Female dissociative responding to extreme sexual violence in a chronic crisis setting: the case of Eastern Congo.

This cross-sectional study aimed to examine relationships between the number of traumatizing events, degree of shutdown dissociation, posttraumatic stress disorder (PTSD), and depression. Fifty-three female survivors of the ongoing war in Congo who sought medical treatment were interviewed. A path-analytic model was created with paths to PTSD via dissociation, and both the number of self-experienced and witnessed traumatizing events. Cumulative exposure and dissociation were associated with increased PTSD severity. Posttraumatic stress disorder and witnessing predicted depression when depression was modeled as a consequence of PTSD. Moreover, PTSD mediated the correlation between dissociation and depression. The findings suggest that shutdown dissociation may have value in predicting PTSD, and there is evidence of differential effects of threat to oneself as opposed to witnessing trauma.