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Dissociation in Posttraumatic Stress Disorder: Evidence from the World Mental Health Surveys
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Background Although the proposal for a dissociative subtype of posttraumatic stress disorder (PTSD) in DSM-5 is supported by considerable clinical and neurobiological evidence, this evidence comes mostly from referred samples in Western countries. Cross-national population epidemiologic surveys were analyzed to evaluate generalizability of the subtype in more diverse samples. Methods Interviews were administered to 25,018 respondents in 16 countries in the World Health Organization World Mental Health Surveys. The Composite International Diagnostic Interview was used to assess 12-month DSM-IV PTSD and other common DSM-IV disorders. Items from a checklist of past-month nonspecific psychological distress were used to assess dissociative symptoms of depersonalization and derealization. Differences between PTSD with and without these dissociative symptoms were examined across a variety of domains, including index trauma characteristics, prior trauma history, childhood adversity, sociodemographic characteristics, psychiatric comorbidity, functional impairment, and treatment seeking. Results Dissociative symptoms were present in 14.4% of respondents with 12-month DSM-IV/Composite International Diagnostic Interview PTSD and did not differ between high and low/middle income countries. Symptoms of dissociation in PTSD were associated with high counts of re-experiencing symptoms and net of these symptom counts with male sex, childhood onset of PTSD, high exposure to prior (to the onset of PTSD) traumatic events and childhood adversities, prior histories of separation anxiety disorder and specific phobia, severe role impairment, and suicidality. Conclusion These results provide community epidemiologic data documenting the value of the dissociative subtype in distinguishing a meaningful proportion of severe and impairing cases of PTSD that have distinct correlates across a diverse set of countries.
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“poor functional outcomes (Stein et al., 2013)”
From A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions (2016) · cites this paper as Stein et al., 2013
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“Transdiagnostically, heighted dissociative symptoms are associated with increased disease severity (Belli et al., 2012;Rufer et al., 2006a;Stein et al., 2013)”
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“elevated risk of suicidality (Stein et al., 2013)”
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“Critically, increased disease severity (e.g., elevated risk of 12-month suicidality), earlier age of onset, and poorer functional outcomes have been reported in this subtype (Stein et al., 2013).”
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Metadata
- Authors
- Stein, D. J., Koenen, K. C., Friedman, M. J., Hill, E., McLaughlin, K. A., Petukhova, M., Ruscio, A. M., Shahly, V., Spiegel, D., Borges, G., Bunting, B., Caldas-de-Almeida, J. M., de Girolamo, G., Demyttenaere, K., Florescu, S., Haro, J. M., Karam, E. G., Kovess-Masfety, V., Lee, S., Matschinger, H., Mladenova, M., Posada-Villa, J., Tachimori, H., Viana, M. C., & Kessler, R. C.
- Affiliations
- University of Cape Town (ZA)
- Columbia University (US)
- United States Department of Veterans Affairs (US)
- Harvard University (US)
- Boston Children's Hospital (US)
- University of Pennsylvania (US)
- Stanford Medicine (US)
- Universidad Autónoma Metropolitana (MX)
- University of Ulster (GB)
- Universitair Ziekenhuis Leuven (BE)
- National School of Public Health, Management and Professional Development (RO)
- Centro de Investigación Biomédica en Red de Salud Mental (ES)
- University of Balamand (LB)
- Chinese University of Hong Kong (HK)
- Leipzig University (DE)
- New Bulgarian University (BG)
- National Center of Neurology and Psychiatry (JP)
- Corresponding author
- Kessler, Ronald C.
- ORCID
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2013-02
- Volume
- 73
- Issue
- 4
- Pages
- 302-312
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC3589990
- OpenAlex
- W2133036344
- Semantic Scholar
- 8601d919bf5250f9bfb8f93096a6cecaa3d5db7a
- Cited by
- 328
- References
- 61
- Citations by year
- 2026: 19 · 2025: 19 · 2024: 19 · 2023: 19 · 2022: 22 · 2021: 29 · 2020: 31 · 2019: 20 · 2018: 24 · 2017: 30 · 2016: 17 · 2015: 29 · 2014: 34 · 2013: 15
- FWCI
- 28.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Public Health Agency (COM/4411/10, COM/4437/11)
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05, 5r01mh093612-03)
- Medical Research Council (MR/K023241/1)
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, U01-MH-60220, R01-MH092526, R01-MH093612, K01MH092526, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (R03TW006481)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- post-traumatic stress disorder, dissociation, depersonalization, derealization, DSM-5, childhood adversity, re-experiencing symptoms, psychiatric comorbidity, suicidality, functional disability, treatment seeking, World Mental Health Surveys
- MeSH terms
- Adolescent, Adult, Dissociative Disorders, Female, Health Surveys, Humans, Interview, Psychological, Life Change Events, Male, Mental Health, Stress Disorders, Post-Traumatic, Suicide, Comorbidity, Prevalence, Diagnostic and Statistical Manual of Mental Disorders
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