PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample

Abstract

Exposure to multiple traumas has been shown to result in many negative mental health outcomes, including posttraumatic stress disorder (PTSD). Dissociation, which involves disruptions in memory, identity, and perceptions, may be a component of PTSD, particularly among individuals who have experienced childhood trauma. Emotion regulation difficulties are also strongly associated with childhood trauma and emotion dysregulation may be a particularly important factor to consider in the development and maintenance of dissociative symptoms. The goal of the present study was to determine whether emotion dysregulation mediated the relationship between PTSD symptoms and dissociation in a sample of 154 (80% female, 97% African-American) adults recruited from a public, urban hospital. PTSD was measured using the Clinician Administered PTSD Scale, emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale, and dissociation was measured using the Multiscale Dissociation Inventory. A linear regression analysis showed that both PTSD and emotion dysregulation were statistically significant predictors of dissociation even after controlling for trauma exposure. Alexithymia and an inability to use emotion regulation strategies in particular were predictive of dissociation above and beyond other predictor variables. Using bootstrapping techniques, we found that overall emotion dyregulation partially mediated the effect of PTSD symptoms on dissociative symptoms. Our results suggest that emotion dysregulation may be important in understanding the relation between PTSD and dissociative symptoms. Treatment approaches may consider a focus on training in emotional understanding and the development of adaptive regulation strategies as a way to address dissociative symptoms in PTSD patients.

Keywords: Dissociation; Emotion dysregulation; Emotion regulation; Posttraumatic stress disorder; Trauma.

Figure 1

The partial mediating effect of emotion dysregulation symptoms on the relation between current PTSD symptoms and dissociative symptoms found using INDIRECT, a macro for SPSS that estimates the path coefficients in a multiple mediator model and generates bootstrap confidence intervals (bias-corrected) for total and specific indirect effects of X on Y through one or more mediator variable(s) M. Age, sex, race, and overall trauma load were controlled. Current PTSD symptoms were measured using the CAPS; Emotion dysregulation was measured using the DERS; Dissociative symptoms were measured using the MDI.