A latent class analysis of dissociation and posttraumatic stress disorder: evidence for a dissociative subtype

Abstract

Context: The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosologic importance.

Objectives: To examine evidence for a dissociative subtype of PTSD and to examine its association with different types of trauma.

Design: A latent profile analysis of cross-sectional data from structured clinical interviews indexing DSM-IV symptoms of current PTSD and dissociation.

Settings: The VA Boston Healthcare System and the New Mexico VA Health Care System.

Participants: A total of 492 veterans and their intimate partners, all of whom had a history of trauma. Participants reported exposure to a variety of traumatic events, including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents, and natural disasters, with most participants reporting exposure to multiple types of traumatic events. Forty-two percent of the sample met the criteria for a current diagnosis of PTSD.

Main outcome measures: Item-level scores on the Clinician-Administered PTSD Scale.

Results: A latent profile analysis suggested a 3-class solution: a low PTSD severity subgroup, a high PTSD severity subgroup characterized by elevations across the 17 core symptoms of the disorder, and a small but distinctly dissociative subgroup that composed 12% of individuals with a current diagnosis of PTSD. The latter group was characterized by severe PTSD symptoms combined with marked elevations on items assessing flashbacks, derealization, and depersonalization. Individuals in this subgroup also endorsed greater exposure to childhood and adult sexual trauma compared with the other 2 groups, suggesting a possible etiologic link with the experience of repeated sexual trauma.

Conclusions: These results support the subtype hypothesis of the association between PTSD and dissociation and suggest that dissociation is a highly salient facet of posttraumatic psychopathology in a subset of individuals with the disorder.

Conflict of interest statement

None of the authors of this manuscript have a conflict of interest to disclose.

Figures

Figure 1. Mean Scores on CAPS Items by Latent Class

Note. The Figure shows the pattern of mean PTSD and dissociative symptom severity scores on the CAPS as a function of latent class. Mean scores on PTSD criterion B3, and on the derealization and depersonalization items differed significantly between the two high PTSD groups. There was a trend to suggest a significant difference between the two high PTSD groups on PTSD criterion C3 (p = .10) and PTSD criterion B5 (p = .05). CAPS = Clinician Administered PTSD Scale; PTSD = posttraumatic stress disorder; RA = reduction in awareness; dereal = derealization; depers = depersonalization.