Skip to main content
Log in

Assessing Latent Level Associations Between PTSD and Dissociative Factors: Is Depersonalization and Derealization Related to PTSD Factors More So than Alternative Dissociative Factors?

  • Published:
Psychological Injury and Law Aims and scope Submit manuscript

Abstract

Posttraumatic stress disorder (PTSD) criteria in DSM-5 included a dissociative diagnostic subtype characterized by a depersonalization item and a derealization item. Researchers have queried whether this was too restrictive, as alternative dissociative symptomatology may also be characteristic of the subtype. The current study utilized data from 318 Northern Irish students, of which 165 were trauma exposed. Participants were assessed for PTSD symptomatology based on DSM-5 criteria via a modified version of the PTSD Symptom Scale-Self-Report (PSS-5) and dissociative experiences via the Dissociative Experiences Scale (DES). Confirmatory factor analysis of PTSD and DES models revealed an optimal four-factor DSM-5 PTSD model including reexperiencing, avoidance, negative alterations in mood and cognitions, and alterations in hyperarousal and reactivity factors, and an optimal three-factor DES model including absorption, amnesia, and depersonalization/derealization factors. When comparing the correlations between depersonalization/derealization and the four PTSD factors, significant Wald tests of parameter constraints revealed that depersonalization/derealization is more related to alterations in arousal and reactivity (r = .432) compared to avoidance (r = .289), χ 2 (1, N = 165) = 8.352, p = .004. We discuss whether the mechanism for comorbid PTSD and dissociation may be related to PTSD’s arousal factor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Amdur, R., & Liberzon, I. (1996). Dimensionality of dissociation in subjects with PTSD. Dissociation: Progress in the Dissociative Disorders, 9, 118–124.

    Google Scholar 

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., text rev.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

    Google Scholar 

  • Armour, C., Elhai, J. D., Richardson, D., Ractliffe, K., Wang, L., & Elklit, A. (2012). Assessing a five factor model of PTSD: is dysphoric arousal a unique PTSD construct showing differential relationships with anxiety and depression? Journal of Anxiety Disorders, 26(2), 368–376. doi:10.1016/j.janxdis.2011.12.002

    Article  PubMed  Google Scholar 

  • Armour, C., Carragher, N., & Elhai, J. D. (2013a). Assessing the fit of the dysphoric arousal model across two nationally representative epidemiological surveys; the Australian NSMHWB and the United States NESARC. Journal of Anxiety Disorders, 27, 109–115.

    Article  PubMed  Google Scholar 

  • Armour, C., Ghazali, S. R., & Elklit, A. (2013b). PTSD’s latent structure in Malayan tsunami victims: assessing the newly proposed dysphoric arousal model. Psychiatry Research, 1, 26–32.

    Article  Google Scholar 

  • Armour, C., O’Conner, M., Elklit, A., & Elhai, J. D. (2013c). Assessing PTSD’s latent structure in European trauma victims: evidence for a five factor dysphoric and anxious arousal model. Journal of Nervous and Mental Disease, 201, 901–906.

    Article  PubMed  Google Scholar 

  • Armour, C., Elklit, A., Lauterbach, D., Elhai, J. D. (2014a). The DSM-5 dissociative-PTSD subtype: can levels of depression, anxiety, hostility, and sleeping difficulties differentiate between dissociative-PTSD and PTSD in rape victims? Journal of Anxiety Disorders. (in press).

  • Armour, C., Karstoft, K.I., & Richardson, J. D. (2014b). The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD. Social Psychiatry & Psychiatric Epidemiology. (in press).

  • Berger, O., McNiel, D. E., & Binder, R. L. (2012). PTSD as a criminal defense: a review of case law. Journal of the American Academy of Psychiatry & Law, 4, 509–521.

    Google Scholar 

  • Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174(12), 727–735.

    Article  PubMed  Google Scholar 

  • Bewin, C. R., & Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23, 339–376.

    Article  Google Scholar 

  • Biehn, T. L., Contractor, A., Elhai, J. D., Tamburrino, M., Fine, T. H., Prescott, M. R., et al. (2013). Relations between the underlying dimensions of PTSD and major depression using an epidemiological survey of deployed Ohio National Guard soldiers. Journal of Affective Disorders, 144, 106–111.

