The impact of dissociation on the development and maintenance of posttraumatic stress disorder
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[S.l. : s.n.]
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RU Radboud Universiteit Nijmegen, 14 februari 2008
Promotores : Hoogduin, C.A.L., Minnen, A. van
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SW OZ BSI KLP
SubjectExperimental Psychopathology and Treatment
This dissertation investigated the impact of dissociation on the development of posttraumatic stress disorder (PTSD), on memory formation, and on treatment efficacy. First, the predictive power of peritraumatic psychological and somatoform dissociation was investigated in two studies using a prospective and an experimental design. Neither study found peritraumatic dissociation to predict later PTSD after controlling for initial numbing symptoms and non-movement respectively. Instead, dysfunctional cognitions and non-movement per se predicted PTSD development. Catalepsy proved a useful paradigm in the study of motorsensori dissociatieve symptoms. Second, the uniqueness of PTSD trauma memories was investigated by comparing them to memories of a panic attack in patients with panic disorder and agoraphobia (PDA) and trauma memories in healthy controls, using a narrative coding and a meta-memory method. Both PTSD and PDA memories were disorganized relative to those of the controls. Reliving-intensity was also rated as equally high in PTSD and PDA patients. PTSD trauma memories had more intrusion characteristics than PDA panic memories and trauma memories of healthy controls. However, PDA panic memories had more intrusion characteristics than the memories of controls, suggesting a continuum of memory processing rather than a qualitatively different process in PTSD. Peritraumatic and memory-associated dissociation were high in both patient groups relative to the controls, and neither forms of dissociation were related to memory disorganization. Only memory-associated dissociation was related to intrusion characteristics. The results suggest that dissociation may affect memory-retrieval and not necessarily the encoding of information into memory. Finally, the effect of three forms of dissociation (trait dissociation, depersonalisation, and numbing) on PTSD exposure treatment efficacy was determined. It was found that none of the dissociation forms affected on treatment efficacy. The decline of PTSD symptoms was similar or even larger in patients with high versus those with low dissociatieve symptoms. Fear activation during exposure was not impeded by dissociatieve symptoms either. Implications of the results are discussed.
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