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Misitano A, Moro AS, Ferro M, Forresi B. The Dissociative Subtype of Post-Traumatic Stress Disorder: A Systematic Review of the Literature using the Latent Profile Analysis. J Trauma Dissociation 2024; 25:349-365. [PMID: 36062756 DOI: 10.1080/15299732.2022.2120155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
A PTSD subtype with dissociative symptoms (D-PTSD) was included in the DSM-5 recognizing the existence of a more severe form of PTSD, associated to past trauma, high comorbidity, and complex clinical management. As research is rapidly growing and results are inconsistent, a better investigation of this subtype is of primary importance. We conducted a systematic review of studies using Latent Profile Analysis to investigate the existence of a D-PTSD subtype. Covariates of D-PTSD were included, to understand additional symptoms, risk factors and comorbidities. The search was performed on PubMed, EBSCOHost, and PTSDPubs according to 2020 PRISMA guidelines. Eligible articles assessed trauma exposure, PTSD symptoms and diagnosis, and dissociation, in adult samples. 13 of 165 articles met the inclusion criteria. All identified a dissociative subtype of PTSD, mainly characterized by higher levels of depersonalization and derealization. D-PTSD profile sometimes presented other dissociative symptoms, such as gaps in awareness and memory, other comorbid disorders, and a history of abuse. Despite some limitations, this review supports the existence of a dissociative subgroup of individuals among those with PTSD. More rigorous studies are needed to clarify these findings and their clinical implications.
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Affiliation(s)
- Alberto Misitano
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Andrea Stefano Moro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Ferro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Barbara Forresi
- Department of Psychology, Sigmund Freud University, Milan, Italy
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2
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Bi Y, Cao C, Fang R, Wang N, Liu P, Luo S, Grace E, Wang L. A latent class analysis of dissociative PTSD subtype among Chinese adolescents following the COVID-19 pandemic and lockdown. J Affect Disord 2024; 349:596-603. [PMID: 38199423 DOI: 10.1016/j.jad.2023.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The COVID-19 pandemic and related policies have amplified the vulnerability of adolescents to the development of posttraumatic stress disorder (PTSD) and dissociation symptoms. This study sought to explore the profile patterns and psychopathological characteristics of co-occurring PTSD and dissociation symptoms in Chinese adolescents. METHODS A total of 57,984 junior and senior high school students in Deyang City, China were recruited between July 13 and July 19, 2020. PTSD and dissociation symptoms, risk factors, and functional impairment variables were assessed using the Global Psychotrauma Screen for Teenagers (GPS-T) instrument. Latent class analysis (LCA) was employed to examine the phenomenology and risk factors of co-occurring PTSD and dissociation symptoms. Analysis of Variance (ANOVA) was utilized to investigate differences in COVID-19 pandemic-related exposure and functional impairment across distinct symptom profiles. RESULTS A 4-class model was selected as the optimal solution, comprising subgroups of low symptom, predominant PTSD symptom, predominant dissociation symptom, and PTSD-dissociation symptom. Class membership could be significantly predicted by other stressful experiences, social support, childhood maltreatment and psychiatric histories. The PTSD-dissociation symptom class exhibited the most severe COVID-19 pandemic-related exposure and functional impairment among all classes. LIMITATIONS The cross-sectional design, Chinese cultural background, online survey method and oversimple measurements were the limitations. CONCLUSIONS Our findings extend existing knowledge about the coexisting patterns of PTSD and dissociation symptoms in adolescents, which could assist in identifying high-risk youths. Furthermore, our findings offer recommendations for shaping public health policies and formulating effective clinical interventions for adolescents following the COVID-19 pandemic and lockdown.
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Affiliation(s)
- Yajie Bi
- Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan Province, China; School of Psychology, Guizhou Normal University, Guiyang, Guizhou Province, China; Sichuan Clinical Research Center for Neurological Disease, Deyang, Sichuan Province, China
| | - Chengqi Cao
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ruojiao Fang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Na Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ping Liu
- Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan Province, China; Sichuan Clinical Research Center for Neurological Disease, Deyang, Sichuan Province, China
| | - Shu Luo
- Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan Province, China; Sichuan Clinical Research Center for Neurological Disease, Deyang, Sichuan Province, China
| | - Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Li Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China; School of Psychology, Guizhou Normal University, Guiyang, Guizhou Province, China.
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3
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Ng ASY, Chan WS. Sleep Quality, Sleep-Related Experiences, and Dissociation in Adult Survivors of Childhood Trauma. Behav Sleep Med 2023; 21:659-670. [PMID: 36409021 DOI: 10.1080/15402002.2022.2148669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Exposure to traumatic stress in childhood increases the risk of sleep disturbances. Preliminary evidence suggests that the relationship between childhood trauma and sleep may depend on trauma chronicity. Additionally, little is known about the relationship between sleep and dissociation, a common symptom in post-traumatic stress disorder. This study examined sleep quality, sleep-related experiences, and dissociation in survivors of childhood trauma with different trauma chronicity. METHOD Nine-hundred-and-fourteen community-dwelling adults completed an online survey. They were divided into three groups: no childhood trauma, short-term childhood trauma, and chronic childhood trauma. RESULTS We found that survivors of chronic childhood trauma had poorer sleep quality than survivors of short-term childhood trauma and individuals without a history of childhood trauma, controlling for age, number of trauma types experienced, psychological distress, and PTSD symptoms. The relationship between dissociation and sleep quality was moderated by trauma chronicity such that dissociation was associated with better sleep quality only in the chronic trauma group. Dissociation was positively associated with sleep-related experiences regardless of trauma exposure and trauma chronicity. CONCLUSION Our findings highlighted the differential impact of acute and chronic traumatic stress on sleep, and suggested that the relationship between dissociation and sleep could depend on trauma chronicity.
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Affiliation(s)
- Albe S Y Ng
- Department of Psychology, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Sze Chan
- Department of Psychology, University of Hong Kong, Pok Fu Lam, Hong Kong
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4
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Fitzpatrick SS, Liebman RE, Monson CM, Resick PA. Latent emotion profiles of PTSD and specific emotions predicting differential therapy outcomes in a dismantling study of cognitive processing therapy. J Anxiety Disord 2023; 95:102681. [PMID: 36848714 DOI: 10.1016/j.janxdis.2023.102681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Posttraumatic stress disorder (PTSD) is theoretically maintained by avoidance of emotions elicited from trauma-related beliefs. Whether PTSD symptom profiles and specific emotions predict treatment response is unknown. This secondary data analysis examined: a) whether individuals with PTSD can be sub-classified based on symptom clusters and specific emotions, and b) if these subgroups predict differential responses to cognitive versus exposure-based PTSD interventions. Women with physical or sexual assault-related PTSD were randomized to CPT (cognitive processing therapy elements only), CPT with written accounts (CPT+A), or written accounts (WA) only (n = 150). Participants completed baseline measures of PTSD, state anxiety, internalized anger, externalized anger, shame, and guilt, and weekly PTSD measures during and 6 months after treatment. Latent profile analyses revealed four subgroups: low symptoms and emotions; moderate-high reexperiencing, low internalized emotions (i.e., moderate-high reexperiencing, moderate avoidance/hyperarousal/guilt, low shame/internalized anger/anxiety); low reexperiencing, moderate emotions (i.e., low re-experiencing, moderate avoidance/hyperarousal/guilt, moderate other emotions); and high symptoms and emotions (high symptoms and emotions except moderate externalized anger). The high symptom and emotion subgroup experienced greater PTSD symptom improvements in cognitive conditions than WA. Other groups did not exhibit differential change across conditions. Cognitive interventions may be well-suited for severe PTSD with high self-directed emotions. CLINICALTRIALS.GOV IDENTIFIER: NCT00245232.
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Affiliation(s)
| | - Rachel E Liebman
- Department of Psychiatry, University Health Network, Canada; Department of Psychology, Toronto Metropolitan University, Canada
| | - Candice M Monson
- Department of Psychology, Toronto Metropolitan University, Canada
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Canada
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5
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Shih CH, Zhou A, Grider S, Xie H, Wang X, Elhai JD. Early self-reported post-traumatic stress symptoms after trauma exposure and associations with diagnosis of post-traumatic stress disorder at 3 months: latent profile analysis. BJPsych Open 2023; 9:e27. [PMID: 36700253 PMCID: PMC9885326 DOI: 10.1192/bjo.2023.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Trauma exposure can cause post-traumatic stress symptoms (PTSS), and persistently experiencing PTSS may lead to the development of post-traumatic stress disorder (PTSD). Research has shown that PTSS that emerged within days of trauma was a robust predictor of PTSD development. AIMS To investigate patterns of early stress responses to trauma and their associations with development of PTSD. METHOD We recruited 247 civilian trauma survivors from a local hospital emergency department. The PTSD Checklist for DSM-5 (PCL-5) and Acute Stress Disorder Scale (ASDS) were completed within 2 weeks after the traumatic event. Additionally, 3 months post-trauma 146 of these participants completed a PTSD diagnostic interview using the Clinician Administered PTSD Scale for DSM-5. RESULTS We first used latent profile analysis on four symptom clusters of the PCL-5 and the dissociation symptom cluster of the ASDS and determined that a four-profile model ('severe symptoms', 'moderate symptoms', 'mild symptoms', 'minimal symptoms') was optimal based on multiple fit indices. Gender was found to be predictive of profile membership. We then found a significant association between subgroup membership and PTSD diagnosis (χ2(3) = 11.85, P < 0.01, Cramer's V = 0.263). Post hoc analysis revealed that this association was driven by participants in the 'severe symptoms' profile, who had a greater likelihood of developing PTSD. CONCLUSIONS These findings fill the knowledge gap of identifying possible subgroups of individuals based on their PTSS severity during the early post-trauma period and investigating the relationship between subgroup membership and PTSD development, which have important implications for clinical practice.
