The course of (comorbid) trauma-related, dissociative and personality disorders: two year follow up of the Friesland study cohort

<b>Background</b>: There is substantial comorbidity between trauma-related disorders (TRDs), dissociative disorders (DDs) and personality disorders (PDs), especially in patients who report childhood trauma and emotional neglect. However, little is known about the course of these comorbid disorders, despite the fact that this could be of great clinical importance in guiding treatment. <b>Objective</b>: This study describes the two-year course of a cohort of patients with (comorbid) TRDs, DDs and PDs and aims to identify possible predictors of course. Possible gender differences will be described, as well as features of non-respondents. <b>Method</b>: Patients (N = 150) referred to either a trauma treatment program or a PD treatment program were assessed using five structured clinical interviews for diagnosing TRDs, DDs, PDs and trauma histories. Three self-report questionnaires were used to assess general psychopathology, dissociative symptoms and personality pathology in a more dimensional way. Data on demographics and received treatment were obtained using psychiatric records. We described the cohort after a two-year follow-up and used t-tests or chi-square to test possible differences between respondents and non-respondents and between women and men. We used regression analysis to identify possible course predictors. <b>Results</b>: A total of 85 (56.7%) of the original 150 patients participated in the follow-up measurement. Female respondents reported more sexual abuse than female non-respondents. Six patients (4.0%; all women) died because of suicide. Levels of psychopathology significantly declined during the follow-up period, but only among women. Gender was the only significant predictor of change. <b>Conclusions</b>: Comorbidity between TRDs, DDs and PDs was more the rule than the exception, pleading for a more dimensional and integrative view on pathology following childhood trauma and emotional neglect. Courses significantly differed between men and women, advocating more attention to gender in treatment and future research.

<b>研究背景</b>：创伤相关障碍（TRDs）、分离障碍（DDs）与人格障碍（PDs）之间存在显著共病现象，在报告童年创伤与情感忽视的患者群体中尤为突出。尽管此类共病障碍的病程对临床诊疗指导具有重要价值，但目前学界对其病程的了解仍较为有限。<b>研究目的</b>：本研究旨在描述共病创伤相关障碍、分离障碍与人格障碍的患者队列为期两年的病程，并识别潜在的病程预测因素；同时将分析可能存在的性别差异，以及无应答者的特征。<b>研究方法</b>：本研究纳入150名转诊至创伤治疗项目或人格障碍治疗项目的患者，通过五项结构化临床访谈对其创伤相关障碍、分离障碍、人格障碍及创伤史进行诊断评估；同时采用三份自评问卷，从更具维度化的视角评估患者的一般精神病理状态、分离症状与人格病理特征。通过精神科病历收集患者的人口学资料与接受的治疗信息。本研究对该队列完成了为期两年的随访，采用t检验或卡方检验分析应答者与无应答者、女性与男性之间的潜在差异，并通过回归分析识别可能的病程预测因素。<b>研究结果</b>：初始纳入的150名患者中，共有85名（56.7%）参与了随访评估。女性应答者报告的性虐待经历比例显著高于女性无应答者。共有6名患者（占比4.0%，均为女性）因自杀身亡。随访期间，患者的精神病理水平出现显著下降，但该变化仅见于女性群体；性别是唯一具有统计学意义的病程变化预测因素。<b>研究结论</b>：创伤相关障碍、分离障碍与人格障碍之间的共病现象极为普遍，这提示针对童年创伤与情感忽视引发的精神病理，应采用更具维度化与整合性的视角。男性与女性的病程存在显著差异，因此呼吁在临床治疗与未来研究中更加关注性别因素的影响。