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Ross J, Armour C. A latent profile analysis of the dissociative subtype of PTSD in a sample of UK Armed Forces veterans residing in Northern Ireland. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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Al-Khazali HM, Ashina H, Iljazi A, Al-Sayegh Z, Lipton RB, Ashina M, Ashina S, Schytz HW. Psychiatric Sequelae Following Whiplash Injury: A Systematic Review. Front Psychiatry 2022; 13:814079. [PMID: 35530017 PMCID: PMC9072624 DOI: 10.3389/fpsyt.2022.814079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anxiety, depression, post-traumatic stress disorder (PTSD), and sleep disturbance are reported following whiplash injury. However, the prevalence of these condition varies among studies. In this review, anxiety, depression, PTSD, and sleep disturbance will be referred as psychiatric outcomes. METHODS We performed a systematic literature search on PubMed and Embase (from database inception until March 20, 2021) to identify studies reporting on the relative frequency of these psychiatric outcomes. Three independent investigators screened titles, abstracts and full-texts. Studies including patients with whiplash injury and where the number of patients with whiplash and anxiety, depression, PTSD, or sleep disturbances could be extrapolated, were included. Furthermore, to be included, studies had to defined psychiatric outcomes in accordance with diagnostic criteria [i.e., Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD)] or by use of a validated instrument with cut-off scores for assessing psychiatric symptoms. Quality rating was done using the Newcastle-Ottawa Scale (NOS) on the included studies. A protocol was registered with PROSPERO (CRD42021232037). RESULTS The literature search identified 5,068 citations, of which five articles were eligible for inclusion. The relative frequency of depressive symptoms following whiplash injury was 32.8% at 6 months, and 34.0% at 6-12 months. The relative frequency of PTSD symptoms after whiplash injury was 9.0-22.3% at 3 months, 15.8% at 6 months and 14.6-17.1% at 12 months. No studies evaluating the relative frequency of anxiety and sleep disturbances were eligible for inclusion. DISCUSSION AND CONCLUSION Our results suggest that there are persistent psychiatric outcomes following whiplash trauma. However, we found considerable heterogeneity among the studies. Thus, we have focused on the most notable limitations of the included studies: 1) small sample sizes, 2) differences in enrollment criteria, 3) lack of control groups, 4) considerable variation in the method used for outcome assessment, 5) directionality of association is difficult to determine and 6) incomplete assessment of compensation factors. We highlight these methodological limitations and outline recommendations for future research. Since psychiatric outcomes are potentially modifiable, future studies should optimize and address the identified methodological limitations so psychiatric sequelae following whiplash injury may be prevented.
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Affiliation(s)
- Haidar Muhsen Al-Khazali
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neurorehabilitation / Traumatic Brain Injury, Rigshospitalet Glostrup, Copenhagen, Denmark
| | - Afrim Iljazi
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zainab Al-Sayegh
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, United States
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sait Ashina
- BIDMC Comprehensive Headache Center, Departments of Neurology and Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Henrik W Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Deen A, Biedermann SV, Lotzin A, Krüger-Gottschalk A, Dyer A, Knaevelsrud C, Rau H, Schellong J, Ehring T, Schäfer I. The dissociative subtype of PTSD in trauma-exposed individuals: a latent class analysis and examination of clinical covariates. Eur J Psychotraumatol 2022; 13:2031591. [PMID: 35273782 PMCID: PMC8903748 DOI: 10.1080/20008198.2022.2031591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND A dissociative subtype of posttraumatic stress disorder (D-PTSD) was introduced into the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) but latent profiles and clinical correlates of D-PTSD remain controversial. OBJECTIVE The aims of our study were to identify subgroups of individuals with distinct patterns of PTSD symptoms, including dissociative symptoms, by means of latent class analyses (LCA), to compare these results with the categorization of D-PTSD vs. PTSD without dissociative features according to the CAPS-5 interview, and to explore whether D-PTSD is associated with higher PTSD severity, difficulties in emotion regulation, and depressive symptoms. METHOD A German sample of treatment-seeking individuals was investigated (N = 352). We conducted an LCA on the basis of symptoms of PTSD and dissociation as assessed by the CAPS-5. Moreover, severity of PTSD (PCL-5), difficulties in emotion regulation (DERS), and depressive symptoms (BDI-II) were compared between patients with D-PTSD according to the CAPS-5 interview and patients without dissociative symptoms. RESULTS LCA results suggested a 5-class model with one subgroup showing the highest probability to fulfill criteria for the dissociative subtype and high scores on both BDI and DERS. Significantly higher scores on the DERS, BDI and PCL-5 were found in the D-PTSD group diagnosed with the CAPS-5 (n = 75; 35.7%). Sexual trauma was also reported more often by this subgroup. When comparing the dissociative subtype to the LCA results, only a partial overlap could be found. CONCLUSIONS Our findings suggest that patients with D-PTSD have significantly more problems with emotion regulation, more depressive symptoms, and more severe PTSD-symptoms. Given the results of our LCA, we conclude that the dissociative subtype seems to be more complex than D-PTSD as diagnosed by means of the CAPS-5.
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Affiliation(s)
- Aljosha Deen
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Anne Dyer
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Free University Berlin, Berlin, Germany
| | - Heinrich Rau
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | | | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
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Tesarz J, Baumeister D, Andersen TE, Vaegter HB. Pain perception and processing in individuals with posttraumatic stress disorder: a systematic review with meta-analysis. Pain Rep 2020; 5:e849. [PMID: 33490843 PMCID: PMC7808684 DOI: 10.1097/pr9.0000000000000849] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a known risk factor for the development of chronic pain conditions, and almost 1 in 5 individuals with chronic pain fulfills the criteria for PTSD. However, the relationship between PTSD and pain is poorly understood and studies on pain perception in patients with PTSD show inconsistent results suggesting that different sensory profiles exist among individuals with PTSD. Here, we (1) systematically summarize the current literature on experimentally evoked pain perception in patients with PTSD compared to subjects without PTSD, and (2) assess whether the nature of the traumatic event is associated with different patterns in pain perception. The main outcome measures were pain threshold, pain tolerance, and pain intensity ratings as well as measures of temporal summation of pain and conditioned pain modulation. A systematic search of MEDLINE, EMBASE, Web of Science, PsycINFO, and CINAHL identified 21 studies for the meta-analysis, including 422 individuals with PTSD and 496 PTSD-free controls. No main effect of PTSD on any outcome measure was found. However, stratification according to the nature of trauma revealed significant differences of small to medium effect sizes. Combat-related PTSD was associated with increased pain thresholds, whereas accident-related PTSD was associated with decreased pain thresholds. No clear relationship between PTSD and experimentally evoked pain perception exists. The type of trauma may affect pain thresholds differently indicating the presence of different subgroups with qualitative differences in pain processing.
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Affiliation(s)
- Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Heidelberg, Germany
| | - David Baumeister
- Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Heidelberg, Germany
| | | | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Department of Anesthesiology and Intensive Care Medicine, University Hospital Odense, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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