Dissociative Symptoms in Traumatized Treatment-Seeking Refugees: Rate of the Dissociative Subtype of Posttraumatic Stress Disorder and Associations with Complex PTSD Symptoms.

Abstract

DSM-5 and ICD-11 differ regarding their conceptualization of dissociation in relation to Posttraumatic Stress Disorder (PTSD). DSM-5 defines a subtype of PTSD characterized by dissociative symptoms (PTSD-DS), whereas ICD-11 only comprises some specific dissociative symptoms in their diagnosis of (complex) PTSD. To improve diagnostic assessments and treatment approaches, it is important to investigate the relationship between dissociation and (c)PTSD. Research on the relation of trauma and dissociation in refugees is very limited. The rate of PTSD-DS and the association of cPTSD symptoms and dissociation severity were investigated using the baseline data of treatment-seeking traumatized refugees participating in a multi-center randomized controlled clinical trial (registration: DRKS00019876). PTSD-DS was assessed with the Clinician-administered PTSD Scale for DSM-5 and cPTSD with the Complex PTSD Item Set additional to the CAPS. We used the Adolescent Dissociative Experiences Scale to assess dissociative symptoms. In a sample of N = 104, we found a rate of 36.54% for PTSD-DS. In an exploratory multiple regression analysis of dissociation severity, in which all cPTSD symptoms were entered as predictors, only reexperiencing and affective dysregulation emerged as relevant contributors. Our results support the notion that there is a subgroup of individuals with additional dissociative symptoms, while reexperiencing and affective dysregulation are associated with dissociation. We recommend to add a culturally sensitive assessment of dissociative symptoms to standard practices in clinical care of refugees so that appropriate interventions can be selected.