Evidence for a Dissociative Subtype of Post-Traumatic Stress Disorder Among Help-Seeking Childhood Sexual Abuse Survivors

ABSTRACT

This study examined evidence for a dissociative subtype of post-traumatic stress disorder (PTSD) among women seeking psychotherapy for childhood sexual abuse (CSA). One hundred and twenty-two women seeking treatment for CSA completed a battery of questionnaires assessing PTSD, dissociative symptoms, and child maltreatment. Using signal detection analysis, we identified high and low dissociation PTSD subgroups. A constellation of three PTSD symptoms-hypervigilance, sense of foreshortened future, and sleep difficulties–discriminated between these two subgroups (OR = 8.15). Further evidence was provided by the finding of a nonlinear relationship between severity of childhood maltreatment and dissociation in the women with PTSD. These results provide support for a dissociative subtype of PTSD that may stem from more severe childhood experiences of neglect and abuse.     

Dissociative experiences during sexual behavior among a sample of adults living with HIV infection and a history of childhood sexual abuse

Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of dissociative experiences during sexual behavior. Predictor variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses of posttraumatic stress disorder (PTSD) and dissociative disorders, rape by an intimate partner, duration of CSA, number of perpetrators of CSA, and current sexual satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, dissociative disorders, rape by an intimate partner, duration of CSA, and number of perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA.     

Relationships among childhood trauma, posttraumatic stress disorder, and dissociation in men living with HIV/AIDS

This study examined the relationships among dissociation, childhood trauma and sexual abuse, and posttraumatic stress disorder (PTSD) symptoms in HIV-positive men. Data were collected from 167 men enrolled in a randomized clinical trial that examined a group therapy intervention to decrease HIV-related risk behavior and trauma-related stress symptoms. Participants completed the Trauma History Questionnaire, the Impact of Events Scale-Revised, and the Stanford Acute Stress Reaction Questionnaire. Overall, 35.3% of the participants reported having experienced childhood sexual abuse. A total of 55.7% of the sample met diagnostic criteria for PTSD. The intensity of dissociative symptoms that participants endorsed was positively associated with experience of childhood sexual abuse (r?=?.20, p < .01). Dissociative symptoms were also positively associated with specific PTSD symptoms, notably hyperarousal (r?=?.69, p < .001). Hierarchical regression indicated that hyperarousal symptoms accounted for more of the variance in dissociation than childhood sexual abuse. These results suggest that childhood sexual abuse may be involved in the development of dissociative symptoms in the context of adulthood stress reactions. Furthermore, the pattern of the association between dissociation and PTSD is consistent with the possibility of a dissociative PTSD subtype among HIV-positive men.     

Peritraumatic Somatoform and Psychological Dissociation in Relation to Recall of Childhood Sexual Abuse

Abstract

Objective: Overwhelming experience can evoke psychological dissociation during or immediately after the event, including dissociative amnesia. Whereas some data suggest that such peritraumatic dissociation can also find expression in somatoform symptoms, only a limited range of such symptoms has been systematically studied. The present study hypothesized that peritraumatic psychological and somatoform dissociation are associated with each other, with delayed recall of childhood sexual abuse (CSA), and with CSA severity. Because current somatoform dissociation is most strongly associated with recalled childhood physical abuse (CPA), we also hypothesized that peritraumatic somatoform dissociation is associated with reported CPA over and above CSA.

Method: Thirty-four Dutch women who reported CSA were interviewed using a modified version of the Traumatic Memory Inventory (TMI) which assesses the characteristics of traumatic memories. The participants also completed the Traumatic Experiences Checklist, the Peritraumatic Dissociation Experiences Questionnaire, and the Peritraumatic Somatoform Dissociation Questionnaire.

Results: Peritraumatic psychological and somatoform dissociation were associated with each other, with delayed recall of trauma, and with severity of reported CS A. Reported CPA predicted peritraumatic somatoform dissociation over and above the severity of CS A in terms of the acts involved. Approximately 44% of the women reported independent corroboration of the abuse. Similar proportions of delayed, partial, and continuous CSA memories were corroborated.

Conclusions: This retrospective study suggested that delayed recall of CSA is associated with peritraumatic dissociation and CSA severity. It also suggested that trauma-especially that which involves serious threat to the integrity of the body-may evoke somatoform dissociation. Based on patient report, delayed recall of some CSA memories was as accurate as continuous recall of CSA.     

