientific literature. In contrast to the 1955 study quoted above, for instance, more recent estimates claim that there are approximately one million cases of child abuse and neglect substantiated in the US each year (US Department of Health, 2005, And we have even more precise data, showing the incidence of various types of trauma in percentage:

Table 1. Incidence of different types of trauma in general population (adapted after: Putnam et al., 2015)





Sample size




Type of abuse


Physical abuse




Sexual abuse




Emotional abuse




The table shows that the incidence rate changes for different types of trauma, but is constantly alarmingly high. This impressively large sample shows that in some cases one quarter or even a third of the subjects were exposed to trauma, with strong gender differences (e.g., there are more physically abused men, but more sexually abused women). From this, we cannot make conclusions about the difference between general and clinical populations, but we will return to

Aleksandar Dimitrijevic: Trauma as a neglected etiological factor of mental disorders


that shortly. It seems, however, that we have learned that trauma occurs very frequently in contemporary Western society. How about cumulative trauma? Is it frequent that the same child gets molested or exposed to witnessing trauma 2 more than once? Here is data from the same sample:

Table 2. Cumulative incidence of trauma in general population (after: Putnam et al., 2015)





Sample size




















4 or more




We can be relieved about the almost two fifths of the population who have grown up without serious trauma. The problem may be, however, important for the majority, at 63.9%, have been traumatized. Worse still, among them as many as 37.9% were traumatized more than once, and every eighth subject had adverse experiences repeatedly (four or more times). This study would, thus, suggest that there are almost twice more traumatized than non-traumatized individuals and that almost two fifths of the general population (or, in real numbers, millions and millions of adults) suffered repeatedly. To make the matters more worrisome, empirical evidence shows that most maltreatment happens in the earliest childhood, when it has greater negative effects on developing mind and brain. The troubling 5.7% children of ages 0–3 experience trauma or neglect, which is, happily, followed by a steady decline, to reach 1.9% at the age 16–17 (US Department of Health and Human Services,


Another important question may well be where all this takes place. How frequent is „family trauma“?

Table 3. Incidence of family dysfunctions in general population (after: Putnam et al., 2015)





Sample size




Type of household dysfunction


Substance abuse




Parental separation or divorce




Mental illness




Mother treated violently




Incarcerated member





SOCIOLOGIJA, Vol. LVII (2015), N° 2

We see, again, that the incidence is disturbingly high, and especially for women. Every fifth subject has experienced at least one type of household dysfunction, sometimes the rate is higher, and for some it must have been more than one. It is also significant that four out of five types of the listed family disfunctions actually make parents emotionally unavailable: substance abuse, divorce, mental illness and incarceration (this one does not have to involve the parent, though). 3 Based on all this evidence, which comes from recent studies on large samples, we can conclude that trauma is a widespread phenomenon and that it frequently happens to infants and preschool children, inside their homes. But, what are the consequences of trauma? Does this evidence bear clinical importance?

Consequences of childhood trauma

Many clinical psychologists have, in studies of various types, found that consequences of childhood trauma include and are not limited to the following (see Lieberman & Van Horn, 2011; Osofsky, 2011):

– more frequent adoptions, child fatalities, developmental delays;

– poor attachment and socialization, low self-esteem;

– distortions in sensory perception and meaning, constrictions in action, deficits in readiness to learn, attention, abstract reasoning and executive function;

– HPA/cortisol dysregulation, smaller frontal lobe volume, asymmetry of left and right brain centers included in the cognitive processes of language production.

It is also found that prevalence of many serious somatic conditions correlates positively with the number of traumatic events, like Ischemic Heart Disease, Stroke, Diabetes, and especially Chronic Obstructive Pulmonary Disease and Sexually Transmitted Diseases (Felitti et al., 1998). Besides developmental and health issues, trauma is especially important for the field of mental health care. Strong positive correlations were found between the number of traumatic events and several types of mental disorders:

Aleksandar Dimitrijevic: Trauma as a neglected etiological factor of mental disorders


as a neglected etiological factor of mental disorders 291 Figure 1 – Correlation between number of

Figure 1 – Correlation between number of traumatic events and mental disorders

(Adapted after: Putnam et al., 2013; Wang et al., 2005)

Colleagues gathered in the „International Society for Psychological and Social Approaches to Psychosis“ ( have prepared reviews of more than 40 research studies about trauma and psychotic disorders conducted between 1984 and 2003 (Read et al., 2004). Clinical samples included in the meta-analysis ranged between 7 and 321 and included: persons with schizophrenia; persons with other psychoses; outpatient samples in which at least 50% of subjects were persons with psychotic disorders; child and adolescent inpatients. I have used their work to draw a simple table that compares frequencies of trauma in general population and among psychiatry patients.

