title: Early childhood trauma, posttraumatic stress disorder, and non-adherence in persons with AIDS: a psychodynamic perspective.
abstract: Non-adherence to treatment and risk-reduction measures not only leads to increased morbidity and mortality in patients with HIV/AIDS but is also a major public health hazard. While there are multiple determinants of non-adherence, one that is particularly complex and refractory to intervention appears to be the history of childhood trauma and the development of post-traumatic stress disorder (PTSD). While behavioral intervention is occasionally helpful in increasing a patient's commitment to self-care, it is our view that the use of a more psychoanalytic framework, as well as the development of a psychodynamic understanding of the patient's history and struggles, may provide both patient and clinician with a more profound understanding of the forces that perpetuate non-adherence, thus facilitating a more cohesive and empathic approach to treatment. It is the aim of this article to explore, from a psychodynamic perspective, the possible connections between early childhood trauma resulting in PTSD and non-adherence to risk reduction and HIV treatment.
authors.affiliation: Department of Psychiatry, New York University School of Medicine, USA. erin.k.samuels@gmail.com
authors.forename: Erin
authors.initials: E
authors.lastname: Samuels
authors.forename: Sami
authors.initials: S
authors.lastname: Khalife
authors.forename: César A
authors.initials: CA
authors.lastname: Alfonso
authors.forename: Ricardo
authors.initials: R
authors.lastname: Alvarez
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Cohen
mesh_terms: D000328:Adult; D002648:Child; D002649:Child Abuse / Q000523:psychology; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D011247:Pregnancy; D011613:Psychotherapy / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy