Evidence for a Dissociative Subtype of Post-Traumatic Stress Disorder Among Help-Seeking Childhood Sexual Abuse Survivors

Bob Shappel School of Social Work, Tel-Aviv, 69978, Israel.
Journal of Trauma & Dissociation (Impact Factor: 1.72). 02/2006; 7(2):7-27. DOI: 10.1300/J229v07n02_02
Source: PubMed


This study examined evidence for a dissociative subtype of post-traumatic stress disorder (PTSD) among women seeking psychotherapy for childhood sexual abuse (CSA). One hundred and twenty-two women seeking treatment for CSA completed a battery of questionnaires assessing PTSD, dissociative symptoms, and child maltreatment. Using signal detection analysis, we identified high and low dissociation PTSD subgroups. A constellation of three PTSD symptoms-hypervigilance, sense of foreshortened future, and sleep difficulties-discriminated between these two subgroups (OR = 8.15). Further evidence was provided by the finding of a nonlinear relationship between severity of childhood maltreatment and dissociation in the women with PTSD. These results provide support for a dissociative subtype of PTSD that may stem from more severe childhood experiences of neglect and abuse.

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Available from: Lisa Butler, Oct 06, 2015
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    • "The DSM-5 accepted a dissociative subtype of PTSD [8]. This subtype is associated with childhood adversities alongside the traumatic event(s) in adulthood leading to the main diagnosis [60] [61] [62]. The dissociative subtype of PTSD may overlap partly with Complex PTSD both in terms of descriptive features and due to its relationship to chronic traumatization [63]. "
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    ABSTRACT: Objective: This study sought to determine the trauma-related psychiatric comorbidity of somatization disorder among women who applied to an outpatient psychiatric unit of a general hospital in eastern Turkey. Methods: Forty women with somatization disorder and 40 non-clinical controls recruited from the same geographic region participated in the study. Somatization disorder and posttraumatic stress disorder (PTSD) sections of the Structured Clinical Interview for DSM-IV (including its criterion A traumatic events checklist), Dissociative Disorders Interview Schedule, Dissociative Experiences Scale (Taxon), Hamilton Depression Rating Scale, and Childhood Abuse and Neglect Questionnaire were administered to all participants. Results: A significant proportion of the women with somatization disorder had the concurrent diagnoses of major depression, PTSD, dissociative disorder, and borderline personality disorder. Women with somatization disorder reported traumatic experiences of childhood and/or adulthood more frequently than the comparison group. A significant proportion of these patients reported possession and/or paranormal experiences. Binary logistic regression analysis demonstrated that current major depression, being married, total number of traumatic events in adulthood, and reports of possession and/or paranormal experiences were independent risk factors for somatization disorder diagnosis. Conclusions: Among women with endemically high exposition to traumatic stress, multiple somatic complaints were in a significant relationship with major depressive disorder and lifelong cumulative traumatization. While accompanying experiences of possession and paranormal phenomena may lead to seeking help by paramedical healers, the challenge of differential diagnosis may also limit effective service to this group of somatizing women with traumatic antecedents and related psychiatric comorbidities.
    Comprehensive Psychiatry 08/2014; 55(8):1837-1846. DOI:10.1016/j.comppsych.2014.08.052 · 2.25 Impact Factor
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    • "Empirical findings motivated Ginzburg et al. (2006) "
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    ABSTRACT: Abstract The DSM-5 formally recognizes a dissociative subtype of PTSD ('PTSD with dissociative symptoms'). This nomenclative move will boost empirical and theoretical efforts to further understand the links between dissociation, trauma and PTSD. This paper examines the empirical literature showing that patients with PTSD can be divided into two different groups based on their neurobiology, psychological symptom profile, history of exposure to early relational trauma and depersonalization/derealization symptoms. It then explores the conceptual and empirical challenges of conceiving one of these types as reflecting a 'dissociative' type of PTSD. First, this classification is based on the presence of a limited subset of dissociative symptoms (i.e., depersonalization, derealization). This sets aside an array of positive and negative psychoform and somatoform dissociative symptoms that may be related to PTSD. Second, empirical evidence suggests heightened dissociation in PTSD compared to many other disorders, indicating that dissociation is relevant to PTSD more broadly, rather than simply to the so-called dissociative subtype. This paper sets out important issues to be examined in the future study of dissociation in PTSD, which need to be informed by solid conceptual understandings of dissociation. [184 words].
    Journal of Trauma & Dissociation 07/2014; 16(1). DOI:10.1080/15299732.2014.908806 · 1.72 Impact Factor
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    • "Peritraumatic and persistent dissociative experiences have been shown to be correlated at .25 (Tichenor, Marmar, Weiss, Metzler, and Ronfeldt, 1996 ), and therefore, one must be careful when generalizing findings based on studies of peritraumatic dissociation to matters of persistent dissociation. The DSM-5 dissociative PTSD subtype was proposed and has subsequently been supported based on both clinical and neurobiological evidence (Armour, Karstoft, and Richardson, 2014a, b; Cloitre, Petkova, Wang, and Lassell, 2012 ; Ginzburg, Koopman, Butler, et al., 2006 ; Lanius, Vermetten, Loewenstein, et al., 2010, 2012; Resick, Suvak, Johnides, Mitchell, Iverson, 2012; Spiegel, Loewenstein, Lewis- Fernandez, Sar, Simeon, Vermetten et al., 2011; Steuwe, Lanius, and Frewen, 2012; Wolf, Miller et al., 2012). Researchers initially proposed that the dissociative PTSD subtype be characterized by the presence of only depersonalization and derealization symptoms of dissociation (cf. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) criteria in DSM-5 included a dissociative diagnostic subtype characterized by a depersonalization item and a derealization item. Researchers have queried whether this was too restrictive, as alternative dissociative symptomatology may also be characteristic of the subtype. The current study utilized data from 318 Northern Irish students, of which 165 were trauma exposed. Participants were assessed for PTSD symptomatology based on DSM-5 criteria via a modified version of the PTSD Symptom Scale-Self-Report (PSS-5) and dissociative experiences via the Dissociative Experiences Scale (DES). Confirmatory factor analysis of PTSD and DES models revealed an optimal four-factor DSM-5 PTSD model including reexperiencing, avoidance, negative alterations in mood and cognitions, and alterations in hyperarousal and reactivity factors, and an optimal three-factor DES model including absorption, amnesia, and depersonalization/derealization factors. When comparing the correlations between depersonalization/derealization and the four PTSD factors, significant Wald tests of parameter constraints revealed that depersonalization/derealization is more related to alterations in arousal and reactivity (r = .432) compared to avoidance (r = .289), χ 2 (1, N = 165) = 8.352, p = .004. We discuss whether the mechanism for comorbid PTSD and dissociation may be related to PTSD's arousal factor.
    Psychological Injury and Law 06/2014; 7(2). DOI:10.1007/s12207-014-9196-9
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