Department of Clinical Psychology, Utrecht University, The Netherlands.
Arq Psychotrauma Expert Group, Diemen, The Netherlands.
Br J Clin Psychol. 2018 Jun;57(2):203-222. doi: 10.1111/bjc.12169. Epub 2018 Jan 7.
Dissociation is a prevalent phenomenon among veterans with post-traumatic stress disorder (PTSD) that may interfere with the effectiveness of treatment. This study aimed to replicate findings of a dissociative PTSD subtype, to identify corresponding patterns in coping style, symptom type, and symptom severity, and to investigate its impact on post-traumatic symptom improvement.
Latent profile analysis (LPA) was applied to baseline data from 330 predominantly (97%) male treatment-seeking veterans (mean age 39.5 years) with a probable PTSD. Multinomial logistic models were used to identify predictors of dissociative PTSD. Eighty veterans with PTSD that commenced with psychotherapy were invited for a follow-up measure after 6 months. The majority (n = 64, 80% response rate) completed the follow-up measure. Changes in post-traumatic stress between baseline and follow-up were explored as a continuous distal outcome.
Latent profile analysis revealed four distinct patient profiles: 'low' (12.9%), 'moderate' (33.2%), 'severe' (45.1%), and 'dissociative' (8.8%) PTSD. The dissociative PTSD profile was characterized by more severe pathology levels, though not post-traumatic reactions symptom severity. Veterans with dissociative PTSD benefitted equally from PTSD treatment as veterans with non-dissociative PTSD with similar symptom severity.
Within a sample of veterans with PTSD, a subsample of severely dissociative veterans was identified, characterized by elevated severity levels on pathology dimensions. The dissociative PTSD subtype did not negatively impact PTSD treatment.
The present findings confirmed the existence of a distinct subgroup veterans that fit the description of dissociative PTSD. Patients with dissociative PTSD subtype symptoms uniquely differed from patients with non-dissociative PTSD in the severity of several psychopathology dimensions. Dissociative and non-dissociative PTSD patients with similar post-traumatic severity levels showed similar levels of improvement after PTSD treatment. The observational design and small sample size caution interpretation of the treatment outcome data. The IES-R questionnaire does not assess all PTSD DSM-IV diagnostic criteria (14 of 17), although it is considered a valid measure for an indication of PTSD.
分离是创伤后应激障碍（PTSD）退伍军人中普遍存在的现象，可能会干扰治疗效果。本研究旨在复制分离性 PTSD 亚型的发现，确定应对方式、症状类型和症状严重程度的相应模式，并探讨其对创伤后症状改善的影响。
对 330 名主要（97%）男性寻求治疗的 PTSD 退伍军人（平均年龄 39.5 岁）的基线数据进行潜在剖面分析（LPA）。使用多项逻辑回归模型确定分离性 PTSD 的预测因子。80 名开始接受心理治疗的 PTSD 退伍军人被邀请在 6 个月后进行随访测量。大多数（n=64，80%的回复率）完成了随访测量。将基线和随访之间的创伤后应激变化作为连续的远端结果进行探讨。
潜在剖面分析显示出四种不同的患者特征：“低”（12.9%）、“中”（33.2%）、“重”（45.1%）和“分离”（8.8%）PTSD。分离性 PTSD 特征是严重程度更高的病理水平，尽管不是创伤后反应症状的严重程度。分离性 PTSD 退伍军人和非分离性 PTSD 退伍军人的 PTSD 治疗获益相同，尽管症状严重程度相同。
在 PTSD 退伍军人样本中，确定了一个严重分离的退伍军人亚组，其特征是病理维度的严重程度升高。分离性 PTSD 亚型对 PTSD 治疗没有负面影响。
本研究结果证实了存在一个独特的亚组退伍军人，符合分离性 PTSD 的描述。分离性 PTSD 亚组患者在多个精神病理学维度的严重程度上与非分离性 PTSD 患者独特不同。分离性和非分离性 PTSD 患者在创伤后严重程度相似的情况下，在 PTSD 治疗后表现出相似的改善水平。观察性设计和小样本量告诫解释治疗结果数据。IES-R 问卷不评估 PTSD DSM-IV 诊断标准的所有 17 项（14 项），尽管它被认为是 PTSD 指征的有效测量。
