Terock Jan, Van der Auwera Sandra, Janowitz Deborah, Spitzer Carsten, Barnow Sven, Miertsch Martin, Freyberger Harald J, Grabe Hans-Jörgen
Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Stralsund, Germany.
Psychopathology. 2016;49(5):374-382. doi: 10.1159/000449004. Epub 2016 Sep 14.
The mechanism of how childhood trauma leads to increased risk for adult dissociation is not sufficiently understood. We sought to investigate the predicting effects and the putatively mediating roles of PTSD and alexithymia on the path from childhood trauma to adult dissociation.
A total of 666 day-clinic outpatients were administered the Childhood Trauma Questionnaire (CTQ), the Toronto Alexithymia Scale (TAS-20), the Posttraumatic Diagnostic Scale (PDS), and the Dissociative Experiences Scale (DES) and controlled for sex, age, and the Global Symptom Index (GSI). Linear regression analyses and mediation analyses were applied.
Independent predictive effects on dissociation were found for childhood trauma, alexithymia and PDS, even after adjusting for GSI. Effects of childhood neglect on dissociation were slightly stronger than of abuse. Alexithymia did not mediate the path from childhood trauma to dissociation. Mediation by PDS was specific for childhood abuse, with all PTSD symptom clusters being significantly involved.
Childhood abuse and neglect are important predictors of dissociation. While the effects of abuse are mediated by PTSD, the mechanism of how neglect leads to dissociation remains unclear. The results further support the predictive value of alexithymia for adult dissociation above and beyond the effects of childhood trauma, PTSD, and GSI scores.
童年创伤导致成人解离风险增加的机制尚未得到充分理解。我们试图研究创伤后应激障碍（PTSD）和述情障碍在童年创伤到成人解离过程中的预测作用及可能的中介作用。
对666名日间门诊患者进行了童年创伤问卷（CTQ）、多伦多述情障碍量表（TAS - 20）、创伤后诊断量表（PDS）和解离体验量表（DES）的测评，并对性别、年龄和总体症状指数（GSI）进行了控制。应用线性回归分析和中介分析。
即使在调整GSI后，仍发现童年创伤、述情障碍和PDS对解离有独立的预测作用。童年期忽视对解离的影响略强于虐待。述情障碍并未介导童年创伤到解离的路径。PDS的中介作用仅针对童年期虐待，所有PTSD症状群均显著参与其中。
童年期虐待和忽视是解离的重要预测因素。虽然虐待的影响由PTSD介导，但忽视导致解离的机制仍不清楚。结果进一步支持了述情障碍在超出童年创伤、PTSD和GSI分数影响之外对成人解离的预测价值。
