Each student will write a critique paper related to a topic covered in the text. Using a critical thinking analysis and supporting evidence, you will either support or refute the arguments made by the...

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Each student will write a critique paper related to a topic covered in the text. Using a critical thinking analysis and supporting evidence, you will either support or refute the arguments made by the author of one or more articles. You are required to use outside empirical research to support your position, as well as other relevant evidence. Use only what I provided to write the paper on.


Tonic immobility during sexual assault – a common reaction predicting post‐traumatic stress disorder and severe depression AOGS ORIGINAL RESEARCH ARTICLE Tonic immobility during sexual assault – a common reaction predicting post-traumatic stress disorder and severe depression ANNA M€OLLER , HANS PETER S€ONDERGAARD & LOTTI HELSTR€OM Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden Key words Depression, peritraumatic reactions, post- traumatic stress disorder, rape, sexual assault, Tonic Immobility Scale Correspondence Anna M€oller, Stockholm South General Hospital, Department of Obstetrics and Gynecology, Sjukhusbacken 10, 118 83 Stockholm, Sweden. E-mail: [email protected] Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article. Please cite this article as: M€oller A, S€ondergaard HP, Helstr€om L. Tonic immobility during sexual assault – a common reaction predicting post-traumatic stress disorder and severe depression. Acta Obstet Gynecol Scand 2017; 96:932–938. Received: 30 August 2016 Accepted: 21 May 2017 DOI: 10.1111/aogs.13174 Abstract Introduction. Active resistance is considered to be the ‘normal’ reaction during rape. However, studies have indicated that similar to animals, humans exposed to extreme threat may react with a state of involuntary, temporary motor inhibition known as tonic immobility. The aim of the present study was to assess the occurrence of tonic immobility during rape and subsequent post- traumatic stress disorder and severe depression. Material and methods. Tonic immobility at the time of the assault was assessed using the Tonic Immobility Scale in 298 women who had visited the Emergency clinic for raped women within 1 month of a sexual assault. Information about the assault and the victim characteristics were taken from the structured clinical data files. After 6 months, 189 women were assessed regarding the development of post- traumatic stress disorder and depression. Results. Of the 298 women, 70% reported significant tonic immobility and 48% reported extreme tonic immobility during the assault. Tonic immobility was associated with the development of post-traumatic stress disorder (OR 2.75; 95% CI 1.50–5.03, p = 0.001) and severe depression (OR 3.42; 95% CI 1.51–7.72, p = 0.003) at 6 months. Further, previous trauma history (OR 2.36; 95% CI 1.48–3.77, p < 0.001)="" and="" psychiatric="" treatment="" history="" (or="" 2.00;="" 95%="" ci="" 1.26–3.19,="" p="0.003)" were="" associated="" with="" the="" tonic="" immobility="" response.="" conclusions.="" tonic="" immobility="" during="" rape="" is="" a="" common="" reaction="" associated="" with="" subsequent="" post-traumatic="" stress="" disorder="" and="" severe="" depression.="" knowledge="" of="" this="" reaction="" in="" sexual="" assault="" victims="" is="" important="" in="" legal="" matters="" and="" for="" healthcare="" follow="" up.="" abbreviations:="" asd,="" acute="" stress="" disorder;="" bdi,="" beck="" depression="" index;="" dsm-="" iv,="" diagnostic="" and="" statistical="" manual="" of="" mental="" disorders,="" 4th="" edition;="" or,="" odds="" ratio;="" pds,="" post-traumatic="" stress="" diagnostic="" scale;="" ptsd,="" post-traumatic="" stress="" disorder;="" sasrq,="" stanford="" acute="" stress="" reaction="" questionnaire;="" scid-i,="" structured="" clinical="" interview="" for="" dsm-iv;="" ti,="" tonic="" immobility;="" tis,="" tonic="" immobility="" scale.="" introduction="" tonic="" immobility="" (ti)="" in="" animals="" has="" been="" considered="" an="" evolutionary="" adaptive="" defensive="" reaction="" to="" a="" predatory="" attack="" when="" resistance="" is="" not="" possible="" and="" other="" resources="" are="" unavailable="" (1).