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Affiliation(s)
- Chia-Hao Shih
- Department of Emergency Medicine, University of Toledo, Toledo, Ohio, USA
| | - Adrian Zhou
- Department of Psychiatry, University of Toledo, Toledo, Ohio, USA
| | - Stephen Grider
- Department of Emergency Medicine, University of Toledo, Toledo, Ohio, USA
| | - Hong Xie
- Department of Neurosciences, University of Toledo, Toledo, Ohio, USA
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, Ohio, USA
| | - Jon D Elhai
- Department of Psychiatry, University of Toledo, Toledo, Ohio, USA; and Department of Psychology, University of Toledo, Toledo, Ohio, USA
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6
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Geng F, Liang Y, Zhan N, Wang J. Prevalence, Clinical Features, and Psychological Characteristics of Dissociative Subtype of Posttraumatic Stress Disorder in Chinese Prisoners. J Trauma Dissociation 2023; 24:63-78. [PMID: 35611661 DOI: 10.1080/15299732.2022.2079797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study aimed to examine prevalence, clinical symptoms, and psychological characteristics of D-PTSD in a sample of Chinese prisoners with probable PTSD. A total of 1458 male prisoners were recruited from a large prison in Guangdong, China. Participants completed self-administrated questionnaires that assessed PTSD and dissociative symptoms, psychopathology, emotion regulation, emotional expressivity, social pleasure, traumatic events, and social support. According to DSM-5 criteria, participants were classified into four groups: D-PTSD, PTSD only, derealization/depersonalization (DD) only, and neither. The proportions of D-PTSD, PTSD only, DD only and neither were 2.5%, 4.7%, 2.4%, and 92.2%, respectively. PTSD symptoms and emotion regulation difficulties were distinguishing for the four groups: PTSD symptoms declined gradually in the order of D-PTSD, PTSD only, DD only, and neither, while emotion regulation difficulties declined in an order from D-PTSD, DD only, and PTSD only to neither, all ps < .001. D-PTSD and DD only had higher depressive and dissociative symptoms than PTSD only and the neither groups, all ps < .001. D-PTSD also had more borderline personality symptoms, emotion regulation difficulties, and more negative emotional expressivity than PTSD only and DD only, all ps < .05. Logistic regressions indicated that D-PTSD reported lower social support compared to PTSD only (OR = 0.95, p < .01), DD only (OR = 0.96, p < .05) and neither (OR = 0.93, p < .001). D-PTSD is common in probable PTSD in prisoners and is associated with complex clinical presentations as well as emotional processing. Social support is an important protective factor of D-PTSD.
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Affiliation(s)
- Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, Jiangxi, China
| | - Yingxin Liang
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong
| | - Nalan Zhan
- School of Psychology, Jiangxi Normal University, Nanchang, Jiangxi, China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
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7
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Pan X, Palermo CA, Kaplan CS, Harnett NG, Winternitz SR, Kaufman ML, Lebois LAM. Anxiety sensitivity predicts depression severity in individuals with dissociative identity disorder. J Psychiatr Res 2022; 155:263-268. [PMID: 36126396 PMCID: PMC9588735 DOI: 10.1016/j.jpsychires.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Anxiety sensitivity involves the fear of anxiety-related symptoms and can exacerbate both major depressive disorder and posttraumatic stress disorder (PTSD) symptoms. However, it is unclear if anxiety sensitivity plays a similar role in dissociative identity disorder (DID) where symptoms of depression and PTSD commonly co-occur. We examined the association between anxiety sensitivity, depression, PTSD and dissociative symptoms in DID, hypothesizing a positive association between all symptoms and anxiety sensitivity. METHOD Participants were 21 treatment-seeking adult females with histories of childhood trauma, current PTSD, and DID. Participants completed the Anxiety Sensitivity Index (ASI), Beck Depression Inventory-II, Childhood Trauma Questionnaire, Multidimensional Inventory of Dissociation, and PTSD Checklist for DSM-5. The ASI included subscales that assessed anxiety sensitivity in cognitive, physical, and social domains. RESULTS Participants reported high levels of anxiety sensitivity. A multiple regression analysis demonstrated that the ASI cognitive subscale was the strongest predictor of depressive symptoms. No direct associations were identified between anxiety sensitivity and PTSD or dissociative symptoms. We conducted a mediation analysis to test an indirect relationship between cognitive anxiety sensitivity and dissociative symptoms, and found a significant indirect effect through depressive symptoms. CONCLUSIONS Our results suggest that cognitive anxiety sensitivity or the fear of cognitive dyscontrol is linked with symptom severity in DID. These findings emphasize the need to assess for and utilize interventions that target anxiety sensitivity, which may in turn alleviate symptoms of depression and dissociation in DID.
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Affiliation(s)
- Xi Pan
- McLean Hospital, Belmont, MA, USA
| | | | | | - Nathaniel G Harnett
- McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sherry R Winternitz
- McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Milissa L Kaufman
- McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauren A M Lebois
- McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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8
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White WF, Burgess A, Dalgleish T, Halligan S, Hiller R, Oxley A, Smith P, Meiser-Stedman R. Prevalence of the dissociative subtype of post-traumatic stress disorder: a systematic review and meta-analysis. Psychol Med 2022; 52:1629-1644. [PMID: 35734787 DOI: 10.1017/s0033291722001647] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The dissociative subtype of post-traumatic stress disorder (PTSD-DS) was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and is characterised by symptoms of either depersonalisation or derealisation, in addition to a diagnosis of post-traumatic stress disorder (PTSD). This systematic review and meta-analysis sought to estimate the point prevalence of current PTSD-DS, and the extent to which method of assessment, demographic and trauma variables moderate this estimate, across different methods of prevalence estimation. Studies included were identified by searching MEDLINE (EBSCO), PsycInfo, CINAHL, Academic Search Complete and PTSDpubs, yielding 49 studies that met the inclusion criteria (N = 8214 participants). A random-effects meta-analysis estimated the prevalence of PTSD-DS as 38.1% (95% CI 31.5-45.0%) across all samples, 45.5% (95% CI 37.7-53.4%) across all diagnosis-based and clinical cut-off samples, 22.8% (95% CI 14.8-32.0%) across all latent class analysis (LCA) and latent profile analysis (LPA) samples and 48.1% (95% CI 35.0-61.3%) across samples which strictly used the DSM-5 PTSD criteria; all as a proportion of those already with a diagnosis of PTSD. All results were characterised by high levels of heterogeneity, limiting generalisability. Moderator analyses mostly failed to identify sources of heterogeneity. PTSD-DS was more prevalent in children compared to adults, and in diagnosis-based and clinical cut-off samples compared to LCA and LPA samples. Risk of bias was not significantly related to prevalence estimates. The implications of these results are discussed further.
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Affiliation(s)
- William F White
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Aaron Burgess
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Rachel Hiller
- Division of Psychology and Language Sciences, University College London, London, UK
- Anna Freud Centre for Children and Families, London, UK
| | - Anna Oxley
- Cambridgeshire Community Services NHS Trust, UK
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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Staniaszek K, Cyniak-Cieciura M, Zawadzki B. Posttraumatic stress disorder symptom profiles – The role of temperament, traumatization, and cognitive factors. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Abstract
This article reviews the literature on the relationship between sleep deficiency and unipolar and bipolar depression, anxiety disorders, and posttraumatic stress disorder. We consider the evidence for sleep as a contributory causal factor in the development of psychiatric disorders, as well as sleep as an influential factor related to the outcome and recurrence of psychopathology. A case for sleep deficiency being an important treatment target when sleep and psychiatric disorders are comorbid is also made. Our recommendation is that sleep deficiency is recognized as a means to positively impact the development and course of psychopathology and, as such, is routinely assessed and treated in clinical practice.
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11
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Yu Q, Wang Z, Li Z, Liu X, Oteng Agyeman F, Wang X. Hierarchical Structure of Depression Knowledge Network and Co-word Analysis of Focus Areas. Front Psychol 2022; 13:920920. [PMID: 35664156 PMCID: PMC9160970 DOI: 10.3389/fpsyg.2022.920920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
Contemporarily, depression has become a common psychiatric disorder that influences people's life quality and mental state. This study presents a systematic review analysis of depression based on a hierarchical structure approach. This research provides a rich theoretical foundation for understanding the hot spots, evolutionary trends, and future related research directions and offers further guidance for practice. This investigation contributes to knowledge by combining robust methodological software for analysis, including Citespace, Ucinet, and Pajek. This paper employed the bibliometric methodology to analyze 5,000 research articles concerning depression. This current research also employed the BibExcel software to bibliometrically measure the keywords of the selected articles and further conducted a co-word matrix analysis. Additionally, Pajek software was used to conduct a co-word network analysis to obtain a co-word network diagram of depression. Further, Ucinet software was utilized to calculate K-core values, degree centrality, and mediated centrality to better present the research hotspots, sort out the current status and reveal the research characteristics in the field of depression with valuable information and support for subsequent research. This research indicates that major depressive disorder, anxiety, and mental health had a high occurrence among adolescents and the aged. This present study provides policy recommendations for the government, non-governmental organizations and other philanthropic agencies to help furnish resources for treating and controlling depression orders.
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Affiliation(s)
- Qingyue Yu
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zihao Wang
- College of Medicine, Jiangsu University, Zhenjiang, China
| | - Zeyu Li
- Jingjiang College of Jiangsu University, Zhenjiang, China
| | - Xuejun Liu
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | | | - Xinxing Wang
- School of Management, Jiangsu University, Zhenjiang, China
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12
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Emotional processing prospectively modulates the impact of anxiety on COVID-19 pandemic-related post-traumatic stress symptoms: an ERP study. J Affect Disord 2022; 303:245-254. [PMID: 35172175 PMCID: PMC8842094 DOI: 10.1016/j.jad.2022.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/01/2022] [Accepted: 02/12/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Considering that the elevated distress caused by the COVID-19 pandemic, in some cases, led to post-traumatic stress symptoms (PTSS), it has been proposed as a specific traumatic event. The present longitudinal study investigated pre-pandemic motivated attention to emotional stimuli, as indexed by Late Positive Potential (LPP) amplitude, in relation with the potential differential role of anxiety and depressive symptoms in predicting PTSS severity related to the COVID-19 pandemic. METHODS A total of 79 university students initially completed self-report measures of depression and anxiety along with a passive viewing task of emotional (pleasant, unpleasant) and neutral pictures while electroencephaloghic activity was recorded. In December 2020, 57 participants completed a questionnaire assessing PTSS. RESULTS Significant interactions between anxiety and LPP emerged in predicting pandemic-related PTSS, where greater anxiety symptoms predicted PTSS only in individuals with greater LPP to unpleasant or with reduced LPP to pleasant stimuli. LIMITATIONS The prevalence of the female sex, the relatively young age of the participants, as well as the fact that they were all enrolled in a University course might not allow the generalization of the findings. CONCLUSIONS Taken together, the present longitudinal study provided novel evidence on EEG predictors of pandemic-related PTSS that might be useful for the prevention and treatment of PTSS. Indeed, assessing anxiety symptoms and pre-trauma LPP to emotional stimuli might be a useful target for identifying individuals that are more vulnerable to the development of PTSS during times of crisis.
