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Randomized Controlled Trial
. 2016 Jan;84(1):95-100.
doi: 10.1037/ccp0000036. Epub 2015 Jul 13.

The influence of the dissociative subtype of posttraumatic stress disorder on treatment efficacy in female veterans and active duty service members

Erika J Wolf  1 , Carole A Lunney  2 , Paula P Schnurr  2
Affiliations
Randomized Controlled Trial

The influence of the dissociative subtype of posttraumatic stress disorder on treatment efficacy in female veterans and active duty service members

Erika J Wolf et al. J Consult Clin Psychol. 2016 Jan.

Abstract

Objective: A dissociative subtype of posttraumatic stress disorder (PTSD) was recently added to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013) and is thought to be associated with poor PTSD treatment response.

Method: We used latent growth curve modeling to examine data from a randomized controlled trial of prolonged exposure and present-centered therapy for PTSD in a sample of 284 female veterans and active duty service members with PTSD to test the association between the dissociative subtype and treatment response.

Results: Individuals with the dissociative subtype (defined using latent profile analysis) had a flatter slope (p = .008) compared with those with high PTSD symptoms and no dissociation, such that the former group showed, on average, a 9.75 (95% confidence interval [-16.94, -2.57]) lesser decrease in PTSD severity scores on the Clinician Administered PTSD Scale (Blake et al., 1995) over the course of the trial. However, this effect was small in magnitude. Dissociative symptoms decreased markedly among those with the subtype, though neither treatment explicitly addressed such symptoms. There were no differences as a function of treatment type.

Conclusions: Results raise doubt about the common clinical perception that exposure therapy is not effective or appropriate for individuals who have PTSD and dissociation, and provide empirical support for the use of exposure treatment for individuals with the dissociative subtype of PTSD.

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Figures

Figure 1
Figure 1
The figure shows the estimated mean CAPS severity scores at pre-treatment and follow-up assessments as a function of class assignment. PTSD = posttraumatic stress disorder; CAPS = Clinician Administered PTSD Scale.
Figure 2
Figure 2
The figure shows the estimated mean dissociation item severity scores at pre-treatment and follow-up assessments as a function of class assignment. PTSD = posttraumatic stress disorder; CAPS = Clinician Administered PTSD Scale.
See this image and copyright information in PMC

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