Background Dissociative symptoms are increasingly recognized in individuals with posttraumatic stress disorder (PTSD). The aim of this study was to investigate the prevalence of derealization and depersonalization symptoms via latent profile analyses (LPAs) in a civilian PTSD sample and examine the relationship between PTSD and dissociative symptoms via factor analytic methods. Methods A civilian sample of individuals with PTSD predominantly related to childhood abuse (n = 134) completed a diagnostic interview for PTSD and comorbid psychiatric disorders. LPAs and confirmatory factor analyses (CFAs) were performed on the severity scores for PTSD, derealization, and depersonalization symptoms. Results LPAs extracted three groups, one of which was uniquely characterized by high derealization and depersonalization symptoms, and accounted for 25% of the sample. Individuals in the dissociative subgroup also showed a higher number of comorbid Axis I disorders and a more significant history of childhood abuse and neglect. CFAs suggested the acceptance of a five factor solution in which dissociative symptoms are distinct from but correlate significantly with the core PTSD symptom clusters. Conclusions The results from LPAs and CFAs are concordant with the concept of a dissociative subtype in patients with PTSD and suggest that symptoms of derealization-depersonalization and the core symptoms of PTSD are positively correlated. Thought should be given to including a dissociative subtype of PTSD in the DSM-5.
The start of the Syrian Civil War in 2011 displaced many from their homes. In the years since, Western countries have received an influx of Syrian asylum seekers and refugees. The United Nations High Commissioner for Refugees (UNHCR) defines an asylum seeker as someone who claims to be a refugee without those claims being verified (UNHCR, 1951). Thus, as these displaced people wait to qualify for international protection they are classed as asylum seekers. Consequently, a refugee is defined by the UNHCR as someone whoowing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country. (UNHCR, 1951, p. 3, para. 1)A recent poll by the UNHCR (2015) estimated there were 15.1 million refugees and 2.3 million asylum seekers worldwide by mid-2015, the highest rates recorded in 20 years, with Syrian refugees being the largest source by mid-2015 (4.2 million, apCisse proximately 24.1%). As part of the newly elected Canadian government's plan to resettle 25,000 refugees from Syria to Canada, it is crucial that such individuals are looked after for their humanitarian needs, including mental health.To determine whether an asylum seeker qualifies as a refugee they must demonstrate a well-found fear of persecution in their home country, and the legitimacy of this claim is determined by the host country. The refugee status determination is conducted by the state or the UNHCR-if the state is unable or unwilling. Once refugee status is awarded, refugees that are deemed low risk by the UNHCR or the state are contacted to determine whethere they are interested in being resettled to Canada. Canadian visa officers process refugees overseas in Beirut or Amman, interviewing interested refugees and conducting a full medical examination. As well, interested refugees undergo a security screening against immigration, law enforcement, and security databases using biometrics. Following that, refugee identification is verified before departure to the host country and once again upon arrival (Ministry of Justice Canada, 2001). As can be expected on the basis of the requirement of fear of persecution by one's home country in determining refugee status, elevated rates of posttraumatic stress disorder (PTSD) in refugees have been documented (Teodorescu et al., 2012). Moreover, interestingly, previous studies found that asylum seekers experienced more traumatic life events when compared to refugees and that PTSD symptom severity is predicted by a lack of refugee status (vs. asylum seeking status) and the number of traumatic life events experienced (Knipscheer et al., 2015; Nickerson et al., 2011; Stenmark et al., 2013). Although there are multiple factors that predict PTSD symptom severity, it is worthwhile to note that refugee status is potentially one that could be controlled for with faster processing of refugee applications without sacrificing the rigor of detailed security checks (Knipscheer et al., 2015). For example, Nickerson et al. (2011) found that refugees with temporary protection visa who were granted permanent residency demonstrated a decrease in PTSD symptoms and depression, along with an increase in quality of life, suggesting ease of transition into residency status can directly impact psychological symptoms and functioning. The most common fears identified in refugees indeed include being sent back to their country of origin, whereas on the other hand also include being unable to return home in case of emergencies. In other words, the cause of PTSD in asylum seekers and refugees may have begun with the conflict in their native country; however, stress experienced as a result of the process of becoming a refugee and seeking asylum in a foreign country has been shown to evoke further psychological disturbance. …
Intrusive negative affect and concurrent deficits in positive affect are hallmarks of posttraumatic stress disorder (PTSD). We sought to further extend the extant literature by exploring the experience of negative affect intrusion upon potentially positive situations (here termed, "negative affect interference," NAI).Two studies with adults endorsing at least 1 traumatic event (Study 1, N = 294; Study 2, N = 286) examined how NAI and more general hedonic deficits (HD) relate to psychopathology, trauma exposure characteristics, and ratings of normed visual stimuli.Study 1 found that NAI and HD were positively correlated with PTSD symptoms and childhood trauma, and NAI incremented over depressive symptoms in predicting PTSD severity. Study 2 results indicated additional strong positive correlations between NAI and HD and anhedonia, affect regulation problems, negative affect, and neuroticism. NAI and HD were found to increment over trait NA in predicting PTSD symptoms. Individuals endorsing elevated NAI and HD rated positively valenced pictures (including food and erotic images) as less arousing, although not more negative.These findings expand conceptualizations of anhedonia and emotional numbing by drawing attention to negative affect in otherwise positive contexts. (PsycINFO Database Record
Abstract Objective To investigate the functional connectivity of large‐scale intrinsic connectivity networks ( ICN s) in post‐traumatic stress disorder ( PTSD ) during subliminal and supraliminal presentation of threat‐related stimuli. Method Group independent component analysis was utilized to study functional connectivity within the ICN s most correlated with the Default‐mode Network ( DMN ), Salience Network ( SN ), and Central Executive Network ( CEN ) in PTSD participants ( n = 26) as compared to healthy controls ( n = 20) during sub‐ and supraliminal processing of threat‐related stimuli. Results Comparing patients with PTSD with healthy participants, prefrontal and anterior cingulate cortex involved in top‐down regulation showed increased integration during subliminal threat processing within the CEN and SN and during supraliminal threat processing within the DMN . The right amygdala showed increased connectivity with the DMN during subliminal processing in PTSD as compared to controls. Brain regions associated with self‐awareness and consciousness exhibited decreased connectivity during subliminal threat processing in PTSD as compared to controls: the claustrum within the SN and the precuneus within the DMN . Conclusion Key nodes of the ICN s showed altered functional connectivity in PTSD as compared to controls, and differential results characterized sub‐ and supraliminal processing of threat‐related stimuli. These findings enhance our understanding of ICN s underlying PTSD at different levels of conscious threat perception.
