Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Department of Addictive Disorders and Psychiatry, LVR-Klinik Cologne, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany.
J Subst Abuse Treat. 2019 Apr;99:73-79. doi: 10.1016/j.jsat.2019.01.004. Epub 2019 Jan 4.
The dissociative subtype of posttraumatic stress disorder (PTSD) was officially introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In accordance with this new classification, prior studies using Latent Class Analysis (LCA) empirically identified a subgroup of patients that were characterized by a high severity of dissociative symptoms. Despite the high prevalence of PTSD in patients with substance use disorders (SUD), however, no LCA studies on the dissociative subtype of PTSD exist in this population so far. Therefore, the current study aimed to identify subgroups of patients with different symptom and exposure profiles in patients with SUD and PTSD. It was assumed that one symptom and exposure profile could be identified that would be characterized by higher dissociative symptoms, higher additional psychopathology and a higher burden of childhood trauma, as compared to other subgroups. In N = 258 female patients with SUD and PTSD, clinical characteristics of dissociative symptoms, PTSD severity, borderline personality disorder (BPD), depression, childhood trauma and substance abuse were assessed. To identify symptom and exposure profiles, Latent Class Analysis was applied. A three-class solution indicated the best model fit to our data. One class was characterized by a high probability of dissociative symptoms (D-PTSD class), whereas the other two classes were characterized by lower probabilities of dissociative symptoms. The D-PTSD class encompassed 18.7% of the patients. In accordance with our hypothesis, the D-PTSD class showed higher probabilities of PTSD severity, borderline personality disorder symptoms, depressive symptoms, childhood emotional and sexual abuse, childhood emotional neglect, and drug abuse. Our results indicate that the dissociative subtype of PTSD could also be identified in a sample of female patients with SUD. Patients with SUD and PTSD characterized by the dissociative subtype showed more severe psychopathological symptoms than the remaining patients, indicating enhanced clinical needs for this vulnerable group.
创伤后应激障碍（PTSD）的分离亚型于第五版《精神障碍诊断与统计手册》（DSM-5）中正式引入。根据这一新分类，先前使用潜在类别分析（LCA）的研究从实证上确定了一组以高度分离症状为特征的患者亚组。尽管物质使用障碍（SUD）患者中 PTSD 的患病率很高，但迄今为止，在该人群中尚未有关于 PTSD 分离亚型的 LCA 研究。因此，本研究旨在确定 SUD 和 PTSD 患者中具有不同症状和暴露特征的亚组。假设可以确定一个症状和暴露特征，与其他亚组相比，该特征具有更高的分离症状、更高的附加精神病理学和更高的儿童期创伤负担。在 258 名患有 SUD 和 PTSD 的女性患者中，评估了分离症状、PTSD 严重程度、边缘型人格障碍（BPD）、抑郁、儿童期创伤和物质滥用的临床特征。为了确定症状和暴露特征，应用了潜在类别分析。三类别解决方案表明该模型最适合我们的数据。一类的分离症状可能性较高（D-PTSD 类），而另外两类的分离症状可能性较低。D-PTSD 类包括 18.7%的患者。与我们的假设一致，D-PTSD 类表现出更高的 PTSD 严重程度、边缘型人格障碍症状、抑郁症状、儿童期情感和性虐待、儿童期情感忽视和药物滥用的可能性。我们的研究结果表明，在 SUD 女性患者样本中也可以识别出 PTSD 的分离亚型。以分离亚型为特征的 SUD 和 PTSD 患者表现出比其余患者更严重的精神病理学症状，这表明这一弱势群体的临床需求增强。
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