Dissociation in posttraumatic stress disorder: Evidence from the world mental health surveys

Dan J. Stein, Karestan C. Koenen, Matthew J. Friedman, Eric Hill, Katie A. McLaughlin, Maria Petukhova, Ayelet Meron Ruscio, Victoria Shahly, David A. Spiegel, Guilherme Borges, Brendan Bunting, Jose Miguel Caldas-De-Almeida, Giovanni de Girolamo, Koen Demyttenaere, Silvia Florescu, Josep Maria Haro, Elie G. Karam, Viviane Kovess-Masfety, Sing Lee, Herbert MatschingerMaya Mladenova, Jose Posada-Villa, Hisateru Tachimori, Maria Carmen Viana, Ronald C. Kessler

Research output: Contribution to journalArticle

155 Citations (Scopus)

Abstract

Background: Although the proposal for a dissociative subtype of posttraumatic stress disorder (PTSD) in DSM-5 is supported by considerable clinical and neurobiological evidence, this evidence comes mostly from referred samples in Western countries. Cross-national population epidemiologic surveys were analyzed to evaluate generalizability of the subtype in more diverse samples. Methods: Interviews were administered to 25,018 respondents in 16 countries in the World Health Organization World Mental Health Surveys. The Composite International Diagnostic Interview was used to assess 12-month DSM-IV PTSD and other common DSM-IV disorders. Items from a checklist of past-month nonspecific psychological distress were used to assess dissociative symptoms of depersonalization and derealization. Differences between PTSD with and without these dissociative symptoms were examined across a variety of domains, including index trauma characteristics, prior trauma history, childhood adversity, sociodemographic characteristics, psychiatric comorbidity, functional impairment, and treatment seeking. Results: Dissociative symptoms were present in 14.4% of respondents with 12-month DSM-IV/Composite International Diagnostic Interview PTSD and did not differ between high and low/middle income countries. Symptoms of dissociation in PTSD were associated with high counts of re-experiencing symptoms and net of these symptom counts with male sex, childhood onset of PTSD, high exposure to prior (to the onset of PTSD) traumatic events and childhood adversities, prior histories of separation anxiety disorder and specific phobia, severe role impairment, and suicidality. Conclusion: These results provide community epidemiologic data documenting the value of the dissociative subtype in distinguishing a meaningful proportion of severe and impairing cases of PTSD that have distinct correlates across a diverse set of countries.

Original languageEnglish
Pages (from-to)302-312
Number of pages11
JournalBiological Psychiatry
Volume73
Issue number4
DOIs
Publication statusPublished - 15 Feb 2013

Keywords

  • Dissociation
  • dissociative subtype
  • DSM-5
  • epidemiology
  • nosology
  • posttraumatic stress disorder
  • World Mental Health Surveys

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