Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA.
Department of Counseling Psychology, Fordham University, New York, New York, USA.
J Trauma Dissociation. 2020 May-Jun;21(3):305-318. doi: 10.1080/15299732.2019.1678214. Epub 2019 Oct 12.
The dissociative subtype of posttraumatic stress disorder (PTSD) is estimated to characterize about 12-30% of those with PTSD. Some research links this subtype with increased severity of PTSD symptoms compared to samples with "classic" PTSD. However, prevalence and severity rates reported in the literature have varied. One possible explanation for these discrepancies could be related to where the populations were sampled. Therefore, we investigated whether these differences are still observed when holding level of care constant. We collected data from 104 women at a partial and residential psychiatric hospital program focused on trauma-related disorders. Participants completed self-report questionnaires assessing trauma exposure, symptoms and provisional diagnosis of PTSD, trauma-related thoughts and beliefs, and feelings of shame. All participants reported a history of childhood and/or adulthood trauma exposure. Eighty-eight (85%) met criteria for PTSD, and of those, seventy-three (83%) met criteria for the dissociative subtype as assessed by the Dissociative Subtype of PTSD Scale. A series of independent t-tests revealed no significant differences between the "classic" and dissociative PTSD groups with respect to lifetime or childhood trauma exposure, posttraumatic cognitions, shame, or overall PTSD severity. Our results suggest that samples with classic PTSD and the dissociative subtype may not differ in some types of symptom severity when holding level of care constant. Importantly, however, we found at partial/residential level of care the majority of patients with PTSD were dissociative. Given the elevated prevalence rate in this sample, these findings support the need to assess dissociative symptoms, particularly in more acute psychiatric settings.
创伤后应激障碍（PTSD）的分离亚型估计占 PTSD 患者的 12-30%。一些研究将这种亚型与 PTSD 症状的严重程度增加联系起来，与具有“典型” PTSD 的样本相比。然而，文献中报告的患病率和严重程度有所不同。这些差异的一个可能解释可能与人群抽样有关。因此，我们研究了在保持护理水平不变的情况下，这些差异是否仍然存在。我们从一家专注于创伤相关障碍的部分和住院精神病院计划中收集了 104 名女性的数据。参与者完成了自我报告问卷，评估创伤暴露、症状和 PTSD 的临时诊断、与创伤相关的想法和信念，以及羞耻感。所有参与者都报告了儿童期和/或成年期创伤暴露的病史。88 人（85%）符合 PTSD 标准，其中 73 人（83%）符合 PTSD 分离亚型的标准，由 PTSD 分离亚型量表评估。一系列独立 t 检验显示，在一生中或儿童时期的创伤暴露、创伤后认知、羞耻感或 PTSD 总体严重程度方面，“典型”和分离性 PTSD 组之间没有显著差异。我们的研究结果表明，在保持护理水平不变的情况下，具有典型 PTSD 和分离性 PTSD 的样本在某些类型的症状严重程度上可能没有差异。然而，重要的是，我们发现，在部分/住院护理水平上，大多数 PTSD 患者都有分离症状。鉴于该样本中的患病率较高，这些发现支持需要评估分离症状，尤其是在更急性的精神科环境中。
