Greater Peritraumatic Dissociation Research Articles

A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents.

BackgroundPost‐traumatic stress disorder (PTSD) is a common reaction to trauma in children and adolescents. While a significant minority of trauma‐exposed youth go on to have persistent PTSD, many youths who initially have a severe traumatic stress response undergo natural recovery. The present study investigated the role of cognitive processes in shaping the early reactions of child and adolescents to traumatic stressors, and the transition to persistent clinically significant post‐traumatic stress symptoms (PTSS).MethodsA prospective longitudinal study of youth aged 8–17 years who had attended a hospital emergency department following single trauma was undertaken, with assessments performed at 2–4 weeks (N = 226) and 2 months (N = 208) post‐trauma. Acute stress disorder and PTSD were assessed using a structured interview, while PTSS, depression severity and peritraumatic and post‐traumatic cognitive processes were assessed using self‐report questionnaires. On the basis of their PTSS scores at each assessment, participants were categorised as being on a resilient, recovery or persistent trajectory.Results PTSS decreased between the two assessments. Cognitive processes at the 2‐ to 4‐week assessment accounted for the most variance in PTSS at both the initial and follow‐up assessment. The onset of post‐traumatic stress was associated particularly with peritraumatic subjective threat, data‐driven processing and pain. Its maintenance was associated with greater peritraumatic dissociation and panic, and post‐traumatic persistent dissociation, trauma memory quality, rumination and negative appraisals. Efforts to deliberately process the trauma were more common in youth who experienced the onset of clinically significant PTSS. Regression modelling indicated that the predictive effect of baseline negative appraisals remained when also accounting for baseline PTSS and depression.ConclusionsCognitive processes play an important role in the onset and maintenance of PTSS in children and adolescents exposed to trauma. Trauma‐related appraisals play a particular role when considering whether youth make the transition from clinically significant acute PTSS to persistent PTSS.

Peritraumatic dissociation predicts posttraumatic stress disorder symptoms via dysfunctional trauma-related memory among war-affected children

ABSTRACTBackground: Among adults there is strong evidence about peritraumatic dissociation (PD) predicting posttraumatic stress disorder (PTSD), yet evidence among children is very limited. It has been suggested that disturbances in memory functioning might explain the association between PD and PTSD, but this has not yet been empirically tested.Objective: We aimed to test the hypotheses that greater PD would be associated with more posttraumatic stress disorder (PTSD) symptoms, and that some of this association would be mediated by disorganized and non-verbal memories about the traumatic event.Method: The sample included 197 Palestinian children (10–12-years) living in the Gaza Strip, participating in the aftermath of the 2008/9 war. Self-report questionnaires were used to measure PD (Peritraumatic Dissociative Experiences Questionnaire) three months post-war, as well as trauma-related memory (Trauma Memory Quality Questionnaire) and PTSD symptoms (Children’s Revised Impact of Event Scale) six months later. Exposure to war trauma was assessed by a checklist. Structural equation modelling was used to examine direct and indirect paths from PD to posttraumatic PTSS, controlling for number of traumatic war events.Results: Structural equation modelling results showed that greater self-reported PD predicted higher levels of PTSS nine months post-war, and that a significant part, but not all, of this relationship was mediated via the quality of trauma-related memories.Conclusions: This study provided empirical evidence that, among war-affected children, greater PD during traumatic events is linked with higher levels of PTSD symptoms several months later, even when accounting for their personal exposure to war trauma. Further, the study supported the idea that the detrimental effects of dissociation during a traumatic event may be due to dysfunctional memories characterized by disorganization and lack of access to verbal and coherence. Further tests of these hypotheses with larger samples and more points of measurement are called for.

Cortisol Awakening Response Prospectively Predicts Peritraumatic and Acute Stress Reactions in Police Officers

The hypothalamic-pituitary-adrenal axis is a major stress response system hypothesized to be involved in the pathogenesis of posttraumatic stress disorder (PTSD). However, few studies have prospectively examined the relationships among pre-exposure hypothalamic-pituitary-adrenal activity, acute stress reactions and PTSD. Two hundred ninety-six police recruits were assessed during academy training before critical incident exposure and provided salivary cortisol at first awakening and after 30 minutes. A measure of cortisol awakening response (CAR) was computed as the change in cortisol level from the first to the second collection. At 12, 24, and 36 months following the start of active police service, officers were assessed for peritraumatic distress, peritraumatic dissociation, acute stress disorder (ASD) symptoms, and PTSD symptoms to their self-identified worst duty-related critical incident. Mixed models for repeated measures were used to analyze the effects of CAR on the outcome variables pooled across the three follow-up assessments. After controlling for time of awakening, first awakening cortisol levels, and cumulative critical incident stress exposure, CAR during academy training was associated with greater peritraumatic dissociation, β = .14, z = 3.49, p < .0001, and greater ASD symptoms during police service assessed at 12, 24, and 36 months, β = .09, Z = 2.03, p < .05, but not with peritraumatic distress, β = .03, z = .81, p = .42, or PTSD symptoms, β = -.004, z = -.09, p = .93. These findings suggest that greater cortisol response to awakening is a pre-exposure risk factor for peritraumatic dissociation and ASD symptoms during police service.

