Peritraumatic Dissociation Symptoms Research Articles

Four reasons why we should screen for dissociation in competitive sports

Four reasons why we should screen for dissociation in competitive sports

Psychological Evaluation of the First Quarantined People due to COVID-19 in Turkey

The outbreak of the novel coronavirus has started to appear in 2019, and has become an epidemic. Practices of quarantine, reported to have negative psychological effects in the past, have become widespread. In this study our aim was to examine the psychological conditions of individuals who were taken under quarantine. The sample of this study consisted of 42 individuals who came from Wuhan and were quarantined. All individuals were evaluated through questionnaires to provide psychological support to those in need during that process. Questionnaires were applied to all individuals on a voluntary basis and 30 questionnaires were evaluated. In the monitoring group, the difficulty caused by the risk of infection rather than quarantine stress appeared to be effective on anxiety and peritraumatic dissociation symptoms and at the end of quarantine, no difference has been observed in terms of traumatic stress levels and anxiety scores in the monitoring group compared to the beginning of quarantine. A need for psychosocial support may arise due to psychological impact related to risk of infectious diseases during quarantine practices.

The relationship between dissociation and acute pain: the impact of prior and reactive dissociation

Acute pain can trigger reactions related to acute stress. Such reactions may also include peritraumatic dissociative symptoms. The aim of this experimental study was threefold: (a) to examine which type of dissociation symptoms (DiSym) are associated with acute pain, (b) to assess how DiSym affect pain tolerance, intensity and psychophysiological response and, (c) to evaluate the effect of prior DiSym on the development of further symptoms of dissociation and on pain. A dissociation group (DG) underwent dissociation induction through audio photic stimulation prior to exposure to a painful stimulus (cold water immersion) whereas a control group (CG) underwent exposure only to the painful stimulus. All participants were undergraduate psychology students invited through announcements (47 women, 6 men. Mean age = 21, SD = 1.4). State and peritraumatic dissociation symptoms were assessed; pain was assessed through a visual analogue scale, and tolerance through total immersion time. We found that acute pain was related to somatoform DiSym in both groups (p < .001, η2 = .39). Participants in the DG reported more psychological and state DiSym and exhibited lower pain tolerance (p = .001, d = .82) than CG participants, as well as significant heart rate increase during cold water immersion (p < .001, d = .77). We conclude that certain forms of DiSym may emerge spontaneously in response to acute pain. A detrimental effect on pain intensity/ tolerance was associated to prior symptoms of dissociation. Moreover, DiSym induced prior to exposure to pain may contribute to the development of further dissociation symptoms. Thus, dissociation screening in all pain conditions may improve clinical interventions’ efficacy.

Symptoms of depression and post-traumatic stress in a group of lightning strike victims

IntroductionLightning strike victims often suffer repercussions. Although a lightning strike constitutes a severe traumatic event, there is a lack of data about potential psychological sequelae. This is precisely the context in which we assessed the prevalence of Post-Traumatic Stress Disorder (PTSD) and Major Depressive Episode (MDE) in a group of lightning strike victims. MethodsThe symptoms of peritraumatic dissociation were evaluated on the basis of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) whilst the Peritraumatic Distress Inventory (PDI) was used to assess symptoms of distress. PTSD and MDE diagnoses were evaluated using the MINI (Mini International Neuropsychiatric Interview). Symptom intensity was assessed using the self-report PTSD Checklist-Specific (PCLS) and the Beck Depression Inventory II (BDI II), respectively. ResultsForty-nine patients were enrolled in the study. As regards symptoms of depression, 28 patients (57.1%) reported a major depressive episode (MINI) including 10 (20.4%) of moderate intensity and 5 (10.2%) of severe intensity (BDI). In terms of PTSD symptoms, 13 patients (26.5%) reported probable PTSD (MINI) with a PCL-S score ≥ 45. A significant correlation was established between PDEQ and BDI II (Spearman correlation coefficient = 0.36, p = .012). A significant correlation was also found between PDI and PCLS (Spearman correlation coefficient = 0.43, p = .002). A further significant correlation was noted between PDEQ and PCLS (Spearman correlation coefficient = 0.31, p = .028). DiscussionThis study highlights the need for a multidisciplinary evaluation of lightning strike victims. Indeed, the prevalence of psychiatric disorders such as PTSD and MDE appears to be significant.

