Frewen Paul, Hegadoren Kathy, Coupland Nick J, Rowe Brian H, Neufeld Richard W J, Lanius Ruth
a Departments of Psychiatry and Psychology and Graduate Program in Neuroscience , Western University , London , Ontario , Canada.
b Faculty of Nursing , The University of Alberta , Edmonton , Alberta , Canada.
J Trauma Dissociation. 2015;16(5):500-19. doi: 10.1080/15299732.2015.1022925. Epub 2015 Sep 17.
A theoretical framework referred to as a 4-D model has been described for classifying posttraumatic stress symptoms into those potentially occurring within normal waking consciousness (NWC) versus those thought to intrinsically exemplify dissociative experiences, specifically, trauma-related altered states of consciousness (TRASC). As a further test of this theoretical distinction, this prospective study evaluated whether TRASC and NWC forms of distress incrementally and prospectively predicted functional impairment at 6 and 12 weeks following presentation at hospital emergency departments in the acute aftermath of traumatic events in 180 persons. Establishing the clinical significance of both TRASC and NWC-distress symptoms, we found that 6-week markers of TRASC and NWC-distress independently predicted 12-week self-reported levels of social and occupational impairment. We also observed broad support for various predictions of the 4-D model except that, in contrast with hypotheses, childhood trauma history was generally more strongly correlated with symptoms of NWC-distress than with TRASC. Future research directions are discussed.
一种被称为4-D模型的理论框架已被描述，用于将创伤后应激症状分为可能在正常清醒意识（NWC）中出现的症状与那些被认为本质上体现解离体验的症状，具体而言，即与创伤相关的意识改变状态（TRASC）。作为对这一理论区分的进一步检验，这项前瞻性研究评估了在180名创伤事件急性期后到医院急诊科就诊的患者中，TRASC和NWC形式的痛苦是否会逐步且前瞻性地预测6周和12周后的功能损害。在确定TRASC和NWC痛苦症状的临床意义时，我们发现TRASC和NWC痛苦的6周指标独立预测了12周时自我报告的社会和职业损害水平。我们还观察到对4-D模型的各种预测有广泛支持，只是与假设相反的是，儿童创伤史通常与NWC痛苦症状的相关性比与TRASC的相关性更强。文中讨论了未来的研究方向。