    Article  PubMed  Google Scholar 

  • Breh, D. C., & Seidler, G. H. (2007). Is peritraumatic dissociation a risk factor for PTSD? Journal of Trauma and Dissociation, 8, 53–69.

    Article  PubMed  Google Scholar 

  • Breuer, J., & Freud, S. (1955). Studies on hysteria. The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: The Hogarth Press (Original Publication, 1895).

    Google Scholar 

  • Bunting, B., Ferry, F., Murphy, S. D., O'Neill, S., & Bolton, D. (2013). Trauma associated with civil conflict and posttraumatic stress disorder: evidence from the Northern Ireland Study of Health and Stress. Journal of Traumatic Stress, 26, 134–141.

    Article  PubMed  Google Scholar 

  • Carlson, E. B., Waelde, L., Palmieri, P. A., McDade-Montez, E. Macia, K. S. (submitted). Development and validation of the Dissociative Symptoms Scale.

  • Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation, 6, 16–27.

    Google Scholar 

  • Cloitre M, Petkova E, Wang J, Lu Lassell F (2012). An examination of the influence of a sequential treatment on the course and impact of dissociation among women with PTSD related to childhood abuse [published online ahead of print May 1]. Depress Anxiety. http://dx.doi.org/10.1002/da.21920

  • Coffey, S. F., Dansky, B. S., Falsetti, S. A., Saladin, M. E., & Brady, K. T. (1998). Screening for PTSD in a substance abuse sample: psychometric properties of a modified version of the PTSD Symptom Scale Self-Report. Journal of Traumatic Stress, 11, 393–399.

    Article  PubMed  Google Scholar 

  • Contractor, A. A., Durham, T. A., Brennan, J. A., Armour, C., Wutrick, H. R., Frueh, B. C., & Elhai, J. D. (2014). DSM-5 PTSD’s symptom dimensions and relations with major depression’s symptom dimensions in a primary care sample. Psychiatry Research, 215, 146–153.

  • Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1, 16–29.

    Article  Google Scholar 

  • Dalenberg, C., & Paulson, K. (2009). The case for the study of “normal” dissociation processes. In P. F. Dell, J. O'Neil, & E. Somer (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 145–154). New York: Routledge.

    Google Scholar 

  • Dunn, G. E., Ryan, J. J., & Paolo, A. M. (1994). A principal components analysis of the dissociative experiences scale in a substance abuse population. Journal of Clinical Psychology, 50, 936–940.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., & Palmieri, P. A. (2011). The factor structure of posttraumatic stress disorder: a literature update, critique of methodology, and agenda for future research. Journal of Anxiety Disorders, 25, 849–854. doi:10.1016/j.janxdis.2011.04.007

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Biehn, T. L., Armour, C., Klopper, J. J., Frueh, B. C., & Palmieri, P. A. (2011a). Evidence for a unique PTSD construct represented by PTSD’s D1-D3 symptoms. Journal of Anxiety Disorders, 25, 340–345. doi:10.1016/j.janxdis.2010.10.007

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Contractor, A. A., Palmieri, P. A., Forbes, D., & Richardson, J. D. (2011b). Exploring the relationship between underlying dimensions of posttraumatic stress disorder and depression in a national, trauma-exposed military sample. Journal of Affective Disorders, 133, 477–480. doi:10.1016/j.jad.2011.04.035

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Contractor, A., Tamburrino, M., Fine, T. H., Prescott, M. R., Shirley, E., et al. (2012a). The factor structure of major depression symptoms: a test of four competing models using the Patient Health Questionnaire-9. Psychiatry Research, 199, 169–173. doi:10.1016/j.psychres.2012.05.018

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Miller, M. E., Ford, J. D., Biehn, T. L., Palmieri, P. A., & Frueh, B. C. (2012b). Posttraumatic stress disorder in DSM-5: estimates of prevalence and symptom structure in a nonclinical sample of college students. Journal of Anxiety Disorders, 26, 58–64. doi:10.1016/j.janxdis.2011.08.013

    Article  PubMed  Google Scholar 

  • Fisher, D. G., & Elnitsky, S. (1990). A factor analytic study of two scales measuring dissociation. American Journal of Clinical Hypnosis, 32, 201–207.

