Peritraumatic dissociation and posttraumatic stress symptoms: the moderating role of perceived threat.

Background: Although peritraumatic dissociation (PD) is viewed as a risk factor for posttraumatic stress disorder (PTSD), prospective studies taking into account other well-known risk factors for PTSD have been scarce, and the exploration of potential moderators within the relations between PD and PTSD has been lacking.Objective: Filling this gap, this prospective study explored the moderating role of perceived threat within the relations between PD and PTSD, above and beyond age, gender, education, and early trauma-related symptoms.Method: A convenience sample of 200 Israeli civilians filled out self-report questionnaires during the peritraumatic phase (T1) and one to two months after the posttraumatic phase (T2) of being exposed to rocket attacks.Results: The results showed that perceived threat and PD were associated with early trauma-related symptoms and PTSD symptoms. Moreover, perceived threat moderated the relationship between PD and all PTSD symptom clusters apart from avoidance.Conclusions: The present results suggest that the implications of PD are shaped by levels of perceived threat, so that detriments of PD are evident when the trauma is appraised as being highly threatening. Therefore, early interventions that aim to decrease PD may be beneficial in preventing PTSD symptoms of intrusion, hyper arousal, and negative alterations in mood and cognition, for individuals who perceive traumatic events as highly threatening.

Perceived threat was related to early trauma-related symptoms and PTSD symptoms.Peritraumatic dissociation was related to early trauma-related symptoms and PTSD symptoms.Perceived threat moderated the link between peritraumatic dissociation and PTSD symptoms.

Testing previously proposed models of the Tonic Immobility Scale in a peritraumatic sample of Israeli civilians: Support for a three-factor model.

OBJECTIVE: Tonic immobility (TI) is a peritraumatic response to extreme threats. It is associated with trauma psychopathology and poor treatment outcomes. Yet, previous psychometric evaluations have yielded inconsistent results regarding the number of latent factors of the Tonic Immobility Scale (TIS). Moreover, the TIS has never been validated in a Hebrew-speaking population. This study had two objectives: (a) to reassess previously proposed models of the TIS to determine whether it is best represented by a one-factor model of TI, a two-factor model of TI and fear, or a three-factor model of TI, fear, and detachment; and (b) to validate the TIS in a Hebrew translation. METHOD: A sample of Israeli adults was culled from an online survey following rocket attacks. Confirmatory factor analysis was applied to test the previously proposed models, and Pearson's correlations were used to test the association between each of the subscales representing the latent factors and psychological distress. RESULTS: The best representation of the data was provided by a three-factor model with latent constructs of TI, fear, and detachment. All three peritraumatic responses had significant correlations with peritraumatic distress. Moreover, the internal consistency of the TIS was good for the three subscales; this supports the reliability of the Hebrew version. CONCLUSION: This study supports using a three-factor model with latent constructs, and the scale appears to be psychometrically sound when translated into Hebrew. Future research should seek to replicate these findings in different trauma populations and should study the unique association of trauma symptomatology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Prospective Study of the Mediating Role of Tonic Immobility and Peritraumatic Dissociation on the 4 DSM-5 Symptom Clusters of Posttraumatic Stress Disorder.

Objective: Tonic immobility (TI) and peritraumatic dissociation (PD) are common peritraumatic reactions associated with psychopathology following trauma. The present study aimed to test whether TI and PD mediated the relationship between perceived threat during an episode of rocket shelling and subsequent posttraumatic stress symptoms.Methods: In a prospective study among 226 Israeli civilians, data were collected both during rocket shelling, between May 14, 2021, until ceasefire on May 21, 2021 (T1) and 1 to 2 months after ceasefire (T2). Measures included the Tonic Immobility Scale, Peritraumatic Dissociative Experiences Questionnaire, and PTSD Checklist for DSM-5. Four mediation models were applied for each posttraumatic stress symptom cluster.Results: Findings showed that a substantial proportion of participants had developed posttraumatic stress disorder (PTSD) symptoms at the time of follow-up (18.8%). Both TI and PD fully mediated the relationship between perceived threat and symptoms of intrusion, avoidance, and negative alterations in mood and cognition, but only PD mediated the relationship with alterations in arousal and reactivity.Conclusions: The present findings suggest that TI and PD may serve as mechanisms underlying the link between individuals' appraisals of threat during the peritraumatic phase and subsequent PTSD symptomatology. Future research should seek to replicate the present findings before any conclusions can be drawn. In particular, the association between PD and arousal and reactivity symptoms should be further explored, given that it might be multifaceted in nature.

Validation of ICD-11 PTSD and DSO using the International Trauma Questionnaire in five clinical samples recruited in Denmark.

