Peritraumatic Dissociation as a Predictor of Posttraumatic Symptomatology among College Women with a...

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?WHY?

* What makes an individual * What makes an individual vulnerable?vulnerable?

* Early detection of risk factors may * Early detection of risk factors may result result in early intervention.in early intervention.

Constructs of InterestConstructs of Interest

•peritraumatic peritraumatic dissociationdissociation

•posttraumatic posttraumatic symptomatologysymptomatology

•childhood sexual childhood sexual victimizationvictimization

•trait dissociationtrait dissociation

Peritraumatic DissociationPeritraumatic Dissociation

experiences of depersonalization, experiences of depersonalization, derealization, alterations in sense of time derealization, alterations in sense of time and/or imageand/or image

extent to which individual dissociates during extent to which individual dissociates during or immediately after traumatic eventor immediately after traumatic event

Peritraumatic DissociationPeritraumatic Dissociation

natural disasternatural disaster (Cardena & Spiegel, 1993; Koopman, (Cardena & Spiegel, 1993; Koopman, Classen, & Spiegel, 1994; Marmar, Weiss, Metzler, & Delucchi, Classen, & Spiegel, 1994; Marmar, Weiss, Metzler, & Delucchi, 1996)1996)

severe childhood physical & sexual abusesevere childhood physical & sexual abuse (Briere, 1992)(Briere, 1992)

combat exposurecombat exposure (Bremner, Southwick, Fontana, (Bremner, Southwick, Fontana, Rosenheck, & Charney, 1994)Rosenheck, & Charney, 1994)

rape rape (Coons & Milstein, 1986)(Coons & Milstein, 1986)

witnessing an executionwitnessing an execution (Feinkel, Koopman, & (Feinkel, Koopman, & Spiegel, 1994)Spiegel, 1994)

strong association between peritraumatic strong association between peritraumatic dissociation and variety of traumatic dissociation and variety of traumatic events:events:


•peritraumatic dissociationperitraumatic dissociation

•posttraumatic posttraumatic symptomatologysymptomatology

•childhood sexual victimizationchildhood sexual victimization


Posttraumatic Stress Disorder Posttraumatic Stress Disorder (PTSD) and Posttraumatic (PTSD) and Posttraumatic SymptomatologySymptomatology1. symptoms follow exposure to traumatic 1. symptoms follow exposure to traumatic event event 2. must include - fear, helplessness, horror, 2. must include - fear, helplessness, horror, or (in or (in

children) disorganized or agitated children) disorganized or agitated behaviorbehavior3. symptoms include - reexperiencing event, 3. symptoms include - reexperiencing event,

persistent avoidance of stimuli, numbing,persistent avoidance of stimuli, numbing,

persistent hyperarousalpersistent hyperarousal

Posttraumatic Stress Disorder Posttraumatic Stress Disorder (PTSD) and Posttraumatic (PTSD) and Posttraumatic SymptomatologySymptomatology

McLeer, Deblinger, Atkins, Foa, & Ralphe (1988)McLeer, Deblinger, Atkins, Foa, & Ralphe (1988)

N = 31N = 31

48.4% met criteria for PTSD48.4% met criteria for PTSD

Many who did not meet full criteria were symptomatic.Many who did not meet full criteria were symptomatic.

Epstein, Saunders, Kilpatrick, & Resnick (1998)Epstein, Saunders, Kilpatrick, & Resnick (1998)

N = 2,994 women, n = 282 w/ hx. of abuseN = 2,994 women, n = 282 w/ hx. of abuse

Ss w/ hx. had twice as many PTSD sx Ss w/ hx. had twice as many PTSD sx



•posttraumatic symptomatologyposttraumatic symptomatology

•childhood sexual childhood sexual victimizationvictimization


Childhood Sexual Childhood Sexual VictimizationVictimizationWhat is childhood sexual What is childhood sexual victimization?victimization?

** fondling to intercourse fondling to intercourse

** by an individual 5 or more years by an individual 5 or more years olderolder* * prior to age 16prior to age 16

Prevalence of Prevalence of Childhood Sexual Childhood Sexual VictimizationVictimization

Estimated at 20%Estimated at 20% (Briere, 1992; Finkelhor, 1979)(Briere, 1992; Finkelhor, 1979)