="" far="" less="" is="" known="" about="" ti="" in="" humans.="" the="" legal="" system="" seeks="" visible="" signs="" of="" resistance="" because="" when="" it="" is="" absent,="" it="" is="" more="" difficult="" to="" prove="" a="" sexual="" assault="" (2).="" however,="" a="" substantial="" number="" of="" vic-="" tims="" do="" not="" resist="" the="" attacker="" in="" any="" way="" (3).="" in="" humans,="" ti="" has="" been="" described="" as="" an="" involuntary,="" temporary="" state="" of="" motor="" inhibition="" in="" response="" to="" situations="" involving="" intense="" fear.="" it="" has="" been="" further="" described="" as="" a="" catatonic-="" ª="" 2017="" nordic="" federation="" of="" societies="" of="" obstetrics="" and="" gynecology,="" acta="" obstetricia="" et="" gynecologica="" scandinavica="" 96="" (2017)="" 932–938932="" http://orcid.org/0000-0002-4097-6169="" http://orcid.org/0000-0002-4097-6169="" http://orcid.org/0000-0002-4097-6169="" info:doi/10.1111/aogs.13174="" info:doi/10.1111/aogs.13174="" like="" state="" with="" muscle="" hyper-="" or="" hypo-tonicity,="" tremor,="" lack="" of="" vocalization,="" analgesia="" and="" relative="" unresponsive-="" ness="" to="" external="" stimuli.="" most="" studies="" on="" ti="" in="" humans="" have="" focused="" on="" sexual="" assault="" victims.="" this="" is="" probably="" because="" there="" is="" a="" postulated="" similarity="" between="" sexual="" assaults="" and="" predatory="" encounters="" (1).="" sexual="" assault="" has="" also="" been="" described="" as="" one="" of="" the="" most="" traumatic="" experi-="" ences="" a="" person="" can="" be="" exposed="" to="" (4),="" and="" studies="" have="" shown="" that="" ti="" scores="" are="" significantly="" higher="" in="" victims="" of="" sexual="" abuse="" compared="" with="" other="" types="" of="" trauma="" (5).="" in="" these="" studies,="" significant="" immobility="" has="" been="" reported="" in="" 37%="" (6),="" 42%="" (7),="" and="" 52%="" of="" the="" sexual="" assault="" victims="" (8).="" along="" with="" other="" peritraumatic="" stress="" reactions,="" ti="" has="" been="" associated="" with="" the="" development="" of="" post-traumatic="" stress="" disorder="" (ptsd)="" (9–11).="" lima="" and="" colleagues="" (10)="" showed="" that="" among="" victims="" of="" violence,="" ti="" predicted="" the="" severity="" of="" post-traumatic="" stress="" symptoms,="" as="" well="" as="" a="" poor="" response="" to="" treatment.="" further,="" bovin="" and="" collegues="" (12)="" suggested="" that="" ti="" could="" be="" one="" path="" through="" which="" victims="" develop="" ptsd.="" volchan="" and="" collegues="" (13)="" sug-="" gested="" that="" patients="" with="" ptsd="" were="" more="" likely="" to="" expe-="" rience="" ti="" during="" subsequent="" stress.="" however,="" most="" studies="" on="" ti="" in="" humans="" have="" been="" ret-="" rospective="" (7–12,14).="" further,="" earlier="" studies="" have="" been="" based="" on="" small="" sample="" sizes,="" making="" assumptions="" on="" cau-="" sal="" relationships="" hazardous.="" in="" the="" present="" study,="" we="" wanted="" to="" assess="" ti="" during="" rape="" in="" a="" large="" group="" of="" sexual="" assault="" victims="" at="" a="" follow-="" up="" appointment="" shortly="" after="" the="" emergency="" visit.="" we="" hypothesized="" that="" in="" screening="" a="" large="" clinical="" sample="" shortly="" after="" an="" assault,="" the="" experience="" of="" ti="" would="" be="" even="" greater="" than="" what="" has="" been="" found="" in="" earlier="" studies="" because="" it="" would="" reduce="" the="" possibility="" of="" a="" recall="" bias.="" additionally,="" we="" wanted="" to="" explore="" the="" association="" between="" ti="" and="" the="" development="" of="" ptsd.="" in="" an="" earlier="" study="" (15)="" we="" found="" that="" the="" major="" risk="" factors="" for="" ptsd="" included="" having="" been="" sexually="" assaulted="" by="" a="" group,="" suf-="" fering="" from="" acute="" stress="" disorder="" (asd)="" shortly="" after="" the="" assault,="" having="" been="" subjected="" to="" several="" acts="" during="" the="" assault,="" having="" been="" injured="" and="" having="" a="" history="" of="" ear-="" lier="" traumatization.