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Published in: Social Psychiatry and Psychiatric Epidemiology 8/2014

01-08-2014 | Original Paper

The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD

Authors: Cherie Armour, Karen-Inge Karstoft, J. Don Richardson

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 8/2014

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Abstract

Purpose

A dissociative-posttraumatic stress disorder (PTSD) subtype has been included in the DSM-5. However, it is not yet clear whether certain socio-demographic characteristics or psychological/clinical constructs such as comorbid psychopathology differentiate between severe PTSD and dissociative-PTSD. The current study investigated the existence of a dissociative-PTSD subtype and explored whether a number of trauma and clinical covariates could differentiate between severe PTSD alone and dissociative-PTSD.

Methods

The current study utilized a sample of 432 treatment seeking Canadian military veterans. Participants were assessed with the Clinician Administered PTSD Scale (CAPS) and self-report measures of traumatic life events, depression, and anxiety. CAPS severity scores were created reflecting the sum of the frequency and intensity items from each of the 17 PTSD and 3 dissociation items. The CAPS severity scores were used as indicators in a latent profile analysis (LPA) to investigate the existence of a dissociative-PTSD subtype. Subsequently, several covariates were added to the model to explore differences between severe PTSD alone and dissociative-PTSD.

Results

The LPA identified five classes: one of which constituted a severe PTSD group (30.5 %), and one of which constituted a dissociative-PTSD group (13.7 %). None of the included, demographic, trauma, or clinical covariates were significantly predictive of membership in the dissociative-PTSD group compared to the severe PTSD group.

