National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.
Depress Anxiety. 2012 Aug;29(8):679-88. doi: 10.1002/da.21946. Epub 2012 May 25.
The nature of the relationship between dissociation and posttraumatic stress disorder (PTSD) has clinical and nosological importance. The aim of this study was to evaluate the evidence for a dissociative subtype of PTSD in two independent samples and to examine the pattern of personality disorder (PD) comorbidity associated with the dissociative subtype of PTSD.
Latent profile analyses were conducted on PTSD and dissociation items reflecting derealization and depersonalization in two samples of archived data: Study 1 included 360 male Vietnam War Veterans with combat-related PTSD; Study 2 included 284 female Veterans and active duty service personnel with PTSD and a high base rate of exposure to sexual trauma.
The latent profile analysis yielded evidence for a three-class solution in both samples: the model was defined by moderate and high PTSD classes and a class marked by high PTSD severity coupled with high levels of dissociation. Approximately 15% of the male sample and 30% of the female sample were classified into the dissociative class. Women (but not men) in the dissociative group exhibited higher levels of comorbid avoidant and borderline PD diagnoses.
Results provide support for a dissociative subtype of PTSD and also suggest that dissociation may play a role in the frequent co-occurrence of PTSD and borderline PD among women. These results are pertinent to the on-going revisions to the DSM and suggest that consideration should be given to incorporating a dissociative subtype into the revised PTSD criteria.
分离与创伤后应激障碍（PTSD）之间的关系性质具有临床和分类学意义。本研究的目的是在两个独立样本中评估 PTSD 的分离亚型的证据，并研究与 PTSD 的分离亚型相关的人格障碍（PD）共病模式。
在两个存档数据样本中，对反映现实解体和人格解体的 PTSD 和分离项目进行潜在剖面分析：研究 1 包括 360 名有战斗相关 PTSD 的男性越南战争退伍军人；研究 2 包括 284 名 PTSD 且性创伤暴露率较高的女性退伍军人和现役人员。
潜在剖面分析在两个样本中均提供了存在三分类解决方案的证据：该模型由中度和高度 PTSD 分类以及高度 PTSD 严重程度与高水平分离相结合的分类定义。大约 15%的男性样本和 30%的女性样本被归入分离组。在分离组中，女性（而非男性）表现出更高水平的共病回避和边缘 PD 诊断。
结果支持 PTSD 的分离亚型，也表明分离可能在 PTSD 和边缘 PD 在女性中频繁共病中起作用。这些结果与 DSM 的正在进行的修订有关，并表明应考虑将分离亚型纳入修订后的 PTSD 标准。