="" therefore,="" we="" hypothesized="" that="" ti="" increases="" the="" risk="" of="" ptsd="" development,="" even="" after="" adjusting="" for="" these="" other="" known="" risk="" factors.="" material="" and="" methods="" the="" study="" was="" performed="" at="" the="" emergency="" clinic="" for="" raped="" women="" in="" stockholm,="" sweden.="" in="" stockholm="" all="" sexual="" assault="" victim="" care="" is="" centralized="" to="" this="" unit="" and="" the="" clinic="" is="" open="" 24="" h="" a="" day.="" the="" clinic="" offers="" medical="" and="" forensic="" examination="" within="" 1="" month="" of="" the="" sexual="" assault="" and="" services="" approximately="" 600="" patients="" per="" year="" after="" rape.="" all="" services="" are="" free="" of="" charge="" and="" independent="" of="" police="" reporting.="" at="" the="" time="" of="" the="" study,="" the="" clinic="" saw="" only="" female="" patients.="" at="" a="" medical="" check-up="" appointment,="" approximately="" 10–14="" days="" after="" the="" acute="" visit,="" all="" eligible="" women="" were="" asked="" to="" participate="" in="" the="" study.="" women="" were="" found="" eli-="" gible="" if="" they="" were="" over="" the="" age="" of="" 18="" years="" and="" were="" liter-="" ate="" in="" swedish.="" in="" addition,="" the="" consenting="" women="" needed="" to="" be="" able="" to="" participate="" in="" an="" interview="" that="" assessed="" ptsd="" symptoms="" and="" complete="" self-report="" ques-="" tionnaires="" about="" their="" mental="" health.="" the="" participants="" were="" informed="" of="" the="" research="" procedure="" and="" risks,="" and="" they="" signed="" written="" consent.="" of="" 1047="" eligible="" women,="" 317="" female="" victims="" of="" rape="" or="" attempted="" rape,="" who="" had="" been="" in="" contact="" with="" the="" clinic="" between="" february="" 2009="" and="" december="" 2011,="" agreed="" to="" participate="" in="" the="" study.="" of="" these,="" 298="" women="" completed="" the="" assessment="" regarding="" ti="" and="" 63%="" of="" the="" post-trau-="" matic="" came="" back="" for="" the="" 6-month="" visit,="" leading="" to="" a="" final="" sample="" of="" 189="" women="" who="" were="" also="" assessed="" for="" the="" pos-="" sible="" development="" of="" ptsd="" (15).="" consenting="" women="" completed="" four="" self-rating="" questionnaires:="" tonic="" immobil-="" ity="" scale="" (tis),="" beck="" depression="" index="" (bdi),="" post-traumatic="" stress="" diagnostic="" scale="" (pds),="" and="" stan-="" ford="" acute="" stress="" reaction="" questionnaire="" (sasrq).="" infor-="" mation="" on="" any="" history="" of="" earlier="" sexual="" assaults,="" sexual="" assault="" in="" childhood,="" and="" the="" number="" of="" other="" earlier="" traumas="" were="" taken="" from="" the="" pds="" questionnaire.="" infor-="" mation="" regarding="" victim="" and="" assault="" characteristics="" were="" taken="" from="" the="" clinic’s="" structured="" data="" files.="" six="" months="" after="" the="" rape,="" study="" participants="" were="" assessed="" regarding="" ptsd="" using="" the="" structured="" clinical="" interview="" for="" diag-="" nostic="" and="" statistical="" manual="" of="" mental="" disorders,="" 4th="" edition="" (dsm-iv;="" scid-i),="" and="" they="" completed="" two="" of="" the="" self-rating="" questionnaires="" (bdi,="" sasrq).="" measures="" the="" tonic="" immobility="" scale-adult="" form="" (tis-a;="" 16),="" part="" 1,="" is="" a="" 12-item="" questionnaire="" designed="" to="" assess="" the="" core="" features="" and="" components="" of="" ti.="" a="" swedish="" version="" of="" the="" scale="" was="" used="" that="" had="" been="" translated="" using="" forward="" key="" message="" tonic="" immobility="" during="" rape="" is="" a="" common="" reaction,="" yet="" overlooked.="" in="" sexual="" assault="" victims,="" tonic="" immo-="" bility="" is="" associated="" with="" an="" increased="" risk="" of="" subse-="" quent="" post-traumatic="" stress="" disorder="" and="" severe="" depression.="" tonic="" immobility="" should="" be="" assessed="" in="" all="" sexual="" assault="" victims.