    Article  Google Scholar 

  • Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9(4), 466–491. doi:10.1037/1082-989x.9.4.466

    Article  PubMed Central  PubMed  Google Scholar 

  • Foa, E. B., Riggs, D. S., & Gershuny, B. S. (1995). Arousal, numbing, and intrusion: symptom structure of PTSD following assault. The American Journal of Psychiatry, 152(1), 116–120.

    PubMed  Google Scholar 

  • Foa, E. B., & Tolin, D. F. (2000). Comparison of the PTSD Symptom Scale-Interview version and the Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 13, 181-191. doi:10.1023/A:1007781909213

  • Foote, B., Smolin, Y., Neft, D. I., & Lipschitz, D. J. (2008). Dissociative disorders and suicidality in psychiatric outpatients. Journal of Nervous and Mental Disease, 1, 29–36.

    Article  Google Scholar 

  • Friedman, M. J., Resick, P. A., Bryant, R. A., Strain, J., Horowitz, M., & Spiegel, D. (2011). Classification of trauma and stressor-related disorders in DSM-5. Depression and Anxiety, 28, 737–749. doi:10.1002/da.20845

    Article  PubMed  Google Scholar 

  • Gershuny, B. S., & Thayer, J. F. (1999). Relations among psychological trauma, dissociative phenomena, and trauma-related distress: a review and integration. Clinical Psychology Review, 19, 631–637.

    Article  PubMed  Google Scholar 

  • Ginzburg, K., Koopman, C., Butler, L. D., Palesh, O., Kraemer, H. C., Classen, C. C., & Spiegel, D. (2006). Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors. Journal of Trauma & Dissociation, 7, 7–27.

  • Goodman, L., Corcoran, C., Turner, K., Yuan, N., & Green, B. L. (1998). Assessing traumatic event exposure: general issues and preliminary findings for the Stressful Life Events Screening Questionnaire. Journal of Traumatic Stress, 11, 521–542.

    Article  PubMed  Google Scholar 

  • Graham, J. W. (2009). Missing data analysis: making it work in the real world. Annual Review of Psychology, 60(1), 549–576. doi:10.1146/annurev.psych.58.110405.085530

    Article  PubMed  Google Scholar 

  • Harpaz-Rotem, I., Tsai, J., Pietrzak, R. H., & Hoff, R. (2014). The dimensional structure of posttraumatic stress symptomatology in 323,903 U.S. veterans. Journal of Psychiatric Research, 49, 31-36. .doi:10.1016/j.jpsychires.2013.10.020

  • Harrington, T., & Newman, E. (2007). The psychometric utility of two self-report measures of PTSD among women substance users. Addictive Behaviours, 32, 2788–2798.

    Article  Google Scholar 

  • Hawton, K., Linsell, L., Adeniji, T., Sariaslan, A. & Fazel, S. (2014). Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide. Lancet, 383, 1147-54. doi:10.1016/S0140-6736(13)62118-2

  • Holtgraves, T., & Stockdale, G. (1997). The assessment of dissociative experiences in a non-clinical population: reliability, validity, and factor structure of the dissociative experiences scale. Personality and Individual Differences, 22, 699–706.

    Article  Google Scholar 

  • Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.

    Article  Google Scholar 

  • Janet, P. (1907). The major symptoms of hysteria, Macmillan, London/New York. Second edition with new matter: 1920. Reprint of 1920-edition: Hafner, New York, 1965. Janet, P. (1909a). Les névroses, Flammarion, Paris.

  • Kass, R. E., & Rafferty, A. E. (1995). Bayes factor. Journal of the American Statistical Association, 90, 430. doi:10.1080/01621459.1995.10476572

    Google Scholar 

  • King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the Clinician-Administered PTSD Scale. Psychological Assessment, 10(2), 90–96. doi:10.1037/1040-3590.10.2.90

    Article  Google Scholar 

  • Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010). Emotion modulation in PTSD: clinical and neurobio logical evidence for a dissociative subtype. American Journal of Psychiatry, 167, 640–647.

  • Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012). The dissociative subtype of posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications. Depress & Anxiety, 29, 701–708.

    Article  PubMed  Google Scholar 

  • McFarlane, A. C. (2013). Biology not culture explains dissociation in posttraumatic stress disorder. Biological Psychiatry, 73, 296–297.

    Article  PubMed  Google Scholar 

  • Moleman, N., van der Hart, O., & van der Kolk, B. A. (1992). Dissociation and hypnotizability in posttraumatic stress disorder. Journal of Nervous and Mental Disease, 180, 271–272.

    Article  PubMed  Google Scholar 

  • Olsen, S. A., Clapp, J. D., Parra, G. R., & Beck, J. B. (2013). Factor structure of the Dissociative Experiences Scale: an examination across sexual assault status. Journal of Psychopathology & Behavioral Assessment, 35, 394–403. doi:10.1007/s10862-013-9347-4

    Article  Google Scholar 

  • Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Bulletin, 129, 52–73.

    Article  PubMed  Google Scholar 

  • Putman, F. W. (1989). Pierre Janet and modern views of dissociation. Journal of Traumatic Stress, 2, 413–429. doi:10.1002/jts.2490020406

    Article  Google Scholar 

  • Ray, W. J., & Faith, M. (1995). Dissociative experiences in a college age population: follow-up with 1190 subjects. Personality and Individual Differences, 18, 223–230.

    Article  Google Scholar 

  • Reddy, M. K., Andersond, B. J., Liebschutze, J., & Steind, M. D. (2013). Factor structure of PTSD symptoms in opioid-dependent patients rating their overall trauma history. Drug and Alcohol Dependence, 132, 597–602.

    Article  PubMed  Google Scholar 

  • Resick, P. A., Suvak, M. K., Johnides, B. D., Mitchell, K. S., Iverson, K. M. (2012). The impact of dissociation on PTSD treatment with cognitive processing therapy [published online ahead of print March 30]. Depress Anxiety. http://dx.doi.org/10.1002/da.21938

  • Ross, C. A., Joshi, S., & Currie, R. (1991). Dissociative experiences in the general population: identification of three factors. Hospital & Community Psychiatry, 42, 297–300.

    Google Scholar 

  • Ross, C. A., Ellason, J. W., & Anderson, G. (1995). A factor analysis of the Dissociative Experiences Scale in dissociative identity disorder. Dissociation, 8, 229–235.

    Google Scholar 

  • Ruiz, M., Poythress, N. G., Lilienfeld, S. O., & Douglass, K. S. (2008). Factor structure and correlates of the Dissociative Experiences Scale in a large offender sample. Assessment, 15, 511–521.

    Article  PubMed  Google Scholar 

  • Sanders, A., & Green, G. A. (1994). The factor structure of the dissociative experiences scale in college students. Dissociation, 7, 23–27.

    Google Scholar 

  • Satorra, A., & Bentler, E. M. (1994). Corrections to test statistics and standard errors in covariance structure analysis. In A. von Eye & C. C. Clogg (Eds.), Latent variables analysis: Applications for developmental research (pp. 399–419). Thousand Oaks: Sage.

    Google Scholar 

  • Semage, S. N., Sivayogan, S., Forbes, D., O'Donnell, M., Monaragala, R. M., Lockwood, E., & Dunt, D. (2013). Cross-cultural and factorial validity of PTSD check list-military version (PCL-M) in Sinhalese language. European Journal of Psychotraumatology, 4. doi:10.3402/ejpt.v4i0.19707 .

  • Simms, L. J., Watson, D., & Doebbeling, B. N. (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. Journal of Abnormal Psychology, 111(4), 637–647. doi:10.1037//0021-843x.111.4.637

    Article  PubMed  Google Scholar 

  • Spiegel, D. (1991). Neurophysiological correlates of hypnosis and dissociation. Journal of Neuropsychiatry, 3, 440–445.