First national survey of adultsFirst national survey of adults (Finkelhor, (Finkelhor, Hotaling, Lewis, & Smith, 1989)Hotaling, Lewis, & Smith, 1989)

sample included 1,481 femalessample included 1,481 females

prevalence among females reported at prevalence among females reported at 27%27%

Consequences of Consequences of Childhood Sexual VictimizationChildhood Sexual Victimization

anxietyanxiety

depressiondepression

somatizationsomatization

sexual dysfunctionsexual dysfunction

interpersonal interpersonal problemsproblems

substance abusesubstance abuse

suicidality suicidality (Briere, 1992; Fromuth, 1986; Kendall-Tacket, Williams, & (Briere, 1992; Fromuth, 1986; Kendall-Tacket, Williams, & Finkelhor, 1993)Finkelhor, 1993)

Consequences of Consequences of Childhood Sexual Childhood Sexual VictimizationVictimizationReview of 45 empirical studies of CSV Review of 45 empirical studies of CSV

(Kendall-Tacket, et al., 1993)(Kendall-Tacket, et al., 1993)

1. abused children more symptomatic than non-1. abused children more symptomatic than non-abusedabused

2. no specific symptom characterized sexually abused 2. no specific symptom characterized sexually abused childrenchildren3. most prevalent - fears, posttraumatic stress, 3. most prevalent - fears, posttraumatic stress, behavioral behavioral

problems, inappropriate sexual behavior, poor self-problems, inappropriate sexual behavior, poor self-esteemesteem



•posttraumatic symptomatologyposttraumatic symptomatology

•childhood sexual victimizationchildhood sexual victimization


Trait Trait DissociationDissociationdisconnection of psychological systems (i.e. disconnection of psychological systems (i.e. thoughts, feelings, beliefs) that are thoughts, feelings, beliefs) that are normally integratednormally integrated

certain memories may not be assimilated certain memories may not be assimilated with other infowith other info

clinical & behavioral manifestations of clinical & behavioral manifestations of changes in memory and identity on changes in memory and identity on continuum of severitycontinuum of severity

Trait DissociationTrait Dissociation

strong association between strong association between dissociation and variety of traumatic dissociation and variety of traumatic events:events:

combat exposurecombat exposure (Brende, 1986)(Brende, 1986)

witnessing a violent death during childhoodwitnessing a violent death during childhood (Putnam, Guroff, Silberman, Barban, & Post, 1986)(Putnam, Guroff, Silberman, Barban, & Post, 1986)

rape rape (Coons & Milestein, 1986)(Coons & Milestein, 1986)

childhood physical & sexual abusechildhood physical & sexual abuse (Briere, 1992; (Briere, 1992; Chu & Dill, 1990; Frischholz, 1985; Putnam, 1989; Putnam, Chu & Dill, 1990; Frischholz, 1985; Putnam, 1989; Putnam, Guroff, Silberman, Baran, & Post, 1986)Guroff, Silberman, Baran, & Post, 1986)

Link Between Peritraumatic Dissociation Link Between Peritraumatic Dissociation and PTSDand PTSD

Peritraumatic dissociation may be Peritraumatic dissociation may be an effective mechanism to cope an effective mechanism to cope with an event that would otherwise with an event that would otherwise be overwhelming be overwhelming (Spiegel & Cardena, (Spiegel & Cardena, 1991)1991)..

Peritraumatic dissociation has been Peritraumatic dissociation has been identified as a significant risk factor for identified as a significant risk factor for development of posttraumatic development of posttraumatic symptomatology among:symptomatology among:


witnesses of violencewitnesses of violence (Classen, Koopman, Hales, & (Classen, Koopman, Hales, & Spiegel, 1998)Spiegel, 1998)

MVA victimsMVA victims (Harvey & Bryant, 1998)(Harvey & Bryant, 1998)

EMS workersEMS workers (Marmar, Weiss, Metzler, Ronfeldt, & (Marmar, Weiss, Metzler, Ronfeldt, & Foreman, 1996; Marmar, Weiss, Metzler, Delucchi, Best, Foreman, 1996; Marmar, Weiss, Metzler, Delucchi, Best, Wentworth, 1999)Wentworth, 1999)

natural disaster victimsnatural disaster victims (Koopman, Classen, & (Koopman, Classen, & Spiegel, 1994)Spiegel, 1994)


Marmar, Weiss, Schlenger, Fairbanks, Marmar, Weiss, Schlenger, Fairbanks, Jordan, Kulka, and Hough (1994)Jordan, Kulka, and Hough (1994)

Ss: 251 male Vietnam combat veteransSs: 251 male Vietnam combat veterans

predictor variable: peritraumatic dissociation predictor variable: peritraumatic dissociation

criterion variable: posttraumatic criterion variable: posttraumatic symptomatologysymptomatology

control variables: severity of combat control variables: severity of combat exposureexposure

trait dissociationtrait dissociation


Findings:Findings:

Greater peritraumatic dissociation Greater peritraumatic dissociation resulted in greater incidence of PTSD resulted in greater incidence of PTSD even after controlling for war zone even after controlling for war zone stress exposure and trait dissociation.stress exposure and trait dissociation.