The 5-HTTLPR polymorphism of the serotonin transporter gene and child's sex moderate the relationship between disaster-related prenatal maternal stress and autism spectrum disorder traits: The QF2011 Queensland flood study.

The 5-HTTLPR polymorphism of the serotonin transporter has been shown to play a role in autism spectrum disorders (ASD). Moreover, disaster-related prenatal maternal stress (PNMS) has also been shown to be associated with ASD. However, no study to date has examined whether these two factors, either individually or in combination, are predictive of ASD traits in the same sample. We hypothesized that children, particularly boys, with the LL genotype exposed to high levels of disaster-related PNMS would exhibit higher levels of ASD traits compared to boys with the LS or SS genotypes and girls regardless of genotype. Genotype and ASD levels obtained using the Australian normed Autism Spectrum Rating Scales - Short Form were available for 105 30-month-old children exposed to varying levels of PNMS following the 2011 Queensland Flood. For boys, higher ASD traits were associated with the 5-HTTLPR LL genotype in combination with either a negative maternal appraisal of the flood, or high levels of maternal composite subjective stress, PSTD-like or peritraumatic dissociation symptoms. For girls, maternal peritraumatic dissociation levels in combination with the 5-HTTLPR LS or SS genotype were associated with higher ASD traits. The present findings are the first to demonstrate that children's genotype moderates effects of disaster-related PNMS on ASD traits, with different pattern according to child sex.

Trauma-related dissociation: Psychological features and psychophysiological responses to script-driven imagery in borderline personality disorder.

Defense reactions to threatening situations are vital adaptations to stress that protect organisms from injury and ensure survival. We retrospectively investigated the role of peritraumatic dissociation (PD) in the occurrence of severe psychopathology and dissociative patterns of reactions in borderline personality disorder (BPD). We recruited 28 patients with a clinical diagnosis of BPD and 15 healthy controls. The BPD group was divided according to the level of PD (low vs. high): BPD and PD (n = 15) and BPD only (n = 13). We conducted an extensive investigation of history of trauma, clinical status, and measurements of emotional and physiologic responses to recall of personalized aversive experiences. Participants with BPD and high PD displayed highest degrees of trauma exposure and clinical symptoms. Their significant heart rate decline during the imagery of personal traumatic events was opposed to the heart rate increases exhibited by the other two groups and may indicate a dissociative reaction pattern. Skin conductance responses did not differentiate between groups. Several emotional responses to imagery also reinforced the idea that PD may play a role in memory processing of traumatic events and thus in the aggravation and maintenance of symptoms in particularly severe forms of BPD. Within a stepwise linear regression analysis, the best model for trauma-evoked heart rate responses included PD and borderline symptoms, but no measures of state or trait dissociation. Our findings may provide initial evidence of an evolutionary model of peritraumatic reaction stages evolving from arousal to dissociation.

EPA-1315 - Role of peritraumatic and persistent dissociation in development of posttraumatic stress disorder

Acute stress disorder (ASD) and its predictivity in development of posttraumatic stress disorder (PTSD) has been researched extensively so far. Symptoms of peritraumatic dissociation (PD) has been proven as a predictive factor for PTSD, but recent studies have shown greater need for distinction of peritraumatic versus persistent dissociation. Symptoms of PD and of persistent dissociation in subjects diagnosed with ASD will be predictive of PTSD symptoms. To investigate the development of ASD symptoms, symptoms of PD and of persistent dissociation within the first month of traumatic event (initial) and six months later (follow-up) in victims of traffic accidents. At the moment, 25 subject were included in initial phase, and 18 at follow-up. Subject were interwieved, Mini International Neuropsychiatric Interview, Acute Stress Disorder Structured Interview, Clinician Administered PTSD Scale, The Dissociative Experience Scale, and The Peritraumatic Dissociative Experiences Questionnaire were administered. 10 subjects were diagnosed with PTSD in the follow-up. Preliminary results support for a greater risk for PTSD when dissociative symptoms are present, of PD or persistent dissociation. Greater distinction of dissociative symptoms in the acute trauma phase should be taken into account when diagnosing ASD. It could be eventually helpfull with identifying individuals at risk for PTSD.