Peritraumatic Dissociation and Emotions as Predictors of PTSD Symptoms Following Childbirth

ABSTRACT

The current study investigated the contributive role of perinatal dissociative and perinatal emotional responses to the development of PTSD symptoms following childbirth. Method: Using a prospective, longitudinal design, 140 women were studied who were followed from the first week after delivery to three months postpartum. Results: Three women (2.1%) met criteria for PTSD and 21.4% reported a traumatic childbirth experience. Both perinatal negative emotional reactions and perinatal dissociative reactions were the predictors of PTSD symptoms at three months postpartum. The effect of perinatal dissociation, however, was partially mediated by perinatal emotional reactions. Conclusion: Posttraumatic stress disorder can be a consequence of the experience of childbirth. Women who reported high levels of negative emotions during and shortly after childbirth were more likely to develop PTSD symptoms than women who did not. Women who experienced an instrumental delivery and also reported higher levels of psychoform perinatal dissociation, were at higher risk than women who reported higher levels of perinatal dissociation during a spontaneous delivery. These findings add to the growing body of literature regarding traumatic childbirth and indicate that perinatal dissociative and emotional phenomena are associated with posttraumatic stress.     

Salivary cortisol levels and the cortisol response to dexamethasone before and after EMDR: a case report

Trauma survivors with posttraumatic stress disorder (PTSD) have been shown to have lower basal cortisol levels in the urine, plasma, and saliva than in trauma survivors without PTSD, nontraumatized mentally ill, or healthy subjects. We report on a case study in which we measured pre- and post-Eye Movement Desensitization and Reprocessing (EMDR) treatment salivary cortisol levels and salivary cortisol response to 0.50 mg of dexamethasone in a 41-year-old female with chronic PTSD symptoms. Our goal was to determine whether symptom improvement following trauma-focused treatment (EMDR) is associated with changes in basal salivary cortisol or in the cortisol response to dexamethasone administration. Our findings show moderate symptom improvement, an increase in basal cortisol levels, and a more attenuated cortisol hypersuppression in response to the dexamethasone suppression test following EMDR treatment. These results suggest the potential utility of including neuroendocrine measures in the assessment of treatment outcome in PTSD.     

Sleep problems and dissociation in preschool victims of sexual abuse

Objective: Child sexual abuse (CSA) is associated with a host of deleterious impacts, yet little is known about the short-term correlates in children. This study aimed to investigate the association between dissociation and sleep problems in a sample of preschool-age sexual abuse victims while controlling for potentially confounding variables, including gender, age, polytrauma, CSA characteristics, and parental distress. Method: The sample consisted of 179 children (ages 3–6 years) and their non-offending parents. Parents completed questionnaires assessing their child’s dissociative symptoms and sleep problems as well as their own level of psychological distress. Results: Regression analyses revealed that sleep problems were significantly associated with dissociative symptoms over and above all other control variables (children’s gender and age, polytrauma, and parental distress). A longer duration of sexual abuse also predicted greater dissociative symptoms in preschool children. Conclusion: Findings highlight the association between sleep problems and dissociation in preschool-age victims of CSA. Further research is needed to understand their impact on children’s development to design appropriate treatment and prevention initiatives aimed at fostering resilience in young vulnerable children.     

Participation in War-Zone Atrocities and Trait Dissociation Among Vietnam Veterans with Combat-Related Posttraumatic Stress Disorder

Abstract

Objective: This study tested the hypothesis that participation in war-zone atrocities would be significantly related to long-standing dissociative symptomatology among Vietnam veterans with combat-related PTSD.

Method: Self-report data concerning childhood sexual/physical abuse, combat exposure, participation in war-zone atrocities, and trait dissociation were examined.

Conclusion: Vietnam veterans who participated in war-zone atrocities are more likely to report long-standing dissociative symptoms.

Results: Exposure to childhood abuse, as well as exposure to general combat events, was not correlated with trait dissociation. However, participation in war-zone atrocities was correlated with trait dissociation.     