Chronic posttraumatic stress and its predictors in patients living with an implantable cardioverter defibrillator

IntroductionPatients with an implantable cardioverter defibrillator (ICD) show clinically relevant depression and anxiety, but little is known about their levels of posttraumatic stress. We assessed chronic posttraumatic stress attributable to a traumatic cardiac event and its predictors in patients at two time points after ICD placement. MethodsWe investigated 107 consecutively enrolled patients (57±14years, 62% men) on average 24±21months after ICD placement (baseline) and again 41±18months later (follow-up). All patients completed the Impact of Event Scale-Revised (IES-R) to self-rate the severity of posttraumatic stress (range 0–110). The 30% of patients with the highest IES-R scores (≥25) at baseline were defined as PTSD cases; the same threshold was applied to define PTSD caseness at follow-up. ResultsPosttraumatic stress increased from baseline to follow-up (19±22 vs. 25±19, p<0.001); 19% of patients had PTSD at both assessments, 12% at baseline only, and 18% at follow-up only. Female gender as well as greater peritraumatic dissociation and depression predicted greater posttraumatic stress at baseline (p-values≤0.041). Greater baseline posttraumatic stress, helplessness, alexithymia, and ≥5 shocks during follow-up all predicted greater posttraumatic stress at follow-up (p-values≤0.029). Female gender, helplessness, and depression predicted PTSD at baseline (p-values≤0.022); low education and posttraumatic stress at baseline predicted PTSD at follow-up (p-values≤0.003). ConclusionsBetween 2 and 5.5years post-ICD placement chronic posttraumatic stress slightly increased and nearly one-fifth of patients had newly developed PTSD. The identified psychological predictors of long-term chronicity of posttraumatic stress might particularly inform behavioral interventions for ICD recipients.

Dissociation versus posttraumatic stress: Cortisol and physiological correlates in adults highly exposed to the World Trade Center attack on 9/11

Nine months on average after the World Trade Center (WTC) attack, 21 highly exposed adults and 10 healthy controls without major exposure did not differ in cortisol and physiologic measures. Dissociation and posttraumatic stress symptoms were quantified in the exposed group. Dissociation was associated with greater peritraumatic dissociation and, marginally, childhood trauma, lower plasma cortisol levels at 08.00h, and blunted heart rate reactivity to psychosocial stress. Posttraumatic stress was associated with exposure, peritraumatic distress, and early posttraumatic stress, and marginally associated with peritraumatic dissociation; it was not associated with cortisol or physiologic measures. Urinary cortisol differed significantly in its relationship to dissociation versus posttraumatic stress. This small study emphasizes the importance of dissecting the neurobiology of posttraumatic stress versus dissociative traumatic responses.

Predictors of Posttraumatic Stress in Police and Other First Responders

We provide an overview of previous research conducted by our group on risk and resilience factors for PTSD symptoms in police and other first responders. Based on our work, the findings of other investigators on individual differences in risk for PTSD, and drawing on preclinical studies fear conditioning and extinction, we propose a conceptual model for the development of PTSD symptoms emphasizing the role of vulnerability and resilience to peritraumatic panic reactions. We tested this conceptual model in a cross-sectional sample of police officers (n = 715). Utilizing an hierarchical linear regression model we were able to explain 39.7% of the variance in PTSD symptoms. Five variables remained significant in the final model; greater peritraumatic distress (beta = 0.240, P < .001), greater peritraumatic dissociation (beta = 0.174, P < .001), greater problem-solving coping (beta = 0.103, P < .01), greater routine work environment stress (beta = 0.182, P < .001), and lower levels of social support (beta = -0.246, P < .001). These results were largely consistent with the proposed conceptual model. Next steps in this line of research will be to test this model prospectively in a sample of 400 police academy recruits assessed during training and currently being followed for the first 2 years of police service.

Comparisons Between High and Low Peritraumatic Dissociators in Cardiovascular and Emotional Activity While Remembering Trauma

ABSTRACT Peritraumatic dissociation (PD) is one of the best predictors of posttraumatic stress disorder (PTSD). In this pilot study, we examined cardiovascular psychophysiology and negative emotions in 19 adults who, retrospectively, reported experiencing high or low levels of PD during the worst trauma of their lives. In a contiguous series of ten-minute phases, they rested, thought about, talked about, and recovered from talking about their index trauma. We hypothesized that greater PD would be associated with more negative emotion, lower cardiovascular activity, and greater discordance between negative emotions and cardiovascular activity. Our main findings were that PD was associated with lower blood pressure prior to talking about the trauma, greater negative emotion while talking about the trauma, and greater emotional and cardiovascular discordance throughout the experiment. These findings add to the very limited empirical data on physiological concomitants of peritraumatic dissociation and may aid in developing preventive interventions for PTSD.

