Dissociative subtype of posttraumatic stress disorder in women in partial and residential levels of psychiatric care

ABSTRACT

The dissociative subtype of posttraumatic stress disorder (PTSD) is estimated to characterize about 12-30% of those with PTSD. Some research links this subtype with increased severity of PTSD symptoms compared to samples with “classic” PTSD. However, prevalence and severity rates reported in the literature have varied. One possible explanation for these discrepancies could be related to where the populations were sampled. Therefore, we investigated whether these differences are still observed when holding level of care constant. We collected data from 104 women at a partial and residential psychiatric hospital program focused on trauma-related disorders. Participants completed self-report questionnaires assessing trauma exposure, symptoms and provisional diagnosis of PTSD, trauma-related thoughts and beliefs, and feelings of shame. All participants reported a history of childhood and/or adulthood trauma exposure. Eighty-eight (85%) met criteria for PTSD, and of those, seventy-three (83%) met criteria for the dissociative subtype as assessed by the Dissociative Subtype of PTSD Scale. A series of independent t-tests revealed no significant differences between the “classic” and dissociative PTSD groups with respect to lifetime or childhood trauma exposure, posttraumatic cognitions, shame, or overall PTSD severity. Our results suggest that samples with classic PTSD and the dissociative subtype may not differ in some types of symptom severity when holding level of care constant. Importantly, however, we found at partial/residential level of care the majority of patients with PTSD were dissociative. Given the elevated prevalence rate in this sample, these findings support the need to assess dissociative symptoms, particularly in more acute psychiatric settings.

KEYWORDS:

• PTSD
• dissociation
• traumatic stress
• women’s health

Authorship

LAML, JDW, SW, KJR and MLK developed the study concept and design. SBH, CEB, and JDW performed data collection. LAML and SBH performed the data analysis and interpretation. SBH drafted the paper, and all authors provided critical revisions. All authors approved the final version of the paper for submission.

Acknowledgments

The authors would like to thank our study participants, the staff at McLean Hospital’s Hill Center for Women, and Susan Kattlove and Kathryn Kieran for feedback and comments.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship or the publication of this article.

Clinical Trial Registration

NCT02757339 Evaluating the Neurobiological Basis of Traumatic Dissociation in Women With Histories of Abuse and Neglect

Additional information

Funding

The work was supported by National Institute of Mental Health (NIMH) grant R21MH112956 to MLK, and NIMH fellowship grant F32MH109274 to LAML, the Anonymous Women’s Health Fund to MLK, the O’Keefe Family Foundation to MLK, the Trauma Scholars Fund to MLK, the Barlow Family Fund to MLK and the Frazier Foundation Grant for Mood and Anxiety Research to KJR.