Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 8, pp 1297–1306 | Cite as

The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD

  • Cherie ArmourEmail author
  • Karen-Inge Karstoft
  • J. Don Richardson
Original Paper

Abstract

Purpose

A dissociative-posttraumatic stress disorder (PTSD) subtype has been included in the DSM-5. However, it is not yet clear whether certain socio-demographic characteristics or psychological/clinical constructs such as comorbid psychopathology differentiate between severe PTSD and dissociative-PTSD. The current study investigated the existence of a dissociative-PTSD subtype and explored whether a number of trauma and clinical covariates could differentiate between severe PTSD alone and dissociative-PTSD.

Methods

The current study utilized a sample of 432 treatment seeking Canadian military veterans. Participants were assessed with the Clinician Administered PTSD Scale (CAPS) and self-report measures of traumatic life events, depression, and anxiety. CAPS severity scores were created reflecting the sum of the frequency and intensity items from each of the 17 PTSD and 3 dissociation items. The CAPS severity scores were used as indicators in a latent profile analysis (LPA) to investigate the existence of a dissociative-PTSD subtype. Subsequently, several covariates were added to the model to explore differences between severe PTSD alone and dissociative-PTSD.

Results

The LPA identified five classes: one of which constituted a severe PTSD group (30.5 %), and one of which constituted a dissociative-PTSD group (13.7 %). None of the included, demographic, trauma, or clinical covariates were significantly predictive of membership in the dissociative-PTSD group compared to the severe PTSD group.

Conclusions

In conclusion, a significant proportion of individuals report high levels of dissociation alongside their PTSD, which constitutes a dissociative-PTSD subtype. Further investigation is needed to identify which factors may increase or decrease the likelihood of membership in a dissociative-PTSD subtype group compared to a severe PTSD only group.

Keywords

Posttraumatic stress disorder Dissociation Dissociative subtype CAPS LPA Veterans Canadian 