Characteristics of Child Maltreatment,Psychological Dissociation,and Somatoform Dissociation of Canadian Inmates

ABSTRACT

Data are presented on childhood maltreatment characteristics, psychological dissociation, somatoform dissociation, and offense types with a sample of 93 Canadian inmates (62 males and 31 females), with a mean age of 34 years (SD = 9.5). The present study includes findings based on the Child Maltreatment Interview Schedule-Short Form (CMIS-SF), the Detailed Assessment of Posttraumatic States (DAPS), the Multidimensional Dissociation Inventory (MDI), the Somatoform Dissociation Questionnaire (SDQ-20), and indices of violent and sexual offending during adulthood. Chi-square, Cohen's d, and regression analyses were conducted with the data. Results showed that women reported more childhood sexual abuse (CSA) than men, and men committed more violent and sexual offenses than women. Mean comparisons using Cohen's d statistic showed that inmates (N = 62) reported more trauma-related dissociation (DAPS) and more MDI dissociation compared to normative data for these instruments; however, inmates had lower somatoform dissociation scores when compared to published means of dissociative disorder, somatoform disorder, and eating-disorder patients. Inmates with CSA histories had higher SDQ-20 scores than those who did not. No differences were found between sex offenders and non-sex offenders in terms of probable PTSD, probable DID, MDI scales, or the SDQ-20. CSA that involved penetration predicted MDI dissociation and also predicted later sexual offending. Of the MDI scales, derealization and memory disturbance predicted sexual offending. Neither MDI scales nor any of the CMIS-SF maltreatment types predicted violent offending. Results are discussed in terms of treatment implications for incarcerated individuals with histories of child maltreatment.     

Dissociative subtype of posttraumatic stress disorder in women in partial and residential levels of psychiatric care

ABSTRACT

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.     

Childhood Psychological and Physical Abuse: Psychopathology,Dissociation, and Axis I Diagnosis

ABSTRACT

The present study compared (1) college students who reported childhood physical and psychological abuse (combined; N = 35) with (2) students who reported psychological abuse alone (psychological; N = 30), and with (3) students who reported no history of childhood abuse (no abuse; N = 35). Combined abuse and psychological abuse participants were more likely to receive an Axis I diagnosis on a structured interview and to report more dissociative experiences than were no abuse participants. In addition, a structured interview for dissociative disorders was the single measure that differentiated psychologically abused participants from participants reporting combined abuse and no abuse. However, the most psychological impairment was evident in the combined abuse group. Relative to participants who reported no abuse history, combined abuse participants reported more dissociative symptoms on a structured interview and more symptoms of general psycho-pathology, depression, and state and trait anger on self-report measures.     

Women's history of sexual abuse, their sexuality, and sexual self-schemas

In this study, the authors assessed 48 female survivors of child sexual abuse (CSA) and 71 female control participants using measures of adult sexual function, psychological function (i.e., depression and anxiety), and sexual self-schemas. The primary purpose of this study was to examine whether differences existed between women with and without a history of CSA in the way that they viewed themselves as a sexual person and, if so, whether such differences mediated the link between early unwanted sexual experiences and later adult sexuality. CSA survivors were found to view themselves as less romantic and passionate than women who were not abused. In particular, CSA survivors showed an inverse relationship between romantic/passionate sexual self-schemas and negative sexual affect during sexual arousal. The relationship between CSA and negative sexual affect was independent from symptoms of depression and anxiety, suggesting that the impact of CSA on sexual self-schemas may be independent from the impact that the abuse may have in other areas of the survivor's life.     

Peritraumatic Dissociation Is Inversely Related to Catecholamine Levels in Initial Urine Samples of Motor Vehicle Accident Victims

ABSTRACT

This study was designed to determine the relationship between self-reports of peritraumatic dissociation during a motor vehicle accident and measures of physiological arousal in the immediate aftermath of the accident. Upon admittance to the hospital, 15-hour urine samples were collected from participants to measure levels of urinary catecholamines and cortisol. Within two days of the accident, participants reported symptoms of peritraumatic dissociation, and one month after the accident, 59 (34 male and 25 female) participants completed an interview designed to assess symptoms of PTSD. Results revealed that patients who subsequently developed PTSD reported significantly higher levels of peritraumatic dissociation than victims who did not develop PTSD, and that dissociation was negatively associated with levels of urinary norepinephrine and epinephrine. Dissociation was not related to urinary cortisol or cardiovascular levels upon admission. These findings are consistent with previous research that has suggested that high dis-sociators may constitute a subgroup of trauma victims who are physiologically less reactive to trauma.     

