Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Alcohol and Drug Research, Treatment and Training Center AMATEM, Istanbul 34147, Turkey.
Compr Psychiatry. 2013 Feb;54(2):158-66. doi: 10.1016/j.comppsych.2012.06.013. Epub 2012 Aug 16.
The aim of this study was to investigate the mediator roles of negative affect, aggression, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients. In addition, the effect of some variables that may be related with childhood trauma and dissociation among treatment-seeking substance dependents, such as substance of choice (alcohol/drug), mean of current age, and age at regular substance use was controlled. Participants were consecutively admitted 200 male substance-dependent inpatients. Patients were investigated with the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, the Barratt Impulsiveness Scale, the Buss-Perry Aggression Questionnaire, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory. Seventy-seven patients (38.5%) with pathologic dissociation were compared with 123 nondissociative patients (61.5%) classified by dissociative taxon membership. The dissociative group had lower age, age at regular substance use, duration of education, and higher rate of drug dependency rather than alcohol dependency. Beside higher scores on anxiety, depression, childhood trauma, aggression, and impulsivity, a larger proportion of dissociative group reported suicide attempts and self-mutilation than did the nondissociative group. Results of regression analyses suggest that severity of chronic anxiety, aggression (particularly hostility), and impulsivity were found to be mediators of association between childhood trauma and dissociation. Results suggest that, to reduce the risk of dissociation and related behavior such as suicide attempt and self-mutilation among substance dependents, chronic anxiety together with the feelings of hostility and impulsivity must be the targets of evaluation and treatment among those with history of childhood trauma.
本研究旨在探讨负性情绪、攻击性和冲动性在童年创伤与男性物质依赖住院患者分离之间的中介作用。此外，还控制了一些可能与治疗寻求物质依赖者的童年创伤和分离有关的变量，如选择的物质（酒精/药物）、当前年龄的平均值和定期使用物质的年龄。参与者为连续入院的 200 名男性物质依赖住院患者。使用分离体验量表、儿童创伤问卷、巴瑞特冲动量表、巴斯-佩里攻击问卷、贝克抑郁量表和斯皮尔伯格状态-特质焦虑量表对患者进行调查。将 77 名（38.5%）病理性分离患者与 123 名（61.5%）分类为分离分类成员的非分离患者进行比较。分离组年龄较小、定期使用物质的年龄、受教育程度较低，药物依赖率高于酒精依赖率。除了焦虑、抑郁、童年创伤、攻击性和冲动性得分较高外，分离组报告自杀企图和自残的比例也高于非分离组。回归分析结果表明，慢性焦虑、攻击性（特别是敌意）和冲动性的严重程度被认为是童年创伤与分离之间关联的中介因素。结果表明，为了降低物质依赖者出现分离和相关行为（如自杀企图和自残）的风险，对于有童年创伤史的患者，必须将慢性焦虑以及敌意和冲动的感觉作为评估和治疗的目标。
