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

Abstract

Background: Posttraumatic Stress Disorder (PTSD) is associated with significant functional impairment in important areas, including interpersonal relationships and occupational or educational roles. Preliminary evidence suggests that the dissociative subtype of PTSD (PTSD+DS), characterized by marked symptoms of depersonalization and derealization, is associated with increased functional impairment and disease severity, including among military members and veterans diagnosed with PTSD. Similarly, first responders (e.g. police, fire, paramedics) have also been found to experience dissociative symptoms. Despite these findings, little work has investigated whether dissociative symptoms are related to heightened functional impairment among these populations.Objective: We examined the relation between functional impairment and symptom level variables, including dissociative symptoms of depersonalization and derealization among military members, veterans, and first responders with probable PTSD. We further investigated the hypothesis that dissociative symptoms mediate the relation between PTSD symptomatology and functional impairment.Method: Eighty-one medical charts of inpatients at a residential PTSD treatment programme were accessed via retrospective review. Sixty-two were included in the present analyses. Comparison of means on symptom measures between first responders and military members/veterans were conducted, followed by correlational and mediation analyses.Results: Compared with first responders, military members and veterans showed higher levels of derealization, functional impairment, alexithymia, anxiety, and depression. Within the total sample, dissociative symptoms emerged as the strongest correlate of functional impairment and, among the dissociative symptom clusters, derealization symptoms demonstrated the strongest relation with impairment. Mediation analyses revealed that total dissociative symptoms and derealization symptoms significantly mediated the relation between PTSD symptoms and functional impairment.Conclusions: These findings highlight the importance of assessing and treating dissociative symptoms, consistent with the dissociative subtype of PTSD, among military members, veterans, and first responders with PTSD. Successful recovery on a functional and symptomatic level may necessitate treatment of dissociative symptoms, particularly derealization.

Peripersonal Space and Bodily Self-Consciousness: Implications for Psychological Trauma-Related Disorders

“…Investigation of the different aspects of PPS representation (function, plasticity and dynamics, neural correlates) in psychopathology can deepen our scientific and clinical understanding of bodily self-consciousness, particularly in relation to the altered states of consciousness that underlie dissociative symptoms characterizing certain psychological disorders, including trauma-related disorders. Depersonalization and derealization symptoms remain among the most difficult psychological symptoms to recognize, diagnose, and treat, despite seriously impacting the quality of life of individuals ( Boyd et al, 2018 ). A greater understanding of the PPS representation in trauma-related disorders has the potential to lead to innovative diagnostic methods for recognizing dissociative symptoms, as well as the development of novel clinical interventions designed to specifically target these symptoms.…”

Pain perception and processing in individuals with posttraumatic stress disorder: a systematic review with meta-analysis

“…For example, the dissociative subtype of PTSD is rarely seen in whiplash-associated disorder, 18 whereas pronounced levels of dissociation have been seen in complex PTSD. 3 Subjects with accident-related or whiplash-associated PTSD conditions may show more pronounced levels of anxiety and pain catastrophizing, and lower levels of dissociation. 18 It has been shown that experimental pain ratings are negatively related to dissociation levels, 7 and positively related to anxiety associated with fearful appraisals of pain.…”

Post-traumatic stress disorder in train crash survivors in Italy: the role of mood spectrum dysregulations and intrusiveness

“…Previously, other studies analyzed the potential relationships among traumatic events, PTSD and depression in groups of subjects exposed to completely different types of recurrent or chronic traumatic events, including student military veterans, 43 homeless women with mental illnesses, 44 refugees and asylum seekers, 45 or Korean fire fighters. 46 Other studies highlighted clinical similarities between PTSD and depression, as demonstrated in samples of inpatients with PTSD, 47 community samples, 48 Vietnam veterans, 49 underground train drivers, 50 military members, veterans, and first responders (eg, police, fire, and paramedics) with probable PTSD, 51 or survivors of a chemical warfare. 52 Taken as a whole, all these studies pointed out to the substantial symptoms' overlap between the two disorders, to the impact on psychosocial and occupational levels, and to the low treatments' response.…”