Nijenhuis Ellert R S, van der Hart Onno, Kruger Karlien, Steele Kathy
Outpatient Department, Mental Health Care Drenthe, PO Box 30007, 9400 RA Assen, The Netherlands.
Aust N Z J Psychiatry. 2004 Sep;38(9):678-86. doi: 10.1080/j.1440-1614.2004.01441.x.
To test the hypotheses that among general psychiatric outpatients, somatoform dissociation is associated with posttraumatic stress symptoms and with reported potentially traumatizing events, especially with events that involve bodily threat from a person, also when reported age at onset, duration and subjectively rated impact of potentially traumatizing events are considered.
Administration of self-report questionnaires evaluating the severity of somatoform and psychoform dissociation, posttraumatic stress-symptoms, and reported traumatizing events, using samples of consecutive and unselected psychiatric outpatients (n = 153).
Somatoform dissociation was strongly correlated with posttraumatic stress symptoms and with reported cumulative traumatization as assessed with two different self-report trauma questionnaires. Among a wide range of trauma types, bodily threat from a person best predicted somatoform dissociation. Emotional neglect and age further improved the prediction, but emotional neglect and abuse did not predict somatoform dissociation when interpersonal threat to the body was not reported. Somatoform dissociation was also best predicted by bodily threat when reported age at onset, duration and subjective impact of reported traumatization were included in the analyses.
This retrospective study suggests that recurrent interpersonal bodily threat may evoke animal defence-like psychobiological systems manifesting as somatoform dissociation and that this type of threat is often accompanied by emotional neglect. These hypotheses should now be tested in prospective studies.
检验以下假设:在普通精神科门诊患者中,躯体形式解离与创伤后应激症状以及报告的潜在创伤性事件相关,特别是与涉及他人身体威胁的事件相关,同时考虑到潜在创伤性事件的报告发病年龄、持续时间和主观评定的影响。
使用连续且未经过筛选的精神科门诊患者样本(n = 153),通过自我报告问卷来评估躯体形式和心理形式解离的严重程度、创伤后应激症状以及报告的创伤性事件。
躯体形式解离与创伤后应激症状以及通过两种不同的自我报告创伤问卷评估的报告累积创伤密切相关。在广泛的创伤类型中,他人的身体威胁最能预测躯体形式解离。情感忽视和年龄进一步改善了预测效果,但当未报告对身体的人际威胁时,情感忽视和虐待并不能预测躯体形式解离。在分析中纳入报告的发病年龄、持续时间和报告创伤的主观影响时,身体威胁也最能预测躯体形式解离。
这项回顾性研究表明,反复出现的人际身体威胁可能引发类似动物防御的心理生理系统,表现为躯体形式解离,并且这种类型的威胁通常伴随着情感忽视。这些假设现在应该在前瞻性研究中进行检验。