Peritraumatic Dissociation Symptoms Research Articles

Adaptação transcultural para o português do instrumento Peritraumatic Dissociative Experiences Questionnaire, Versão Auto-Aplicativa

INTRODUÇÃO: Este artigo apresenta a adaptação transcultural para o português do instrumento Peritraumatic Dissociative Experiences Questionnaire, Self-Report Version (PDEQ-SRV), para rastrear e quantificar os fenômenos dissociativos peritraumáticos. MÉTODOS: Fizeram-se duas traduções e suas respectivas retrotraduções, avaliação da equivalência semântica, elaboração da versão-síntese, pré-teste na população-alvo e realização da versão final. RESULTADOS: Observou-se um grau elevado de equivalência semântica entre o instrumento original e os dois pares de traduções/retrotraduções da perspectiva dos significados referencial e geral. O pré-teste na população-alvo conduziu a poucas modificações, que confirmaram a realização dos critérios de equivalência semântica. DISCUSSÃO: Este trabalho disponibiliza a primeira adaptação para o contexto brasileiro de um instrumento específico para a detecção e a quantificação de sintomas dissociativos peritraumáticos.

PTSD Following Terrorist Attacks: A Prospective Evaluation

This study evaluated the prevalence of posttraumatic stress disorder (PTSD) and the longitudinal course of early PTSD symptoms in survivors of terrorist attacks. It additionally assessed the effect of continuous terrorism on the course of early symptoms of PTSD. Thirty-nine survivors of terrorist attacks and 354 survivors of motor vehicle accidents were evaluated upon admission to a general hospital emergency room and 1 week and 4 months later. Heart rate was measured upon admission to the emergency room. Peritraumatic dissociation was assessed at 1 week. PTSD symptoms, anxiety, and depression were measured at 1 week and 4 months. The Clinician-Administered PTSD Scale conferred a diagnosis of PTSD at 4 months. Additionally, the course of early PTSD symptoms during an era of frequent terrorist attacks (N=137) was compared with that seen during years of relative calm (N=256). Survivors of terrorist attacks had higher rates of PTSD than motor vehicle accident survivors (37.8% versus 18.7%). The type of traumatic event, however, did not add to the prediction of PTSD from the emergency room heart rate, peritraumatic dissociation symptoms, and early PTSD symptoms. The longitudinal course of early PTSD symptoms was not affected by the greater frequency of terrorist attacks. Early symptoms are reliable risk indicators of PTSD across events and circumstances. Converging effects of terror-induced fear, adjustment, and resiliency might explain the lack of effect of intense terrorism on the course of PTSD symptoms.

Predictors of posttraumatic stress disorder following cancer.

This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. Individuals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression; individuals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving one's cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology.

Posttraumatic distress, alcohol disorders, and recurrent trauma across level 1 trauma centers.

Injured survivors of individual and mass trauma receive their initial evaluation in acute care. Few investigations have comprehensively screened for posttraumatic stress disorder (PTSD) symptoms and related comorbidities across sites. This investigation included 269 randomly selected injury survivors hospitalized at two level 1 trauma centers. All patients were screened for PTSD, depressive, and peritraumatic dissociative symptoms during their surgical inpatient admission. Prior traumatic life events and alcohol abuse/dependence also were assessed. In this study, 58% of the patients demonstrated high levels of immediate posttraumatic distress or alcohol abuse/dependence. Regression analyses identified greater prior trauma, female gender, nonwhite ethnicity, and site as significant independent predictors for high levels of posttraumatic distress. High levels of posttraumatic distress, recurrent trauma, and alcohol abuse/dependence were present in more than half of acute care inpatients. Early mental health screening and intervention procedures that target both PTSD and alcohol use should be developed for acute care settings.

