Peritraumatic Dissociation, Acute Stress, and Early Posttraumatic Stress Disorder in Victims of General Crime

Abstract

Ob jec tive:To com pare the re la tion be tween pe ri trau matic dis so cia tion and acute stress and the early de vel op ment of post traumatic stress dis or der (PTSD) T he re la tion be tween pe ri trau matic dis so cia tion (im me diate dis so cia tion at the time of the trau matic event) and post trau matic stress dis or der (PTSD) has been stud ied follow ing com bat ex po sure, dis as ters, criti cal in ci dents, and motor-vehicle ac ci dents. Vic tims with acute dis so cia tive symp toms ap pear to be at greater risk for PTSD, in de pend ent of trauma ex po sure level, gen eral dis so cia tive ten den cies, and gen eral psy cho pa thol ogy (1-4). Mar mar and oth ers (2,3) have pro posed a meas ure of acute dis so cia tive re sponse to trauma: The Pe ri trau matic Dis so cia tive Ex pe ri ences Question naire (PDEQ). The PDEQ Self-Report Ver sion (PDEQ-10-SRV) con tains 10 items that ad dress dis so cia tive ex pe riences at the time of the trau matic event. These in clude moments of los ing track or blank ing out; find ing the self act ing on "auto matic pi lot"; sense of time chang ing dur ing the event; the event seem ing un real; feel ing as if float ing above the scene; feel ing of body dis tor tion; con fu sion about what was hap pen ing to the self and oth ers; not be ing aware of things that hap pened dur ing the event; and dis ori en ta tion (3). Some stud ies have been lim ited by ret ro spec tive de sign. Prospec tive and lon gi tu di nal as sess ments pro vide a pow er ful meth od ol ogy to study PTSD risk fac tors.Acute stress dis or der in cludes a set of symp toms ex pe ri enced in the first month fol low ing a trau matic event. The vic tim must pres ent 3 dis so cia tive symp toms and at least 1 each of the fol low ing symp toms: in tru sion, avoid ance, and hy perarousal (5). Re cent stud ies show that acute stress dis or der af ter mass shoot ings, traf fic ac ci dents, and vio lent crimes strongly pre dict later PTSD de vel op ment (6-8).In the cur rent study, sub jects were in ter viewed within 24 hours of an as sault to as sess the pres ence of pe ri trau matic disso cia tion. They were re in ter viewed af ter 2 and 5 weeks to assess acute stress and post trau matic stress. These re sults com pared the pre dic tive pow ers of pe ri trau matic dis so cia tion

The independent predictive value of peritraumatic dissociation for PTSD symptomatology after type I trauma: A systematic review of prospective studies

“…Due to the small sample sizes it cannot be ruled out that statistical significance for PD was not reached due to insufficient test power. However, considering the weak associations (4.6% explained variance in Birmes et al (2001a) and an uncontrolled effect size of d=.3 in Shalev et al (1998)), such an explanation appears to be less meaningful.…”

“…In the Birmes et al (2001a) study of a small sample of assault victims (N=35) the following pattern emerged. Entered in the first step of the hierarchical regression analysis, PD explained a significant proportion of PTSD symptom variance.…”

Cross-Cultural Assessment of Psychological Trauma and PTSD

“…Of interest PDEQ levels were strongly positively associated with both peritraumatic physical and emotional reactivity, consistent with the findings of Brunet and colleagues showing that greater emotional distress and physical manifestations of anxiety are strongly associated with greater peritraumatic dissociation. Birmes et al (2001) studied 48 French crime victims within 24 h of traumatic exposure. The participants were followed to assess acute stress responses 2 weeks after the assault and posttraumatic stress at 5 weeks.…”

Emotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype

“…For example, a number of studies of individuals experiencing danger or life threat have shown specific peritraumatic dissociative changes, including alterations in time sense, perception, attentional focus, and awareness of pain among others (12, 13). In addition, depersonalization has been described in a significant percentage of individuals facing acute life threat (reviewed in 9).…”