Kienle Johanna, Rockstroh Brigitte, Bohus Martin, Fiess Johanna, Huffziger Silke, Steffen-Klatt Astrid
Department of Psychology, University of Konstanz, P.O.Box 905, D-78457, Konstanz, Germany.
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, J5, 68159, Mannheim, Germany.
BMC Psychiatry. 2017 Jul 11;17(1):248. doi: 10.1186/s12888-017-1414-z.
History of traumatic experience is common in dissociative disorder (DD), and similarity of symptoms and characteristics between DD and posttraumatic stress disorder (PTSD) encouraged to consider DD as trauma-related disorder. However, conceptualization of DD as a trauma-related syndrome would critically affect diagnosis and treatment strategies. The present study addressed overlap and disparity of DD and PTSD by directly comparing correspondence of symptoms, adverse/traumatic experience, and altered affect regulation between patients diagnosed with dissociative disorder (characterized by negative functional neurological symptoms) and patients diagnosed with PTSD.
Somatoform and psychoform dissociation, symptoms of posttraumatic stress, general childhood adversities and lifetime traumata, and alexithymia as index of altered affect regulation were screened with standardized questionnaires and semi-structured interviews in 60 patients with DD (ICD-codes F44.4, F44.6, F44.7), 39 patients with PTSD (ICD-code F43.1), and 40 healthy comparison participants (HC).
DD and PTSD patients scored higher than HC on somatoform and psychoform dissociative symptom scales and alexithymia, and reported more childhood adversities and higher trauma load. PTSD patients reported higher symptom severity and more traumata than DD patients. Those 20 DD patients who met criteria of co-occuring PTSD did not differ from PTSD patients in the amount of reported symptoms of somatoform dissociation, physical and emotional childhood adversities and lifetime traumata, while emotional neglect/abuse in childhood distinguished DD patients with and without co-occuring PTSD (DD patients with co-occuring PTSD reporting more emotional maltreatment).
The pattern of distinctive somatoform and psychoform dissociative symptom severity, type of childhood and lifetime traumata, and amount of alexithymia suggests that DD and PTSD are distinctive syndromes and, therefore, challenges the conceptualization of DD as trauma-related disorder. Together with the detected close correspondence of symptom and experience profiles in DD patients with co-occuring PTSD and PTSD patients, these findings suggest that adverse/traumatic experience may intensify dissociative symptoms, but are not a necessary condition in the generation of functional neurological symptoms. Still, diagnosis and treatment of DD need to consider this impact of traumata and post-traumatic stress symptoms.
创伤经历史在分离性障碍（DD）中很常见，DD与创伤后应激障碍（PTSD）症状和特征的相似性促使人们将DD视为与创伤相关的障碍。然而，将DD概念化为与创伤相关的综合征会严重影响诊断和治疗策略。本研究通过直接比较诊断为分离性障碍（以阴性功能性神经症状为特征）的患者和诊断为PTSD的患者之间的症状对应、不良/创伤经历以及情感调节改变，探讨了DD和PTSD的重叠与差异。
采用标准化问卷和半结构化访谈，对60例DD患者（国际疾病分类代码F44.4、F44.6、F44.7）、39例PTSD患者（国际疾病分类代码F43.1）和40名健康对照参与者（HC）进行了躯体形式和心理形式解离、创伤后应激症状、儿童期一般逆境和终生创伤以及作为情感调节改变指标的述情障碍筛查。
DD和PTSD患者在躯体形式和心理形式解离症状量表以及述情障碍方面的得分高于HC，并且报告了更多的儿童期逆境和更高的创伤负荷。PTSD患者报告的症状严重程度高于DD患者，且创伤更多。那20例符合共病PTSD标准的DD患者在躯体形式解离症状、儿童期身体和情感逆境以及终生创伤的报告症状数量方面与PTSD患者没有差异，而儿童期情感忽视/虐待区分了有和没有共病PTSD的DD患者（共病PTSD的DD患者报告了更多的情感虐待）。
独特的躯体形式和心理形式解离症状严重程度模式以及儿童期和终生创伤类型、述情障碍程度表明，DD和PTSD是独特的综合征，因此，挑战了将DD概念化为与创伤相关障碍的观点。连同在共病PTSD的DD患者和PTSD患者中检测到的症状和经历概况的密切对应，这些发现表明不良/创伤经历可能会加剧解离症状，但不是功能性神经症状产生的必要条件。尽管如此，DD的诊断和治疗仍需考虑创伤和创伤后应激症状的这种影响。
