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


CONCLUSIONS
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.
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Dan J
DJ
Stein
Karestan C
KC
Koenen
Matthew J
MJ
Friedman
Eric
E
Hill
Katie A
KA
McLaughlin
Maria
M
Petukhova
Ayelet Meron
AM
Ruscio
Victoria
V
Shahly
David
D
Spiegel
Guilherme
G
Borges
Brendan
B
Bunting
Jose Miguel
JM
Caldas-de-Almeida
Giovanni
G
de Girolamo
Koen
K
Demyttenaere
Silvia
S
Florescu
Josep Maria
JM
Haro
Elie G
EG
Karam
Viviane
V
Kovess-Masfety
Sing
S
Lee
Herbert
H
Matschinger
Maya
M
Mladenova
Jose
J
Posada-Villa
Hisateru
H
Tachimori
Maria Carmen
MC
Viana
Ronald C
RC
Kessler
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004213:Dissociative Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007406:Interview, Psychological; D008016:Life Change Events; D008297:Male; D008603:Mental Health; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology*; D013405:Suicide / Q000523:psychology