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13
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Radell ML, Hamza EA, Moustafa AA. Depression in post-traumatic stress disorder. Rev Neurosci 2021; 31:703-722. [PMID: 32866132 DOI: 10.1515/revneuro-2020-0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/31/2020] [Indexed: 12/12/2022]
Abstract
Major depressive disorder (MDD) symptoms commonly occur after trauma-exposure, both alone and in combination with post-traumatic stress disorder (PTSD). This article reviews recent research on comorbidity between these disorders, including its implications for symptom severity and response to treatment. Despite considerable symptom overlap, the two disorders represent distinct constructs and depend, at least in part, on separate biological mechanisms. Both, however, are also clearly related to stress psychopathology. We recommend that more research focus specifically on the study of individual differences in symptom expression in order to identify distinct subgroups of individuals and develop targeted treatments. However, a barrier to this line of inquiry is the trend of excluding particular patients from clinical trials of new interventions based on symptom severity or comorbidity. Another obstacle is the overreliance on self-report measures in human research. We argue that developing computer-based behavioral measures in order to supplement self-report can help address this challenge. Furthermore, we propose that these measures can help tie findings from human and non-human animal research. A number of paradigms have been used to model MDD-and PTSD-like behavior in animals. These models remain valuable for understanding the biological basis of these disorders in humans and for identifying potential interventions, but they have been underused for the study of comorbidity. Although the interpretation of animal behavior remains a concern, we propose that this can also be overcome through the development of close human analogs to animal paradigms.
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Affiliation(s)
- Milen L Radell
- Department of Psychology, Niagara University, Lewiston, NY, USA
| | - Eid Abo Hamza
- Department of Mental Health, Faculty of Education, Tanta University, Tanta, Egypt
| | - Ahmed A Moustafa
- School of Psychology, Western Sydney University, Sydney, NSW, Australia.,Marcs Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia.,Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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14
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Zhu Y, Zhang L, Zhou X, Li C, Yang D. The impact of social distancing during COVID-19: A conditional process model of negative emotions, alienation, affective disorders, and post-traumatic stress disorder. J Affect Disord 2021; 281:131-137. [PMID: 33316718 PMCID: PMC7723399 DOI: 10.1016/j.jad.2020.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/29/2020] [Accepted: 12/03/2020] [Indexed: 01/16/2023]
Abstract
Background The social distancing during COVID-19 is likely to cause a feeling of alienation, which may pose a threat to the public's mental health. Our research aims to examine the relationship between negative emotions and Post-Traumatic Stress Disorder (PTSD), considering the mediation effect of alienation and how it is moderated by anxiety and depression. Methods For this, the current study conducted a cross-sectional survey on 7145 participants during the outbreak of COVID-19, via online questionnaires comprised of a self-designed Negative emotions questionnaire, Symptom Check List 90 (SCL-90), PTSD Checklist-civilian version (PCL-C), and Adolescent Students Alienation Scale (ASAS). Results A total of 6666 pieces of data from the general population were included in the statistical analysis. The descriptive statistics showed a relatively mild level of mental disorders. Besides, results of Conditional Process Model analysis supported our hypotheses that negative emotions and alienation were both predictors for PTSD symptoms, and their direct and indirect effects were all moderated by the level of anxiety. Limitations This study was limited by the generality and causality of the conclusion. The moderating effect of depression was left for further study due to the collinearity problem of variables. Conclusions Social distancing may have an impact on individuals' mental health by the feeling of alienation, which was moderated by affective disorders. Clinical psychologists should identify individuals' particular cognition and mental disorders to provide a more accurate and adequate intervention for them.
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Affiliation(s)
- Yue Zhu
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Lab of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, China
| | - Lihua Zhang
- Chongqing Nankai Secondary School, Chongqing 400030, China
| | - Xia Zhou
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Lab of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, China
| | - Chenxiang Li
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Lab of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, China
| | - Dong Yang
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Lab of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, China.
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15
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Barone DA. Dream enactment behavior-a real nightmare: a review of post-traumatic stress disorder, REM sleep behavior disorder, and trauma-associated sleep disorder. J Clin Sleep Med 2020; 16:1943-1948. [PMID: 32804070 PMCID: PMC8034213 DOI: 10.5664/jcsm.8758] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/16/2023]
Abstract
NONE Dream enactment behavior is a phenomenon demonstrated in patients with post-traumatic stress disorder, rapid eye movement sleep behavior disorder, as well as with a more recently described condition entitled trauma-associated sleep disorder, which shares diagnostic criteria for rapid eye movement sleep behavior disorder. While these conditions share some commonalities, namely dream enactment behavior, they are quite different in pathophysiology and underlying mechanisms. This review will focus on these 3 conditions, with the purpose of increasing awareness for trauma-associated sleep disorder in particular.
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16
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Ellickson-Larew S, Escarfulleri S, Wolf EJ. The Dissociative Subtype of Posttraumatic Stress Disorder: Forensic Considerations and Recent Controversies. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09381-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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17
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Hill SB, Wolff JD, Bigony CE, Winternitz SR, Ressler KJ, Kaufman ML, Lebois LAM. Dissociative subtype of posttraumatic stress disorder in women in partial and residential levels of psychiatric care. J Trauma Dissociation 2020; 21:305-318. [PMID: 31607239 PMCID: PMC7138694 DOI: 10.1080/15299732.2019.1678214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The dissociative subtype of posttraumatic stress disorder (PTSD) is estimated to characterize about 12-30% of those with PTSD. Some research links this subtype with increased severity of PTSD symptoms compared to samples with "classic" PTSD. However, prevalence and severity rates reported in the literature have varied. One possible explanation for these discrepancies could be related to where the populations were sampled. Therefore, we investigated whether these differences are still observed when holding level of care constant. We collected data from 104 women at a partial and residential psychiatric hospital program focused on trauma-related disorders. Participants completed self-report questionnaires assessing trauma exposure, symptoms and provisional diagnosis of PTSD, trauma-related thoughts and beliefs, and feelings of shame. All participants reported a history of childhood and/or adulthood trauma exposure. Eighty-eight (85%) met criteria for PTSD, and of those, seventy-three (83%) met criteria for the dissociative subtype as assessed by the Dissociative Subtype of PTSD Scale. A series of independent t-tests revealed no significant differences between the "classic" and dissociative PTSD groups with respect to lifetime or childhood trauma exposure, posttraumatic cognitions, shame, or overall PTSD severity. Our results suggest that samples with classic PTSD and the dissociative subtype may not differ in some types of symptom severity when holding level of care constant. Importantly, however, we found at partial/residential level of care the majority of patients with PTSD were dissociative. Given the elevated prevalence rate in this sample, these findings support the need to assess dissociative symptoms, particularly in more acute psychiatric settings.
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Affiliation(s)
- Sarah B Hill
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA
| | - Jonathan D Wolff
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA
| | - Cara E Bigony
- Department of Counseling Psychology, Fordham University, New York, New York, USA
| | - Sherry R Winternitz
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Milissa L Kaufman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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18
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Severity profiles of posttraumatic stress, depression, anxiety, and somatization symptoms in treatment seeking traumatized refugees. J Affect Disord 2020; 266:71-81. [PMID: 32056948 DOI: 10.1016/j.jad.2020.01.077] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/20/2019] [Accepted: 01/19/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Western countries are facing many challenges hosting refugees from several regions in the world. Many of them are severely traumatized and suffer from a variety of mental health symptoms, which complicates the identification and treatment of refugees at risk. This study examined subgroups based on a broad range of psychopathology, and several predictors, including trauma characteristics and gender. METHODS Participants were 1147 treatment-seeking, traumatized refugees. Latent profile analysis was conducted to identify different subgroups based on levels of posttraumatic stress disorder (PTSD), depression, anxiety, and somatic symptoms. Multinomial logistic regression was used to identify predictors of subgroup membership. RESULTS Three distinct subgroups were identified, reflecting Moderate (10.2%), Severe (43.0%), and Highly Severe (45.9%) symptom severity levels, respectively. Symptom severity of all psychopathology dimensions was distributed equally between the subgroups. Participants in the Severe and Highly Severe Symptoms subgroups reported more types of traumatic events compared to the Moderate subgroup. In particular, traumatic events associated with human right abuses, lack of human needs and separation from others predicted subgroup membership, as did gender. LIMITATIONS The results are confined to treatment-seeking, traumatized refugee populations. CONCLUSIONS Distinguishable symptom severity profiles of PTSD, depression, anxiety and somatic complaints could be identified in this large treatment-seeking refugee population, without qualitative differences in symptom distribution. Instead of focusing on specific mental disorders, classification based on overall symptom severity is of interest in severely traumatized patients. This knowledge will help to identify individuals at risk and to enhance existing treatment programs for specific patient groups.
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19
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Boisclair Demarble J, Fortin C, D'Antono B, Guay S. Gender Differences in the Prediction of Acute Stress Disorder From Peritraumatic Dissociation and Distress Among Victims of Violent Crimes. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:1229-1250. [PMID: 29294663 DOI: 10.1177/0886260517693000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Peritraumatic dissociation and distress are strong predictors of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) development. However, there is limited data concerning gender differences in these relations, particularly among victims of violent crimes (VVC). The objective of this study is to examine whether peritraumatic dissociation and distress predict the number of ASD symptoms differently for men and women VVC. In all, 162 adults (97 women, M age = 39.6 years), 63% of whom experienced physical assaults, completed the Acute Stress Disorder Interview, the Peritraumatic Dissociative Experience Questionnaire, and the Peritraumatic Distress Inventory. Analyses included t tests and multiple hierarchical regressions models controlling for known PTSD risk factors. The regression model showed dissociation and distress to be significant predictors of ASD for both men and women (β = .349 and β =.312 respectively; all p < .001). A significant three-way interaction was also observed between peritraumatic distress (PDI), past potentially traumatic experiences, and gender. In simple slopes analyses, the combination of high levels of PDI and of a high number of past potentially traumatic events were associated with greater risk of ASD in men only (b = 3.78, p < .001). However, women experienced greater PDI, t(157) = 5.844, p = .005, than men, and elevated distress was associated with more ASD symptoms independently of past traumatic events. Gender differences were revealed as a function of past potentially traumatic experiences. There is a cumulative impact of past potential traumas and current distress that predicts ASD in men, while in women, it contributes to ASD via increased distress.
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Affiliation(s)
- Julie Boisclair Demarble
- Department of Psychology, Université de Montreal, Québec, Canada
- Institut Universitaire en Santé Mentale de Montreal, Montreal, Quebec, Canada
| | - Christophe Fortin
- Trauma Studies Center, Institut Universitaire en Santé Mentale de Montreal
- Department of Psychology, Université d'Ottawa, Ottawa, Canada
| | - Bianca D'Antono
- Department of Psychology, Université de Montreal, Québec, Canada
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Stéphane Guay
- Trauma Studies Center, Institut Universitaire en Santé Mentale de Montreal
- School of Criminology, Université de Montreal, Québec, Canada
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20
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Eidhof MB, Ter Heide FJJ, van Der Aa N, Schreckenbach M, Schmidt U, Brand BL, Lanius RA, Loewenstein RJ, Spiegel D, Vermetten E. The Dissociative Subtype of PTSD Interview (DSP-I): Development and Psychometric Properties. J Trauma Dissociation 2019; 20:564-581. [PMID: 31132959 DOI: 10.1080/15299732.2019.1597806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The inclusion of the dissociative subtype of post-traumatic stress disorder (PTSD-DS) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflects the importance of assessing PTSD-DS. We developed the Dissociative Subtype of PTSD Interview (DSP-I). This clinician-administered instrument assesses the presence and severity of PTSD-DS (i.e., symptoms of depersonalization or derealization) and contains a supplementary checklist that enables assessment and differentiation of other trauma-related dissociative symptoms (i.e., blanking out, emotional numbing, alterations in sensory perception, amnesia, and identity confusion). The psychometric properties were tested in 131 treatment-seeking individuals with PTSD and histories of multiple trauma, 17.6 % of whom met criteria for PTSD-DS in accordance with the DSP-I. The checklist was tested in 275 treatment-seeking individuals. Results showed the DSP-I to have high internal consistency, good convergent validity with PTSD-DS items of the CAPS-5, and good divergent validity with scales of somatization, anxiety and depression. The depersonalization and derealization scales were highly associated. Moreover, the DSP-I accounted for an additional variance in PTSD severity scores of 8% over and above the CAPS-5 and number of traumatic experiences. The dissociative experiences of the checklist were more strongly associated with scales of overall distress, somatization, depression, and anxiety than scales of depersonalization and derealization. In conclusion, the DSP-I appears to be a clinically relevant and psychometrically sound instrument that is valuable for use in clinical and research settings.
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Affiliation(s)
- Marloes B Eidhof
- Psychotraumacentrum Zuid Nederland, Reinier van Arkel , 's Hertogenbosch , The Netherlands.,Psychotrauma Expert Group, Arq , Diemen , The Netherlands
| | | | | | | | - Ulrike Schmidt
- Max Planck Institute of Psychiatry , München , Germany.,Clinic of Psychiatry and Psychotherapy, Psychotrauma Unit & RG Stress Modulation of Neurodegeneration, University Medical Center Göttingen (UMG) , Göttingen , Germany.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Bethany L Brand
- Department of Psychology, Towson University , Towson , MD , USA
| | - Ruth A Lanius
- Department of Psychiatry, University of Western Ontario , London , Ontario , Canada
| | - Richard J Loewenstein
- Sheppard Pratt Health System , Baltimore , MD , USA.,Department of Psychiatry, University of Maryland School of Medicine , Baltimore , MD , USA
| | - David Spiegel
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine , Stanford , CA , USA
| | - Eric Vermetten
- Psychotrauma Expert Group, Arq , Diemen , The Netherlands.,Department of Psychiatry, Leiden University Medical Center , Leiden , The Netherlands.,Military Mental Health Care - Research, Ministry of Defense , Utrecht , The Netherlands
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21
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Guetta RE, Wilcox ES, Stoop TB, Maniates H, Ryabchenko KA, Miller MW, Wolf EJ. Psychometric Properties of the Dissociative Subtype of PTSD Scale: Replication and Extension in a Clinical Sample of Trauma-Exposed Veterans. Behav Ther 2019; 50:952-966. [PMID: 31422850 PMCID: PMC6703168 DOI: 10.1016/j.beth.2019.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
The addition of the dissociative subtype of posttraumatic stress disorder (PTSD) to the DSM-5 has spurred investigation of its genetic, neurobiological, and treatment response correlates. In order to reliably assess the subtype, we developed the Dissociative Subtype of PTSD Scale (DSPS; Wolf et al., 2017), a 15-item index of dissociative features. Our initial investigation of the dichotomous DSPS lifetime items in a veteran epidemiological sample demonstrated its ability to identify the subtype, supported a three-factor measurement structure, distinguished the three subscales from the normal-range trait of absorption, and demonstrated the greater contribution of derealization and depersonalization symptoms relative to other dissociative symptomatology. In this study, we replicated and extended these findings by administering self-report and interview versions of the DSPS, and assessing personality and PTSD in a sample of 209 trauma-exposed veterans (83.73% male, 57.9% with probable current PTSD). Results replicated the three-factor structure using confirmatory factor analysis of current symptom severity interview items, and the identification of the dissociative subtype (via latent profile analysis). Associations with personality supported the discriminant validity of the DSPS and suggested the subtype was marked by tendencies towards odd and unusual cognitive experiences and low positive affect. Receiver operating characteristic curves identified diagnostic cut-points on the DSPS to inform subtype classification, which differed across the interview and self-report versions. Overall, the DSPS performed well in psychometric analyses, and results support the utility of the measure in identifying this important component of posttraumatic psychopathology.
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Affiliation(s)
| | | | | | | | - Karen A. Ryabchenko
- National Center for PTSD at VA Boston Healthcare System,Boston University School of Medicine, Department of Psychiatry
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System,Boston University School of Medicine, Department of Psychiatry
| | - Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System,Boston University School of Medicine, Department of Psychiatry
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22
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Burton MS, Feeny NC, Connell AM, Zoellner LA. Exploring evidence of a dissociative subtype in PTSD: Baseline symptom structure, etiology, and treatment efficacy for those who dissociate. J Consult Clin Psychol 2019; 86:439-451. [PMID: 29683701 DOI: 10.1037/ccp0000297] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE With the inclusion of a dissociative subtype, recent changes to the DSM-5 diagnosis of posttraumatic stress disorder (PTSD) have emphasized the role of dissociation in the experience and treatment of the disorder. However, there is a lack of research exploring the clinical impact for highly dissociative groups receiving treatment for PTSD. The current study examined the presence and clinical impact of a dissociative subtype in a sample of individuals receiving treatment for chronic PTSD. METHOD This study used latent transition analyses (LTA), an expanded form of latent profile analyses (LPA), to examine latent profiles of PTSD and dissociation symptoms before and after treatment for individuals (N = 200) receiving prolonged exposure (PE) or sertraline treatment for chronic PTSD. RESULTS The best fitting LTA model was one with a 4-class solution at both pretreatment and posttreatment. There was a latent class at pretreatment with higher levels of dissociative symptoms. However, this class was also marked by higher reexperiencing symptoms, and membership was not predicted by chronic child abuse. Further, although those in the class were less likely to transition to the responder class overall, this was not the case for exposure-based treatment specifically. CONCLUSION These findings are not in line with the dissociative-subtype theoretical literature that proposes those who dissociate represent a clinically distinct group that may respond worse to exposure-based treatments for PTSD. (PsycINFO Database Record
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23
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Seligowski AV, Lebois LAM, Hill SB, Kahhale I, Wolff JD, Jovanovic T, Winternitz SR, Kaufman ML, Ressler KJ. Autonomic responses to fear conditioning among women with PTSD and dissociation. Depress Anxiety 2019; 36:625-634. [PMID: 31012207 PMCID: PMC6602841 DOI: 10.1002/da.22903] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Individuals with posttraumatic stress disorder (PTSD) demonstrate alterations in autonomic responses to fear conditioning, such as exaggerated startle and poor fear inhibition. However, there is a paucity of research on fear conditioning among individuals with PTSD and dissociative symptoms, which represents 10-30% of those with PTSD. The current study used a fear-potentiated startle (FPS) conditioning paradigm to examine autonomic responses among women with PTSD and a range of dissociative symptoms. METHODS Participants included 39 women with PTSD and dissociation, and 53 women with PTSD with unknown levels of dissociation. The FPS paradigm consisted of conditioned stimuli associated and not associated with an aversive unconditioned stimulus. FPS response (eyeblink startle), electrocardiogram (ECG), and skin conductance response (SCR) were collected during the FPS paradigm. RESULTS Compared to the PTSD-unknown dissociation sample, the PTSD-dissociation sample demonstrated significantly lower FPS during the last block of conditioning. Among the PTSD-dissociation sample, higher dissociation scores were associated with decreased FPS and SCR, and higher respiratory sinus arrhythmia (derived from ECG). CONCLUSIONS Results suggest that autonomic responses to fear conditioning differ depending on the presence and severity of dissociative symptoms. Given that treatment response may differ depending on dissociative symptoms, it is important to understand the mechanisms that underlie different subtypes of PTSD and that may affect treatment response and outcome.
