Association between baseline dissociation levels and stress-induced state dissociation in patients with posttraumatic-stress disorder, borderline personality disorder, and major depressive disorder

Abstract

Introduction Dissociative symptoms are highly prevalent in patients with trauma-related disorders such as borderline personality disorder (BPD) and posttraumatic-stress disorder (PTSD), and also occur in patients with depressive disorders. Acute dissociative states are theorized to be stress-related, and some individuals experience recurring patterns of dissociation. The relationship between the intensity of dissociative episodes (trait-like dissociation) and acute dissociative states, however, is incompletely understood. In the present study, we investigated how levels of baseline (trait-like) dissociation relate to changes in dissociative states during a laboratory stress induction. Methods Our female sample comprised 65 patients with BPD and/or PTSD, 84 patients with major depressive disorder (MDD) and 44 non-clinical controls (NCC). Baseline dissociation was assessed at the start of the study using the Dissociation Tension Scale past week version (DSS-7). All participants underwent the Trier Social Stress Test (TSST) and a placebo version (P-TSST). Before and after the TSST or P-TSST, state dissociation was assessed using the Dissociation Tension Scale acute (DSS-4). We used structural equation models to estimate changes in state dissociation items (somatoform dissociation, derealization, depersonalization, analgesia), and to test whether these changes relate to levels of baseline dissociation. Results We found significant increases in all state dissociation items in response to the TSST in patients with BPD and/or PTSD and patients with MDD, but not in NCCs. Increases in somatoform dissociation and derealization during the TSST were significantly related to higher levels of baseline dissociation in patients with BPD and/or PTSD, but not in patients with MDD or NCCs. Results indicate no significant changes in state dissociation during the P-TSST. Conclusion Our results replicate earlier findings that patients with BPD and/or PTSD report higher levels of stress-related state dissociation than NCC and extend them to patients with MDD. In addition, our findings indicate that baseline levels of dissociation relate to stress-induced changes in state dissociation among patients with BPD and PTSD, but not patients with MDD. In clinical applications, measures of baseline dissociation could be used to facilitate the prediction and treatment of stress-related dissociative states in patients with BPD and/or PTSD.

The Temporal Dynamics of Dissociation: Protocol for an Ecological Momentary Assessment and Laboratory Study in a Transdiagnostic Sample

“…However, the study has several methodological limitations and current evidence is insufficient to conclude that distress increases prior to and decreases during dissociation across diagnostic categories. In addition, laboratory studies have shown increased dissociation during or shortly after exposure to various stressors such as personalized stressful narratives (Chung et al, 2020), arousal induced by the hyperventilation provocation test (Nixon & Bryant, 2006), panic induced by carbon dioxide inhalation (Rassovsky & Kushner, 2003), psychosocial stress (Graumann et al, 2023;Metz et al, 2020;Wingenfeld et al, 2018), and trauma reminders (Zoellner et al, 2007;see Krause-Utz et al, 2021;Lynn et al, 2019 for reviews). Changes in physiological parameters that serve as markers for autonomous nervous system activity during dissociation have also been investigated, but current evidence is mixed (see Beutler et al, 2022;Roydeva & Reinders, 2021 for reviews).…”

“…Effect estimates for the laboratory study simulation RI-CLPMs are based on pilot data from our working group that investigated the effects of the TSST on dissociative states in patients with BPD and/or PTSD (Graumann et al, 2023). For hypothesis 1, we assume that the fixed effect between arousal after the first part of the TSST (preparing the speech, t-1) and dissociative states after the second part of the TSST (delivering the speech, t) will be 0.30.…”

“…For hypothesis 1, we assume that the fixed effect between arousal after the first part of the TSST (preparing the speech, t-1) and dissociative states after the second part of the TSST (delivering the speech, t) will be 0.30. The estimate is based on an earlier study that reports an effect of 0.25 across everyday life situations (Heekerens et al, 2023), and can be considered conservative as the association between arousal and dissociative states is expected to be higher under stress (Graumann et al, 2023). In a sample of N = 85, we estimate the power of our model to detect the effect of 0.30 to be 0.88.…”

The Temporal Dynamics of Dissociation: Protocol for an Ecological Momentary Assessment and Laboratory Study in a Transdiagnostic Sample

“…For hypothesis 1, we assume that the fixed effect between arousal after the first part of the TSST (preparing the speech, t-1) and dissociative states after the second part of the TSST (delivering the speech, t) will be 0.30. The estimate is based on an earlier study that reports an effect of 0.25 across everyday life situations (Heekerens et al, 2023), and can be considered conservative as the association between arousal and dissociative states is expected to be higher under stress (Graumann et al, 2023). In a sample of N = 85, we estimate the power of our model to detect the effect of 0.30 to be 0.88.…”

The temporal dynamics of dissociation: protocol for an ecological momentary assessment and laboratory study in a transdiagnostic sample

“…However, the study has several methodological limitations and current evidence is insufficient to conclude that distress increases prior to and decreases during dissociation across diagnostic categories. In addition, laboratory studies have shown increased dissociation during or shortly after exposure to various stressors such as personalized stressful narratives [ 15 ], arousal induced by the hyperventilation provocation test [ 53 ], panic induced by carbon dioxide inhalation [ 62 ], psychosocial stress [ 23 , 48 , 83 ], and trauma reminders ([ 16 , 88 ], see [ 39 , 45 ] for reviews). Changes in physiological parameters that serve as markers for autonomous nervous system activity during dissociation have also been investigated, but current evidence is mixed (see [ 7 , 63 ] for reviews).…”