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

Hill, Sarah B.; Wolff, Jonathan D.; Bigony, Cara E.; Winternitz, Sherry; Ressler, Kerry J.; Kaufman, Milissa L.; Lebois, Lauren A. M.

doi:10.1080/15299732.2019.1678214

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…The high D-PTSD rate, may be a function of several factors: 1) the recruitment location is known to treat dissociation and thus individuals with these symptoms may seek out this facility, 2) many of the patients seeking treatment in this program have histories of chronic childhood interpersonal trauma which may be associated with dissociative coping responses as discussed above (Cloitre et al, 2012;Hansen et al, 2017;Stein et al, 2013;Steuwe et al, 2012), and 3) we recruited from a partial and residential hospital program, representing a more acute level of care. D-PTSD may be more common at higher levels of care (Hill et al, 2019). Although treating the dissociation dependent variable continuously addresses some of these issues, future studies should seek to replicate and extend these findings in other populations.…”

Section: Discussionmentioning

confidence: 98%

Childhood maltreatment type and severity predict depersonalization and derealization in treatment-seeking women with posttraumatic stress disorder

King

Hill

Wolff

et al. 2020

Psychiatry Research

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The dissociative subtype of posttraumatic stress disorder (D-PTSD) is estimated to occur in approximately 14% of those with posttraumatic stress disorder (PTSD), and is characterized by clinically significant dissociative symptoms in addition to typical PTSD symptoms. Prior research has found childhood maltreatment contributes to dissociation and D-PTSD susceptibility, but more nuanced questions about the nature of childhood maltreatment remain unexplored. We investigated how childhood maltreatment type and severity are associated with the dissociative symptoms of D-PTSD among women with PTSD (N=106) receiving psychiatric care at a program specializing in trauma-related disorders. Participants completed self-report surveys of psychiatric symptoms and prior trauma exposure including the PTSD Checklist for DSM-5, the Dissociative Subtype of PTSD Scale, and the Childhood Trauma Questionnaire. We used multivariate linear regression to model the association of childhood maltreatment types and dissociation. In our final model childhood emotional abuse and physical abuse significantly predicted the dissociative symptoms of D-PTSD. This suggests childhood maltreatment type and severity, in particular of emotional and physical abuse, are associated with the dissociative symptoms of D-PTSD. This work points toward potential etiological contributions to D-PTSD.

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Section: Discussionmentioning

confidence: 98%

Childhood maltreatment type and severity predict depersonalization and derealization in treatment-seeking women with posttraumatic stress disorder

King

Hill

Wolff

et al. 2020

Psychiatry Research

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“…Findings are typically more mixed when focused on a particular type of childhood trauma and its association with dissociation, however. For example, some studies link dissociation with greater childhood sexual abuse exposure and some do not (Hill et al, 2020 ). Taken together, our supervised learning results validated diagnostic interviews/self-reports with data-driven machine learning and highlighted childhood sexual abuse as a common exposure associated with adult dissociation symptoms.…”

Section: Discussionmentioning

confidence: 99%

Unravelling psychiatric heterogeneity and predicting suicide attempts in women with trauma-related dissociation using artificial intelligence

Srinivasan

Harnett

Zhang

et al. 2022

European Journal of Psychotraumatology

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Background: Suicide is a leading cause of death, and rates of attempted suicide have increased during the COVID-19 pandemic. The under-diagnosed psychiatric phenotype of dissociation is associated with elevated suicidal self-injury; however, it has largely been left out of attempts to predict and prevent suicide. Objective: We designed an artificial intelligence approach to identify dissociative patients and predict prior suicide attempts in an unbiased, data-driven manner. Method: Participants were 30 controls and 93 treatment-seeking female patients with posttraumatic stress disorder (PTSD) and various levels of dissociation, including some with the PTSD dissociative subtype and some with dissociative identity disorder (DID). Results: Unsupervised learning models identified patients along a spectrum of dissociation. Moreover, supervised learning models accurately predicted prior suicide attempts with an score up to 0.83. DID had the highest risk of prior suicide attempts, and distinct subtypes of dissociation predicted suicide attempts in PTSD and DID. Conclusions: These findings expand our understanding of the dissociative phenotype and underscore the urgent need to assess for dissociation to identify individuals at high-risk of suicidal self-injury.

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“…Though controversial, the conceptualization of the relationship between dissociation and PTSD shifted in DSM-5 with the inclusion of a new dissociative subtype of PTSD as defined by meeting full criteria for PTSD and also exhibiting “persistent or recurrent” (APA, 2013, p. 274) symptoms of derealization (perceiving the world as unreal) and/or depersonalization (perceiving one's self as unreal). A substantial body of research has provided evidence for this subtype configuration and suggested that the subtype represents roughly 10%–30% of the PTSD population (e.g., Frewen et al, 2015; Stein et al, 2013; Wolf, Miller, et al, 2012), though this may be greater in clinics providing inpatient care (Hill et al, 2020). A recent meta-analysis reported that the prevalence of the dissociative subtype per latent class or latent profile analysis (LCA and LPA, respectively) was 22.8% (White et al, 2022).…”

Section: Functional Connectivitymentioning

confidence: 99%

Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder.

Wolf¹,

Hawn²,

Sullivan³

et al. 2023

Journal of Psychopathology and Clinical Sci

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Approximately 10%–30% of individuals with posttraumatic stress disorder (PTSD) exhibit a dissociative subtype of the condition defined by symptoms of depersonalization and derealization. This study examined the psychometric evidence for the dissociative subtype of PTSD in a sample of young, primarily male post-9/11-era Veterans (n = 374 at baseline and n = 163 at follow-up) and evaluated its biological correlates with respect to resting state functional connectivity (default mode network [DMN]; n = 275), brain morphology (hippocampal subfield volume and cortical thickness; n = 280), neurocognitive functioning (n = 337), and genetic variation (n = 193). Multivariate analyses of PTSD and dissociation items suggested a class structure was superior to dimensional and hybrid ones, with 7.5% of the sample comprising the dissociative class; this group showed stability over 1.5 years. Covarying for age, sex, and PTSD severity, linear regression models revealed that derealization/depersonalization severity was associated with: decreased DMN connectivity between bilateral posterior cingulate cortex and right isthmus (p = .015; adjusted-p [padj] = .097); increased bilateral whole hippocampal, hippocampal head, and molecular layer head volume (p = .010–.034; padj = .032–.053); worse self-monitoring (p = .018; padj = .079); and a candidate genetic variant (rs263232) in the adenylyl cyclase 8 gene (p = .026), previously associated with dissociation. Results converged on biological structures and systems implicated in sensory integration, the neural representation of spatial awareness, and stress-related spatial learning and memory, suggesting possible mechanisms underlying the dissociative subtype of PTSD.

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

Cited by 11 publications

References 23 publications

Childhood maltreatment type and severity predict depersonalization and derealization in treatment-seeking women with posttraumatic stress disorder

Childhood maltreatment type and severity predict depersonalization and derealization in treatment-seeking women with posttraumatic stress disorder

Unravelling psychiatric heterogeneity and predicting suicide attempts in women with trauma-related dissociation using artificial intelligence

Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder.

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