Awake/sleep cortisol levels and the development of posttraumatic stress disorder in injury patients with peritraumatic dissociation.

Differences in the time of day that cortisol is sampled and failure to consider the impact of peritraumatic dissociation have been hypothesized as factors possibly contributing to the inconsistent findings in research examining associations between cortisol levels soon after trauma exposure and the subsequent development of posttraumatic stress disorder (PTSD). The present study examined associations between urinary cortisol levels during wake and sleep times soon after a serious injury and the subsequent development of PTSD in adult patients reporting low or high peritraumatic dissociative (PD) symptoms. Thirty-nine injury patients (20 with high and 19 with low PD symptoms) provided a 15-hour (6 PM to 9 AM) urine sample at 3-weeks post-injury and completed the Clinician Administered PTSD Scale at a 7-week follow-up. Participants collected their urine during wake and sleep times separately. Results showed that in the total sample and in the high PD group, wake, but not sleep, cortisol levels were lower in patients who developed PTSD compared to those who did not. A multiple linear regression analysis revealed a significant main effect of PD and a non-significant interaction between wake cortisol and PD in predicting PTSD symptom severity. In addition, results showed that PD was a better predictor of PTSD symptom severity than wake cortisol levels. These results were consistent with prior research indicating lower afternoon/evening cortisol levels in PTSD and strong associations between PD and PTSD, but did not support the existence of subgroups of PTSD patients (dissociators versus non-dissociators) who may differ in basal cortisol levels.

Psychological distress after physical injury: A one-year follow-up study of conscious hospitalised patients

BackgroundAcute physical injury may lead to psychological distress. The relationship between peritraumatic responses, injury severity, the personality trait of optimism/pessimism and psychological distress is not fully understood. In addition, the development of post-traumatic stress symptoms may differ in subgroups. MethodsOne hundred and eighty-one patients (18–65years) completed questionnaires 1 (baseline), 3 and 12months after first admission for acute physical injury. All patients were conscious on arrival. Scores on the Casualty Chain Inventory (CCI) for peritraumatic responses, the Impact of Event Scale (IES), the Hospital Anxiety and Depression Scale (HADS), the Life Orientation Test-Revised (LOT-R), trauma-related variables (ISS, Abbreviated Injury Scale [AIS], Glasgow Coma Scale [GCS]), and background variables were assessed. ResultsMean IES scores were 21.5 (95% CI: 19.0–24.0) at baseline and 15.8 (13.5–18.1) at 12months (p<0.001). One subgroup (delayed onset, 12.2%) had an increase of at least 10 points in the IES score and another subgroup (chronic, 13.3%) had high and persistent post-traumatic stress symptoms during the follow-up period. At baseline, 45.3% had an IES score≥20, indicating possible clinical case levels, compared with 33.1% at 12months. Accordingly, 14% had anxiety symptoms and 10.8% had depression symptoms at a case level (HADS≥8) at one-year follow-up. Mutually independent predictors of post-traumatic stress symptoms at 12months were dissociation (OR 1.3, 95% CI: 1.1–1.6) and perception (OR 1.1, 95% CI: 1.0–1.3) measured by the CCI. Being in work before injury (OR 0.1, 95% CI: 0.02–0.4) and higher educational level (OR 0.3, 95% CI: 0.1–0.7) were associated with fewer IES symptoms. Dissociation and having a pessimistic trait predicted anxiety and depression at 12months. Previous psychiatric problems predicted anxiety symptoms, and high educational level predicted less depression symptoms. ConclusionOne-third of conscious physical injured patients had post-traumatic stress symptoms at a possible clinical case level one year after the traumatic event, and one-third of these had delayed onset. Symptoms of peritraumatic dissociation and perception were mutually independent predictors of psychological distress.

