The dissociative posttraumatic stress disorder: Treatment results cohort study involving veterans

The dissociative posttraumatic stress disorder: Treatment results cohort study involving veterans

Abstract

Dissociation is a common characteristic among veterans experiencing posttraumatic stress disorder (PTSD), which influences the active treatment. The research targets to replicate the outcomes of a dissociative PTSD, and find the relational trends in survival mechanisms, symptomatic levels, severity, and to examine the effects on posttraumatic symptom enhancement. Veterans suspected of deployment-related pathology were examined by psychiatrists concerning axis I and II disorders and finished a baseline assessment. Those seeking intervention received the baseline assessment. Patients who began treatment got invitations for a follow-up cross-examination to re-examine posttraumatic reactive symptoms. The investigation involved veterans having a mean age of 39.5 years, and who tested for DSM-IV-TR PTSD. Eighty veterans began treatment with sixty-four engaging in follow-up measures. The patients received trauma-focused interventions or non-trauma-focused PTSD remedies. The medics committee granted the research exemption of ethical approval since the cross-examination was part of standard protocols and could not affect intervention protocols.

Introduction

Posttraumatic stress syndrome (PTSD) is a mental illness that may result from undergoing a traumatic scene. Its key attributes include involuntary re-experiencing, persistent avoidance of traumatic content, negative alterations in cognitions, and symptoms of arousal and reactivity. The recent inclusion of a dissociative PTSD in DSM-5 recognizes the existence of a subsample of patients with PTSD who suffer from severe dissociation at conceivable risk of treatment stagnation. Dissociation is regarded as a potential indicator of poor PTSD treatment results, and treatment manuals contemplate its probable adverse treatment impacts. This paper presents empirical evidence of these suggestions in a sample of veterans with PTSD.

Research Hypothesis

The recent empirical data indicate the existence of a subgroup of patients with PTSD and severe dissociative symptoms of depersonalization.

Literature Review

The concept of dissociation

The idea of dissociation lacks a clear and frequently acceptable definition; instead, it has several conceptions outlining different phenomena and processes. Dissociation refers to a disruption in the normal integrated function of consciousness, memory, identity, or perception of the environment. These disruptions are divided into psycho-form and somatoform types, which are pathological or non-pathological. Psycho-form dissociation entails disturbances in the integration and perception of cognition, affect, memory, identity, and behavior. Somatoform dissociation involves disruptions in the integration and perception of bodily functions, sensations, and movement.

Non-pathological dissociation is prevalent in the general population, and it associates with a tendency to become immersed in an activity and losing focus on one’s surroundings. Pathological dissociation is primarily split between two distinct phenomena, amnesia and depersonalization. Amnesia refers to an inability to recall important autobiographic information that is inconsistent with traditional forgetfulness. Depersonalization represents a state of consciousness detached from one’s everyday experience of one’s self or the world. It includes out-of-body experiences, feeling unreal, and in a dreamlike state.

PTSD and dissociation

Dissociative and posttraumatic stress symptoms seem highly correlated. However, the nature of their relationship remains ambiguous. Scholars give a detailed synopsis of models that explains this relationship. Their review illustrates a lack of consensus between researchers, whether PTSD and dissociation refer to a single shared constructor, whether they are distinctive in origin and manifestation. Some models consider the relationship between PTSD and dissociation to be weak or non-existent. Others view dissociation and PTSD as distinct but comorbid phenomena with a shared background of trauma and vulnerabilities.

Again other models posit a strong relationship between dissociation and PTSD, for instance, because dissociation is seen as a vulnerability for the development of PTSD. The two models that have received the most empirical support are the component model and the subtype model, regarding PTSD and dissociation as strongly related. The component model perceives the traumatic event as a cause of both PTSD and dissociation. Dissociation is viewed as a symptom of PTSD. The subtype model concurs and adds that PTSD with a high level of dissociative symptoms can differ in (comorbid) symptom patterns and severity. It views dissociative PTSD as qualitatively different from non-dissociative PTSD.

Another prominent model that describes the relationship between dissociation and PTSD is the trauma/avoidance model. It is mostly associated with symptoms of depersonalization, corresponding with the DSM-5 dissociative PTSD subtype. The model considers dissociation as an avoidant coping strategy that shifts attention from traumatic memories to safeguard against overwhelming emotions. This view is supported by experimental cognitive research, demonstrating that dissociative persons consciously avoid traumatic memories using improved attention redirection strategies compared to non-dissociative patients.