Table 4. Frequency of childhood trauma among adults with mental disorders (after: Read et al., 2004)


General population

Psychiatry patients

Physical abuse

3% of men 5% of women

30% of men 34–42% of women

Sexual molestation

3% of men 12% of women

18% of men 51% of women


7% of men 13–17% of women

62% of men 62% of women

Parental loss


38% of patients with SCH 17% of patients with BAD

I believe that the table clearly illustrates that certain forms of early individual trauma are 4–10 times more frequent among our patients than in general populations (although values for the latter are much lower than in the studies performed in the US). This is further underlined by comparison studies that established differences between psychotic patients with the history of childhood


SOCIOLOGIJA, Vol. LVII (2015), N° 2

trauma and those without it (Read et al., 2004, p. 223), which resulted in the finding that the consequences of childhood trauma are associated with:

– more self-mutilation, higher symptom severity, more suicide attempts;

– earlier first admissions;

– more medication;

– longer and more frequent hospitalizations and seclusions.

We can, thus, plausibly conclude, based on many international studies and meta-analyses, that trauma is far more frequent among persons who experience somatic or mental health problems. We still have to wonder, however, whether these correlations indicate causal relationships or not.

Attachment trauma

One type of trauma has in recent studies been emphasized as specially important and that is attachment trauma. 4 Consequences seem to be most disturbing when trauma is inflicted in closest relationships, those from which children expect safety and encouragement for exploration. Children exposed to attachment trauma frequently develop the so-called disorganized attachment pattern, characterized by complete lack of strategy in close relationships, freezing out of movement and expression, and/or incomprehensible behavior. About 15% of children in non-clinical samples are classified as disorganised (Van Ijzendoorn & Bakermans-Kranenburg, 1997, p. 136), but this number raises to astonishing 82% of maltreated children (Lyons-Ruth & Jacobvitz, 1999, p. 526). There is obvious connection between the disorganized attachment in children and their parents’ mental health status. Most mothers suffering from depression and schizophrenia, and about 80% of mothers with anxious disorders, have insecurely attached children (Greenberg, 1999, p. 478). More than a half of D-children have parents who had suffered significant loss(es) two years before the children’s birth that are still unresolved (Lyons-Ruth & Jacobvitz, 1999, pp. 528–9, 540; Van Ijzendoorn & Bakermans-Kranenburg, 1997, p. 136). Disorganized attachment pattern at the age of 12 months, based very frequently on attachment trauma, is predictive of the following set of variables (based on Greenberg, 1999, p. 479; Solomon & George, 1999, p. 294):

– controlling, pseudo-parental behavior in preschool years;

– aggressive behavior in 83% of 7-year-olds;

problems with adaptation to school in majority of these children; 5

– delinquency, addictions, and personality disorders in majority of these adolescents;

4 Another form that is attracting more attention is social or genocidal trauma, but it cannot be discussed properly here for the lack of space. For detailed review see Delic et al., 2014; Hamburger, in press.

Aleksandar Dimitrijevic: Trauma as a neglected etiological factor of mental disorders


mental health problems in about 80% of these adults, and especially dissociative phenomena and disorders.