Peritraumatic and persistent dissociation as predictors of PTSD symptoms in a female cohort

Recent research has investigated peritraumatic and persistent dissociation as a possible predictive factor for posttraumatic stress disorder (PTSD). The current study aimed to add to this literature by examining dissociative responses in female assault survivors (N = 92 at initial assessment; n = 62 at follow-up). Dissociative symptoms experienced at 3 time points were assessed: peritraumatic dissociation (PD), persistent dissociation-initial (M = 28.2 days posttrauma) and follow-up (M = 224.9 days posttrauma), as well as initial and follow-up PTSD symptoms. We hypothesized that PD and persistent dissociative symptoms would predict chronic PTSD symptoms at the follow-up assessment with initial PTSD symptoms and assault type in the model. Hierarchical regression resulted in a significant model predicting 39% of the variance in follow-up PTSD symptom scores (p < .001). Both peritraumatic and follow-up persistent dissociative symptoms significantly and uniquely added to the variance explained in follow-up PTSD symptom score contributing 4% (p = .05) and 8% (p = .008) of the variance, respectively. Results support the predictive value of peritraumatic and persistent dissociative symptoms, and the findings suggest that persistent dissociation may contribute to the development and continuation of PTSD symptoms. We discuss the implications for assessment and possible treatment of PTSD as well as future directions.

The Contributions of Prior Trauma and Peritraumatic Dissociation to Predicting Post-Traumatic Stress Disorder Outcome in Individuals Assessed in the Immediate Aftermath of a Trauma

ObjectiveThis study analyzed predictors of post-traumatic stress disorder (PTSD) in civilian trauma victims to assess how peritraumatic dissociation (PD) relates to PTSD symptom development. We examined PD and PTSD symptoms from a prior trauma simultaneously to better understand the extent to which past and current reactions to a trauma can predict the development of PTSD for a current trauma.MethodsParticipants (N=48) were recruited from the emergency department (ED) of a large, southeastern hospital and assessed immediately after a trauma and again at 4 weeks and 12 weeks post-trauma. We used both self-report and interviewer-based questionnaires to assess PD and PTSD symptoms for prior and current trauma.ResultsA hierarchical linear regression revealed that at 4-week follow up, when controlling for several demographic variables and trauma type, a model including both PD and PTSD symptoms from a prior trauma significantly predicted PTSD outcome (F(47)= 3.70, p=0.00), with PD and prior PTSD symptoms significantly contributing 17% and 9% of variance respectively. At 12 weeks, PTSD symptoms from prior trauma (β=0.094, p=0.538) and PD (β=−0.017, p=0.909) did not account for a significant proportion of the variance in PTSD for the enrolling trauma.ConclusionPrior and current reactions to trauma are both important factors in predicting the development of PTSD symptoms to a current trauma. The more immediate measurement of PD during presentation to the ED may explain the strength of its relationship to PTSD symptom development. Furthermore, our findings support the use of PTSD symptoms of a past trauma, as opposed to trauma frequency, as a predictor of PTSD from a subsequent trauma. Methodological limitations and future directions are discussed.

Peritraumatic dissociation and experiential avoidance as prospective predictors of posttraumatic stress symptoms.

Peritraumatic dissociation (PD) and experiential avoidance (EA) have been implicated in the etiology of posttraumatic stress symptomatology (PTSS); however, the function of these two factors in the onset and maintenance of PTSS following a potentially traumatic event is unclear. The temporal relationships between EA, PD, and the four clusters of PTSS proposed by the Simms/Watson dysphoria model (Simms, Watson, & Doebbeling, 2002) were examined in a three-wave prospective investigation of 532 undergraduate women participating in an ongoing longitudinal study at the time of a campus shooting. Path analyses indicated that preshooting EA predicted greater PD, intrusions, and dysphoria symptoms approximately one month postshooting. PD was associated with increased symptomatology across all four clusters 1-month postshooting, while 1-month postshooting EA was associated with higher dysphoria and hyperarousal symptoms eight months postshooting. PD had a significant indirect effect on all four PTSS clusters eight months postshooting via 1-month postshooting symptom reports. The results suggest that both EA and PD show unique influences as risk factors for PTSS following a potentially traumatic event.

Acute stress disorder, depression, and tobacco use in disaster workers following 9/11.

