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A latent class analysis of dissociation and posttraumatic stress disorder: evidence for a dissociative subtype.

作者信息

Wolf Erika J, Miller Mark W, Reardon Annemarie F, Ryabchenko Karen A, Castillo Diane, Freund Rachel

机构信息

National Center for PTSD, VA Boston Healthcare System, Massachusetts, USA.

出版信息

Arch Gen Psychiatry. 2012 Jul;69(7):698-705. doi: 10.1001/archgenpsychiatry.2011.1574.


DOI:10.1001/archgenpsychiatry.2011.1574
PMID:22752235
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3390764/
Abstract

CONTEXT: The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosologic importance. OBJECTIVES: To examine evidence for a dissociative subtype of PTSD and to examine its association with different types of trauma. DESIGN: A latent profile analysis of cross-sectional data from structured clinical interviews indexing DSM-IV symptoms of current PTSD and dissociation. SETTINGS: The VA Boston Healthcare System and the New Mexico VA Health Care System. PARTICIPANTS: A total of 492 veterans and their intimate partners, all of whom had a history of trauma. Participants reported exposure to a variety of traumatic events, including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents, and natural disasters, with most participants reporting exposure to multiple types of traumatic events. Forty-two percent of the sample met the criteria for a current diagnosis of PTSD. MAIN OUTCOME MEASURES: Item-level scores on the Clinician-Administered PTSD Scale. RESULTS: A latent profile analysis suggested a 3-class solution: a low PTSD severity subgroup, a high PTSD severity subgroup characterized by elevations across the 17 core symptoms of the disorder, and a small but distinctly dissociative subgroup that composed 12% of individuals with a current diagnosis of PTSD. The latter group was characterized by severe PTSD symptoms combined with marked elevations on items assessing flashbacks, derealization, and depersonalization. Individuals in this subgroup also endorsed greater exposure to childhood and adult sexual trauma compared with the other 2 groups, suggesting a possible etiologic link with the experience of repeated sexual trauma. CONCLUSIONS: These results support the subtype hypothesis of the association between PTSD and dissociation and suggest that dissociation is a highly salient facet of posttraumatic psychopathology in a subset of individuals with the disorder.

摘要

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本文引用的文献

[1]
Multilevel Latent Class Analysis: An Application of Adolescent Smoking Typologies with Individual and Contextual Predictors.

Struct Equ Modeling. 2010-4-1

[2]
Relationship between posttraumatic stress disorder, quality of life, social support, and affective and dissociative status in severely injured accident victims 12 months after trauma.

Psychosomatics. 2010

[3]
Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype.

Am J Psychiatry. 2010-4-1

[4]
Posttraumatic symptomatology and dissociation in outpatients with chronic posttraumatic stress disorder.

J Trauma Dissociation. 2010

[5]
A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity.

J Trauma Stress. 2009-9-30

[6]
The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD.

Behav Res Ther. 2009-9-6

[7]
Cognitive processes in dissociation: an analysis of core theoretical assumptions.

Psychol Bull. 2008-9

[8]
The dissociative experiences taxon is related to fantasy proneness.

J Nerv Ment Dis. 2007-9

[9]
Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors.

J Trauma Dissociation. 2006

[10]
Item response mixture modeling: application to tobacco dependence criteria.

Addict Behav. 2006-6

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