RationaleRationale

Why do some people develop posttraumatic Why do some people develop posttraumatic symptoms while others do not?symptoms while others do not?

Dissociation was originally viewed as psychological Dissociation was originally viewed as psychological adaptation that protected victims.adaptation that protected victims.

There is growing evidence that peritraumatic dissociation There is growing evidence that peritraumatic dissociation may be maladaptive and predictive of future problems.may be maladaptive and predictive of future problems.

Peritraumatic dissociation has been found to be Peritraumatic dissociation has been found to be significantly predictive of posttraumatic significantly predictive of posttraumatic symptomatology while controlling for other variables for symptomatology while controlling for other variables for several populations.several populations.

RationaleRationale

The purpose of this study is to examine the The purpose of this study is to examine the relationship between peritraumatic relationship between peritraumatic dissociation and posttraumatic dissociation and posttraumatic symptomatology among college women symptomatology among college women with a history of childhood sexual with a history of childhood sexual victimization.victimization.

HypothesisHypothesis

Participants reporting greater Participants reporting greater peritraumatic dissociation would also peritraumatic dissociation would also report greater posttraumatic report greater posttraumatic symptomatology, even after symptomatology, even after controlling for severity of childhood controlling for severity of childhood sexual victimization and trait sexual victimization and trait dissociation.dissociation.

MethodMethod

ParticipantsParticipants

N = 73N = 73

college women with a history of CSVcollege women with a history of CSV

age: 18 to 54 (age: 18 to 54 (MM = 25.45; = 25.45; SDSD = 8.39; median = = 8.39; median = 22)22)

ethnicity: 74% Caucasian (n = 53)ethnicity: 74% Caucasian (n = 53)

marital status: 58% single (n = 42)marital status: 58% single (n = 42)

incomes: 31% >$50,000 (n = 23)incomes: 31% >$50,000 (n = 23)

MethodMethod

MeasuresMeasures

Childhood Sexual Victimization Childhood Sexual Victimization QuestionnaireQuestionnaire adapted from Finkelhor, 1979adapted from Finkelhor, 1979Asks participants to respond “yes” or “no” to Asks participants to respond “yes” or “no” to questions regarding:questions regarding:

specific sexual experiences before age 16specific sexual experiences before age 16

if experiences were with someone if experiences were with someone >> 5 years older 5 years older

If the participant responds affirmatively, she is asked to If the participant responds affirmatively, she is asked to respond to follow-up questions about the most respond to follow-up questions about the most significant experience.significant experience.

MethodMethod

MeasuresMeasuresChildhood Sexual VictimizationChildhood Sexual Victimization

intercourse or attempted intercourse vs. other than intercourse or attempted intercourse vs. other than intercourse or attempted intercourse (i.e. fondling)intercourse or attempted intercourse (i.e. fondling)

perpetrator was a parental figure (i.e. parent, step-perpetrator was a parental figure (i.e. parent, step-parent) vs. other than a parental figure (i.e. sibling, parent) vs. other than a parental figure (i.e. sibling, neighbor)neighbor)physical force or threat of physical force vs. no physical force or threat of physical force vs. no physical force or threat of physical force.physical force or threat of physical force.

higher scores = greater severityhigher scores = greater severity

MethodMethod

MeasuresMeasures

Dissociative Experiences ScaleDissociative Experiences Scale (Bernstein & (Bernstein & Putnam, 1986)Putnam, 1986)28-item self-report questionnaire 28-item self-report questionnaire

most widely used measure (test-retest reliability most widely used measure (test-retest reliability Pearson Pearson rr = .84; good internal consistency; good = .84; good internal consistency; good criterion-referenced and construct validity)criterion-referenced and construct validity)

indicate % of time experience emotion or exhibit indicate % of time experience emotion or exhibit behaviorbehaviorscore reflects mean of all items score reflects mean of all items

higher scores = greater trait dissociationhigher scores = greater trait dissociation

MethodMethod

MeasuresMeasures

Stanford Acute Stress Reaction Stanford Acute Stress Reaction QuestionnaireQuestionnaire (Koopman, Cardena, Classen, & Spiegel, (Koopman, Cardena, Classen, & Spiegel, 1993)1993)good internal consistency, high reliability, good good internal consistency, high reliability, good concurrent validityconcurrent validity

list of statements indicative of dissociative symptomslist of statements indicative of dissociative symptoms