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Affiliation(s)
- Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Lauren A. M. Lebois
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Sarah B. Hill
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Isabella Kahhale
- Department of Psychology, Stanford University, Stanford, California
| | - Jonathan D. Wolff
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Sherry R. Winternitz
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Milissa L. Kaufman
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
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24
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van Huijstee J, Vermetten E. The Dissociative Subtype of Post-traumatic Stress Disorder: Research Update on Clinical and Neurobiological Features. Curr Top Behav Neurosci 2019; 38:229-248. [PMID: 29063485 DOI: 10.1007/7854_2017_33] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recently, a dissociative subtype of post-traumatic stress disorder (PTSD) has been included in the DSM-5. This review focuses on the clinical and neurobiological features that distinguish the dissociative subtype of PTSD from non-dissociative PTSD. Clinically, the dissociative subtype of PTSD is associated with high PTSD severity, predominance of derealization and depersonalization symptoms, a more significant history of early life trauma, and higher levels of comorbid psychiatric disorders. Furthermore, PTSD patients with dissociative symptoms exhibit different psychophysiological and neural responses to the recall of traumatic memories. While individuals with non-dissociative PTSD exhibit an increased heart rate, decreased activation of prefrontal regions, and increased activation of the amygdala in response to traumatic reminders, individuals with the dissociative subtype of PTSD show an opposite pattern. It has been proposed that dissociation is a regulatory strategy to restrain extreme arousal in PTSD through hyperinhibition of limbic regions. In this research update, promises and pitfalls in current research studies on the dissociative subtype of PTSD are listed. Inclusion of the dissociative subtype of PTSD in the DSM-5 stimulates research on the prevalence, symptomatology, and neurobiology of the dissociative subtype of PTSD and poses a challenge to improve treatment outcome in PTSD patients with dissociative symptoms.
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Affiliation(s)
- Jytte van Huijstee
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Vermetten
- Department Psychiatry, Leiden University Medical Center Utrecht, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
- Arq Psychotrauma Research Group, Diemen, 1112 XE, The Netherlands.
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25
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Nugent N, Gaston SA, Perry J, Rung AL, Trapido EJ, Peters ES. PTSD symptom profiles among Louisiana women affected by the 2010 Deepwater Horizon Oil Spill: A latent profile analysis. J Affect Disord 2019; 250:289-297. [PMID: 30875671 PMCID: PMC6461508 DOI: 10.1016/j.jad.2019.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/01/2019] [Accepted: 03/04/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few prior studies have investigated the latent class structure of PTSD using DSM-5 symptoms. METHODS To describe latent PTSD profiles among women who resided in Deepwater Horizon Oil Spill (DHOS)-affected coastal Louisiana communities, we used data from women enrolled in The Women and Their Children's Health (WaTCH) Study. Latent profile analysis was performed on the 20-item PTSD Checklist for DSM-5 (PCL-5) and model fit statistics for 2-class through 6-class solutions were compared. The pseudo-class draws method was employed on the best class solution to compare key covariates (including demographics, mental health indicators, DHOS exposure indicators, and trauma exposures) across classes. RESULTS Among 1997 women (mean age 46.63 ± 12.14 years, 56.8% white, mean trauma categories 6.09 ± 2.98, 9.55% previously diagnosed with PTSD), model fit statistics supported a five-class solution: low symptoms (mean PCL-5 = 4.10), moderate without mood alterations (mean = 19.73), moderate with mood alterations (mean = 34.24), severe without risk-taking (mean = 55.75), and severe with risk-taking (mean = 53.80). Women in the low-symptom class were significantly more likely to be white, have finished high school, have an income of at least $40,001 per year, be married or living with a partner, and endorse fewer trauma categories than women in the four symptomatic classes. Women with moderate to severe symptoms often had co-morbid depressive symptoms and no prior PTSD diagnosis. LIMITATIONS This study was limited by use of self-reported data and one-time assessment of PTSD symptoms. DISCUSSION Five distinct latent profiles of DSM-5 PTSD symptoms consisted of notably different individuals. Most affected women did not report prior PTSD diagnosis. Future research and practice identifying and addressing barriers to care for trauma-affected women in these communities is warranted.
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Affiliation(s)
- Nicole Nugent
- Departments of Pediatrics and Psychiatry and Human Behavior, Brown University Warren Alpert School of Medicine, Providence, RI, United States
| | - Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States
| | - Jacqueline Perry
- Division of Transplant Surgery, Brigham & Women's Hospital, Boston, MA, United States
| | - Ariane L Rung
- Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
| | - Edward J Trapido
- Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
| | - Edward S Peters
- Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States.
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26
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Jongedijk RA, van der Aa N, Haagen JFG, Boelen PA, Kleber RJ. Symptom severity in PTSD and comorbid psychopathology: A latent profile analysis among traumatized veterans. J Anxiety Disord 2019; 62:35-44. [PMID: 30500478 DOI: 10.1016/j.janxdis.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 11/07/2018] [Accepted: 11/16/2018] [Indexed: 12/11/2022]
Abstract
Individuals diagnosed with posttraumatic stress disorder (PTSD) show remarkably different symptom presentations. Identification of diagnostic profiles of PTSD may contribute to knowledge about treatment modifications to enhance treatment effectiveness. The present study aimed to identify symptom severity classes among 236 Dutch veterans based on a broad range of psychopathology outcomes, including PTSD, using Latent Profile Analysis (LPA). Moreover, multinomial logistic regression was used to test whether class membership could be predicted by the number and characteristics of traumatic event types, coping and personality dimensions. LPA identified three classes of individuals, defined as average, severe, and highly severe symptom severity classes, respectively. No qualitative differences in the symptom dimensions emerged between classes. Veterans with higher amounts of traumatic experiences and specifically with regard to lack of basic human needs, as well as those using more avoidant and problem-focused coping strategies and with more dysfunctional personality characteristics regarding neuroticism and agreeableness were significantly more often in the severe and/or highly severe symptom classes. In conclusion, general symptom severity was found to be an important diagnostic characteristic in this population. Integrated treatments targeting the broad spectrum of mental health problems may be of importance in treating patients that show low therapeutic recovery.
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Affiliation(s)
- Ruud A Jongedijk
- Foundation Centrum' 45 / partner in Arq, Rijnzichtweg 35, 2342 AX, Oegstgeest, the Netherlands; Arq Psychotrauma Expert Group, Nienoord 10, Diemen, 1112XE, the Netherlands.
| | - Niels van der Aa
- Foundation Centrum' 45 / partner in Arq, Rijnzichtweg 35, 2342 AX, Oegstgeest, the Netherlands; Arq Psychotrauma Expert Group, Nienoord 10, Diemen, 1112XE, the Netherlands.
| | - Joris F G Haagen
- Arq Psychotrauma Expert Group, Nienoord 10, Diemen, 1112XE, the Netherlands.
| | - Paul A Boelen
- Arq Psychotrauma Expert Group, Nienoord 10, Diemen, 1112XE, the Netherlands; Utrecht University, Department of Clinical Psychology, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands.
| | - Rolf J Kleber
- Arq Psychotrauma Expert Group, Nienoord 10, Diemen, 1112XE, the Netherlands; Utrecht University, Department of Clinical Psychology, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands.
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Zuj DV, Norrholm SD. The clinical applications and practical relevance of human conditioning paradigms for posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:339-351. [PMID: 30134147 DOI: 10.1016/j.pnpbp.2018.08.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/31/2018] [Accepted: 08/15/2018] [Indexed: 01/17/2023]
Abstract
The classical conditioning paradigm of fear learning has spawned a number of experimental variations for the explanation of posttraumatic stress disorder (PTSD) etiology. These paradigms include extinction learning and recall, fear inhibition, fear generalization, and conditioned avoidance. As such, each of these paradigms have significant applications for understanding the development, maintenance, treatment, and relapse of the fear-related features of PTSD. In the present review, we describe each of these conditioning-based paradigms with reference to the clinical applications, and supported by case examples from patients with severe PTSD symptoms. We also review the neurobiological models of conditioning and extinction in animals, psychiatrically healthy humans, and PTSD patients, and discuss the current balance of evidence suggesting a number of biological, behavioral, and cognitive mechanisms/moderators of the conditioning and extinction process in experimental and clinical contexts.
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Affiliation(s)
- Daniel V Zuj
- Department of Psychology, Swansea University, UK
| | - Seth Davin Norrholm
- Atlanta Veterans Affairs Medical Center, Mental Health Service Line, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA.
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Gidzgier P, Grundmann J, Lotzin A, Hiller P, Schneider B, Driessen M, Schaefer M, Scherbaum N, Hillemacher T, Schäfer I. The dissociative subtype of PTSD in women with substance use disorders: Exploring symptom and exposure profiles. J Subst Abuse Treat 2019; 99:73-79. [PMID: 30797397 DOI: 10.1016/j.jsat.2019.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/23/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022]
Abstract
The dissociative subtype of posttraumatic stress disorder (PTSD) was officially introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In accordance with this new classification, prior studies using Latent Class Analysis (LCA) empirically identified a subgroup of patients that were characterized by a high severity of dissociative symptoms. Despite the high prevalence of PTSD in patients with substance use disorders (SUD), however, no LCA studies on the dissociative subtype of PTSD exist in this population so far. Therefore, the current study aimed to identify subgroups of patients with different symptom and exposure profiles in patients with SUD and PTSD. It was assumed that one symptom and exposure profile could be identified that would be characterized by higher dissociative symptoms, higher additional psychopathology and a higher burden of childhood trauma, as compared to other subgroups. In N = 258 female patients with SUD and PTSD, clinical characteristics of dissociative symptoms, PTSD severity, borderline personality disorder (BPD), depression, childhood trauma and substance abuse were assessed. To identify symptom and exposure profiles, Latent Class Analysis was applied. A three-class solution indicated the best model fit to our data. One class was characterized by a high probability of dissociative symptoms (D-PTSD class), whereas the other two classes were characterized by lower probabilities of dissociative symptoms. The D-PTSD class encompassed 18.7% of the patients. In accordance with our hypothesis, the D-PTSD class showed higher probabilities of PTSD severity, borderline personality disorder symptoms, depressive symptoms, childhood emotional and sexual abuse, childhood emotional neglect, and drug abuse. Our results indicate that the dissociative subtype of PTSD could also be identified in a sample of female patients with SUD. Patients with SUD and PTSD characterized by the dissociative subtype showed more severe psychopathological symptoms than the remaining patients, indicating enhanced clinical needs for this vulnerable group.