Dissociation and PTSD treatment

Dissociation is known as a problematic experience among veterans who have PTSD. Studies use baseline dissociation severity to foresee harmful posttraumatic intervention. The foreshadowed impact disappears upon remedying posttraumatic symptoms. The few research examining the treatment outcomes for dissociative PTSD patients indicate that dissociation may influence posttraumatic treatment results. This research focused, particularly on depersonalization. It is hypothesized that distinguishable clinical features would characterize a dissociative PTSD profilein following the subtype model, and high use of avoidant survival measures. The age factor was used to predict the profile membership since old age associates with dissociative disorder. It was hypothesized that patients suffering dissociative disorder profile indicate low intervention improvement contrary to other profiles.

Methodology

The research involves multisite longitudinal cohort model with a pre-intervention diagnosis examination and a regular result after six months of psychotherapy. The study involved four Dutch psycho-trauma centers. Patients suspected of pathology relating to deployment were examined by psychiatrists concerning axis I and II disorders and finished a baseline assessment. Those seeking intervention received the baseline assessment. Patients who began treatment got invitations for a follow-up to re-examine posttraumatic reactionary symptoms. The sample involved male patients having a mean age of 39.5 years, and who tested for DSM-IV-TR PTSD. Eighty patients  began treatment with sixty-four. The research employs a mixed-method design, there will be a series of quantitative questions, such as “do you regularly assess patients in the ED for PTSD?”, and “Does your place of work have a protocol for assessing patients for PTSD?”; followed by an open-ended question asking the study participants if they would like to elaborate on any of their answers, or if they have any suggestions for future studies.

Sampling

The sample population will entail of ED nurses in hospitals from Sacramento to Redding.  The researcher will call ED supervisors and explain the study purpose and protocol and get permission to include the hospital in the study. The researcher will then schedule several dates on different shifts to perform the research.  The sample will be a convenience sample of nurses willing and available to fill out a questionnaire that will include data such as age, sex, ethnicity, income level, and level of education, as well as the questions from the methods section of this paper.

Instruments

Questionnaires are employed for this research, which will entail the clients’ demographic data and a no or yes questions concerning whether the nurse screens patients for PTSD, or whether the hospital has a PTSD screening procedure. Also, whether there is PTSD screening education available at the hospital, and finally, if the nurse is comfortable screening patients for PTSD.  It will have a list of PTSD screening tools and a box next to each one for the nurse to check if the hospital uses a screening tool, there will also be an area for write-ins just in case the hospital uses a screening tool, not on the list.  The end of the questionnaire will entail an open space for the nurse to remark further on any of the above questions, and to provide feedback on the research.

Results

The outcome baseline and completer scrutinize patients who under therapy, and found high degrees paralleled to overall baseline sample concerning posttraumatic condition, depression, hostility, cognitive performance deficits, and as well as traumatic pathology. The patients who began therapy and finished the follow-up measures were regarded as completers. Those who began therapy and later pull out before attaining recovery accordingly were regarded as premature dropouts. Those who successfully finished treatment before follow-up were regarded as successful treatment completers. The study completers revealed low levels of posttraumatic stress disorder severity rates than dropouts and high severe rating than successful therapy completers. There was no critical distinction in pre-intervention posttraumatic reaction symptoms among the completers and those unwilling participants and who did not get a follow-up diagnosis.

The fit guides for every profile remedy, BLRT and BIC are regarded as powerful. The profiles remedies provides crucial BLRT tests, suggesting that the four-profile gives the greatest fit. BIC displays low in the five-profile, showing the powerfulness of the approach. The five-profile remedy closely relates to the four-profile, only that it contains a class of 6.7% of the unit, hindering its relevance. The four-profile approach was serves as the optimal approach focusing on the fit data, prevalence rating, and precise interpretation. The entropy indices are sufficient, and mean profile project possibility supports great entropy precision. The z-scores indicate high posttraumatic stress according to the profile. Third as well as fourth profiles indicate indistinctly severe degrees of posttraumatic stress, whereby the fourth profile indicates severe dissociative syndrome.

