Trauma-Related Altered States of Consciousness (TRASC) and Functional Impairment I: Prospective Study in Acutely Traumatized Persons

Abstract

A theoretical framework referred to as a 4-D model has been described for classifying posttraumatic stress symptoms into those potentially occurring within normal waking consciousness (NWC) versus those thought to intrinsically exemplify dissociative experiences, specifically, trauma-related altered states of consciousness (TRASC). As a further test of this theoretical distinction, this prospective study evaluated whether TRASC and NWC forms of distress incrementally and prospectively predicted functional impairment at 6 and 12 weeks following presentation at hospital emergency departments in the acute aftermath of traumatic events in 180 persons. Establishing the clinical significance of both TRASC and NWC-distress symptoms, we found that 6-week markers of TRASC and NWC-distress independently predicted 12-week self-reported levels of social and occupational impairment. We also observed broad support for various predictions of the 4-D model except that, in contrast with hypotheses, childhood trauma history was generally more strongly correlated with symptoms of NWC-distress than with TRASC. Future research directions are discussed.

KEYWORDS:

• dissociation
• posttraumatic stress disorder
• trauma-related altered states of consciousness
• childhood abuse and neglect
• 4-D model

Notes

1. Of note is that we determined that the internal consistency reliability evidenced by the Identity Dissociation subscale could be substantially improved (>.60) by removing two items that more blatantly assess identity alteration or multiple personality (“switching back and forth between different personalities” and “having different people inside of you with different names”). However, the full subscale was retained in order to afford comparability with previous studies that have used the full subscale.