Early posttraumatic psychiatric disorders have not been well studied in disaster workers. This study examined the rates of probable acute stress disorder (ASD), probable depression, increased tobacco use, and their associated risk factors in 9/11 World Trade Center disaster workers. Surveys were obtained from 90 disaster workers (e.g., medical personnel, police, firefighters, search and rescue) 2-3 weeks after 9/11. Nearly 15% of disaster workers had probable ASD and 26% had probable depression. Probable ASD and depression were highly related to functional impairment. The risk for ASD was increased for those with 9/11-specific disaster exposures, more pre-9/11 trauma exposures, and the peritraumatic dissociative symptom of altered sense of time. Disaster workers who were younger, non-White, or who had increasing numbers of peritraumatic dissociative symptoms were more likely to have probable depression. More than half of tobacco users increased their tobacco use after 9/11. Additionally, all tobacco users with probable ASD and almost all tobacco users with probable depression increased tobacco use. Rapid mobilization of resources for early screening and intervention and health promotion campaigns aimed at improving adverse health-related behaviors may be helpful for this high-risk group.

A cognitive model of peritraumatic dissociation

Interacting cognitive subsystems (ICS; Barnard & Teasdale, 1991) is presented as a framework for understanding the impact of perceptual problems in peritraumatic dissociation. This paper analyses two peritraumatic dissociation symptoms, attention being drawn to stimuli and the experience of time slowing. ICS is described. Information processes in peritraumatic dissociation are analysed. Peritraumatic dissociative symptoms are conceptualized as problems with early processing of sensory information that result from problems of sensory feature binding. These problems are discussed in relation to experiences of fragmented memories in trauma within the context of ICS. A role for mindful attention in psychological therapy is raised.

Stress hormones and post-traumatic stress disorder in civilian trauma victims: a longitudinal study. Part I: HPA axis responses

The aim of the study was to evaluate the association between post-traumatic disorder (PTSD) and hypothalamic-pituitary-adrenal (HPA) axis responses to the triggering trauma. A companion paper evaluates the adrenergic response and interactions between the two. We measured plasma and saliva cortisol, hourly urinary excretion of cortisol, plasma levels of adrenocorticotropin (ACTH), and the leukocyte glucocorticoid receptor (GR) density of 155 non-injured survivors of traumatic events (91 males and 64 females; 125 road traffic accidents, 19 terrorist attacks, 11 others). Measurements were taken during survivors' admissions to an emergency room (ER) of a general hospital, and in the mornings, 10 d, 1 month, and 5 months later. Symptoms of peri-traumatic dissociation, PTSD, and depression were assessed on each follow-up session. The clinician-administered PTSD scale (CAPS) conferred a diagnosis of PTSD at 5 months. Survivors with (n=31) and without (n=124) PTSD at 5 months had similar levels of hormones at all times. Plasma cortisol levels decreased with time in both groups. Female subjects had lower ACTH levels than males. PTSD in females was associated with higher levels of ACTH. In unselected cohorts of trauma survivors, PTSD is not preceded by a detectable abnormality of peripheral HPA axis hormones.

Stress hormones and post-traumatic stress disorder in civilian trauma victims: a longitudinal study. Part II: The adrenergic response

The aim of the study was to prospectively evaluate the association between the occurrence of post-traumatic stress disorder (PTSD) and the adrenergic response to the traumatic event, and additionally, to explore the link between PTSD and the initial norepinephrine:cortisol ratio. Plasma levels and urinary excretion of norepinephrine (NE) were measured in 155 survivors of traumatic events during their admission to a general hospital emergency room (ER) and at 10 d, 1 month and 5 months later. Symptoms of peri-traumatic dissociation, PTSD and depression were assessed in each follow-up session. The Clinician-Administered PTSD Scale (CAPS) conferred a diagnosis of PTSD at 5 months. Trauma survivors with (n=31) and without (n=124) PTSD had similar levels of plasma NE, urinary NE excretion, and NE:cortisol ratio in the ER. Plasma NE levels were lower in subjects with PTSD at 10 d, 1 month, and 5 months. There was a weak but significant positive correlation between plasma levels of NE in the ER and concurrent heart rate, and a negative correlation between NE in the ER and dissociation symptoms. Peripheral levels of NE, shortly after traumatic events, are poor risk indicators of subsequent PTSD among civilian trauma victims. Simplified biological models may not properly capture the complex aetiology of PTSD.

A preliminary study of peritraumatic dissociation, social support, and coping in relation to posttraumatic stress symptoms for a parent's cancer

This study examined predictors of posttraumatic stress disorder (PTSD) symptoms in adults who, as children, had a parent diagnosed with cancer. Possible predictors of adulthood PTSD examined were peritraumatic dissociation, satisfaction with social support, coping through denial, behavioral disengagement and self-distraction, and whether or not the parent died. Thirty research participants (20 women and 10 men, ages 18-38) were recruited who were 8-17-years old at the time of a parent's cancer diagnosis. Each participant completed measures of their current PTSD symptoms in response to their parent's cancer, peritraumatic dissociative experiences, demographic characteristics, and satisfaction with social support and use of coping strategies at the time of their parent's cancer diagnosis. Seventeen percent met screening criteria for likely PTSD. As hypothesized, PTSD symptoms were strongly and positively correlated with peritraumatic dissociation. Furthermore, PTSD symptoms were greater among females and were related to greater use of denial and behavioral disengagement and to less satisfaction with social support. These results suggest that health care providers need to recognize symptoms of peritraumatic dissociation in the children of parents who are diagnosed with cancer so that steps can be taken to minimize the children's development of PTSD that may extend into their adult lives.

Low predictive power of peritraumatic dissociation for PTSD symptoms in accident survivors

To test the predictive power of peritraumatic dissociation for the development of psychopathology, the authors assessed symptoms of peritraumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire; PDEQ), posttraumatic stress disorder (Clinician-Administered PTSD Scale; CAPS), anxiety and depression (Hospital Anxiety and Depression Scale; HADS) in a sample of 214 accident victims 5 days postaccident (T1). Six months later (T2), CAPS and HADS were administered again. Acute stress disorder (ASD) and PTSD symptom levels were surprisingly low. In sequential regression analyses, initial reexperiencing and hyperarousal significantly predicted PTSD symptom level (T2) over several possibly confounding variables controlled for. Peritraumatic dissociation explained less than 3% of variance. For PTSD scores, 38% overall variance explanation was obtained; the variance for HADS scores was low. Possible explanations for the low-predictive power of peritraumatic dissociation for posttraumatic psychopathology in the sample are discussed.

Dissociation, Hardiness, and Performance in Military Cadets Participating in Survival Training

The present study examined the relationship between peritraumatic dissociation, hardiness, and military performance in Norwegian Navy officer cadets (N = 80) after a simulated prisoner of war (POW) exercise. The cadets reported symptoms of peritraumatic amnesia, depersonalization, and derealization in response to a mild stress experience (time point 1) and exhibited a significant increase in such symptoms when subsequently exposed to a highly stressful experience of being placed in a mock POW camp (time point 2). Symptoms of peritraumatic dissociation were significantly and negatively related to performance, and predicted between 16 and 26% of the variance between subjects. A subscale of the personality hardiness measure (i.e., the subdimension of challenge) was negatively associated with peritraumatic dissociation in response to both the mild stress situation and the more stressful POW exercise in study subjects. Hardiness was not significantly associated with military performance scores. The present data indicate that individual differences in attribution style and in a propensity to dissociate significantly affect military performance during exposure to high stress situations.

The roles of peritraumatic dissociation, child physical abuse, and child sexual abuse in the development of posttraumatic stress disorder and adult victimization

Objective: Previous research has indicated that women who experience childhood physical abuse or childhood sexual abuse are at increased risk for posttraumatic stress disorder (PTSD) and adult victimization. Recently, peritraumatic dissociation (PD) has been suggested as another possible risk factor for PTSD and adult victimization. The purpose of the present study was to investigate the effects of childhood physical and sexual abuse and PD on PTSD and adult victimization. Method: A sample of 467 female college students completed questionnaires about childhood and adult sexual and physical abuse experiences, PD, and PTSD symptoms. Results: The combined sexual and physical abuse (CA) and sexual abuse only (SA) groups reported significantly higher numbers of PTSD symptoms than the physical abuse only (PA) and no abuse (NA) groups. The CA and PA groups reported significantly more adult sexual and physical victimization than the SA and NA groups. Across all four groups, higher levels of PD were associated with higher levels of PTSD and adult sexual and physical victimization. Conclusions: The results of the current study suggest that different types of childhood abuse may lead to different adult problems. The results also indicated that PD may have a broad effect on PTSD development and adult victimization.