Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both-A multi-center study.
BACKGROUND
The aims of this study were to examine the level of dissociative symptoms in patients with different substance related disorders (alcohol dependence, drug dependence, and combined alcohol and drug dependence), and to investigate the influence of potentially traumatic events in childhood, age, gender, and posttraumatic stress disorder on the relationship between dissociative symptoms and type of substance abuse.


METHODS
Of the 459 participants (59.7% male) 182 (39.7%) were alcohol-dependent (A), 154 (33.6%) were drug-dependent (D), and 123 (26.8%) were dependent on both, alcohol and drugs (AD) based on the DSM-IV criteria for a current diagnosis. Participants completed the Childhood Trauma Questionnaire (CTQ) and the Dissociative Experiences Scale (DES). The International Diagnostics Checklist (IDCL) was administered to diagnose PTSD.


RESULTS
Higher levels of dissociation were observed in patients with drug dependence as compared to patients with mere alcohol dependence (mean DES group A: 9.9+/-8.8; group D: 12.9+/-11.7; group AD: 15.1+/-11.3). However, when severity of potentially traumatic events in childhood, PTSD, age and gender were included in the analysis, the influence of the type of substance abuse did not prove to be statistically significant. The variable most strongly related to dissociative symptoms was severity of potentially traumatic events in childhood, in particular emotional abuse, even after controlling for PTSD and other potential confounders.


CONCLUSIONS
It seems appropriate to screen SUD patients for dissociative symptoms, especially those with a more complex risk profile including (additional) drug abuse, female gender, younger age and most importantly a history of childhood trauma.
Schäfer
Ingo
I
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf and Center for Interdisciplinary Addiction Research, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany. i.schaefer@uke.uni-hamburg.de
Langeland
Willemien
W
Hissbach
Johanna
J
Luedecke
Christel
C
Ohlmeier
Martin D
MD
Chodzinski
Claudia
C
Kemper
Ulrich
U
Keiper
Peter
P
Wedekind
Dirk
D
Havemann-Reinecke
Ursula
U
Teunissen
Sybille
S
Weirich
Steffen
S
Driessen
Martin
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology*; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data*; D002650:Child Abuse, Sexual; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D004213:Dissociative Disorders / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult