Wearne Deborah, Curtis Guy J, Melvill-Smith Peter, Orr Kenneth G, Mackereth Annette, Rajanthiran Leon, Hood Sean, Choy Winston, Waters Flavie
School of Medicine, University of Western Australia, Perth, Australia.
School of Psychological Science, University of Western Australia, Perth, Australia.
BJPsych Open. 2020 May 20;6(3):e54. doi: 10.1192/bjo.2020.31.
It is clinically imperative to better understand the relationship between trauma, auditory hallucinations and dissociation. The personal narrative of trauma has enormous significance for each individual and is also important for the clinician, who must use this information to decide on a diagnosis and treatment approach.
To better understand whether dissociation contributes in a significant way to hallucinations in individuals with and without trauma histories.
Three groups of participants with auditory hallucinations were recruited, with diagnoses of: schizophrenia (without trauma) (n = 18), post-traumatic stress disorder (PTSD, n = 27) and comorbid schizophrenia and PTSD (SCZ+PTSD), n = 26). Clinician-administered measures included the PTSD Symptoms Scale Interview (PSSI-5), the Clinician-Administered Dissociative States Scale (CADSS) and the Psychotic Symptom Rating Scales (PSYRATS).
Dissociative symptoms were significantly higher in participants with trauma histories (PTSD and SCZ+PTSD groups) and significantly correlated with hallucinations in trauma-exposed participants, but not in participants with schizophrenia (without trauma history). Hallucination severity was correlated with the CADSS amnesia subscale score, but depersonalisation and derealisation were not.
Dissociation may be a mechanism in trauma-exposed individuals who hear voices, but it does not explain all hallucinatory experiences. The SCZ+PTSD group were in an intermediary position between schizophrenia and PTSD on dissociative and hallucination measures. The PTSD and SCZ+PTSD groups experienced dissociative phenomena much more frequently than the schizophrenia group, with a significant trend towards the amnesia subtype of dissociation.
更好地理解创伤、幻听和解离之间的关系在临床上至关重要。创伤的个人叙述对每个个体都具有巨大意义，对临床医生也很重要，临床医生必须利用这些信息来决定诊断和治疗方法。
为了更好地理解解离是否在有或没有创伤史的个体的幻觉中起重要作用。
招募了三组有幻听的参与者，诊断分别为：精神分裂症（无创伤）（n = 18）、创伤后应激障碍（PTSD，n = 27）以及精神分裂症合并创伤后应激障碍（SCZ+PTSD，n = 26）。临床医生实施的测量包括创伤后应激障碍症状量表访谈（PSSI-5）、临床医生施测的解离状态量表（CADSS）和精神病症状评定量表（PSYRATS）。
有创伤史的参与者（PTSD和SCZ+PTSD组）的解离症状明显更高，并且与有创伤经历的参与者的幻觉显著相关，但与精神分裂症患者（无创伤史）的幻觉无关。幻觉严重程度与CADSS遗忘分量表得分相关，但与人格解体和现实解体无关。
解离可能是有创伤经历且出现幻听的个体的一种机制，但它并不能解释所有的幻觉体验。在解离和幻觉测量方面，SCZ+PTSD组处于精神分裂症和PTSD之间的中间位置。PTSD组和SCZ+PTSD组比精神分裂症组更频繁地经历解离现象，且有明显的遗忘型解离趋势。