Why are hispanics at greater risk for PTSD?

Several studies have found that Hispanic Americans have higher rates of posttraumatic stress disorder (PTSD) than non-Hispanic Caucasian and Black Americans. The authors identified predictors of PTSD symptom severity that distinguished Hispanic police officers (n=189) from their non-Hispanic Caucasian (n=317) and Black (n=162) counterparts and modeled them to explain the elevated Hispanic risk for PTSD. The authors found that greater peritraumatic dissociation, greater wishful thinking and self-blame coping, lower social support, and greater perceived racism were important variables in explaining the elevated PTSD symptoms among Hispanics. Results are discussed in the context of Hispanic culture and may be important for prevention of mental illness in the fastest growing ethnic group in the United States.

Psychiatric Symptoms and Cognitive Appraisal following the Near Sinking of a Research Submarine

This study assessed the stress reactions of a submarine crew forced to abandon their vessel in high seas after flooding and fire damaged their ship. The remaining crew members (n = 22) were surveyed 7 months after the incident regarding exposures, initial emotional responses, peritraumatic dissociation, subsequent life events, current safety appraisal, and current symptoms of posttraumatic stress disorder (PTSD) and depression. At 7 months, 9.1% met criteria for PTSD and none met criteria for depression. Higher levels of depressive symptoms were associated with previous traumatic exposures, subsequent life events, and higher levels of PTSD symptoms; higher levels of PTSD symptoms were associated with greater peritraumatic dissociation and initial emotional response. Acute exposures of highly trained professionals to potentially fatal events may not result in high levels of posttraumatic symptoms. Previous and subsequent life events may play a more significant role in the level of postdisaster symptoms.

Posttraumatic stress disorder, alcohol use, and perceived safety after the terrorist attack on the pentagon.

The authors examined posttraumatic stress disorder (PTSD), alcohol use, and perceptions of safety in a sample of survivors of the September 11, 2001, terrorist attack on the Pentagon. Analyses were conducted to examine the effect of past traumatic experience, trauma exposure, initial emotional response, and peritraumatic dissociation on probable PTSD, substance use, and perceived safety among 77 survivors seven months after the attack. Eleven respondents (14 percent) had PTSD. Those with PTSD reported higher levels of initial emotional response and peritraumatic dissociation. Ten respondents (13 percent) reported increased use of alcohol. Women were more than five times as likely as men to have PTSD and almost seven times as likely to report increased use of alcohol. Persons with higher peritraumatic dissociation were more likely to develop PTSD and report increased alcohol use. Those with lower perceived safety at seven months had higher initial emotional response and greater peritraumatic dissociation and were more likely to have PTSD, to have increased alcohol use, and to be female. The association of perceived safety with gender, the presence of PTSD, and increased alcohol use among survivors of the terrorist attack on the Pentagon warrants further study.

Stress responses of emergency services personnel to the Loma Prieta earthquake Interstate 880 freeway collapse and control traumatic incidents.

A three-group quasi-experimental design contrasted the responses of rescue workers to the 1989 Loma Prieta earthquake Interstate 880 freeway collapse (n = 198) with responses to critical incident exposure of Bay Area Controls (n = 140) and San Diego Controls (n = 101). The three groups were strikingly similar with respect to demographics and years of emergency service. The I-880 group reported higher exposure, greater immediate threat appraisal, and more sick days. The three groups did not differ on current symptoms. For the sample as a whole EMT/Paramedics reported higher peritraumatic dissociation compared with Police. EMT/Paramedics and California road workers reported higher symptoms compared with Police and Fire personnel. Nine percent of the sample were characterized as having symptom levels typical of psychiatric outpatients. Compared with lower distress responders, those with greater distress reported greater exposure, greater peritraumatic emotional distress, greater peritraumatic dissociation, greater perceived threat, and less preparation for the critical incident.

Stress responses of emergency services personnel to the loma prieta earthquake interstate 880 freeway collapse and control traumatic incidents

AbstractA three‐group quasi‐experimental design contrasted the responses of rescue workers to the 1989 Loma Prieta earthquake Interstate 880 freeway collapse (n = 198) with responses to critical incident exposure of Bay Area Controls (n = 140) and San Diego Controls (n = 101). The three groups were strikingly similar with respect to demographics and years of emergency service. The I‐880 group reported higher exposure, greater immediate threat appraisal, and more sick days. The three groups did not differ on current symptoms. For the sample as a whole EMT/ Paramedics reported higher peritraumatic dissociation compared with Police. EMT/ Paramedics and California road workers reported higher symptoms compared with Police and Fire personnel. Nine percent of the sample were characterized as having symptom levels typical of psychiatric outpatients. Compared with lower distress responders, those with greater distress reported greater exposure, greater peritraumatic emotional distress, greater peritraumatic dissociation, greater perceived threat, and less preparation for the critical incident.