Transcript Peritraumatic Dissociation as a Predictor of Posttraumatic

Peritraumatic Dissociation as a Predictor of
Posttraumatic Symptomatology among
College Women with a History of Childhood
Sexual Abuse
©LouAnne Birch Hawkins
University of North Florida
WHY?
* What makes an individual vulnerable?
* Early detection of risk factors may result
in early intervention.
Constructs of Interest
•peritraumatic dissociation
•posttraumatic symptomatology
•childhood sexual victimization
•trait dissociation
Peritraumatic Dissociation
experiences of depersonalization, derealization,
alterations in sense of time and/or image
extent to which individual dissociates during or
immediately after traumatic event
Peritraumatic Dissociation
strong association between peritraumatic
dissociation and variety of traumatic events:
natural disaster (Cardena & Spiegel, 1993; Koopman, Classen, &
Spiegel, 1994; Marmar, Weiss, Metzler, & Delucchi, 1996)
severe childhood physical & sexual abuse (Briere,
1992)
combat exposure (Bremner, Southwick, Fontana, Rosenheck, &
Charney, 1994)
rape (Coons & Milstein, 1986)
witnessing an execution (Feinkel, Koopman, & Spiegel, 1994)
Constructs of Interest
•peritraumatic dissociation
•posttraumatic symptomatology
•childhood sexual victimization
•trait dissociation
Posttraumatic Stress Disorder (PTSD)
and Posttraumatic Symptomatology
1. symptoms follow exposure to traumatic event
2. must include - fear, helplessness, horror, or (in
children) disorganized or agitated behavior
3. symptoms include - reexperiencing event,
persistent avoidance of stimuli, numbing,
persistent hyperarousal
Posttraumatic Stress Disorder (PTSD)
and Posttraumatic Symptomatology
McLeer, Deblinger, Atkins, Foa, & Ralphe (1988)
N = 31
48.4% met criteria for PTSD
Many who did not meet full criteria were symptomatic.
Epstein, Saunders, Kilpatrick, & Resnick (1998)
N = 2,994 women, n = 282 w/ hx. of abuse
Ss w/ hx. had twice as many PTSD sx
Constructs of Interest
•peritraumatic dissociation
•posttraumatic symptomatology
•childhood sexual victimization
•trait dissociation
Childhood Sexual Victimization
What is childhood sexual victimization?
*
fondling to intercourse
*
by an individual 5 or more years older
*
prior to age 16
Prevalence of
Childhood Sexual
Victimization
Estimated at 20%
(Briere, 1992; Finkelhor, 1979)
First national survey of adults (Finkelhor,
Hotaling, Lewis, & Smith, 1989)
sample included 1,481 females
prevalence among females reported at 27%
Consequences of
Childhood Sexual Victimization
 anxiety
 depression
 somatization
 sexual dysfunction
 interpersonal problems
 substance abuse
 suicidality
(Briere, 1992; Fromuth, 1986; Kendall-Tacket, Williams, & Finkelhor, 1993)
Consequences of
Childhood Sexual Victimization
Review of 45 empirical studies of CSV
(Kendall-Tacket, et al., 1993)
1. abused children more symptomatic than non-abused
2. no specific symptom characterized sexually abused children
3. most prevalent - fears, posttraumatic stress, behavioral
problems, inappropriate sexual behavior, poor self-esteem
Constructs of Interest
•peritraumatic dissociation
•posttraumatic symptomatology
•childhood sexual victimization
•trait dissociation
Trait Dissociation
disconnection of psychological systems (i.e.
thoughts, feelings, beliefs) that are normally
integrated
certain memories may not be assimilated with
other info
clinical & behavioral manifestations of changes in
memory and identity on continuum of severity
Trait Dissociation
strong association between dissociation
and variety of traumatic events:
combat exposure (Brende, 1986)
witnessing a violent death during childhood (Putnam,
Guroff, Silberman, Barban, & Post, 1986)
rape (Coons & Milestein, 1986)
childhood physical & sexual abuse (Briere, 1992; Chu &
Dill, 1990; Frischholz, 1985; Putnam, 1989; Putnam, Guroff, Silberman,
Baran, & Post, 1986)
Link Between Peritraumatic Dissociation
and PTSD
Peritraumatic dissociation may be an
effective mechanism to cope with an
event that would otherwise be
overwhelming (Spiegel & Cardena, 1991).
Link Between Peritraumatic Dissociation
and PTSD
Peritraumatic dissociation has been identified as a
significant risk factor for development of
posttraumatic symptomatology among:
witnesses of violence (Classen, Koopman, Hales, & Spiegel,
1998)
MVA victims (Harvey & Bryant, 1998)
EMS workers (Marmar, Weiss, Metzler, Ronfeldt, & Foreman, 1996;
Marmar, Weiss, Metzler, Delucchi, Best, Wentworth, 1999)
natural disaster victims (Koopman, Classen, & Spiegel, 1994)
Link Between Peritraumatic Dissociation
and PTSD
Marmar, Weiss, Schlenger, Fairbanks, Jordan,
Kulka, and Hough (1994)
Ss: 251 male Vietnam combat veterans
predictor variable: peritraumatic dissociation
criterion variable: posttraumatic symptomatology
control variables: severity of combat exposure
trait dissociation
Link Between Peritraumatic Dissociation
and PTSD
Findings:
Greater peritraumatic dissociation resulted in
greater incidence of PTSD even after
controlling for war zone stress exposure and
trait dissociation.