Conclusions

In conclusion, a significant proportion of individuals report high levels of dissociation alongside their PTSD, which constitutes a dissociative-PTSD subtype. Further investigation is needed to identify which factors may increase or decrease the likelihood of membership in a dissociative-PTSD subtype group compared to a severe PTSD only group.
Literature
2.
go back to reference van der Hart O, van Ochten JM, van Son MJ, Steele K, Lensvelt-Mulders G (2008) Relations among peritraumatic dissociation and posttraumatic stress: a critical review. J Trauma Dissociation 9(4):481–505PubMedCrossRef van der Hart O, van Ochten JM, van Son MJ, Steele K, Lensvelt-Mulders G (2008) Relations among peritraumatic dissociation and posttraumatic stress: a critical review. J Trauma Dissociation 9(4):481–505PubMedCrossRef
4.
go back to reference Layne CM, Warren JS, Watson PJ, Shalev AY (2007) Risk, vulnerabilities, resistance and resilience: towards integrated conceptualization of posttraumatic adaptation. In: Friedman MJ, Keane TM, Watson PA (eds) Handbook of PTSD, science and practice. Guilford Press, New York, pp 497–520 Layne CM, Warren JS, Watson PJ, Shalev AY (2007) Risk, vulnerabilities, resistance and resilience: towards integrated conceptualization of posttraumatic adaptation. In: Friedman MJ, Keane TM, Watson PA (eds) Handbook of PTSD, science and practice. Guilford Press, New York, pp 497–520
6.
go back to reference Waelde LC, Silvern L, Carlson EB, Fairbank JA, Kletter H (2009) Dissociation in PTSD. In: Dell PF, O’Neil JA (eds) Dissociation and the dissociative disorders. Routledge, London Waelde LC, Silvern L, Carlson EB, Fairbank JA, Kletter H (2009) Dissociation in PTSD. In: Dell PF, O’Neil JA (eds) Dissociation and the dissociative disorders. Routledge, London
7.
go back to reference Wolf EJ, Lunney CA, Miller MW, Resick PA, Friedman MJ, Schnurr PP (2012) The dissociative sybtype of PTSD: a replication and extension. Depress Anxiety. doi:10.1002/da.21946 PubMed Wolf EJ, Lunney CA, Miller MW, Resick PA, Friedman MJ, Schnurr PP (2012) The dissociative sybtype of PTSD: a replication and extension. Depress Anxiety. doi:10.​1002/​da.​21946 PubMed
9.
go back to reference Steuwe C, Lanius RA, Frewen PA (2012) Evidence for a dissociative subtype of PTSD by latent profile and confirmatory factor analyses in a civilian sample. Depress Anxiety. doi:10.1002/da.21944 PubMed Steuwe C, Lanius RA, Frewen PA (2012) Evidence for a dissociative subtype of PTSD by latent profile and confirmatory factor analyses in a civilian sample. Depress Anxiety. doi:10.​1002/​da.​21944 PubMed
11.
go back to reference Putnam FW, Carlson EB, Ross CA, Anderson G, Clark P, Torem M, Bowman ES, Coons P, Chu JA, Dill DL, Loewenstein RJ, Braun BG (1996) Patterns of dissociation in clinical and nonclinical samples. J Nerv Ment Dis 184(11):673–679PubMedCrossRef Putnam FW, Carlson EB, Ross CA, Anderson G, Clark P, Torem M, Bowman ES, Coons P, Chu JA, Dill DL, Loewenstein RJ, Braun BG (1996) Patterns of dissociation in clinical and nonclinical samples. J Nerv Ment Dis 184(11):673–679PubMedCrossRef
13.
go back to reference Briere J, Runtz M (1988) Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse Negl 12(1):51–59PubMedCrossRef Briere J, Runtz M (1988) Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse Negl 12(1):51–59PubMedCrossRef
14.
go back to reference Chu JA, Frey LM, Ganzel BL, Matthews JA (1999) Memories of childhood abuse: dissociation, amnesia, and corroboration. Am J Psychiatry 156(5):749–755PubMed Chu JA, Frey LM, Ganzel BL, Matthews JA (1999) Memories of childhood abuse: dissociation, amnesia, and corroboration. Am J Psychiatry 156(5):749–755PubMed
16.
go back to reference Carlson EB, Dalenberg C, McDade-Montez E (2012) Dissociation in posttraumatic stress disorder: part I. Definitions and review of research. Advanced online publication. Psychol Trauma Theory Res Pract Policy 4(5):479–489. doi:10.1037/a0027748 Carlson EB, Dalenberg C, McDade-Montez E (2012) Dissociation in posttraumatic stress disorder: part I. Definitions and review of research. Advanced online publication. Psychol Trauma Theory Res Pract Policy 4(5):479–489. doi:10.​1037/​a0027748
17.
go back to reference Dalenberg C, Carlson EB (2012) Dissociation in posttraumatic stress disorder part II: how theoretical models fit the empirical evidence and recommendations for modifying the diagnostic criteria for PTSD. Psychol Trauma Theory Res Pract Policy 4(6):551–559. doi:10.1037/a0027900 Dalenberg C, Carlson EB (2012) Dissociation in posttraumatic stress disorder part II: how theoretical models fit the empirical evidence and recommendations for modifying the diagnostic criteria for PTSD. Psychol Trauma Theory Res Pract Policy 4(6):551–559. doi:10.​1037/​a0027900
18.
go back to reference Hagenaars JA, McCutcheon AL (eds) (2002) Applied latent class analysis. Cambridge University Press, Cambridge Hagenaars JA, McCutcheon AL (eds) (2002) Applied latent class analysis. Cambridge University Press, Cambridge
19.
go back to reference Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, Keane TM (1995) The development of a Clinician-Administered PTSD Scale. J Trauma Stress 8(1):75–90PubMedCrossRef Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, Keane TM (1995) The development of a Clinician-Administered PTSD Scale. J Trauma Stress 8(1):75–90PubMedCrossRef
21.
go back to reference Weathers FW, Ruscio AM, Keane TM (1999) Psychometric properties of nine scoring rules for the clinician-administered posttraumatic stress disorder scale. Psychol Assessment 11(2):124–133CrossRef Weathers FW, Ruscio AM, Keane TM (1999) Psychometric properties of nine scoring rules for the clinician-administered posttraumatic stress disorder scale. Psychol Assessment 11(2):124–133CrossRef
22.