Notes

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Janet P (1907) The major symptoms of hysteria. McMillan, New YorkCrossRefGoogle Scholar
  2. 2.
    van der Hart O, van Ochten JM, van Son MJ, Steele K, Lensvelt-Mulders G (2008) Relations among peritraumatic dissociation and posttraumatic stress: a critical review. J Trauma Dissociation 9(4):481–505PubMedCrossRefGoogle Scholar
  3. 3.
    Bryant RA (2005) Predicting posttraumatic stress disorder from acute reactions. J Trauma Dissociation 6(2):5–15. doi: 10.1300/J229v06n02_02 PubMedCrossRefGoogle Scholar
  4. 4.
    Layne CM, Warren JS, Watson PJ, Shalev AY (2007) Risk, vulnerabilities, resistance and resilience: towards integrated conceptualization of posttraumatic adaptation. In: Friedman MJ, Keane TM, Watson PA (eds) Handbook of PTSD, science and practice. Guilford Press, New York, pp 497–520Google Scholar
  5. 5.
    Ozer EJ, Best SR, Lipsey TL, Weiss DS (2003) Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 129(1):52–73. doi: 10.1037/0033-2909.129.1.52 PubMedCrossRefGoogle Scholar
  6. 6.
    Waelde LC, Silvern L, Carlson EB, Fairbank JA, Kletter H (2009) Dissociation in PTSD. In: Dell PF, O’Neil JA (eds) Dissociation and the dissociative disorders. Routledge, LondonGoogle Scholar
  7. 7.
    Wolf EJ, Lunney CA, Miller MW, Resick PA, Friedman MJ, Schnurr PP (2012) The dissociative sybtype of PTSD: a replication and extension. Depress Anxiety. doi: 10.1002/da.21946 PubMedGoogle Scholar
  8. 8.
    Wolf EJ, Miller MW, Reardon AF, Ryabchenko KA, Castillo D, Freund R (2012) A latent class analysis of dissociation and PTSD: evidence for a dissociative subtype. Arch Gen Psychiatry 69:698–705. doi: 10.1001/archgenpsychiatry.2011.1574 Google Scholar
  9. 9.
    Steuwe C, Lanius RA, Frewen PA (2012) Evidence for a dissociative subtype of PTSD by latent profile and confirmatory factor analyses in a civilian sample. Depress Anxiety. doi: 10.1002/da.21944 PubMedGoogle Scholar
  10. 10.
    Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, Spiegel D (2010) Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry 167(6):640–647. doi: 10.1176/appi.ajp.2009.09081168 PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Putnam FW, Carlson EB, Ross CA, Anderson G, Clark P, Torem M, Bowman ES, Coons P, Chu JA, Dill DL, Loewenstein RJ, Braun BG (1996) Patterns of dissociation in clinical and nonclinical samples. J Nerv Ment Dis 184(11):673–679PubMedCrossRefGoogle Scholar
  12. 12.
    Waelde LC, Silvern L, Fairbank JA (2005) A taxometric investigation of dissociation in Vietnam veterans. J Trauma Stress 18(4):359–369. doi: 10.1002/jts.20034 PubMedCrossRefGoogle Scholar
  13. 13.
    Briere J, Runtz M (1988) Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse Negl 12(1):51–59PubMedCrossRefGoogle Scholar
  14. 14.
    Chu JA, Frey LM, Ganzel BL, Matthews JA (1999) Memories of childhood abuse: dissociation, amnesia, and corroboration. Am J Psychiatry 156(5):749–755PubMedGoogle Scholar
  15. 15.
    American Psychiatric Association (2010) DSM-5 development. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=165. Accessed 05-07-2012
  16. 16.
    Carlson EB, Dalenberg C, McDade-Montez E (2012) Dissociation in posttraumatic stress disorder: part I. Definitions and review of research. Advanced online publication. Psychol Trauma Theory Res Pract Policy 4(5):479–489. doi: 10.1037/a0027748
  17. 17.
    Dalenberg C, Carlson EB (2012) Dissociation in posttraumatic stress disorder part II: how theoretical models fit the empirical evidence and recommendations for modifying the diagnostic criteria for PTSD. Psychol Trauma Theory Res Pract Policy 4(6):551–559. doi: 10.1037/a0027900
  18. 18.
    Hagenaars JA, McCutcheon AL (eds) (2002) Applied latent class analysis. Cambridge University Press, CambridgeGoogle Scholar
  19. 19.
    Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, Keane TM (1995) The development of a Clinician-Administered PTSD Scale. J Trauma Stress 8(1):75–90PubMedCrossRefGoogle Scholar
  20. 20.
    Gray MJ, Litz BT, Hsu JL, Lombardo TW (2004) Psychometric properties of the life events checklist. Assessment 11(4):330–341. doi: 10.1177/1073191104269954 PubMedCrossRefGoogle Scholar
  21. 21.
    Weathers FW, Ruscio AM, Keane TM (1999) Psychometric properties of nine scoring rules for the clinician-administered posttraumatic stress disorder scale. Psychol Assessment 11(2):124–133CrossRefGoogle Scholar
  22. 22.
