Peritraumatic and persistent dissociation in the presumed etiology of PTSD
Peritraumatic and persistent dissociation in the presumed etiology of PTSD
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DOI：
10.1176/appi.ajp.162.12.2295
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发表时间：
2005-12-01
影响因子：
17.7
通讯作者：
Weathers, F
中科院分区：
文献类型：
--
作者：
Briere, J;Scott, C;Weathers, F
目的：创伤时发生的解离反应（创伤周围解离）被描述为随后发生创伤后应激障碍（PTSD）的主要危险因素。当前的研究从多变量角度评估了创伤周围解离和 PTSD，以及一种调查较少的现象：在事件期间或之后开始并持续到评估时间的创伤特异性解离（持续性解离）。 方法：在两项研究中，对 52 名当地社区参与者和来自普通人群的 386 名至少有过一次创伤事件暴露史的参与者进行了评估，以确定是否存在 PTSD，并采取了解离措施结果：在这两项研究中，通过单变量分析，创伤周围分离、持续分离、创伤周围痛苦和全身分离症状与 PTSD 相关。然而，两项研究的多变量分析表明，一旦考虑到其他变量（特别是持续性和普遍性解离），PTSD 状态就不再与创伤周围解离有关。相反，持续性解离在单变量和多变量水平上是强有力的预测因子。结论：创伤相关的持续性解离是 PTSD 的重要预测因子，而创伤周围解离在多变量水平上不再预测 PTSD。这些发现表明，与创伤后发生的事情（即持续回避）相比，创伤后发生的事情（例如，编码中断）更能预测 PTSD。
Objective: Dissociative responses that occur at the time of a trauma (peritraumatic dissociation) have been described as a major risk factor for subsequent posttraumatic stress disorder ( PTSD). The current study evaluated peritraumatic dissociation and PTSD from a multivariate perspective, along with a less-investigated phenomenon: trauma-specific dissociation that begins during or after an event and continues until the time of assessment (persistent dissociation).Method: In two studies, 52 local community participants and 386 participants from the general population with histories of exposure to at least one traumatic event were assessed for the presence of PTSD and were administered measures of dissociation and peritraumatic distress.Results: In both studies, peritraumatic dissociation, persistent dissociation, peritraumatic distress, and generalized dissociative symptoms were associated with PTSD by univariate analyses. However, multivariate analyses in both studies indicated that PTSD status was no longer related to peritraumatic dissociation once other variables (especially persistent and generalized dissociation) were taken into account. In contrast, persistent dissociation was a strong predictor at univariate and multivariate levels.Conclusions: Trauma-related persistent dissociation is a substantial predictor of PTSD, whereas peritraumatic dissociation ceases to predict PTSD at the multivariate level. These findings suggest that it is less what happens at the time of a trauma ( e. g., disrupted encoding) that predicts PTSD than what occurs thereafter (i.e., persistent avoidance).