A Latent Class Analysis of Dissociation and Posttraumatic Stress Disorder

Abstract

Context The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosological importance. Objective To examine evidence for a distinct subtype of PTSD characterized by high levels of dissociation. Design A latent profile analysis of cross-sectional data from structured clinical interviews indexing DSM-IV symptoms of current PTSD and dissociation. Setting VA Boston and New Mexico VA Healthcare Systems. Participants 492 Veterans and their intimate partners, all of whom had histories of trauma. Participants reported exposure to a variety of traumatic events including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents, and natural disasters, with most participants reporting exposure to multiple types of traumatic events. Forty-two percent of the sample met criteria for a current diagnosis of PTSD. Main Outcome Measures Item-level scores on the Clinician Administered PTSD Scale. Results A latent profile analysis suggested a three class solution: a low severity subgroup, a high PTSD severity subgroup characterized by elevations across the 17 core symptoms of the disorder, and a small but distinctly dissociative subgroup that comprised 12% of individuals with a current diagnosis of PTSD. The latter group was characterized by severe PTSD symptoms combined with marked elevations on items assessing flashbacks, derealization, and depersonalization. Individuals in this subgroup also endorsed greater exposure to childhood and adult sexual trauma compared to the other two groups suggesting a possible etiologic link with the experience of repeated sexual trauma. Conclusions Results support the subtype hypothesis of the association between PTSD and dissociation and suggest that dissociation is a highly salient facet of posttraumatic psychopathology in a subset of individuals with the disorder.

Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD

“…dissociative disorders and borderline personality disorder; Sar, Alioğlu, & Akyuz, 2017), suggesting that derealization and depersonalization symptoms represent distinct constructs with different properties. These results support previous literature highlighting increased disease severity and functional impairment among individuals with PTSD+DS (Evren et al, 2011; Stein et al, 2013), including military members and veterans (Tsai et al, 2015; Waelde et al, 2005; Wolf et al, 2012, 2012). …”

“…hypervigilance, increased startle response; American Psychiatric Association, 2013). DSM-5 also introduced the dissociative subtype of PTSD (PTSD+DS), reflecting approximately 15–30% of individuals with PTSD who experience significant dissociative symptoms of depersonalization (feeling as though one is separated from one’s own body) and derealization (feeling as though things around you are strange or unfamiliar) (Armour, Karstoft, & Richardson, 2014; Bennett, Modrowski, Kerig, & Chaplo, 2015; Blevins, Weathers, & Witte, 2014; Bremner & Brett, 1997; Bremner et al, 1992; Frewen, Brown, Steuwe, & Lanius, 2015; Hansen, Ross, & Armour, 2017; Lanius, Brand, Vermetten, Frewen, & Spiegel, 2012; Lanius et al, 2010; Spiegel et al, 2013; Steuwe, Lanius, & Frewen, 2012; Tsai, Armour, Southwick, & Pietrzak, 2015; Waelde, Silvern, & Fairbank, 2005; Wolf et al, 2012, 2012). Among military members and veterans, recent studies indicate that 8–32% of veterans and active duty military personnel meet criteria for the dissociative subtype (Armour et al, 2014; Tsai et al, 2015; Waelde et al, 2005; Wolf et al, 2012, 2012).…”

“…Critically, within military and veteran samples, as well as other trauma-exposed samples (e.g. incarcerated youth, individuals exposed to motor vehicle accidents, physical or sexual assault, childhood abuse), PTSD+DS has been associated with greater PTSD symptom severity, depressive and alcohol abuse symptoms, and psychiatric comorbidity (Bennett et al, 2015; Blevins et al, 2014; Tsai et al, 2015; Waelde et al, 2005; Wolf et al, 2012, 2012) (but see Steuwe et al (2012)). Although considerably less work has been done in first responder populations, early work has identified significantly greater levels of dissociative symptoms among police officers with PTSD as compared to those without PTSD (Carlier, Lamberts, Fouwels, & Gersons, 1996).…”

Pre-deployment dissociation and personality as risk factors for post-deployment post-traumatic stress disorder in Danish soldiers deployed to Afghanistan

“…; DSM-5) (American Psychiatric Association, 2013). For instance, recent studies of veterans and civilian PTSD populations have identified a subgroup with elevated dissociation scores with an emphasis on depersonalization and derealization symptoms (Steuwe, Lanius, & Frewen, 2012; Tsai, Armour, Southwick, & Pietrzak, 2015; Wolf et al, 2012a, 2012b). …”

Assessing therapeutic change in patients with severe dissociative disorders: the progress in treatment questionnaire, therapist and patient measures

“…Future studies should strive to increase representation of groups under-represented here, examine the validity and utility of the measures with patients who do not demonstrate or endorse DSS, and further examine the PITQ-t and PITQ-p’s consistency and validity in terms of replication and extension. This includes examining the measures’ temporal stability, discriminant validity, and utility with DD patients as well as with other populations that experience dissociation, including patients with the dissociative subtype of PTSD (DSM-5; Lanius, Brand, Vermetten, Frewen, & Spiegel, 2012; Stein et al, 2013; Wolf et al, 2012) and/or those reporting complex trauma histories (Cook et al, 2005; Courtois, 2004; Ford & Courtois, 2009). Given that the measures studied in relation to the patient self-report version of the PITQ were each self-report measures, it is possible that shared method variance may be meaningfully contributing to the PITQ-p’s stronger relationships with these measures.…”