Likert scale Likert scale

score reflects mean item scores with range from 5 to score reflects mean item scores with range from 5 to 1010higher scores = greater peritraumatic higher scores = greater peritraumatic dissociationdissociation

MethodMethod

MeasuresMeasures

PTSD ChecklistPTSD Checklist (Weathers, Litz, Huska, & Keane, 1993)(Weathers, Litz, Huska, & Keane, 1993)

high test-retest reliability, internal consistency, high test-retest reliability, internal consistency, acceptable acceptable criterion validitycriterion validity

17-item self-report correspond to DSM-IV diagnostic 17-item self-report correspond to DSM-IV diagnostic criteriacriteriahow much bothered by PTSD symptoms within last how much bothered by PTSD symptoms within last monthmonthLikert scale Likert scale

higher scores = greater posttraumatic higher scores = greater posttraumatic symptomatologysymptomatology

MethodMethod

ProcedureProcedureapproved by UNF IRBapproved by UNF IRB

conducted in accordance with APA guidelines conducted in accordance with APA guidelines

administered and debriefed by trained research administered and debriefed by trained research assistants in groups of 10 to 20 participantsassistants in groups of 10 to 20 participants

73 female college students were identified via self-73 female college students were identified via self-report as having hx. of CSV from 304 participantsreport as having hx. of CSV from 304 participants

ResultsResults

Sample CharacteristicsSample Characteristics

prevalence rate of 24% is consistent with prevalence rate of 24% is consistent with literatureliteraturemean scores for DES & PCL-C are consistent mean scores for DES & PCL-C are consistent with literaturewith literature

modified version of SASRQ could not be modified version of SASRQ could not be compared to previous datacompared to previous data

ResultsResults

Relationship Between Trait Relationship Between Trait Dissociation and Peritraumatic Dissociation and Peritraumatic DissociationDissociation

Pearson Pearson rr = .32 = .32

distinct constructsdistinct constructs

ResultsResults

Relationship Between Relationship Between Peritraumatic Dissociation and Peritraumatic Dissociation and Posttraumatic SymptomatologyPosttraumatic Symptomatology

Analysis - hierarchical Analysis - hierarchical regressionregression

Why?Why?

ResultsResults

Hierarchical regression or sequential Hierarchical regression or sequential multiple regression multiple regression

1. is used when the researcher has 1. is used when the researcher has developed a developed a model.model.

2. permits the researcher to determine the 2. permits the researcher to determine the unique unique contribution of the variable of contribution of the variable of interest.interest.

(Cohen & Cohen, 1975; Tabachnick & Fidell, 1996)(Cohen & Cohen, 1975; Tabachnick & Fidell, 1996)

ResultsResults

predictor variable: predictor variable: peritraumatic dissociationperitraumatic dissociation

criterion variable: criterion variable: posttraumatic posttraumatic symptomatologysymptomatology

control variables: control variables: CSV severityCSV severity

trait dissociationtrait dissociation

CSVCSV

PTSD PTSD SymptomatologySymptomatology

CSVCSV

Trait Trait DissociationDissociation

PTSD PTSD SymptomatologSymptomatologyy

CSVCSV


Peritraumatic Peritraumatic DissociationDissociation


CSVCSV


Peritraumatic Peritraumatic DissociationDissociation


Unique Predictive Contribution of Peritraumatic Dissociation

Variable

Step 1

CSV .14 R2 = .02

Step 2

CSV .12

DES .45*** R2 = .20 (p < .001)

Step 3

CSV .06

DES .36***

SASRQ .29** R2 = .07 (p = .01)

**p < .01; ***p < .001.

DiscussionDiscussion

The findings of this study indicate that The findings of this study indicate that peritraumatic dissociation is predictive peritraumatic dissociation is predictive of posttraumatic symptomatology of posttraumatic symptomatology among college women with a reported among college women with a reported history of childhood sexual history of childhood sexual victimization.victimization.

DiscussionDiscussion

Findings are consistent with those for other Findings are consistent with those for other populations.populations.

A better understanding of this relationship A better understanding of this relationship may increase early identification of may increase early identification of individuals at risk for PTSD and individuals at risk for PTSD and posttraumatic symptomatology.posttraumatic symptomatology.

Limitations and Limitations and RecommendationsRecommendations

retrospective reportsretrospective reports

examine relationship between examine relationship between measures and specific itemsmeasures and specific items

further substantiate this further substantiate this emerging concept and provide emerging concept and provide additional evidence of additional evidence of construct validityconstruct validity

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