Discussion

The research indicates predominately male patients having dissociative posttraumatic syndrome. Participants with dissociative traumatic syndrome profile show severe dissociative posttraumatic syndromes. They experience, hostility, depression agoraphobia, mental performance deficits, anxiety, interpersonal sensitivity, as well as somatization dissociation. Patients having dissociative disorder display high therapy intervention impacts. The research replicates prior results  of a dissociative  patients, and identifies four different categories of  patient, that is low,  moderate, severe, and dissociative.

The results fosters that dissociative trauma is high psychopathology, and that high anxiety and depression acts as routine indicators of dissociative disorder. Increase in pathological levels, apart from sleep disorders, shows that dissociative symptoms promotes stress and pathology syndromes.

There is no distinction in avoidant survival measures among patients with dissociative in comparison to posttraumatic stress. The results indicate that sound avoidant approaches are not particularly related to dissociative disorder subtype, thus it does not foster avoidance approaches of dissociation.

Participants reveal sleep disorders as a foreshadow to dissociative disorder subtype prevalent in female. Concerning the male patients there is no indications that sleep disorders enhances dissociative syndrome, and this distinction may be due to biological gender differences. The findings illustrate that patients with dissociative syndrome, equally profits from therapy, in comparison to their counterparties. It shows that patients having severe posttraumatic stress have high chance for improvement upon seeking intervention. The results indicate that dissociation do not influence posttraumatic stress treatment, and that therapists can effectively address adverse impacts.

Limitations

Up to date the use of DES is the common instrument used in measuring dissociation, however, it suffers several limitations. It is not certain that DES measures general dissociation or particular traumatic dissociation, or even whether the scale is satisfactory or temporal, thus indicating a possible low scale sensitivity. Besides, there were no formal dialogues employed to investigate the dissociative traumatic subtype. Similarly, the sample applied as a unit analysis may be different from the sum sample unit in a way that might influence the intervention results, though no clear distinction was noted.  Also, the exploratory distal intervention result information does not grant reliable deductions because of the sampling limitations, unequal patient profiles, and due to the intervention conditions for every profile being unknowable.  In addition, the profiles samples may be insufficient to detect every profile variances.

The research examined two measurement events, and therefore, the propositions of severity could not easily be examined. Besides, the recent research investigated the initial six months of intervention, and not the entire scope of therapy interventions. Both outpatient and inpatient intervention setups give weekly therapy sessions which are not evaluated in the research study, since it focusses on therapy intervention as the most satisfactory approach in remedying PTSD. The observational model is limited in developing deductions concerning the causal relations among the variables. The dissociative traumatic condition and intervention outcome for the disorder aims to relate the DSM-5 PTSD, and the findings as clear regarding the DSM-5, however, the DSM-IV PTSD approach is regarded suitable in diagnosing the subtype. Finally, the IES-R questionnaire does not examine every PTSD DSM-IV approach, though it is considered as a valid PTSD indicator.

Implications

The results affirm that there exists a subgroup of PTSD, alongside high dissociative syndromes which fit the definition of dissociative post traumatic subtype condition. The indication of different increase levels of pathological dimensions, above the non-dissociative traumatic profiles imply that a key focus on PTSD may be too specific and permit further clinical intervention. Post traumatic therapy proves profitable to patients suffering from dissociative disorder. They illustrate same posttraumatic stress in comparison to non-dissociative patients with the same and low severe degrees. The result implies that severe dissociation, though discernible in diverse pathological severity elements from non-dissociative trauma, it does not have a negative effect on patients undergoing treatment. The result is significant since both researchers and health practitioners tend to regard dissociation as an indication of poor post trauma treatment result, and intervention guides continue to consider its probable adverse implications. Besides, the results question the health utility of the DSM-5 dissociative post trauma subtype.

Conclusion

Recent research reveals that there exists a subgroup of patients having both post traumatic disorders and severe dissociative syndromes of depersonalization. The patients having dissociative traumatic syndromes reveal unique high levels of pathology in comparison to patients with non-dissociative traumatic disorder and same severity posttraumatic syndrome. Post traumatic patients having dissociative syndromes also reveal a significant impact in intervention, as compared to those with non-dissociative traumatic conditions. Therefore, further studies are required to establish the relation between the subtype and high levels of pathological approaches, which is an important element concerning the treatment and recovery measures.