The Relationship Between Peritraumatic Distress and Peritraumatic Dissociation

McGill University, Douglas Hospital Research Center, Montreal, Quebec, Canada.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 12/2006; 194(11):853-8. DOI: 10.1097/01.nmd.0000244563.22864.f1
Source: PubMed


This study examined whether peritraumatic dissociation serves to protect trauma-exposed individuals from experiencing high levels of peritraumatic distress or is an epiphenomenon of high levels of peritraumatic distress. The sample was comprised of 709 police officers and 317 peer-nominated civilians exposed to a variety of critical incidents. Participants filled out measures of trauma exposure, traumatic stress, peritraumatic distress, and peritraumatic dissociation. There was an overall moderate-to-strong linear relationship between peritraumatic distress and dissociation. Among those with high levels of dissociation, very few reported low levels of distress. Among those with high levels of distress, a significant number--but not all--reported high levels of dissociation. Our results do not provide support for the idea that dissociation protects individuals from experiencing high levels of distress at the time of the trauma but rather suggest that dissociation is an epiphenomenon of high levels of distress observed in a subset of individuals.

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Available from: Alain Brunet, Apr 01, 2015
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    • "Peritraumatic stress reactions refer to the different stress-associated behavioral, emotional, cognitive, and physiological symptoms during and immediately following a traumatic event (e.g., fear of dying, fear of losing emotional control, tachycardia, sweating, shaking, dizziness, dissociative symptoms, reduction of awareness, etc.). These reactions have demonstrated a strong and consistent association with the subsequent development of posttraumatic stress symptoms [7-18]. The degree of the peritraumatic adrenergic hyperactivation following a stressful or traumatic event is related to different patterns of physiological response [19], subjective experience of injury and trauma-related fears [11,20], resilience and coping mechanisms [21], poor military training outcomes [22,23], as well as symptomatic outcomes in trauma sequelae [21,24]. "
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    ABSTRACT: Background Posttraumatic stress disorder (PTSD) is one of the most commonly observed stress-related conditions following combat exposure and its effective prevention is a high health-care priority. Reports of peritraumatic reactions have been shown to be highly associated with PTSD among combat exposed service members. However, existing instruments measuring peritraumatic symptoms were not specifically developed to assess combat-related peritraumatic stress and each demonstrates a different peritraumatic focus. We therefore developed the Peritraumatic Behavior Questionnaire (PBQ), a new military-specific rating scale focused upon the wide range of symptoms suggestive of combat-related peritraumatic distress in actively deployed Service Members. This study describes the development of the PBQ and reports on the psychometric properties of its self-rated version (PBQ-SR). Methods 688 Marine infantry service members were retrospectively assessed by the PBQ-SR within the scope of the Marine Resiliency Study after their deployment to war zone. Participants have been additionally assessed by a variety of questionnaires, as well as clinical interviews both pre and post-deployment. Results The PBQ-SR demonstrated satisfactory internal consistency, convergent and discriminant validity, as well as high correlation with trait dissociation prior to deployment. Component analysis suggested a latent bi-dimensional structure separating a peritraumatic emotional distress and physical awareness factor. The PBQ-SR total score showed high correlation to general anxiety, depression, poorer general health and posttraumatic symptoms after deployment and remained a significant predictor of PTSD severity, after controlling for those measures. The suggested screening cut-off score of 12 points demonstrated satisfactory predictive power. Conclusions This study confirms the ability of the PBQ-SR to unify the underlying peritraumatic symptom dimensions and reliably assess combat-related peritraumatic reaction as a general construct. The PBQ-SR demonstrated promise as a potential standard screening measure in military clinical practice, while It’s predictive power should be established in prospective studies.
    BMC Psychiatry 01/2013; 13(1):9. DOI:10.1186/1471-244X-13-9 · 2.21 Impact Factor
    • "endorsed high levels of distress during the trauma (Fikretoglu et al., 2006). Elevated dissociative symptoms have also been found in those who go on to develop posttraumatic stress disorder (PTSD) after a trauma (Bremner et al., 1992). "
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    ABSTRACT: Recent research has investigated peritraumatic and persistent dissociation as a possible predictive factor for posttraumatic stress disorder (PTSD). The current study aimed to add to this literature by examining dissociative responses in female assault survivors (N = 92 at initial assessment; n = 62 at follow-up). Dissociative symptoms experienced at 3 time points were assessed: peritraumatic dissociation (PD), persistent dissociation-initial (M = 28.2 days posttrauma) and follow-up (M = 224.9 days posttrauma), as well as initial and follow-up PTSD symptoms. We hypothesized that PD and persistent dissociative symptoms would predict chronic PTSD symptoms at the follow-up assessment with initial PTSD symptoms and assault type in the model. Hierarchical regression resulted in a significant model predicting 39% of the variance in follow-up PTSD symptom scores (p < .001). Both peritraumatic and follow-up persistent dissociative symptoms significantly and uniquely added to the variance explained in follow-up PTSD symptom score contributing 4% (p = .05) and 8% (p = .008) of the variance, respectively. Results support the predictive value of peritraumatic and persistent dissociative symptoms, and the findings suggest that persistent dissociation may contribute to the development and continuation of PTSD symptoms. We discuss the implications for assessment and possible treatment of PTSD as well as future directions.
    Journal of Traumatic Stress 08/2012; 25(4):401-7. DOI:10.1002/jts.21725 · 2.72 Impact Factor
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    • "DOI: 10.1002/jts.21716 peritraumatic dissociation usually occurs in the context of high distress, recent notions state that peritraumatic dissociation may be a by-product of high arousal (Fikretoglu et al., 2006). "
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    ABSTRACT: Empirical data have challenged the unidimensionality of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), a widely used measure for peritraumatic dissociation. The aim of this study was to assess the factor structure of the PDEQ in 3 trauma-exposed samples: (a) trauma-exposed police officers (N = 219); (b) trauma-exposed civilians (N = 158); and (c) treatment-seeking trauma-exposed civilians (N = 185). Confirmatory factor analyses using measurement invariance testing supported a 2-factor structure (CFIs .96-.98; RMSEAs .07-.09), but excluded 2 of the original items. Factor 1 was termed Altered Awareness; Factor 2 was termed Derealization. Altered Awareness reflected disturbances in information processing during the traumatic event, whereas Derealization reflected distortions in perception. Hierarchical linear regression analysis showed that Derealization predicted posttraumatic stress severity at 26.5 weeks follow-up only in the sample of police officers (R(2) = .45). Future longitudinal research shortly following trauma is required to elucidate causality and underlying mechanisms of peritraumatic dissociation, which may contribute to the development of more accurate screening strategies, as well as more effective strategies for prevention and early intervention.
    Journal of Traumatic Stress 08/2012; 25(4):475-9. DOI:10.1002/jts.21716 · 2.72 Impact Factor
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