Dissociation,Depression and Trauma in Psychiatric Inpatients in Puerto Rico

ABSTRACT

This study investigated the frequency of self-reported childhood abuse experiences of psychiatric inpatients, and the presence of dissociative and depressive symptoms. A total of 100 Puerto Rican in-patients who were hospitalized during a two month period were included in the study. The participants' dissociative and depressive symptoms were assessed using the Dissociative Experiences Scale and a subset of its items (DES-Taxon), the Questionnaire of Experiences in Dissociation and the Beck Depression Inventory. We also used a self-report instrument to assess the frequency and severity of a variety of abusive experiences. Seventy-eight percent (78%) of the participants reported some type of abusive experiences, 38% reported extreme and frequent abuse, and 40% reported being sexually abused during childhood. The findings showed a correlation between greater frequency of the abusive experiences and higher levels of dissociative and depressive symptoms. When the variable of child sexual abuse was used, only the Dissociative Experiences Scale was able to detect differences between those patients who reported such abusive experiences and those who reported none. We conclude that the level of abusive experiences reported by psychiatric in-patients in Puerto Rico is very similar to the rate in other investigations in the international literature. The data demonstrate that the participants who report frequent and intense abuse endorse a wide variety of dissociative experiences, and, to a lesser extent, depressive symptoms. As more than 95% of our inpatients had never been screened or assessed for the possibility of a dissociative disorder, we suggest that clinicians in psychiatric units in Latin America should be more sensitive and attentive to the presence of such disorders.     

The impact of child abuse on dissociative symptoms:a study of incarcerated women.

One-hundred and ninety-two incarcerated women who were participating in a trauma and abuse psychoeducation program were evaluated for childhood abuse, maltreatment and current dissociative symptoms. The link between childhood abuse and adult criminal behavior has been well studied but the mental health status of adult female inmates and the possible implications for their treatment and behavior is the next step. The participants reported high levels of childhood abuse, 68% reported molestation, 72% rape, 26% emotional abuse, 51% physical abuse. Almost half of the participants reported a clinically significant level of dissociative symptoms. The dissociative group was found to have higher rates of sexual, emotional and physical abuse. They were younger and had shorter sentences. A logistic regression model was developed with only physical abuse being a predictor of clinically significant dissociative symptoms. Results are discussed in terms of how the high level of dissociative symptoms may impact future delinquency and corrections staff and possible future research.     

Intimate partner violence and sexual coercion among pregnant women in India: relationship with depression and post-traumatic stress disorder

BACKGROUND: Intimate partner violence (IPV) is prevalent in most parts of the world. It is also prevalent during pregnancy. METHODS: This study assessed the prevalence of IPV during pregnancy and evaluated its relationship with mental health outcomes, including depression and post-traumatic stress disorder (PTSD). Pregnant women (n=203) attending an antenatal clinic in a public hospital in Bangalore were assessed for presence of IPV as well as depressive, somatic, PTSD symptoms and life satisfaction. RESULTS: Self-reported physical violence in the last year was reported by 14% of women, psychological abuse by 15%, and sexual coercion by 9%. One-half of these women reported ongoing abuse during pregnancy. Depression, somatic, and PTSD symptoms were higher in those with a history of abuse or sexual coercion, and life satisfaction was poorer in those with any form of violence. Among those reporting a history of sexual coercion, severity of violence was related to increased psychiatric morbidity. Alcohol abuse in the spouse was a predictor of the presence and severity of abuse. LIMITATIONS: The study was conducted in a single clinic in southern India which is a large country with very diversified populations. CONCLUSION: The experience of intimate partner violence and its mental health consequences are quite prevalent in India which is a culture where gender disparities are normative and pregnancy is a particularly vulnerable period.     

Childhood sexual abuse and affective symptoms in women: a general population study

BACKGROUND: Child sexual abuse (CSA) is associated, after controlling for other adversities, with a range of non-psychotic disorders in adult life. There is a need to clarify whether CSA contributes to risk of disorder in the absence of such adversities, and given that associations may be accounted for by genetic mechanisms, whether they are seen where the perpetrator of CSA is not a biological relative, and where there has been only one incident. METHODS: A questionnaire-based study of a socio-economically representative sample of women age 25-36 (N = 862) was carried out. Parental care and control were assessed using the Parental Bonding Instrument, and CSA using a previously validated questionnaire. Current affective symptoms were assessed from the depression scale of the GHQ-28. RESULTS: Low maternal and paternal care were associated with risk of abuse by a biologically unrelated perpetrator before the age of 11, but not during early adolescence. Low maternal care and CSA each made independent contributions to the prediction of affective symptoms. CSA by a non-relative was strongly associated with GHQ depression, as was CSA by a non-relative that had occurred only once. CONCLUSIONS: Quality of parental care probably influences risk of CSA by unrelated abusers in younger children, while there may be a combination of genetic and parental influences on the risk of abuse by a relative. The strong association of affective symptoms in adult life with CSA by a non-relative suggests an environmental effect. Studies, utilizing genetic designs, of the role of childhood trauma in relation to adult affective symptoms are needed.     

