title: Trauma-Related Altered States of Consciousness (TRASC) and Functional Impairment I: Prospective Study in Acutely Traumatized Persons.
abstract: A theoretical framework referred to as a 4-D model has been described for classifying posttraumatic stress symptoms into those potentially occurring within normal waking consciousness (NWC) versus those thought to intrinsically exemplify dissociative experiences, specifically, trauma-related altered states of consciousness (TRASC). As a further test of this theoretical distinction, this prospective study evaluated whether TRASC and NWC forms of distress incrementally and prospectively predicted functional impairment at 6 and 12 weeks following presentation at hospital emergency departments in the acute aftermath of traumatic events in 180 persons. Establishing the clinical significance of both TRASC and NWC-distress symptoms, we found that 6-week markers of TRASC and NWC-distress independently predicted 12-week self-reported levels of social and occupational impairment. We also observed broad support for various predictions of the 4-D model except that, in contrast with hypotheses, childhood trauma history was generally more strongly correlated with symptoms of NWC-distress than with TRASC. Future research directions are discussed.
authors.affiliation: a Departments of Psychiatry and Psychology and Graduate Program in Neuroscience , Western University , London , Ontario , Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Frewen
authors.affiliation: b Faculty of Nursing , The University of Alberta , Edmonton , Alberta , Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Hegadoren
authors.affiliation: c Department of Psychiatry , The University of Alberta , Edmonton , Alberta , Canada.
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Coupland
authors.affiliation: d Department of Emergency Medicine and School of Public Health , University of Alberta , Edmonton , Alberta , Canada.|e Alberta Health Services , Edmonton , Alberta , Canada.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.affiliation: a Departments of Psychiatry and Psychology and Graduate Program in Neuroscience , Western University , London , Ontario , Canada.
authors.forename: Richard W J
authors.initials: RW
authors.lastname: Neufeld
authors.affiliation: f Department of Psychiatry and Graduate Program in Neuroscience , Western University , London , Ontario , Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lanius
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003244:Consciousness Disorders / Q000453:epidemiology* / Q000523:psychology*; D004213:Dissociative Disorders / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*
keywords: 4-D model; childhood abuse and neglect; dissociation; posttraumatic stress disorder; trauma-related altered states of consciousness