Peritraumatic Dissociation Is Inversely Related to Catecholamine Levels in Initial Urine Samples of Motor Vehicle Accident Victims

ABSTRACT This study was designed to determine the relationship between self-reports of peritraumatic dissociation during a motor vehicle accident and measures of physiological arousal in the immediate aftermath of the accident. Upon admittance to the hospital, 15-hour urine samples were collected from participants to measure levels of urinary catecholamines and cortisol. Within two days of the accident, participants reported symptoms of peritraumatic dissociation, and one month after the accident, 59 (34 male and 25 female) participants completed an interview designed to assess symptoms of PTSD. Results revealed that patients who subsequently developed PTSD reported significantly higher levels of peritraumatic dissociation than victims who did not develop PTSD, and that dissociation was negatively associated with levels of urinary norepinephrine and epinephrine. Dissociation was not related to urinary cortisol or cardiovascular levels upon admission. These findings are consistent with previous research that has suggested that high dis-sociators may constitute a subgroup of trauma victims who are physiologically less reactive to trauma.

Divergent Perspectives in Prostitutes' Autobiographical Memories: Trauma and Dissociation

ABSTRACT An intriguing aspect of cognition is the perspective one takes when perceiving and/or remembering an event (i.e., field vs. observer perspectives/memories). Although explored from a cognitive viewpoint in terms of remembering, no research has examined this phenomenon from a forensic viewpoint in terms of the original experienced perspective. The objective of the present study was to test the utility of the field vs. observer distinction. Thirty-six prostitutes were interviewed and asked to recall three different autobiographical memories. Peri-traumatic dissociative symptoms, trait dissociation levels, current PTSD symptomatology, the perspective taken, and the quantity of detail were coded for each memory and compared. Extreme memorial variability was found both within and across the types of memories/perspectives reported. Among other findings, the results suggest significantly higher levels of state dissociation in memories originally perceived from an observer perspective than from a field perspective. Implications for expert testimony pertaining are briefly discussed.

Gender differences in posttraumatic stress disorder after motor vehicle accidents.

Women have higher rates of posttraumatic stress disorder (PTSD) than men. The authors examined prior trauma, PTSD, major depression, anxiety disorder not including PTSD, and peritraumatic dissociation; current peritraumatic dissociation; and passenger injury as possible explanations for the different rates of acute PTSD in women and men after a serious motor vehicle accident. Subjects age 18-65 years who had been in a serious motor vehicle accident (N=122) were assessed with the Structured Clinical Interview for DSM-III-R and the Peritraumatic Dissociative Experiences Questionnaire-Rater Version 1 month after the accident. Women did not differ from men in meeting the overall reexperiencing criterion for a diagnosis of PTSD (criterion B), but women were at greater risk for the specific reexperiencing symptoms of intense feelings of distress in situations similar to the motor vehicle accident and physical reactivity to memories of the motor vehicle accident. Women were 4.7 times more likely than men to meet the overall avoidance/numbing criterion (criterion C) and 3.8 times more likely to meet the overall arousal criterion (criterion D). Women were more likely than men to report the criterion C symptoms of avoiding thoughts and situations associated with the accident, loss of interest in significant activities, and a sense of foreshortened future and the criterion D symptoms of trouble sleeping, difficulty concentrating, and exaggerated startle response. Multiple logistic regression analysis indicated that the gender differences in acute PTSD were not associated with prior trauma, PTSD, peritraumatic dissociation, major depression, or anxiety disorder not including PTSD or with passenger injury. However, peritraumatic dissociative symptoms at the time of the accident were associated with a significantly higher risk for acute PTSD in women than in men. Gender differences in peritraumatic dissociation may help explain differences in risk for PTSD and for some PTSD symptoms in women and men.

Peritraumatic dissociation following motor vehicle accidents: relationship to prior trauma and prior major depression.

Individuals who dissociate at the time of a traumatic event (peritraumatic dissociation) are more likely to develop acute and chronic posttraumatic stress disorder (PTSD). However, little is known about who is at risk of peritraumatic dissociation. Motor vehicle accident subjects (N = 122) were systematically recruited and followed over 12 months. We used the Structured Clinical Interview for DSM-III-R (SCID) and the Peritraumatic Dissociative Experiences Questionnaire-Rater Version (PDEQ-RV). Younger subjects were more likely to experience peritraumatic dissociation as were white versus nonwhites, and single versus married subjects. Younger subjects reported a greater number of peritraumatic dissociative symptoms as did subjects with an injured passenger. After adjusting for age and passenger injury, prior major depression was significantly related to more peritraumatic dissociative symptoms. An interaction of age and prior major depression indicated that those who were younger and reported a history of major depression had the greatest number of peritraumatic dissociative symptoms.