The Dissociative Subtype of Ptsd: A Replication and Extension

Wolf, Erika J.; Lunney, Carole A.; Miller, Mark W.; Resick, Patricia A.; Friedman, Matthew J.; Schnurr, Paula P.

doi:10.1002/da.21946

Cited by 180 publications

(197 citation statements)

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“…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). …”

Section: Discussionsupporting

confidence: 90%

“…In particular, the present results suggest that treatment targeting dissociative symptoms, particularly derealization symptoms, among military members and first responders may be imperative in allowing both symptomatic and functional recovery from PTSD. Given that recent studies have identified that 8–32% of veterans and military members with PTSD can be classified as a dissociative subtype (PTSD+DS) (Armour et al, 2014; Tsai et al, 2015; Waelde et al, 2005; Wolf et al, 2012, 2012), these findings hold particular importance for these populations. Critically, military members and veterans often struggle to shift from military or service life to other roles, a transition that is potentially related to the high levels of functional impairment seen in the current sample.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Boyd

Protopopescu

O’Connor

et al. 2018

European Journal of Psychotraumatology

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Boyd

Protopopescu

O’Connor

et al. 2018

European Journal of Psychotraumatology

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“…; 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). …”

Section: Introductionmentioning

confidence: 99%

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

León

Andersen

Karstoft

et al. 2018

European Journal of Psychotraumatology

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Objective: This study investigated whether pre-deployment dissociation was associated with previously identified post-traumatic stress disorder (PTSD) symptom trajectories from before to 2.5 years after military deployment. Furthermore, it examined whether the tendency to dissociate, pre-deployment personality factors, conceptualized by the Big Five model, and previous trauma represented independent risk factors for post-deployment PTSD symptoms.Method: This prospective study included the entire team of 743 soldiers from the Danish Contingent of the International Security Assistance Force 7 deployed to Afghanistan in 2009. Data consisted of self-report measures and were collected six times: before deployment; during deployment; and 1–3 weeks, 2 months, 7 months and 2.5 years after homecoming.Results: The findings indicate significant associations between pre-deployment dissociation and six PTSD trajectories (p < 0.001, η2 = 0.120). Based on mean differences in dissociation for the six trajectories, two main groups emerged: a group with high dissociation scores at pre-deployment, which had moderate PTSD symptom levels at pre-deployment and fluctuated over time; and a group with low dissociation scores at pre-deployment, which had low initial PTSD symptom levels and diverged over time. Our study also confirmed previous findings of a positive association between neuroticism and dissociation (r = 0.31, p < 0.001). This suggests that negative emotionality may be a vulnerability that enhances dissociative experiences, although a causal link cannot be concluded from the findings. Finally, pre-deployment dissociation, pre-deployment neuroticism and a history of traumatic events, as independent factors, were significant predictors of post-deployment PTSD (p < 0.001, R2 = 0.158).Conclusions: The study emphasizes the multiplicity of factors involved in the development of PTSD, and group differences in dissociative symptoms support the heterogeneity in PTSD. Further, this study points to specific aspects of personality that may be targeted in a clinical setting and in pre-deployment assessments in the military.

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