go back to reference Weathers FW, Keane TM, Davidson JR (2001) Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety 13(3):132–156PubMedCrossRef Weathers FW, Keane TM, Davidson JR (2001) Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety 13(3):132–156PubMedCrossRef
23.
go back to reference Beck AT, Brown G, Epstein N, Steer RA (1988) An inventory for measuring clinical anxiety––psychometric properties. J Consult Clin Psych 56(6):893–897CrossRef Beck AT, Brown G, Epstein N, Steer RA (1988) An inventory for measuring clinical anxiety––psychometric properties. J Consult Clin Psych 56(6):893–897CrossRef
24.
go back to reference Wetherell JL, Arean PA (1997) Psychometric evaluation of the beck anxiety inventory with older medical patients. Psychol Assessment 9(2):136–144CrossRef Wetherell JL, Arean PA (1997) Psychometric evaluation of the beck anxiety inventory with older medical patients. Psychol Assessment 9(2):136–144CrossRef
25.
go back to reference Hamilton M (1967) Development of a rating scale for primary depressive illness. Brit J Soc Clin Psyc 6:278–296CrossRef Hamilton M (1967) Development of a rating scale for primary depressive illness. Brit J Soc Clin Psyc 6:278–296CrossRef
26.
go back to reference Hamilton M (1960) A rating scale for depression. J Neurol Neurosur Ps 23(1):56–62CrossRef Hamilton M (1960) A rating scale for depression. J Neurol Neurosur Ps 23(1):56–62CrossRef
27.
go back to reference Rehm LP, O’Hara MW (1985) Item characteristics of the Hamilton Rating Scale for Depression. J Psychiatr Res 19(1):31–41PubMedCrossRef Rehm LP, O’Hara MW (1985) Item characteristics of the Hamilton Rating Scale for Depression. J Psychiatr Res 19(1):31–41PubMedCrossRef
28.
go back to reference Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG (1975) Quantitative rating of depressive states. Acta Psychiat Scand 51(3):161–170PubMedCrossRef Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG (1975) Quantitative rating of depressive states. Acta Psychiat Scand 51(3):161–170PubMedCrossRef
30.
go back to reference Muthen BO, Muthen LK (2012) Mplus (version 7). Los Angeles, California Muthen BO, Muthen LK (2012) Mplus (version 7). Los Angeles, California
31.
go back to reference Muthen LK, Muthen BO (1998–2012) Mplus user’s guide, 7th edn. Muthén & Muthén, Los Angeles, CA Muthen LK, Muthen BO (1998–2012) Mplus user’s guide, 7th edn. Muthén & Muthén, Los Angeles, CA
32.
go back to reference Lazarsfeld PF, Henry NW (1968) Latent structure analysis. Houghton, New York Lazarsfeld PF, Henry NW (1968) Latent structure analysis. Houghton, New York
33.
go back to reference Ruscio J (2004) A nontechnical introduction to the taxometric methods. Understanding Statistics 3:44CrossRef Ruscio J (2004) A nontechnical introduction to the taxometric methods. Understanding Statistics 3:44CrossRef
37.
go back to reference Schwartz G (1978) Estimating the dimensions of a model. Ann Stat 6:461–464CrossRef Schwartz G (1978) Estimating the dimensions of a model. Ann Stat 6:461–464CrossRef
38.
go back to reference Sclove SL (1987) Application of model-selection criteria to some problems in multivariate-analysis. Psychometrika 52(3):333–343CrossRef Sclove SL (1987) Application of model-selection criteria to some problems in multivariate-analysis. Psychometrika 52(3):333–343CrossRef
39.
go back to reference Lo Y, Mendell NR, Rubin DB (2001) Testing the number of components in a normal mixture. Biometrika 88:767–778CrossRef Lo Y, Mendell NR, Rubin DB (2001) Testing the number of components in a normal mixture. Biometrika 88:767–778CrossRef
40.
go back to reference Ramaswamy V, Desarbo WS, Reibstein DJ, Robinson WT (1993) An empirical pooling approach for estimating marketing mix elasticities with PIMS data. Market Sci 12:103–124CrossRef Ramaswamy V, Desarbo WS, Reibstein DJ, Robinson WT (1993) An empirical pooling approach for estimating marketing mix elasticities with PIMS data. Market Sci 12:103–124CrossRef
41.
go back to reference Ginzburg K, Koopman C, Butler LD, Palesh O, Kraemer HC, Classen CC, Spiegel D (2006) Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors. J Trauma Dissociation 7(2):7–27. doi:10.1300/J229v07n02_02 PubMedCrossRef Ginzburg K, Koopman C, Butler LD, Palesh O, Kraemer HC, Classen CC, Spiegel D (2006) Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors. J Trauma Dissociation 7(2):7–27. doi:10.​1300/​J229v07n02_​02 PubMedCrossRef
43.
go back to reference Lanius RA, Bluhm R, Lanius U (2006) PTSD symptom provocation and neuroimaging: heterogeneity of response. In: Vermetten E, Dorahy M, Speigel D (eds) Traumatic dissociation: neurobiology and treatment, chap 10. American Psychiatric Publishing, Washington DC, pp 191–217 Lanius RA, Bluhm R, Lanius U (2006) PTSD symptom provocation and neuroimaging: heterogeneity of response. In: Vermetten E, Dorahy M, Speigel D (eds) Traumatic dissociation: neurobiology and treatment, chap 10. American Psychiatric Publishing, Washington DC, pp 191–217
44.
go back to reference Braakman MH, Kortmann FAM, van den Brink W (2009) Validity of post-traumatic stress disorder with secondary psychotic features: a review of the evidence. Acta Psychiatr Scand 119:15–24PubMedCrossRef Braakman MH, Kortmann FAM, van den Brink W (2009) Validity of post-traumatic stress disorder with secondary psychotic features: a review of the evidence. Acta Psychiatr Scand 119:15–24PubMedCrossRef
45.
go back to reference Hyman IE, Billings FJ (1998) Individual differences and the creation of false childhood memories. Memory 6:1–20PubMedCrossRef Hyman IE, Billings FJ (1998) Individual differences and the creation of false childhood memories. Memory 6:1–20PubMedCrossRef
Metadata
Title
The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD
Authors
Cherie Armour
Karen-Inge Karstoft
J. Don Richardson
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 8/2014
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-014-0819-y

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