One additional benefit from attachment research is that we now have empirical evidence substantiating and nuancing our understanding of the mechanisms that lead from trauma to disorganized attachment to deviant behavior and mental disorder. Attachment theory predicted that trauma would inhibit investigation and heighten the need for comfort coming from the secure attachment base (Bowlby, 1988), and this was indeed corroborated. Furthermore, it was found that traumatized children move toward parents and at the same time away from them and are forced to create multiple models of caregivers (Fonagy & Target, 2008). Faced with the situation in which, for instance, the father, supposed or until recently actual source of comfort and love, starts abusing him or her, the child may unconsciously decide to sacrifice his or her own mind in order to save the representation of the father. Such is the importance of the parent for the highly dependent preschooler that it is easier to lose one’s own inner world, because children survive without introspective capacity, but vanish without adults. These children may split in their minds two types of experiences with parents: loving father from abusive father. There is, then, one part of themselves they do not dare admit even to themselves, one part to horrible to face. The traumatized child first defensively inhibits her capacity to mentalize, trying to avoid the insight that the parent may wish to hurt her (Fonagy et al., 1997, p. 253). Consequently, trauma impedes deeper procession of emotional experiences, and interferes with the (further) development of mentalizing capacity or can even destroy it (Fonagy et al., 2002). 6 This experience may generalize and the child then feels that „looking inside“ is dangerous under any circumstances. Being unaware of inner psychological processes means, of course, that you cannot control or regulate them. Exactly this is considered to lead not only to the disorganized attachment, which is not a pathological condition per se, but to the later dissociative disorders (Liotti, 2004) as well as Borderline Personality Disorder (Allen & Fonagy, 2006). It is even more beneficial that we can use this research evidence to propose prevention and psychotherapy interventions for disorders caused by trauma.

Treatment of (attachment) trauma

This evidence cannot but motivate us to look for ways to prevent trauma or treat its consequences. Sceptics, if they exist, are often reminded about the costs: The US spend about $1.8 Million per victim of early trauma in order to deal with the consequences of child abuse, teen pregnancy, high school dropout, illegal drug and alcohol abuse (Pew Issue Brief, 2011); estimated lifetime costs for all those who in 2014 were victimized for the first time will be $5.9 Trillion (The Perryman Group, 2014).


SOCIOLOGIJA, Vol. LVII (2015), N° 2

Luckily, effective prevention and treatment programs exist. 7 Meta-analysis of 70 studies with 88 different interventions, 7,636 parents and 1,503 children revealed that there was a small but significant improvement ONLY when programs were focused on improving parental capacity to accurately perceive and „translate“ social signals contained in the infants’ and children’s non-verbal signals (Bakermans-Kranenburg, van Ijzendoorn, & Juffer, 2003). Frame-by- frame analysis shows that maternal reactions of smiling, surprise, withdrawal or looking away to the signs of four-months-old infants distress are predictive of disorganized attachment, or even that differences between facial and vocal emotional expressions are predictive of adults dissociation (Beebe et al., 2010). On the basis of this, several programs were developed that use video-taping of parent-infant interaction and subsequent discussion with parents aimed at improving their sensitivity. It seems, however, that improvement may come even from far less sophisticated issues. For instance, successful public advocacy of positive parental skills should be effective, as we have evidence showing that while cumulative trauma and resilience are negatively correlated, positive childhood experiences can counteract negative ones (Lieberman et al., 2005). These might include such broad categories as parental devotion, emotional availability 8 and behavioral predictability (see Winnicott, 1960), but also more specific ones like the positive influence of coherence and mentalizing nature of general discourse at home (Fonagy & Bateman, 2008, p. 145). It turns out that children who grow up in families where emotions are a topic the parents frequently talk and think together develop faster and better in terms of „theory of mind“ and mentalization; the same goes for situations in which mothers ascribe psychological features to their six-months-old babies (Fonagy & Bateman, 2008, p. 145). And where there is mentalization, effects of trauma cannot be too bad. Several studies conducted at the University of Leiden, Holland, confirmed that most disorganized children have mothers with severe trauma and/or loss they were unable to overcome, so they behave frighteningly or frightfully, and are both the source of and the solution for the children’s anxiety, found also who are the most helpful parents. The results showed that securely attached children’s mothers do not suffer from unintegrated trauma, but are not particularly helpful in extreme situations, possibly because they lack personal experience of this kind. On the other hand, autonomously attached women who had experienced significant loss(es) that they managed to overcome (labeled „Earned Secure“, as opposed to „Continuous Secure“) were able to show the lowest frequency and intensity of frightening or frightful behavior, and proved to be most helpful to their children. Due to their experiences of both traumatization and overcoming it, these mothers, more or less unconsciously, know what their children need and how to provide that (after Coates, 1998, pp. 299–300).

7 The always pragmatic Americans have counted that child abuse prevention programs return $3, and Parent Child Interaction Therapy $3.64 to every $1 invested (Lieb et al., 2004).