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Affiliation(s)
- Piotr Gidzgier
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Johanna Grundmann
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Barbara Schneider
- Department of Addictive Disorders and Psychiatry, LVR-Klinik Cologne, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany.
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy Bethel, Ev. Krankenhaus Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany.
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy, Psychosomatic and Addiction Medicine, Kliniken Essen-Mitte, Henricistrasse 92, 45136 Essen, Germany.
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Virchowstrasse 174, 45147 Essen, Germany.
| | - Thomas Hillemacher
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1D, 30625 Hannover, Germany; Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419 Nuremberg, Germany.
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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29
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Kim D, Kim D, Lee H, Cho Y, Min JY, Kim SH. Prevalence and clinical correlates of dissociative subtype of posttraumatic stress disorder at an outpatient trauma clinic in South Korea. Eur J Psychotraumatol 2019; 10:1657372. [PMID: 31528271 PMCID: PMC6735341 DOI: 10.1080/20008198.2019.1657372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 11/04/2022] Open
Abstract
Background: Previous studies on of the dissociative subtype of posttraumatic stress disorder (d-PTSD) have relied on specialized statistical methods (i.e. profile or class analyses) for diagnosis than clinical rating available to clinicians. Objective: This study investigated the prevalence and covariates of d-PTSD diagnosed by a semi-structured interview in a cohort of outpatients with DSM-IV PTSD in a specialized trauma clinic in South Korea. Method: Data from 249 patients with civilian PTSD were examined, including demographics, clinical variables, Clinical Global Impression (CGI) Scale, and Clinician-Administered PTSD Scale (CAPS-IV). We defined d-PTSD as the presence of either depersonalization or derealization according to additional dissociative items of the CAPS. About one third (n = 82, 32.9%) of patients were designated as having d-PTSD. Results: Compared to the other patients with PTSD, those with d-PTSD were younger, had more severe PTSD symptoms, frequent interpersonal trauma, and a higher number of comorbid disorders. When these variables and their interactions were entered into a logistic regression model, younger age, severe PTSD symptoms and two or more comorbid conditions remained for the final model. We did not find a significant difference in improvement over the course of treatment between two groups. Conclusions: This study highlights the high prevalence of d-PTSD in a clinical population. Associated features of d-PTSD were similar to those reported in the Euro-American literature. Further studies are needed to better understand mechanisms and treatment options for d-PTSD.
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Affiliation(s)
- Daeho Kim
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, South Korea.,Research - Industry Cooperation, Hanyang University, Seoul, South Korea
| | - Dongjoo Kim
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyunji Lee
- Research - Industry Cooperation, Hanyang University, Seoul, South Korea
| | - Yubin Cho
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, South Korea
| | - Ji Young Min
- Research - Industry Cooperation, Hanyang University, Seoul, South Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, South Korea
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Hansen M, Hyland P, Armour C, Andersen TE. Assessing the existence of dissociative PTSD in sub-acute patients of whiplash. J Trauma Dissociation 2019; 20:16-31. [PMID: 29547063 DOI: 10.1080/15299732.2018.1451805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Numerous studies investigating dissociative posttraumatic stress disorder (D-PTSD) have emerged. However, there is a lack of studies investigating D-PTSD following a wider range of traumatic exposure. Thus, the present study investigates D-PTSD using latent class analysis (LCA) in sub-acute patients of whiplash and associated risk factors. The results of LCA showed a three-class solution primarily distributed according to posttraumatic stress disorder (PTSD) symptom severity and thus no indication of D-PTSD. Dissociative symptoms, psychological distress (i.e. anxiety/depression), and pain severity significantly predicted PTSD severity. Combined, the results support the component model of dissociation and PTSD, while still stressing the importance of dissociative symptoms when planning treatment for PTSD.
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Affiliation(s)
- Maj Hansen
- a ThRIVE, Department of Psychology , University of Southern Denmark , Odense , Denmark
| | - Philip Hyland
- b School of Business , National College of Ireland , Dublin , Ireland
| | - Cherie Armour
- c Psychology Research Institute, School of Psychology , Ulster University , Coleraine , Ireland
| | - Tonny E Andersen
- a ThRIVE, Department of Psychology , University of Southern Denmark , Odense , Denmark
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31
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Trauma-Related Dissociation Is No Fantasy: Addressing the Errors of Omission and Commission in Merckelbach and Patihis (2018). PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9336-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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32
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Haagen JFG, van Rijn A, Knipscheer JW, van der Aa N, Kleber RJ. The dissociative post-traumatic stress disorder (PTSD) subtype: A treatment outcome cohort study in veterans with PTSD. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 57:203-222. [DOI: 10.1111/bjc.12169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 11/22/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Joris F. G. Haagen
- Department of Clinical Psychology; Utrecht University; The Netherlands
- Arq Psychotrauma Expert Group; Diemen The Netherlands
| | - Allison van Rijn
- Military Mental Health Care; Department of Defense; Utrecht The Netherlands
| | - Jeroen W. Knipscheer
- Department of Clinical Psychology; Utrecht University; The Netherlands
- Foundation Centrum ’45, partner in Arq Psychotrauma Expert Group; Diemen The Netherlands
| | - Niels van der Aa
- Foundation Centrum ’45, partner in Arq Psychotrauma Expert Group; Diemen The Netherlands
| | - Rolf J. Kleber
- Department of Clinical Psychology; Utrecht University; The Netherlands
- Arq Psychotrauma Expert Group; Diemen The Netherlands
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33
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Ross J, Baník G, Dědová M, Mikulášková G, Armour C. Assessing the structure and meaningfulness of the dissociative subtype of PTSD. Soc Psychiatry Psychiatr Epidemiol 2018; 53:87-97. [PMID: 29043375 PMCID: PMC5846870 DOI: 10.1007/s00127-017-1445-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Studies conducted in the USA, Canada and Denmark have supported the existence of the dissociative PTSD subtype, characterized primarily by symptoms of depersonalization and derealization. The current study aimed to examine the dissociative PTSD subtype in an Eastern European, predominantly female (83.16%) sample, using an extended set of dissociative symptoms. METHODS A latent profile analysis was applied to the PTSD and dissociation data from 689 trauma-exposed university students from Slovakia. RESULTS Four latent profiles of varying PTSD and dissociation symptomatology were uncovered. They were named non-symptomatic, moderate PTSD, high PTSD and dissociative PTSD. The dissociative PTSD profile showed elevations on depersonalization and derealization, but also the alternative dissociative indicators of gaps in awareness and memory, sensory misperceptions and cognitive and behavioural re-experiencing. The core PTSD symptoms of 'memory impairment' and 'reckless or self-destructive behaviour' were also significantly elevated in the dissociative PTSD profile. Moreover, anxiety and anger predicted membership in the dissociative PTSD profile. CONCLUSION The results provide support for the proposal that the dissociative PTSD subtype can be characterized by a variety of dissociative symptoms.
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Affiliation(s)
- Jana Ross
- Psychology Research Institute, Ulster University, Coleraine, BT52 1SA Northern Ireland UK
| | - Gabriel Baník
- Faculty of Arts, Institute of Psychology, University of Prešov, Prešov, Slovakia
| | - Mária Dědová
- Faculty of Arts, School of Psychology, Trnava University in Trnava, Trnava, Slovakia
| | - Gabriela Mikulášková
- Faculty of Arts, Institute of Psychology, University of Prešov, Prešov, Slovakia
| | - Cherie Armour
- Psychology Research Institute, Ulster University, Coleraine, BT52 1SA Northern Ireland UK
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Selvi Y, Kandeger A, Boysan M, Akbaba N, Sayin AA, Tekinarslan E, Koc BO, Uygur OF, Sar V. The effects of individual biological rhythm differences on sleep quality, daytime sleepiness, and dissociative experiences. Psychiatry Res 2017. [PMID: 28646790 DOI: 10.1016/j.psychres.2017.06.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals who differ markedly by sleep chronotype, i.e., morning-type or evening-type also differ on a number of psychological, behavioral, and biological variables. Among several other psychological functions, dissociation may also lead to disruption and alteration of consciousness, which may facilitate dream-like experiences. Our study was aimed at an inquiry into the effects of individual biological rhythm differences on sleep quality and daytime sleepiness in conjunction with dissociative experiences. Participants were 372 undergraduate college students, completed a package of psychological instruments, including the Morningness-Eveningness Questionnaire, Dissociative Experiences Scale, Insomnia Severity Index, and Epworth Sleepiness Scale. Using logistic regression models, direct relations of pathological dissociation with sleepiness, sleep quality and circadian preferences were investigated. Poor sleep quality and sleepiness significantly contributed to the variance of dissociative symptomatology. Although there was no substantial linear association between circadian preferences and pathological dissociation, having evening-type preferences of sleep was indirectly associated with higher dissociation mediated by poor sleep quality. Poor sleep quality and daytime sleepiness seems to be significant antecedents of pathological dissociation. Sleep chronotype preferences underlie this relational pattern that chronobiological characteristics seem to influence indirectly on dissociative tendency via sleep quality.