="" ª="" 2017="" nordic="" federation="" of="" societies="" of="" obstetrics="" and="" gynecology,="" acta="" obstetricia="" et="" gynecologica="" scandinavica="" 96="" (2017)="" 932–938="" 933="" a.="" m€oller="" et="" al.="" tonic="" immobility="" during="" rape="" 16000412,="" 2017,="" 8,="" d="" ow="" nloaded="" from="" https://obgyn.onlinelibrary.w="" iley.com="" doi/10.1111/aogs.13174,="" w="" iley="" o="" nline="" l="" ibrary="" on="" [25/05/2023].="" see="" the="" t="" erm="" s="" and="" c="" onditions="" (https://onlinelibrary.w="" iley.com="" term="" s-and-conditions)="" on="" w="" iley="" o="" nline="" l="" ibrary="" for="" rules="" of="" use;="" o="" a="" articles="" are="" governed="" by="" the="" applicable="" c="" reative="" c="" om="" m="" ons="" l="" icense="" translation="" and="" then="" back-translated="" by="" an="" independent="" translator="" for="" control.="" the="" first="" 10="" questions="" are="" answered="" using="" a="" seven-point="" likert="" scale="" (range="" 0–6).="" to="" obtain="" the="" total="" score,="" the="" item="" scores="" are="" summed="" (table="" 1).="" higher="" scores="" in="" response="" to="" items="" 1–10="" reflect="" greater="" ti="" behaviors.="" the="" tis-a="" consists="" of="" two="" subscales:="" tti="" (seven="" items)="" and="" fear="" (three="" items)="" (7).="" the="" ti="" scale="" includes="" questions="" that="" assess="" various="" aspects="" of="" ti,="" such="" as="" feeling="" frozen="" or="" paralyzed,="" the="" inability="" to="" move="" although="" not="" restrained,="" the="" inability="" to="" call="" out="" or="" scream,="" numbness,="" feeling="" cold,="" fearing="" for="" one’s="" life,="" and="" feeling="" detached="" from="" self="" (scores="" 0–42).="" the="" fear="" sub-="" scale="" includes="" items="" that="" assess="" fear/panic,="" trembling/shak-="" ing="" and="" feelings="" of="" detachment="" from="" surroundings="" (scores="" 0–18).="" using="" the="" same="" cut-off="" scores="" as="" earlier="" studies="" (7,8),="" a="" total="" score=""> 21 represented a significant TI and a total score ≥ 28 represented extreme TI. Symptoms of fear were considered clinically significant when a respon- der’s total score on the Fear subscale was ≥ 9. In the pre- sent study the Cronbach’s a was 0.87 for the whole questionnaire, 0.81 for the TI factor, and 0.62 for the fear factor. The Beck Depression Inventory, BDI-II (17), includes 21 questions that measure depressive symptoms. The cut-off points for the sum scores were 0–13 (no depression), 14– 19 (mild depression), 20–28 (moderate depression), and ≥ 29 (severe depression). Cronbach’s a was 0.90. The Post-traumatic Stress Diagnostic Scale, PDS (18) was used at baseline to assess the PTSD symptom score (0–51), a probable pre-existing PTSD diagnosis (using the DSM-IV criteria) and lifetime experience of traumatic events. PTSD was diagnosed at baseline when the respondent in PDS part 1 reported having been exposed to or witnessing a traumatic event that, according to PDS part 2, involved a threat to life or physical integrity; according to PDS part 3, having at least one re-experien- cing symptom, at least three avoidance symptoms, and at least two arousal symptoms; that symptoms lasted for over 1 month; and according to PDS part 4, also caused impairment in the respondents’ daily life in at least one area. Cronbach’s a was 0.85. The Stanford Acute Stress Reaction Questionnaire, SASRQ (19), was used at baseline and at the 6-month visit. The SASRQ is a 30-item self-report instrument with three addi- tional questions relevant to the diagnosis of ASD. The instrument can be used as a Likert scale (0–5), where higher scores reflect greater symptoms, or dichotomously (0–2: 0, 3–5: 1), where 0 means absence and 1 means presence of a symptom. According to the DSM-IV, a diagnosis of ASD requires at least three of the five types of dissociative symp- toms, one re-experiencing symptom, one avoidance symp- tom, one marked anxiety/increased arousal symptom, and impairment in at least one important area of functioning. We also used the SASRQ total score to measure the self- reported PTSD symptom severity over time. Cronbach’s a was 0.90 for the whole questionnaire, which was good, and was 0.87 for the dissociation part. The PTSD Module of the Structured Clinical Interview for DSM-IV (SCID-I) was used to establish current PTSD 6 months