Trauma-related altered states of consciousness: exploring the 4-D model

Abstract

Frewen and Lanius (in press) recently articulated a 4-D model as a framework for classifying symptoms of posttraumatic stress into those that potentially occur within normal waking consciousness (NWC) versus those that intrinsically represent dissociative experiences of trauma-related altered states of consciousness (TRASC). Four dimensions were specified: time-memory, thought, body, and emotion. The 4-D model further hypothesizes that in traumatized persons, symptoms of TRASC, compared with NWC forms of distress, will be (a) observed less frequently; (b) less intercorrelated, especially as measured as moment-to-moment states; (c) observed more frequently in people with high dissociative symptomatology as measured independently; and (d) observed more often in people who have experienced repeated traumatization, particularly early developmental trauma. The aim of the present research was to begin to evaluate these 4 predictions of the 4-D model. Within a sample of 74 women with posttraumatic stress disorder (PTSD) primarily due to histories of childhood trauma, as well as within a 2nd sample of 504 undergraduates (384 females), the 1st 2 hypotheses of the 4-D model were supported. In addition, within the PTSD sample, the 3rd hypothesis was supported. However, inconsistent with the 4th hypothesis, severity of childhood trauma history was not strongly associated with TRASC. We conclude that the hypotheses articulated by the 4-D model were generally supported, although further research in different trauma-related disorders is needed, and the role of childhood trauma history in the etiology of TRASC requires further research.

Keywords: 4-D model; childhood abuse and neglect; depersonalization; dissociation; posttraumatic stress disorder (PTSD); trauma-related altered states of consciousness (TRASC).

FIGURE 1

The 4D-model of the traumatized self. Notes. Posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion are differentiated in so far as they present in trauma-related altered states of consciousness (TRASC) form (red, top) versus in normal waking conscious (NWC) form (blue, bottom). The background coloring of the two states, however, is illustrated as blending into one another in order to represent that it is presently not known whether the difference between the TRASC and NWC forms is a qualitative (categorical) or only quantitative (dimensional) one. The arrow that is increasing in infrequency from bottom (NWC) to top (TRASC) represents the first hypothesis that symptom endorsements of TRASC are expected to be less frequent than symptom endorsements of NWC distress. The arcs connecting the four dimensions are drawn with greater weight when referring to NWC distress versus TRASC in order to represent the second hypothesis that the experience of forms of NWC will be more intercorrelated when compared with the experience of forms of TRASC. The arrow labeled “dissociative” that is increasing from bottom (NWC) to top (TRASC) is intended to illustrate the third hypothesis that the four dimensions in TRASC form, while being distinct in concept from the measurement of dissociation as a disintegration and/or compartmentalization of psychological functions (e.g., Holmes et al., ; Steele et al., 2009), will nevertheless be more often observed in people who also experience dissociative disintegration and/or compartmentalization of psychological functions. Finally, the arrow labeled “Developmental TE [Trauma Exposure],” oriented in the same direction, is intended to illustrate the hypothesis that the etiology of TRASC may often be developmental in origin, that is to say, typically requires repeated trauma exposure at an early age of onset, when a child’s brain is naturally more vulnerable to deviations from NWC such as is normally exhibited through age-appropriate imaginary play.©W. W. Norton and Company. Reproduced with the permission of W. W. Norton and Company. Permission to reuse must be obtained from the rightsholder.

FIGURE 2

Posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion are endorsed less frequently in trauma-related altered states of consciousness (TRASC) form (red) than in normal waking consciousness (NWC) form (blue) (data from Study 1). Notes. Please see Table 1 for survey items used to operationalize each symptom dimension. Error bars denote SD which is also reported in brackets. Differing degrees of freedom due to missing data.

FIGURE 3

Posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion are less intercorrelated in trauma-related altered states of consciousness (TRASC) form (red) than in normal waking consciousness (NWC) form (blue). Notes. Please see Tables 1 and 2 for survey items used to operationalize each symptom dimension. Results from Study 1 below diagonal, and results from Study 2 above the diagonal.

FIGURE 4

Trait dissociation (Dissociative Experiences Scale; DES) is more strongly correlated with posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion in trauma-related altered states of consciousness (TRASC) form (red) than in normal waking consciousness (NWC) form (blue) (data from Study 1). Notes. Please see Table 1 for survey items used to operationalize each symptom dimension. Error bars denote SD which is also reported in brackets. Differing degrees of freedom due to missing data.

FIGURE 5

Posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion are endorsed less frequently in trauma-related altered states of consciousness (TRASC) form (red) than in normal waking consciousness (NWC) form (blue) (data from Study 2). Notes. Please see Table 2 for survey items used to operationalize each symptom dimension. Error bars denote SD which is also reported in brackets. Differing degrees of freedom due to missing data.