Background: The 11th version of the International Classification of Diseases (ICD-11) revised the diagnosis of Posttraumatic Stress Disorder (PTSD) and introduced Complex PTSD as a sibling disorder to PTSD. As the Danish Health Authorities will implement the ICD-11 in 2022, it is more relevant than ever to introduce a measure that enables the identification of ICD-11 PTSD and CPTSD. Objective: The primary aim of the present study was to test the construct validity of the ICD-11 conceptualization of PTSD and DSO in five clinical samples using translated versions of the International Trauma Questionnaire (ITQ). Method: Data from existing studies of adult survivors of sexual abuse (n = 385), women in shelters (n = 147), psychiatric outpatients endorsing an ICD-10 diagnosis of PTSD (n = 111), a heterogenous sample of psychiatric outpatients (n = 178) and refugees and torture survivors (n = 385) was used for the current study. Confirmatory factor analyses were conducted to test the internal structure of the ITQ, and regression models were conducted to test the convergent and discriminant validity of the factor solutions for each sample. Results: Findings supported the ICD-11 formulation of PTSD and disorders in self-organization (DSO) as a representation of the latent structure of the ITQ across five Danish clinical samples. Uniquely for women in shelters, however, the model displayed an unacceptable fit. A revised operationalization of re-experiencing proved a better fit when 'recurrent nightmares' was exchanged with symptoms of intense emotional reactions to reminders of the trauma for women in shelter as well as ICD-10 PTSD psychiatric outpatients. Conclusion: This study supports the use of a Danish translated version of the ITQ to assess symptoms of ICD-11 PTSD and DSO for the introduction of ICD-11 in 2022. Future research is needed to further explore the operationalization of re-experiencing across different trauma exposed populations.

Antecedentes: La décimo primera versión de la Clasificación Internacional de Enfermedades (CIE-11) revisó el diagnóstico de Trastorno de Estrés Postraumático (CIE-11) e introdujo el TEPT complejo como un diagnóstico hermano del TEPT. Como las autoridades de salud danesas implementarán la CIE-11 en el 2022, es más relevante que nunca introducir una medición que permita la identificación del TEPT y el TEPT complejo de acuerdo a la CIE-11.Objetivo: El principal objetivo del presente estudio fue probar la validez del constructo diagnóstico de la conceptualización del TEPT y de las Alteraciones en la Auto-Organización (DSO por sus siglas en inglés) en cinco muestras clínicas usando versiones traducidas del Cuestionario Internacional de Trauma (ITQ por sus siglas en inglés).Método: Se usaron para el presente estudio, datos de estudios ya existentes de sobrevivientes adultos de abuso sexual (n = 147), pacientes psiquiátricos ambulatorios con diagnóstico de TEPT de acuerdo a la CIE-10 (n = 111), una muestra heterogénea de pacientes psiquiátricos ambulatorios (n = 178) y refugiados y sobrevivientes de tortura (n = 385). Se usaron análisis factoriales confirmatorios para probar la estructura interna del ITQ, y se aplicaron modelos de regresión para probar la validez convergente y discriminante de las soluciones factoriales para cada muestra.Resultados: Los hallazgos apoyaron la formulación de ls CIE-11 del TEPT y de los desórdenes en la auto-organización (DSO) como una representación) de la estructura latente del ITQ en 5 muestras clínicas danesas. Sin embargo, en el caso de las mujeres de los centros de acogida, el modelo mostró un ajuste inaceptable. Una operacionalización revisada de la re-experimentación probó ser más ajustada cuando 'pesadillas recurrentes' fue reemplazada por los síntomas de reacciones emocionales intensas ante recordatorios del trauma para mujeres en los centros de acogida así como a los pacientes psiquiátricos ambulatorios con TEPT según la CIE-10.Conclusión: Este estudio apoya el uso de la versión traducida en danés del ITQ para evaluar síntomas de TEPT y DSO de acuerdo a la CIE-11 para la introducción de la CIE-11 en el 2022.Se requiere futura investigación para explorar la operacionalización de la re-experimentación en diferentes poblaciones expuestas al trauma.

PTSD, mental illness, and care among survivors of sexual violence in Northern Uganda: Findings from the WAYS study.

BACKGROUND: Previous studies have mainly considered war-affected youth as a homogenous group yet several subpopulations of war-affected youth, such as survivors of sexual violence, exist with unique mental health problems and treatment needs. This study aimed to assess posttraumatic stress disorder (PTSD), perceptions and meaning of mental illness, and access and barriers to mental health care among survivors of sexual violence. METHOD: Data were collected from survivors of sexual violence during war (N = 181) who are participants in the longitudinal War-Affected Youth Survey (WAYS) study in Northern Uganda. Chi-square tests of independence and binary logistic regression were used to compute participants' characteristics and assess relations between exposure to sexual violence and PTSD. RESULTS: Sixty-six (n = 119, 66%) reported sexual abuse: 35% (n = 63) of whom returned from captivity with at least 1 child, and 43% (n = 78) met the criteria for PTSD (Impact of Events Scale-Revised score [IES-R] ≥33). Those who reported sexual abuse scored significantly higher on PTSD (OR = 3.23; 95% CI [2.09, 6.93]), perceived more stigma, reported more barriers to seeking care, and viewed mental illness as futile and fatal compared with their peers without a history of sexual abuse. CONCLUSIONS: Survivors of sexual violence are at risk of PTSD and report major obstacles to treatment and care. More resources should be allocated for interventions to improve access to care for survivors of sexual violence. Psychoeducation to create awareness, demystify myths and public stigma about mental illness, and trauma-focused cognitive-behavioral therapies to reduce PTSD among survivors are recommended. (PsycINFO Database Record