    Weathers FW, Keane TM, Davidson JR (2001) Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety 13(3):132–156PubMedCrossRefGoogle Scholar
  23. 23.
    Beck AT, Brown G, Epstein N, Steer RA (1988) An inventory for measuring clinical anxiety––psychometric properties. J Consult Clin Psych 56(6):893–897CrossRefGoogle Scholar
  24. 24.
    Wetherell JL, Arean PA (1997) Psychometric evaluation of the beck anxiety inventory with older medical patients. Psychol Assessment 9(2):136–144CrossRefGoogle Scholar
  25. 25.
    Hamilton M (1967) Development of a rating scale for primary depressive illness. Brit J Soc Clin Psyc 6:278–296CrossRefGoogle Scholar
  26. 26.
    Hamilton M (1960) A rating scale for depression. J Neurol Neurosur Ps 23(1):56–62CrossRefGoogle Scholar
  27. 27.
    Rehm LP, O’Hara MW (1985) Item characteristics of the Hamilton Rating Scale for Depression. J Psychiatr Res 19(1):31–41PubMedCrossRefGoogle Scholar
  28. 28.
    Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG (1975) Quantitative rating of depressive states. Acta Psychiat Scand 51(3):161–170PubMedCrossRefGoogle Scholar
  29. 29.
    Graham JW (2009) Missing data analysis: making it work in the real world. Annu Rev Psychol 60:549–576. doi: 10.1146/Annurev.Psych.58.110405.085530 PubMedCrossRefGoogle Scholar
  30. 30.
    Muthen BO, Muthen LK (2012) Mplus (version 7). Los Angeles, CaliforniaGoogle Scholar
  31. 31.
    Muthen LK, Muthen BO (1998–2012) Mplus user’s guide, 7th edn. Muthén & Muthén, Los Angeles, CAGoogle Scholar
  32. 32.
    Lazarsfeld PF, Henry NW (1968) Latent structure analysis. Houghton, New YorkGoogle Scholar
  33. 33.
    Ruscio J (2004) A nontechnical introduction to the taxometric methods. Understanding Statistics 3:44CrossRefGoogle Scholar
  34. 34.
  35. 35.
    Muthen LK (2004b) Latent class analysis and cluster analysis. http://www.statmodel.com/discussion/messages/13/155.html?1141671585
  36. 36.
    Akaike H (1987) Factor analysis and AIC. Psychometrika 52(3):317–332. doi: 10.1007/bf02294359 CrossRefGoogle Scholar
  37. 37.
    Schwartz G (1978) Estimating the dimensions of a model. Ann Stat 6:461–464CrossRefGoogle Scholar
  38. 38.
    Sclove SL (1987) Application of model-selection criteria to some problems in multivariate-analysis. Psychometrika 52(3):333–343CrossRefGoogle Scholar
  39. 39.
    Lo Y, Mendell NR, Rubin DB (2001) Testing the number of components in a normal mixture. Biometrika 88:767–778CrossRefGoogle Scholar
  40. 40.
    Ramaswamy V, Desarbo WS, Reibstein DJ, Robinson WT (1993) An empirical pooling approach for estimating marketing mix elasticities with PIMS data. Market Sci 12:103–124CrossRefGoogle Scholar
  41. 41.
    Ginzburg K, Koopman C, Butler LD, Palesh O, Kraemer HC, Classen CC, Spiegel D (2006) Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors. J Trauma Dissociation 7(2):7–27. doi: 10.1300/J229v07n02_02 PubMedCrossRefGoogle Scholar
  42. 42.
    Luterek JA, Bittinger JN, Simpson TL (2011) Posttraumatic sequelae associated with military sexual trauma in female veterans enrolled in VA outpatient mental health clinics. J Trauma Dissociation 12(3):261–274. doi: 10.1080/15299732.2011.551504 PubMedCrossRefGoogle Scholar
  43. 43.
    Lanius RA, Bluhm R, Lanius U (2006) PTSD symptom provocation and neuroimaging: heterogeneity of response. In: Vermetten E, Dorahy M, Speigel D (eds) Traumatic dissociation: neurobiology and treatment, chap 10. American Psychiatric Publishing, Washington DC, pp 191–217Google Scholar
  44. 44.
    Braakman MH, Kortmann FAM, van den Brink W (2009) Validity of post-traumatic stress disorder with secondary psychotic features: a review of the evidence. Acta Psychiatr Scand 119:15–24PubMedCrossRefGoogle Scholar
  45. 45.
    Hyman IE, Billings FJ (1998) Individual differences and the creation of false childhood memories. Memory 6:1–20PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Cherie Armour
    • 1
    • 2
    Email author
  • Karen-Inge Karstoft
    • 2
  • J. Don Richardson
    • 3
    • 4
    • 5
  1. 1.School of PsychologyUniversity of Ulster at Coleraine CampusColeraineNorthern Ireland, UK
  2. 2.The National Centre for PsychotraumatologyUniversity of Southern DenmarkOdenseDenmark
  3. 3.Parkwood Operational Stress Injury Clinic, St. Joseph’s Health Care London, Parkwood HospitalUniversity of Western OntarioLondonCanada
  4. 4.Department of PsychiatryWestern UniversityLondonCanada
  5. 5.Department of Psychiatry and Behavioral NeuroscienceMcMaster UniversityHamiltonCanada

Personalised recommendations