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Affiliation(s)
- Yavuz Selvi
- Selcuk University Neuroscience Research Center (SAM), Konya, Turkey; Selcuk University Medicine Faculty, Department of Psychiatry, Konya, Turkey.
| | - Ali Kandeger
- Selcuk University Medicine Faculty, Department of Psychiatry, Konya, Turkey
| | - Murat Boysan
- Yuzuncu Yil University, School of Science and Arts, Department of Psychology, Van, Turkey
| | - Nursel Akbaba
- Nusaybin State Hospital, Department of Psychiatry, Mardin, Turkey
| | - Ayca A Sayin
- Selcuk University Medicine Faculty, Department of Psychiatry, Konya, Turkey
| | | | - Basak O Koc
- Mus State Hospital, Department of Psychiatry, Mus, Turkey
| | - Omer F Uygur
- Konya Numune State Hospital, Department of Psychiatry, Konya, Turkey
| | - Vedat Sar
- Koc University School of Medicine (KUSOM), Istanbul, Turkey
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Williams SG, Collen JF, Lettieri CJ. The Continued Search for Optimal Therapy in Patients With OSA and PTSD. J Clin Sleep Med 2017; 13:849. [PMID: 28502285 DOI: 10.5664/jcsm.6644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Scott G Williams
- Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jacob F Collen
- Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Christopher J Lettieri
- Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
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36
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Bailey TD, Brand BL. Traumatic dissociation: Theory, research, and treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cpsp.12195] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hansen M, Ross J, Armour C. Evidence of the dissociative PTSD subtype: A systematic literature review of latent class and profile analytic studies of PTSD. J Affect Disord 2017; 213:59-69. [PMID: 28192736 DOI: 10.1016/j.jad.2017.02.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/30/2017] [Accepted: 02/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The dissociative PTSD (D-PTSD) subtype was first introduced into the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Prior to this, studies using latent profile analysis (LPA) or latent class analysis (LCA), began to provide support for the D-PTSD construct and associated risk factors. This research is important, because dissociative symptoms in the context of PTSD may potentially interfere with treatment course or outcome. The aims of the present study were twofold: to systematically review the LCA and LPA studies investigating support for the D-PTSD construct; and to review the associated research on the risk factors or covariates of D-PTSD in the identified studies. METHOD Six databases (PubMed, Web of Science, Scopus, PILOTS, PsychInfo, and Embase) were systematically searched for relevant papers. RESULTS Eleven studies were included in the present review. The majority of the studies were supportive of the D-PTSD subtype; primarily characterized by depersonalization and derealization. Several covariates of the D-PTSD subtype have been investigated with mixed results. LIMITATIONS Many limitations relate to the state of the current literature, including a small number of studies, the use of self-report measurements of PTSD, and heterogeneity across the samples in investigated covariates. CONCLUSION The results were overall supportive of the D-PTSD construct. Future research on D-PTSD and associated risk factors is needed to shed light on the possibilities of facilitating preventive actions, screening, and implications on treatment effects.
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Affiliation(s)
- Maj Hansen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Jana Ross
- Psychology Research Institute, Psychotraumatology, Mental Health & Suicidal Behavior Research Group, Ulster University, Cromore Road, Coleraine BT52 1SA, Northern Ireland
| | - Cherie Armour
- Psychology Research Institute, Psychotraumatology, Mental Health & Suicidal Behavior Research Group, Ulster University, Cromore Road, Coleraine BT52 1SA, Northern Ireland
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Cox RC, Tuck BM, Olatunji BO. Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor? Curr Psychiatry Rep 2017; 19:22. [PMID: 28321643 DOI: 10.1007/s11920-017-0773-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to integrate recent findings on sleep disturbance and PTSD, examine sleep disturbance as a causal factor in the development of PTSD, and identify future directions for research, treatment, and prevention. RECENT FINDINGS Recent research highlights a relationship between both objective and subjective sleep disturbance and PTSD across diverse samples. Sleep disturbance also predicts PTSD over time. Finally, treatments targeting sleep disturbance lead to decreased PTSD symptoms, while standard PTSD treatments conclude with residual sleep disturbance. Sleep disturbance may be more than a mere epiphenomenon of PTSD. Future research examining the causal role of sleep disturbance in the development of PTSD, as well as the utility of targeting sleep disturbance in prevention and treatment, is necessary to fully understand the likely bidirectional relationship between sleep disturbance and PTSD.
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Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Breanna M Tuck
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA.
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Contractor AA, Roley-Roberts ME, Lagdon S, Armour C. Heterogeneity in patterns of DSM-5 posttraumatic stress disorder and depression symptoms: Latent profile analyses. J Affect Disord 2017; 212:17-24. [PMID: 28142081 DOI: 10.1016/j.jad.2017.01.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/16/2016] [Accepted: 01/23/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and depression co-occur frequently following the experience of potentially traumatizing events (PTE; Morina et al., 2013). A person-centered approach to discern heterogeneous patterns of such co-occurring symptoms is recommended (Galatzer-Levy and Bryant, 2013). We assessed heterogeneity in PTSD and depression symptomatology; and subsequently assessed relations between class membership with psychopathology constructs (alcohol use, distress tolerance, dissociative experiences). METHODS The sample consisted of 268 university students who had experienced a PTE and susequently endorsed clinical levels of PTSD or depression severity. Latent profile analyses (LPA) was used to identify the best-fitting class solution accouring to recommended fit indices (Nylund et al., 2007a); and the effects of covariates was analyzed using a 3-step approach (Vermunt, 2010). RESULTS Results of the LPA indicated an optimal 3-class solutions: high severity (Class 2), lower PTSD-higher depression (Class 1), and higher PTSD-lower depression (Class 3). Covariates of distress tolerance, and different kinds of dissociative experiences differentiated the latent classes. LIMITATIONS Use of self-report measure could lead to response biases; and the specific nature of the sample limits generalizability of results. CONCLUSION We found evidence for a depressive subtype of PTSD differentiated from other classes in terms of lower distress tolerance and greater dissociative experiences. Thus, transdiagnostic treatment protocols may be most beneficial for these latent class members. Further, the distinctiveness of PTSD and depression at comparatively lower levels of PTSD severity was supported (mainly in terms of distress tolerance abilities); hence supporting the current classification system placement of these disorders.
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Affiliation(s)
| | - Michelle E Roley-Roberts
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Susan Lagdon
- School of Nursing & Midwifery, Queens University, Belfast, Northern Ireland, UK
| | - Cherie Armour
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK
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40
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Mergler M, Driessen M, Lüdecke C, Ohlmeier M, Chodzinski C, Weirich S, Schläfke D, Wedekind D, Havemann-Reinecke U, Renner W, Schäfer I. Relationships between a Dissociative Subtype of PTSD and Clinical Characteristics in Patients with Substance Use Disorders. J Psychoactive Drugs 2017; 49:225-232. [DOI: 10.1080/02791072.2017.1296209] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Michaela Mergler
- Psychologist, Alpen-Adria-Universitat Klagenfurt, Clinical Psychology, Klagenfurt, Austria
| | - Martin Driessen
- Professor, Clinic of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany
| | - Christel Lüdecke
- Clinician, Klinikum Region Hannover Psychiatrie Wunstorf, Wunstorf, Germany
| | | | - Claudia Chodzinski
- Social Worker, Medizinische Hochschule Hannover Klinik fur Psychiatrie Sozialpsychiatrie und Psychotherapie, Hannover, Germany
| | - Steffen Weirich
- Clinician, Universitatsmedizin Rostock Klinik und Poliklinik fur Psychiatrie und Psychotherapie, Rostock, Germany
| | - Detlef Schläfke
- Professor, Department of Forensic Psychiatry, University of Rostock, Rostock, Germany
| | - Dirk Wedekind
- Professor, Universitatsklinikum Göttingen, Göttingen, Germany
| | | | - Walter Renner
- Professor, Pan European University Bratislava, Bratislava, Slovakia
| | - Ingo Schäfer
- Clinician, Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Psychiatrie und Psychotherapie, Hamburg, Germany
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41
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Mordeno IG, Carpio JGE, Nalipay MJN, Saavedra RLJ. PTSD's Underlying Dimensions in Typhoon Haiyan Survivors: Assessing DSM-5 Symptomatology-Based PTSD Models and Their Relation to Posttraumatic Cognition. Psychiatr Q 2017; 88:9-23. [PMID: 26921207 DOI: 10.1007/s11126-016-9429-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The recent changes in posttraumatic stress disorder (PTSD) symptomatology in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) call for a re-examination of PTSD's latent factor structure. The present study assessed six competing models of PTSD based on DSM-5 symptomatology using confirmatory factor analysis in a sample of young adult Filipino survivors of typhoon Haiyan, one of the strongest typhoons in the world ever recorded at the time of its landfall (N = 632). Furthermore, the differential relationships of the factors of the best-fitting model with posttraumatic cognitions were also investigated. Results showed the 7-factor hybrid model of PTSD comprised of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal, to be the best fitting model. In addition, the varying degrees of relationship with posttraumatic cognitions support the distinctiveness of each factor. These findings are pertinent in light of the changes in DSM-5 PTSD symptomatology, as well as in understanding the underlying dimensions of PTSD among Asian, particularly Filipino, survivors of a natural disaster.
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Affiliation(s)
- Imelu G Mordeno
- Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Jennifer Gay E Carpio
- Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Ma Jenina N Nalipay
- De La Salle University Manila, 2401 Taft Ave., Malate, 1004, Manila, Philippines.
| | - Rhea Lina J Saavedra
- Leyte Normal University, Tacloban City, Philippines
- University of the Philippines Visayas - Tacloban College, Tacloban City, Philippines
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42
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Zhou X, Wu X, An Y. Understanding the Relationship between Trauma Exposure and Depression among Adolescents after Earthquake: The Roles of Fear and Resilience. Front Psychol 2016; 7:2044. [PMID: 28082947 PMCID: PMC5183574 DOI: 10.3389/fpsyg.2016.02044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 12/16/2016] [Indexed: 11/13/2022] Open
Abstract
Middle school students (N = 1435) were assessed 18 months after the Wenchuan earthquake using measures of trauma exposure, fear, resilience, and depression, to examine the effects of fear and resilience on the relationship between trauma exposure and depression. Fear mediated the relationship between trauma exposure and depression, whereas resilience moderated the relationship between fear and depression. These findings suggest that trauma exposure has a direct positive impact on depression, but also indirectly affects depression through fear. Moreover, fear positively predicted depression under conditions of low resilience, whereas this effect was not significant when resilience was high. These results are discussed in terms of their implications for adolescents after trauma.
