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Cited by 505Posttraumatic Stress Disorder ResearchPsychosomatic Disorders and Their TreatmentsTraumatic Brain Injury Research

Dissociation and post-traumatic stress disorder: two prospective studies of road traffic accident survivors.

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Murray, James, Ehlers, Anke, Mayou, Richard A.·2002·British Journal of Psychiatry
DOI 10.1192/bjp.180.4.363
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Abstract

Background: Dissociative symptoms during trauma predict post-traumatic stress disorder (PTSD), but they are often transient. It is controversial whether they predict chronic PTSD over and above what can be predicted from other post-trauma symptoms. Aims: To investigate prospectively the relationship between dissociative symptoms before, during and after a trauma and other psychological predictors, and chronic PTSD. Method: Two samples of 27 and 176 road traffic accident survivors were recruited. Patients were assessed shortly after the accident and followed at intervals over the next 6 months. Assessments included measures of dissociation, memory fragmentation, data-driven processing, rumination and PTSD symptoms. Results: All measures of dissociation, particularly persistent dissociation 4 weeks after the accident, predicted chronic PTSD severity at 6 months. Dissociative symptoms predicted subsequent PTSD over and above the other PTSD symptom clusters. Memory fragmentation and data-driven processing also predicted PTSD. Rumination about the accident was among the strongest predictors of subsequent PTSD symptoms. Conclusions: Persistent dissociation and rumination 4 weeks after trauma are more useful in identifying those patients who are likely to develop chronic PTSD than initial reactions.

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  • Murray et al. reported that early meta-memory fragmentation weakly predicted PTSD at both four-week and six-month follow-ups across their samples.

    “Meta-memory fragmentation assessed soon after trauma modestly predicted PTSD at four weeks and six months following trauma in both samples.”

    From Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis (2012) · cites this paper as Murray et al., 2002

    The Other cognitive predictors section reports that memory fragmentation tended to have a positive relationship with PTSD severity. Its Table 2 does not show consistent prediction at both follow-ups in both samples: initial self-reported fragmentation was not significantly associated with six-month PTSD in out-patients or with either follow-up in in-patients, although expert-rated fragmentation in in-patients showed stronger associations. (LLM, conf=0.88)

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  • Across Criterion A trauma samples, higher peritraumatic dissociation consistently accompanied higher self-rated fragmentation.

    “Taken together results of Halligan et al. (2003), Murray et al. (2002), and Hardy et al. (2009) generally suggest that, in Criterion A trauma-exposed samples, individuals with higher peritraumatic dissociation consistently show higher meta-memory ratings of fragmentation.”

    From Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis (2012) · cites this paper as Murray et al., 2002

    In “Other cognitive predictors” (page not supplied), self-reported memory fragmentation correlated positively with initial dissociation among out-patients (r = 0.37, P < 0.001). The passage does not report the same association for the in-patient sample, so this paper supports the relationship in one road-accident sample but not the claim that it appeared consistently across samples. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Evidence is growing that trait and persistent dissociation may predict PTSD better than peritraumatic dissociation.

    “Growing evidence suggests a tendency to dissociate (trait) and continued dissociation in response to reminders (persistent) may be more predictive of PTSD than peritraumatic dissociation (Briere et al., 2005; McFarlane, 1997; Murray et al., 2002; Pansetis & Bryant, 2003).”

    From Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis (2012) · cites this paper as Murray et al., 2002

    In “Dissociation as a predictor of PTSD” (page not provided), the paper says persistent dissociation was a stronger predictor of chronic PTSD than dissociation during the accident. It does not support the same comparison for trait dissociation: the outpatient study found that dissociation during the accident predicted PTSD symptoms over and above a pre-accident tendency to dissociate. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • Murray et al. (2002) found that global rating of narrative fragmentation at initial assessment predicted PTSD more strongly than coded fragmentation at one and six months post trauma, at a moderate level.

    “Interestingly, their global rating of narrative fragmentation at initial assessment was a stronger predictor of PTSD than coded fragmentation at both one and six months post trauma, at a moderate level.”

    From Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis (2012) · cites this paper as Murray et al., 2002

    Table 2 (Other cognitive predictors; page not specified) shows that the initial expert rating of narrative fragmentation correlated with PTSD severity at four weeks (0.41) and six months (0.58), more strongly than patients’ self-reports. The paper does not compare the global rating with coded narrative fragmentation; its comparison is with self-reported fragmentation. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Acute stress disorder is associated with PTSD.

    “although acute stress disorder (ASD), a disorder characterized by dissociative symptoms during or immediately following a traumatic event, is associated with PTSD (e.g., Creamer, O'Donnell, & Pattison, 2004; Harvey & Bryant, 2000; Murray et al., 2002)”

    From Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis (2012) · cites this paper as Murray et al., 2002

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Research works printed but not linked: 1

  1. [8]8. Murray, J. (1997) The Role of Dissociation in The Role of Dissociation in Posttraumatic Stress Disorder Posttraumatic Stress Disorder. DPhil Thesis, University of . DPhil Thesis, University of Oxford, Oxford, UK. Oxford, Oxford, UK.

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Authors
Murray, J., Ehlers, A., & Mayou, R. A.
Affiliations
  • University of Surrey (GB)
  • University of Oxford (GB)
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2002-04
Volume
180
Issue
4
Pages
363-368
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.180.4.363
OpenAlex
W1985931457
Cited by
505
References
33
Citations by year
2026: 8 · 2025: 9 · 2024: 24 · 2023: 11 · 2022: 13 · 2021: 16 · 2020: 17 · 2019: 20 · 2018: 22 · 2017: 18 · 2016: 17 · 2015: 25 · 2014: 29 · 2013: 27 · 2012: 34
FWCI
18.10
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 5755 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
  • Wellcome Trust (069777)
  • University of Oxford
  • Medical Research Council
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
dissociation, post-traumatic stress disorder, chronic PTSD, traffic accidents, trauma survivors, memory fragmentation, rumination, bottom-up processing, PTSD risk prediction
MeSH terms
Accidents, Traffic, Adolescent, Adult, Aged, Chronic Disease, Cognition Disorders, Dissociative Disorders, Female, Humans, Male, Memory Disorders, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Psychiatric Status Rating Scales, Regression Analysis, Severity of Illness Index, Stress Disorders, Post-Traumatic

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