Differences in trauma history and psychopathology between PTSD patients with and without co-occurring dissociative disorders

The interplay between different types of potentially traumatizing events, posttraumatic symptoms, and the pathogenesis of PTSD or major dissociative disorders (DD) has been extensively studied during the last decade. However, the phenomenology and nosological classification of posttraumatic disorders is currently under debate. The current study was conducted to investigate differences between PTSD patients with and without co-occurring major DD with regard to general psychopathology, trauma history, and trauma-specific symptoms. Twenty-four inpatients were administered the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Mini-Structured Clinical Interview for DSM-IV Dissociative Disorders (MINI-SKID-D) to assess DD and PTSD. Additionally, participants completed questionnaires to assess general psychopathology and health status. Symptom profiles and axis I comorbidity were similar in all patients. Traumatic experiences did not differ between the two groups, with both reporting high levels of childhood trauma. Only trauma-specific avoidance behavior and dissociative symptoms differed between groups. Results support the view that PTSD and DD are affiliated disorders that could be classified within the same diagnostic category. Our results accord with a typological model of dissociation in which profound forms of dissociation are specific to DD and are accompanied with higher levels of trauma-specific avoidance in DD patients.

近十年来，学界已针对不同类型潜在创伤性事件、创伤后症状与创伤后应激障碍（PTSD）或重度解离障碍（DD）的发病机制之间的相互作用展开广泛研究。然而，当前创伤后障碍的现象学与疾病分类学仍存在争议。本研究旨在对比伴发与不伴发重度解离障碍的PTSD患者在一般精神病理状态、创伤史及创伤特异性症状方面的差异。本研究纳入24名住院患者，采用《DSM-IV临床医师版创伤后应激障碍量表（CAPS）》与《DSM-IV解离障碍迷你结构化临床访谈（MINI-SKID-D）》分别评估PTSD与解离障碍；此外，受试者还完成了用于评估一般精神病理与健康状况的问卷。所有受试患者的症状谱与轴I共病情况均相似，两组的创伤暴露经历亦无显著差异，均报告存在高水平的童年期创伤。仅创伤特异性回避行为与解离症状在两组间存在差异。研究结果支持“PTSD与DD为关联障碍，可归入同一诊断类别”的观点。本研究结果契合解离分型模型：重度解离症状为DD所特有，且DD患者伴随更高水平的创伤特异性回避行为。