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Affiliation(s)
- Xiao Zhou
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal UniversityBeijing, China
- The Bob Shapell School of Social Work, Tel Aviv UniversityTel Aviv, Israel
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal UniversityBeijing, China
| | - Yuanyuan An
- School of Psychology, Nanjing Normal UniversityNanjing, China
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43
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Hong C, Efferth T. Systematic Review on Post-Traumatic Stress Disorder Among Survivors of the Wenchuan Earthquake. TRAUMA, VIOLENCE & ABUSE 2016; 17:542-561. [PMID: 26028651 DOI: 10.1177/1524838015585313] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) widely occurs among victims or witness of disasters. With flashbacks, hyperarousal, and avoidance being the typical symptoms, PTSD became a focus of psychological research. The earthquake in Wenchuan, China, on May 12, 2008, was without precedent in magnitude and aftermath and caused huge damage, which drew scientists' attention to mental health of the survivors. We conducted a systematic overview by collecting published articles from the PubMed database and classifying them into five points: epidemiology, neuropathology, biochemistry, genetics and epigenetics, and treatment. The large body of research during the past 6 years showed that adolescents and adults were among the most studied populations with high prevalence rates for PTSD. Genomic and transcriptomic studies focusing on gene × environment studies as well as epigenetics are still rare, although a few available data showed great potential to better understand the pathophysiology of PTSD as multifactorial disease. Phytotherapy with Chinese herbs and acupuncture are rarely reported as of yet, although the first published data indicated promising therapy effects. Future studies should focus on the following points: (1) The affected populations under observation should be better defined concerning individual risk factor, time of observation, spatial movement, and individual disease courses of patients. (2) The role of social support for prevalence rates of PTSD should be observed in more detail. (3) Efficacy and safety of Chinese medicine should be studied to find potential interventions and effective treatments of PTSD.
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Affiliation(s)
- Chunlan Hong
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
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44
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Brand BL, Webermann AR, Frankel AS. Assessment of complex dissociative disorder patients and simulated dissociation in forensic contexts. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:197-204. [PMID: 28029435 DOI: 10.1016/j.ijlp.2016.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Few assessors receive training in assessing dissociation and complex dissociative disorders (DDs). Potential differential diagnoses include anxiety, mood, psychotic, substance use, and personality disorders, as well as exaggeration and malingering. Individuals with DDs typically elevate on many clinical and validity scales on psychological tests, yet research indicates that they can be distinguished from DD simulators. Becoming informed about the testing profiles of DD individuals and DD simulators can improve the accuracy of differential diagnoses in forensic settings. In this paper, we first review the testing profiles of individuals with complex DDs and contrast them with DD simulators on assessment measures used in forensic contexts, including the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Personality Assessment Inventory (PAI), and the Structured Inventory of Reported Symptoms (SIRS), as well as dissociation-specific measures such as the Dissociative Experiences Scale (DES) and Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). We then provide recommendations for assessing complex trauma and dissociation through the aforementioned assessments.
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Affiliation(s)
- Bethany L Brand
- Psychology Department, Towson University, Towson, MD, United States.
| | - Aliya R Webermann
- Psychology Department, Towson University, Towson, MD, United States.
| | - A Steven Frankel
- Psychology Department, University of Southern California, Lafayette, CA, United States.
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45
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Dutra SJ, Wolf EJ. Perspectives on the conceptualization of the dissociative subtype of PTSD and implications for treatment. Curr Opin Psychol 2016; 14:35-39. [PMID: 28813316 DOI: 10.1016/j.copsyc.2016.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
Abstract
A dissociative subtype of PTSD was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to denote a distinct presentation of PTSD marked by symptoms of derealization and depersonalization. The subtype has brought renewed interest in the conceptualization of dissociation in PTSD, and raised questions about its treatment. We review the evidence for two models of PTSD-related dissociative symptoms and the treatment approaches that align with each. We find support for the contributions of biologically-based trait-level factors to dissociation, and suggest that empirically supported treatments for PTSD demonstrate efficacy for patients with the subtype.
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Affiliation(s)
- Sunny J Dutra
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, United States
| | - Erika J Wolf
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, United States.
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46
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Can the dissociative PTSD subtype be identified across two distinct trauma samples meeting caseness for PTSD? Soc Psychiatry Psychiatr Epidemiol 2016; 51:1159-69. [PMID: 27168183 DOI: 10.1007/s00127-016-1235-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION For over a century, the occurrence of dissociative symptoms in connection to traumatic exposure has been acknowledged in the scientific literature. Recently, the importance of dissociation has also been recognized in the long-term traumatic response within the DSM-5 nomenclature. Several studies have confirmed the existence of the dissociative posttraumatic stress disorder (PTSD) subtype. However, there is a lack of studies investigating latent profiles of PTSD solely in victims with PTSD. PURPOSE AND METHOD This study investigates the possible presence of PTSD subtypes using latent class analysis (LCA) across two distinct trauma samples meeting caseness for DSM-5 PTSD based on self-reports (N = 787). Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in a dissociative compared with a non-dissociative PTSD class. RESULTS The results of LCA revealed a two-class solution with two highly symptomatic classes: a dissociative class and a non-dissociative class across both samples. Increased emotion-focused coping increased the probability of individuals being grouped into the dissociative class across both samples. Social support reduced the probability of individuals being grouped into the dissociative class but only in the victims of motor vehicle accidents (MVAs) suffering from whiplash. CONCLUSIONS The results are discussed in light of their clinical implications and suggest that the dissociative subtype can be identified in victims of incest and victims of MVA suffering from whiplash meeting caseness for DSM-5 PTSD.
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47
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Hansen M, Hyland P, Armour C. Does highly symptomatic class membership in the acute phase predict highly symptomatic classification in victims 6 months after traumatic exposure? J Anxiety Disord 2016; 40:44-51. [PMID: 27101400 DOI: 10.1016/j.janxdis.2016.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/25/2016] [Accepted: 04/08/2016] [Indexed: 11/30/2022]
Abstract
Recently studies have indicated the existence of both posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) subtypes but no studies have investigated their mutual association. Although ASD may not be a precursor of PTSD per se, there are potential benefits associated with early identification of victims at risk of developing PTSD subtypes. The present study investigates ASD and PTSD subtypes using latent class analysis (LCA) following bank robbery (N=371). Moreover, we assessed if highly symptomatic ASD and selected risk factors increased the probability of highly symptomatic PTSD. The results of LCA revealed a three class solution for ASD and a two class solution for PTSD. Negative cognitions about self (OR=1.08), neuroticism (OR=1.09) and membership of the 'High symptomatic ASD' class (OR=20.41) significantly increased the probability of 'symptomatic PTSD' class membership. Future studies are needed to investigate the existence of ASD and PTSD subtypes and their mutual relationship.
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Affiliation(s)
- Maj Hansen
- Department of Psychology, University of Southern Denmark, Denmark.
| | - Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland
| | - Cherie Armour
- Psychology Research Institute, School of Psychology, Ulster University, Coleraine, Northern Ireland, UK
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48
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Frías Á, Martínez B, Palma C, Farriols N. Clinical impact of comorbid major depression in subjects with posttraumatic stress disorder: A review of the literature. NORDIC PSYCHOLOGY 2016. [DOI: 10.1080/19012276.2016.1162106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Wolf EJ, Mitchell KS, Sadeh N, Hein C, Fuhrman I, Pietrzak RH, Miller MW. The Dissociative Subtype of PTSD Scale: Initial Evaluation in a National Sample of Trauma-Exposed Veterans. Assessment 2015; 24:503-516. [PMID: 26603115 DOI: 10.1177/1073191115615212] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The fifth edition of the Diagnostic and Statistical Manual includes a dissociative subtype of posttraumatic stress disorder, but no existing measures specifically assess it. This article describes the initial evaluation of a 15-item self-report measure of the subtype called the Dissociative Subtype of Posttraumatic Stress Disorder Scale (DSPS) in an online survey of 697 trauma-exposed military veterans representative of the U.S. veteran population. Exploratory factor analyses of the lifetime DSPS items supported the intended structure of the measure consisting of three factors reflecting derealization/depersonalization, loss of awareness, and psychogenic amnesia. Consistent with prior research, latent profile analyses assigned 8.3% of the sample to a highly dissociative class distinguished by pronounced symptoms of derealization and depersonalization. Overall, results provide initial psychometric support for the lifetime DSPS scales; additional research in clinical and community samples is needed to further validate the measure.
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Affiliation(s)
- Erika J Wolf
- 1 National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA.,2 Boston University School of Medicine, Boston, MA, USA
| | - Karen S Mitchell
- 1 National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA.,2 Boston University School of Medicine, Boston, MA, USA
| | - Naomi Sadeh
- 1 National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA.,2 Boston University School of Medicine, Boston, MA, USA
| | | | | | - Robert H Pietrzak
- 4 National Center for PTSD at VA Connecticut Healthcare System, New Haven, CT, USA.,5 Yale University School of Medicine, New Haven, CT, USA
| | - Mark W Miller
- 1 National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA.,2 Boston University School of Medicine, Boston, MA, USA
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50
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Diamond DM, Zoladz PR. Dysfunctional or hyperfunctional? The amygdala in posttraumatic stress disorder is the bull in the evolutionary China shop. J Neurosci Res 2015; 94:437-44. [PMID: 26511328 DOI: 10.1002/jnr.23684] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/26/2015] [Accepted: 10/11/2015] [Indexed: 12/30/2022]
Abstract
Our motivation in writing this Review arose not only from the great value in contributing to this special issue of the Journal of Neuroscience Research but also from the desire to express our opinion that the description of the amygdala as "dysfunctional" in posttraumatic stress disorder (PTSD) might not be appropriate. We acknowledge that excessive activation of the amygdala contributes to the cluster of PTSD symptoms, including hypervigilance, intrusive memories, and impaired sleep, that underlies the devastating mental and physical outcomes in trauma victims. The issue that we address is whether the symptoms of PTSD represent an impaired (dysfunctional) or sensitized (hyperfunctional) amygdala status. We propose that the amygdala in PTSD is hyperfunctional rather than dysfunctional in recognition of the fact that the individual has already survived one life-threatening attack and that another may be forthcoming. We therefore consider PTSD to be a state in which the amygdala is functioning optimally if the goal is to ensure a person's survival. The misery caused by a hyperfunctional amygdala in PTSD is the cost of inheriting an evolutionarily primitive mechanism that considers survival more important than the quality of one's life.
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Affiliation(s)
- David M Diamond
- Medical Research Service, Veterans Administration Hospital, Tampa, Florida.,Department of Psychology, University of South Florida, Tampa, Florida.,Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida.,Center for Preclinical and Clinical Research on PTSD, University of South Florida, Tampa, Florida
| | - Phillip R Zoladz
- Department of Psychology, Sociology, and Criminal Justice, Ohio Northern University, Ada, Ohio
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