post-rape (20). The SCID-I is a widely used structured clinical interview. A diagnosis of full PTSD was made using the DSM-IV-TR (i.e. when clusters A and F were fulfilled). Statistical analyses Because most data were not normally distributed, com- parisons between groups (TI vs. without TI) were per- formed using Mann–Whitney U test for continuous variables (age, dissociation score, depression symptom score, and PTSD symptoms score). Chi-square tests were used for categorical/dichotomized variables (marital sta- tus, relationship to assailant, earlier trauma, psychiatric treatment history, pre-existing PTSD, and assault charac- teristics). Risk factors for PTSD at 6 months were assessed as categorical variables using logistic regression. Variables were considered significant if the Wald test resulted in a p-value < 0.05. all statistical analyses were conducted using the statistical software version spss 22.0 (ibm corp., armonk, ny, usa). ethical approval the study was approved by the regional medical ethics committee in stockholm (2008/759-31). table 1. tonic immobility scale, items used to compute the total score. rate the degree to which you/your: mean sd (1) froze or felt paralyzed during your most recent experience. 3.99 2.12 (2) were unable to move even though not restrained. 3.67 2.17 (3) body was trembling/shaking during the event. 3 0.05.="" all="" statistical="" analyses="" were="" conducted="" using="" the="" statistical="" software="" version="" spss="" 22.0="" (ibm="" corp.,="" armonk,="" ny,="" usa).="" ethical="" approval="" the="" study="" was="" approved="" by="" the="" regional="" medical="" ethics="" committee="" in="" stockholm="" (2008/759-31).="" table="" 1.="" tonic="" immobility="" scale,="" items="" used="" to="" compute="" the="" total="" score.="" rate="" the="" degree="" to="" which="" you/your:="" mean="" sd="" (1)="" froze="" or="" felt="" paralyzed="" during="" your="" most="" recent="" experience.="" 3.99="" 2.12="" (2)="" were="" unable="" to="" move="" even="" though="" not="" restrained.="" 3.67="" 2.17="" (3)="" body="" was="" trembling/shaking="" during="" the="" event.="">
Answered 2 days AfterMay 26, 2023

Answer To: Each student will write a critique paper related to a topic covered in the text. Using a critical...

Bidusha answered on May 28 2023
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Critical Thinking Analysis        2
CRITICAL THINKING ANALYSIS
Table of Contents
Analysis    3
References    6
Analysis
Animals' tonic immobility (TI), which occurs when resistance to a predatory
assault is impossible and alternative resources are not accessible, has been considered an evolutionarily adaptive protective response. Much little is understood about TI in individuals. The legal system looks for outward indications of resistance since laying out a sexual assault in the absence of such evidence is seriously difficult (Möller, Söndergaard & Helström, 2017). Be that as it may, a sizable portion of victims give little resistance to the assailant. In humans, TI has been characterized as a wild, transient condition of engine inhibition in reaction to profoundly stressful events. A catatonic-like condition with hyper-or hypotonicity of the muscles, quake, absence of vocalization, analgesia, and relative insensitivity to outside stimuli have also been recorded (Möller, Söndergaard & Helström, 2017). Most of human studies on TI have been on sexual assault victims. This is most reasonable a result of the suggested similarities between sexual assaults and predatory contacts. Quite possibly of the most traumatic occasion a person might have is sexual assault, and research has shown that victims of sexual abuse have a lot higher TI ratings than those who have encountered different forms of trauma. In these investigations, 37%, 42%, and 52% of sexual assault victims were viewed as significantly immobile (Rubin & Bell, 2023).
One essential diagnostic requirement for PTSD is the capacity to remember the distressing occurrence. Because consciousness is continued during TI, it could gain traumatic experiences more distinctive and make it easier to review peritraumatic details, which would raise the severity of PTSD symptoms (Coimbra et al., 2023). It's interesting to take note of that...
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