Ba. Vanderkolk et al., DISSOCIATION, SOMATIZATION, AND AFFECT DYSREGULATION - THE COMPLEXITYOF ADAPTATION TO TRAUMA, The American journal of psychiatry, 153(7), 1996, pp. 83-93
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.