The Role of Depression and Dissociation in the Link Between Childhood Sexual Abuse and Later Parental Practices

ABSTRACT

Research has yielded contradictory results on the relationship between childhood sexual abuse and later parental functioning. This study was undertaken to specify the link between childhood sexual abuse and maternal parenting, while taking into account mothers' childhood physical and emotional traumas and current depressive and dissociative symptoms. Data were collected through self-report measures completed by 93 French-speaking Canadian mothers of children aged 6 to 11 years referred to Youth Protection Services. Parental behaviors examined included involvement with the child, use of positive reinforcement, lack of monitoring and supervision of the child, inconsistency in applying discipline, and use of corporal punishment. Mothers' perception of the quality of the relationship with her child was also assessed. In addition, history of abuse and neglect, depression and dissociation were respectively measured with the Childhood Trauma Questionnaire, the Diagnostic Interview Schedule Simplified, and the Dissociative Experiences Scale. The short-form of the Marlowe-Crowne Social Desirability Scale was used to control for respondent bias aimed at minimizing their problems. Mothers' current depressive symptoms were not found to predict any of the parental dimensions measured. Results from multiple hierarchical regressions pointed to dissociative symptoms as the key predictor of parental practices and attitudes. More specifically, dissociative symptoms predicted the use of positive reinforcement, lack of monitoring and supervision of the child, inconsistency in applying discipline, and use of corporal punishment. Dissociation also mediated the association between childhood maltreatment (physical and emotional abuse and neglect) and inconsistency in applying discipline. Implications for research and practice are discussed.     

Dissociation in sexually abused Puerto Rican children: a replication utilizing social workers as informers

This study explores dissociative symptoms in 3 different groups of Puerto Rican children. Data were collected on 40 children with documented sexual abuse history, 39 children with psychiatric disorders but without a history of sexual abuse, and 40 community control children. Dissociative symptoms were assessed with the child using the Trauma Symptom Checklist for Children (TSCC); a social worker answered the Child Dissociative Checklist (CDC). Results indicated that children with sexual abuse obtained significantly different scores on both the TSCC and the CDC. Further analysis indicated that child and social worker reports of dissociative symptoms were highly correlated (r = .73). Furthermore, 30% of the children in the sexual abuse group scored at or above the cutoff point of 12 on the CDC, which is indicative of a dissociative disorder. None of the children in the other 2 groups obtained such a score. The results suggest that children with documented sexual abuse victimization demonstrate a significant number of dissociative phenomena that not only are subjectively experienced but also can be observed by a non-family member. Finally, as nearly a third of the abused children obtained a score of 12 or higher on the CDC, the next step is to prepare clinicians to conduct a proper and formal diagnosis assessment of dissociative disorders.     

Dissociation, PTSD, and substance abuse: an empirical study

Few studies have examined the relationship between posttraumatic stress disorder (PTSD), substance use disorder, and dissociation. We studied 77 women with current PTSD and substance dependence, classified into high- versus low-dissociation groups per the Dissociative Experiences Scale. They were compared on trauma- and substance-related symptoms, cognitions, coping skills, social adjustment, trauma history, psychiatric symptoms, and self-harm/suicidal behaviors. We found the high-dissociation group consistently more impaired than the low-dissociation group. Also, the sample overall evidenced relatively high levels of dissociation, indicating that even in the presence of recent substance use, dissociation remains a major psychological phenomenon. Indeed, the high-dissociation group reported stronger expectation that substances could manage their psychiatric symptoms. The high-dissociation group also had more trauma-related symptoms and childhood histories of emotional abuse and physical neglect. The discussion addresses methodology, the "chemical dissociation" hypothesis, and the need for a more nuanced understanding of how substances are experienced in relation to dissociative phenomena.