Rationale
Why do some people develop posttraumatic symptoms while
others do not?
Dissociation was originally viewed as psychological adaptation
that protected victims.
There is growing evidence that peritraumatic dissociation may be
maladaptive and predictive of future problems.
Peritraumatic dissociation has been found to be significantly
predictive of posttraumatic symptomatology while controlling for
other variables for several populations.
Rationale
The purpose of this study is to examine the
relationship between peritraumatic dissociation
and posttraumatic symptomatology among
college women with a history of childhood sexual
victimization.
Hypothesis
Participants reporting greater
peritraumatic dissociation would also
report greater posttraumatic
symptomatology, even after controlling for
severity of childhood sexual victimization
and trait dissociation.
Method
Participants
N = 73
college women with a history of CSV
age: 18 to 54 (M = 25.45; SD = 8.39; median = 22)
ethnicity: 74% Caucasian (n = 53)
marital status: 58% single (n = 42)
incomes: 31% >$50,000 (n = 23)
Method
Measures
Childhood Sexual Victimization Questionnaire
adapted from Finkelhor, 1979
Asks participants to respond “yes” or “no” to questions
regarding:
specific sexual experiences before age 16
if experiences were with someone > 5 years older
If the participant responds affirmatively, she is asked to respond
to follow-up questions about the most significant experience.
Method
Measures
Childhood Sexual Victimization
intercourse or attempted intercourse vs. other than
intercourse or attempted intercourse (i.e. fondling)
perpetrator was a parental figure (i.e. parent, step-parent)
vs. other than a parental figure (i.e. sibling, neighbor)
physical force or threat of physical force vs. no physical
force or threat of physical force.
higher scores = greater severity
Method
Measures
Dissociative Experiences Scale (Bernstein & Putnam, 1986)
28-item self-report questionnaire
most widely used measure (test-retest reliability Pearson r =
.84; good internal consistency; good criterion-referenced and
construct validity)
indicate % of time experience emotion or exhibit behavior
score reflects mean of all items
higher scores = greater trait dissociation
Method
Measures
Stanford Acute Stress Reaction Questionnaire
(Koopman, Cardena, Classen, & Spiegel, 1993)
good internal consistency, high reliability, good concurrent
validity
list of statements indicative of dissociative symptoms
Likert scale
score reflects mean item scores with range from 5 to 10
higher scores = greater peritraumatic dissociation
Method
Measures
PTSD Checklist (Weathers, Litz, Huska, & Keane, 1993)
high test-retest reliability, internal consistency, acceptable
criterion validity
17-item self-report correspond to DSM-IV diagnostic criteria
how much bothered by PTSD symptoms within last month
Likert scale
higher scores = greater posttraumatic
symptomatology
Method
Procedure
approved by UNF IRB
conducted in accordance with APA guidelines
administered and debriefed by trained research assistants
in groups of 10 to 20 participants
73 female college students were identified via self-report as
having hx. of CSV from 304 participants
Results
Sample Characteristics
prevalence rate of 24% is consistent with literature
mean scores for DES & PCL-C are consistent with
literature
modified version of SASRQ could not be compared
to previous data
Results
Relationship Between Trait Dissociation
and Peritraumatic Dissociation
Pearson r = .32
distinct constructs
Results
Relationship Between Peritraumatic
Dissociation and Posttraumatic
Symptomatology
Analysis - hierarchical regression
Why?
Results
Hierarchical regression or sequential multiple
regression
1. is used when the researcher has developed a
model.
2. permits the researcher to determine the unique
contribution of the variable of interest.
(Cohen & Cohen, 1975; Tabachnick & Fidell, 1996)
Results
predictor variable: peritraumatic dissociation
criterion variable: posttraumatic symptomatology
control variables: CSV severity
trait dissociation
CSV
PTSD
Symptomatology
CSV
Trait Dissociation
PTSD
Symptomatology
CSV
Trait Dissociation
Peritraumatic
Dissociation
PTSD
Symptomatology
Unique Predictive Contribution of
Peritraumatic Dissociation
CSV
Trait Dissociation
Peritraumatic
Dissociation
PTSD
Symptomatology
Variable
b
Step 1
CSV
.14
R2 = .02
Step 2
CSV
.12
DES
.45***
D R2 = .20 (p < .001)
Step 3
CSV
.06
DES
.36***
SASRQ
.29**
**p < .01; ***p < .001.
D R2 = .07 (p = .01)
Discussion
The findings of this study indicate that
peritraumatic dissociation is predictive of
posttraumatic symptomatology among
college women with a reported history of
childhood sexual victimization.
Discussion
Findings are consistent with those for other
populations.
A better understanding of this relationship may
increase early identification of individuals at risk
for PTSD and posttraumatic symptomatology.
Limitations and Recommendations
retrospective reports
examine relationship between
measures and specific items
further substantiate this emerging
concept and provide additional
evidence of construct validity