Wolf Erika J, Miller Mark W, Reardon Annemarie F, Ryabchenko Karen A, Castillo Diane, Freund Rachel
National Center for PTSD, VA Boston Healthcare System, Massachusetts, USA.
Arch Gen Psychiatry. 2012 Jul;69(7):698-705. doi: 10.1001/archgenpsychiatry.2011.1574.
The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosologic importance.
To examine evidence for a dissociative subtype of PTSD and to examine its association with different types of trauma.
A latent profile analysis of cross-sectional data from structured clinical interviews indexing DSM-IV symptoms of current PTSD and dissociation.
The VA Boston Healthcare System and the New Mexico VA Health Care System.
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.
Item-level scores on the Clinician-Administered PTSD Scale.
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.
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.
解离与创伤后应激障碍（PTSD）之间关系的本质存在争议，具有相当重要的临床和分类学意义。
研究PTSD解离亚型的证据，并探讨其与不同类型创伤的关联。
对来自结构化临床访谈的横断面数据进行潜在剖面分析，这些访谈记录了当前PTSD和解离的DSM-IV症状。
波士顿退伍军人医疗保健系统和新墨西哥州退伍军人医疗保健系统。
共有492名退伍军人及其亲密伴侣，他们都有创伤史。参与者报告经历了各种创伤事件，包括战斗、童年期身体和性虐待、伴侣虐待、机动车事故和自然灾害，大多数参与者报告经历了多种类型的创伤事件。42%的样本符合当前PTSD诊断标准。
临床医生管理的PTSD量表的项目级得分。
潜在剖面分析显示出一个三类解决方案：一个低PTSD严重程度亚组、一个高PTSD严重程度亚组，其特征是该障碍的17种核心症状均有升高，以及一个小但明显解离的亚组，该亚组占当前诊断为PTSD个体的12%。后一组的特征是严重的PTSD症状，同时在评估闪回、现实解体和人格解体的项目上有明显升高。与其他两组相比，该亚组个体还认可更多地暴露于童年期和成年期性创伤，这表明与反复性创伤经历可能存在病因学联系。
这些结果支持PTSD与解离之间关联的亚型假说，并表明解离是该障碍一部分个体创伤后精神病理学的一个高度显著方面。