Aleksandar Dimitrijevic: Trauma as a neglected etiological factor of mental disorders


This lead many authors to come up with a very specific etiological hypothesis. It is now believed that the cause of many mental disorders is a combination of:

a) severe and/or repeated childhood trauma, and b) lack of a person who could provide the intersubjective foundation for mentalizing. Trauma, thus, does not have to lead to a mental disorder and will not do so in cases when there are adults ready to face and recognize child’s traumatic experience and offer help in thinking about and overcoming it (Fonagy, 2000; Levine, 2014). For many children, unfortunately, benevolent, emotionally available and mentalizing adults are not present in their social world, and preventive programs have not reached many others. It is highly likely, as we have seen above, that they will develop one or several forms of somatic illnesses, deviant behaviors and/ or mental disorders. And it is for them that we need to come up with treatment procedures. While noumerous psychotherapy variations are considered applicable for work with victims of trauma, at least one is developed especially for them. The so called Mentalization Based Treatment“ is being formulated over the last decade or so, with all the above mentioned principles in mind (e.g., Bateman & Fonagy, 2006; for a review see Dimitrijević, 2011b). Initially aimed at persons with Borderline Personality Disorder, it is a manualized, short-term treatment, that should help clients acquire capacity and skill of mentalization. They are first faced with many questions that should help them realize how much of the inner and social world they are or have been taking for granted. Subsequently, they should hopefully start understanding their own and other persons’ behaviors in terms of intentional mental states. A randomized control trial has shown that MBT is highly effective in the follow up after 42 months (Fonagy & Bateman, 2008): patients needed less medication and fewer and shorter hospitalizations, referred less self-harming and suicidal behavior, and improved educationally and professionally.


In the last half century, the biological model of mental disorders, and especially the psychotic ones, has gained such prevalence that discussing anything but genes, dopamine, and cerebral ventricles is considered obsolete and non- scientific. There were various forms of resistance to admitting the importance of trauma, including tendency that the best-selling textbooks report about trauma in a misconceived and one-sided way (Brand & McEwan, 2015). It was only in recent times that enough evidence was gathered to make it even more obvious that trauma plays an important role in both development and clinically relevant conditions of a huge number of children and adults. The most troubling aspect of this situation, however, is not denial of the importance of trauma, but the ensuing impossibility for persons with mental disorders to get what they need at the institutions that are meant to provide help. Traumatized persons are more often hospitalized than non-traumatized persons with mental disorders (Read et al., 2004), yet many of them get nothing but disappointment and conviction that help cannot be found, looking for the fault


SOCIOLOGIJA, Vol. LVII (2015), N° 2

in themselves or allegedly incurable diseases instead of at the re-traumatizing nature of depersonalized institutions (see Dimitrijevic, in press). For all these reasons, the frequency and the role of trauma in the onset of various somatic and mental disorders have to be advocated and substantiated, and prevention and therapy of its consequences further developed. Otherwise, the world will remain full of unheard, unrecognized and wrongly treated „victims of peace“.


The preparation of this paper was supported by Ministry of Education and Science of the Republic of Serbia, Grant No. 179018, and by „Trauma, Trust, and Memory“ Project funded by „German Academic Exchange Service [DAAD]“, Grant No. 57173352.


Allen, J. G., & Fonagy, P. (Eds.). (2006). The handbook of mentalization-based treatment. John Wiley & Sons. Bakermans-Kranenburg, M. J., Van Ijzendoorn, M. H., & Juffer, F. (2003). Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129(2), 195. Banjac, S., Altaras Dimitrijević, A., & Dimitrijević, A. (2013). Odnos vezanosti, mentalizacije i inteligencije u uzorku srednjoškolaca. Psihološka istraživanja, 16(2), 175–190. Bateman, A. & P. Fonagy (2008): 8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual. American Journal of Psychiatry, 165, 5, 631–638. Bateman, A. W., & Fonagy, P. (Eds.). (2012). Handbook of mentalizing in mental health practice. American Psychiatric Publishers. Beebe, B., Jaffe, J., Markese, S., Buck, K., Chen, H., Cohen, P., & Feldstein, S. (2010). The origins of 12-month attachment: A microanalysis of 4-month mother–infant interaction. Attachment & Human Development, 12(1–2),


Bonomi, C. (2004). Trauma and the symbolic function of the mind. International Forum of Psychoanalysis, 13, 1–2, 45–50. Bonomi, C. (2015). The Cut and the Building of Psychoanalysis, Volume I:

Sigmund Freud and Emma Eckstein. Routledge. Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. Taylor & Francis. Bowlby, J., Miller, E., & Winnicott, D. W. (1939). Evacuation of small children. British Medical Journal, 2(4119), 1202. Brand, B. L. & McEwan, L. E. (2014). Coverage of CHILD Maltreatment and Its Effects in Three Introductory Psychology Textbooks. Trauma Psychology News, 9(3).