    Google Scholar 

  • Spiegel, D., Loewenstein, R. J., Lewis-Fernandez, R., Sar, V., Simeon, D., Vermetten, E., et al. (2011). Dissociative disorders in DSM-5. Depression and Anxiety, 28, E17–E45.

    Article  PubMed  Google Scholar 

  • Stein, D. J., Koenen, K. C., Friedman, M. J., Hill, E., McLaughlin, K. A., Petukhova, M., et al. (2013). Dissociation in posttraumatic stress disorder: evidence from the world mental health surveys. Biological Psychiatry, 15, 302–312. doi:10.1016/j.biopsych.2012.08.022

  • Steuwe, C., Lanius, R. A., & Frewen, P. A. (2012). Evidence for a dissociative subtype of PTSD by latent profile and confirmatory factor analyses in a civilian sample. Depression and Anxiety, 29, 689–700. doi:10.1002/da.21944

    Article  PubMed  Google Scholar 

  • Stockdale, G. D., Gridley, B. E., Balogh, D. W., & Holtgraves, T. (2002). Confirmatory factor analysis of single-and multiple-factor competing models of the dissociative experiences scale in a non-clinical sample. Assessment, 9, 94–106.

    Article  PubMed  Google Scholar 

  • Tichenor, V., Marmar, C. R., Weiss, D. S., Metzler, T. J., & Ronfeldt, H. M. (1996). The relationship of peritraumatic dissociation and posttraumatic stress: findings in female Vietnam theater veterans. Journal of Consulting and Clinical Psychology, 64, 1054–1059.

    Article  PubMed  Google Scholar 

  • van der Kolk, B. A., & van der Hart, O. (1989). Pierre Janet and the breakdown of adaptation in psychological trauma. American Journal of Psychiatry, 146, 1530–1540.

    PubMed  Google Scholar 

  • van IJzendoorn, M. H., & Schuengel, C. (1996). The measurement of dissociation in normal and clinical populations: meta-analytic validation of the Dissociative Experiences scale (DES). Clinical Psychology Review, 16, 365–382.

    Article  Google Scholar 

  • Wang, L., Cao, C., Wang, R., Zhanga, J., & Li, Z. (2012). The dimensionality of PTSD symptoms and their relationship to health-related quality of life in Chinese earthquake survivors. Journal of Anxiety Disorders, 26, 711–718.

    Article  PubMed  Google Scholar 

  • Wang, M., Armour, C., Li, X., Dai, X., Zu, X., & Yao, S. (2013). Further evidence for a five-factor model of PTSD: factorial invariance across gender in Chinese earthquake survivors. Journal of Nervous and Mental Disease, 201, 145–152.

    Article  PubMed  Google Scholar 

  • Wolf, E. J., Miller, M. W., Reardon, A. F., Ryabchenko, K. A., Castillo, D., & Freund, R. (2012). A latent class analysis of dissociation and posttraumatic stress disorder evidence for a dissociative subtype. Archives of General Psychiatry, 69, 698–705.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wolf, E. J., Miller, M. W., Reardon, A. F., Ryabchenko, K. A., Castillo, D., Freund, R. (2014). A latent class analysis of dissociation and PTSD: evidence for a dissociative subtype. Archives of General Psychiatry (in press)

  • Yufik, T., & Simms, L. J. (2010). A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. Journal of Abnormal Psychology, 119(4), 764–776. doi:10.1037/a0020981

    Article  PubMed  Google Scholar 

  • Zoellner, L. A., Pruitt, L. D., Farach, F. J., & Jun, J. J. (2014). Understanding heterogeneity in PTSD: fear, dysphoria, and distress. Depression & Anxiety, 31, 97–106.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cherie Armour.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Armour, C., Contractor, A.A., Palmieri, P.A. et al. Assessing Latent Level Associations Between PTSD and Dissociative Factors: Is Depersonalization and Derealization Related to PTSD Factors More So than Alternative Dissociative Factors?. Psychol. Inj. and Law 7, 131–142 (2014). https://doi.org/10.1007/s12207-014-9196-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-014-9196-9

Keywords

Navigation