DISSOCIATION, SOMATIZATION, AND AFFECT DYSREGULATION - THE COMPLEXITYOF ADAPTATION TO TRAUMA

Objective: A century of clinical research has noted a range of trauma- related psychological problems that are not captured in the DSM-IV fra mework of posttraumatic stress disorder (PTSD). This study investigate d the relationships between exposure to extreme stress, the emergence of PTSD, and symptoms traditionally associated with ''hysteria,'' whic h can be understood as problems with stimulus discrimination, self-reg ulation, and cognitive integration of experience. Method: The DSM-IV f ield trial for PTSD studied 395 traumatized treatment-seeking subjects and 125 non-treatment-seeking subjects who had also been exposed to t raumatic experiences. Data on age at onset, the nature of the trauma, PTSD, dissociation, somatization, and affect dysregulation were collec ted. Results: PTSD, dissociation, somatization, and affect dysregulati on were highly interrelated. The subjects meeting the criteria for lif etime (but not current) PTSD scored significantly lower on these disor ders than those with current PTSD, but significantly higher than those who never had PTSD. Subjects who developed PTSD after interpersonal t rauma as adults had significantly fewer symptoms than those with child hood trauma, but significantly more than victims of disasters. Conclus ions: PTSD, dissociation, somatization, and affect dysregulation repre sent a spectrum of adaptations to trauma. They often occur together, b ut traumatized individuals may suffer from various combinations of sym ptoms over time. In treating these patients, it is critical to attend to the relative contributions of loss of stimulus discrimination, self -regulation, and cognitive integration of experience to overall impair ment and provide systematic treatment that addresses both unbidden int rusive recollections and these other symptoms associated with having b een overwhelmed by exposure to traumatic experiences.