Aleksandar Dimitrijevic: Trauma as a neglected etiological factor of mental disorders


Coates, S. (1998): Having a Mind of One’s Own and Holding the other in Mind: Commentary on Paper by Peter Fonagy and Mary Target (1998). Psychoanalytic Dialogues, 8, str. 115–148. Delić, A., Hasanović, M., Avdibegović, E., Dimitrijević, A., Hancheva, C., Scher, C., Stefanovic-Stanojevic, T., Streeck-Fischer, A., & Hamburger, A. (2014). Academic model of trauma healing in post-war societies. Acta medica academica, 43(1), 76–80. Dimitrijevic, A. (2011a). Bindung und Phantasie in einer psychoanalytischen Behandlung. Journal fuer Psychoanalyse, 31, 52, 84–100.


mentalizovanju“. Psihijatrija danas, 43, 1, 5–20. Dimitrijevic, A. (in press). Psychiatric Treatment as a Form of Social Trauma. In A. Hamburger (ed.), Trauma, Trust, Memory. Psychoanalytic Approaches to Social Trauma. Karnac Books.

Dimitrijević, A., Altaras Dimitrijević, A., & Jolić Marjanović, Z. (2013). An examination of the relationship between intelligence and attachment in adulthood. In C. Pracana & L. Silva (Eds.), InPACT 2013 – International Psychological Applications Conference and Trends. Book of proceedings (pp. 21–25). Lisbon: World Institute for Advanced Research and Science. Ellenberger, H. F. (2008). The discovery of the unconscious: The history and evolution of dynamic psychiatry. Basic Books. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. Ferenczi, S. (1929). The unwelcome child and his death-instinct. International Journal of Psycho-Analysis, 10, 125–129.

Ferenczi, S. (1933/1949): Confusion of Tongues between the Adult and the Child. International Journal of Psycho-Analysis, 30, 225–230. Originally published in









Fonagy, P. (2000): Attachment and Borderline Personality Disorder. Journal of the American Psychoanalytic Association, 48, 4, 1129–1146. Fonagy, P., G. Gergely, E. L. Jurist & M. Target (2002): Affect Regulation, Mentalization and the Development of the Self. New York, NY: Other Press. Fonagy, P. & M. Target (2008). Attachment, Trauma, and Psychoanalysis. Where Psychoanalysis Meets Neuroscience. In E. L. Jurist, A. Slade & S. Bergner (eds) Mind to Mind. Infant Research, Neuroscience, and Psychoanalysis (pp. 15–49). New York: Other Press. Fonagy, P., M. Target, M. Steele, H. Steele, T. Leigh, A. Levinson & R. Kennedy (1997): Morality, disruptive behavior, borderline personality disorder, crime, and their relationship to security of attachment. In L. Atkinson & K. J. Zucker (eds.) Attachment and psychopatology (pp. 223–274). New York: Guilford.


SOCIOLOGIJA, Vol. LVII (2015), N° 2

Freud, A. (1967). Comments on trauma. In S. Furst (ed.), Psychic Trauma (pp. 235–246). New York: Basic Books. Greenberg, M. T. (1999): Attachment and Psychopathology in Childhood. U: J. Cassidy & P. R. Shaver (ur.) Handbook of Attachment. Theory, Research and Clinical Applications (pp. 469–496). New York & London: The Guilford Press. Hacking, I. (1998). Rewriting the soul: Multiple personality and the sciences of memory. Princeton University Press. Hamburger, A. (in press): Genocidal Trauma. Individual and Social Consequences of the Assault on the Mental and Physical Life of a Group. In: A. Hamburger & D. Laub (eds.), Psychoanalytic Approaches to Social Trauma and Testimony:

Unwanted Memory and Holocaust survivors. London: Routledge. Hesse, E. (1999): Adult Attachment Interview: Historical and Current Perspectives. In J. Cassidy & P. R. Shaver (eds.) Handbook of Attachment. Theory, Research and Clinical Applications (pp. 395–433). New York & London: The Guilford Press. Issroff, J. (2005). Donald Winnicott and John Bowlby: Personal and Professional Perspectives. London: Karnac Books. Levine, H. (2014). Psychoanalysis and trauma. Psychoanalytic Inquiry, 34:214–224. Lewis, B. (2006): Moving Beyond Prozak, DSM, and the New Psychiatry. The Birth of Postpsychiatry. Ann Arbor, MI: The University of Michigan Press. Lieb, R., Mayfield, J., Miller, M., & Pennucci, A. (2004). Benefits and costs of prevention and early intervention programs for youth (No. 04–07, p. 3901). Olympia, WA: Washington State Institute for Public Policy. Lieberman, A. F., Padrón, E., Van Horn, P., & Harris, W. W. (2005). Angels in the nursery: The intergenerational transmission of benevolent parental influences. Infant mental health journal, 26(6), 504–520. Lieberman, A. F., & Van Horn, P. (2011). Psychotherapy with infants and young children: Repairing the effects of stress and trauma on early attachment. Guilford Press. Liotti, G. (2004). Trauma, dissociation, and disorganized attachment: Three strands of a single braid. Psychotherapy: Theory, research, practice, training, 41(4), 472. Lyons-Ruth, K. & Jacobvitz, D. (1999). Attachment Disorganization: Unresolved Loss, Relational Violence, and Lapses in Behavioral and Attentional Strategies. In J. Cassidy & P. R. Shaver (eds.) Handbook of Attachment. Theory, Research and Clinical Applications (pp. 520–554). New York & London: The Guilford Press. Makari, G. (2008). Revolution in mind: The creation of psychoanalysis. New York:

HarperCollins. Masson, J. (ed.) (1985). The Complete Letters of Sigmund Freud to Wilhelm Fliess, 1887–1904. Cambridge, Mass.: Harvard University Press. Masson, J. (1992). The assault on truth: Freud and child sexual abuse. London:


Aleksandar Dimitrijevic: Trauma as a neglected etiological factor of mental disorders


Milojević, S. & Dimitrijević, A. (2012). Socioemocionalni model maloletničke delinkvencije. Engrami, 34 (4), 71–85. Milojević, S. & Dimitrijević, A. (2014). Empathic capacity in convicted delinquent minors. Psihologija, 47(1), 65–79. DOI: 10.2298/PSI1401065M. Osofsky, J. D. (Ed.). (2011). Clinical work with traumatized young children. Guilford Press. Paying later: High cost of failing to invest in young children. 2011. Pew Issue Brief. Putnam, K. T., Harris, W. W., & Putnam, F. W. (2013). Synergistic childhood adversities and complex adult psychopathology. Journal of traumatic stress, 26(4), 435–442. Putnam, K. T., Harris, W. W., & Putnam, F. W., Lieberman, A., & Amaya-Jackson, L. (2015). Oportunities to change the outcomes of traumatized children. Downloaded from Read, J., Mosher, L. R., & Bentall, R. P. (Eds.) (2004). Models of madness:

Psychological, social and biological approaches to schizophrenia. Psychology Press. Ross, C. A. (1996). History, Phenomenology, and Epidemiology of Dissociation. In L. K. Michelson & W. J. Ray (eds.) Handbook of Dissociation. Theoretical, Empirical, and Clinical Perspectives (pp. 3–24). New York – London: Plenum Press. Solomon J. & C. George (1999). The Measurement of Attachment Security in Infancy. In J. Cassidy & P. R. Shaver (eds.) Handbook of Attachment. Theory, Research and Clinical Applications (pp. 287–316). New York & London: The Guilford Press. The Perryman Group. (2014). Suffer the Little Children: An Assessment of the Economic costs of Child Maltreatment. reports/child-abuse-study/ US Department of Health and Human Services. (2014). Child Maltreatment 2012. Washington, DC: US Department of Health and Human Services. Van Ijzendoorn, M. H. & M. J. Bakermans-Kranenburg (1997). Intergenerational Transmission of Attachment: A Move to the Contextual Level. In L. Atkinson & K. J. Zucker (eds.) Attachment and Psychopathology (pp. 135–170). New York & London: The Guilford Press. Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States:

results from the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 629–640. Winnicott, D. W. (1975). Primary Maternal Preocupation. In Through Paediatrics to Psycho-Analysis (pp. 300–305). London: Hogarth Press & Institute of Psychoanalysis.