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. 2018 Nov 14;9(1):1544025.
doi: 10.1080/20008198.2018.1544025. eCollection 2018.

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

Harald Bækkelund  1   2 , Paul Frewen  3 , Ruth Lanius  3 , Akiah Ottesen Berg  4 , Espen Ajo Arnevik  5
Affiliations

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

Harald Bækkelund et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: The four-dimensional ('4-D') model has been proposed as a theoretical framework to understand and delineate trauma-related dissociative experiences, categorizing symptoms into trauma-related altered states of consciousness (TRASC) and normal waking consciousness (NWC), which occur along four dimensions: time, thought, body and emotion. Objective: The main aim of the present study was to evaluate the validity of this model in patients with post-traumatic stress disorder (PTSD), with and without comorbid dissociative disorders. Method: The predictions of the 4-D model were tested in 142 patients with PTSD, with (N = 46) and without (N = 96) comorbid dissociative disorders. Results: As predicted by the 4-D model, experiences of TRASC were less frequent and more specifically related to other measures of dissociation, dissociative disorder comorbidity and a history of childhood sexual abuse compared to experiences of NWC. The predicted lower intercorrelation of TRASC was not supported. Conclusion: The 4-D model represents a promising framework for understanding dissociation across trauma-related disorders.

Antecedentes: El ‘modelo 4-D’ ha sido propuesto como un marco teórico para entender y delinear las experiencias disociativas relacionadas al trauma, categorizando los síntomas en estados alterados de conciencia relacionados al trauma (TRASC en su sigla en inglés) y la conciencia en vigilia normal (NWC en sus siglas en inglés), que ocurren a lo largo de cuatro dimensiones: (1) tiempo; (2) pensamiento; (3) cuerpo; y (4) emoción. El principal objetivo del presente estudio fue evaluar la validez de este modelo en pacientes con Trastorno de Estrés Postraumático (TEPT), con y sin trastornos disociativos comórbidos.Métodos: Los predictores del modelo 4-D fueron probados en 142 pacientes con TEPT, con (N=46) y sin (N=96) trastornos disociativos comórbidos.Resultados: Como predice el modelo 4-D, las experiencias de los TRASC fueron menos frecuentes y más específicamente relacionados a otras medidas de disociación, comorbilidad del trastorno disociativo y una historia de abuso sexual infantil en comparación a las experiencias de NWC. La predicción de la intercorrelación más baja de los TRASC no fue confirmada.Conclusión: El modelo 4-D representa un prometedor marco para el entendimiento de la disociación de forma transversal en los trastornos relacionados al trauma.

背景：‘4-D模型’已被提议作为理解和描述创伤相关的解离经验的理论框架，将症状分类为创伤相关的意识改变状态（TRASC）和正常清醒意识（NWC），其中有四个维度：（1）时间; （2）思想; （3）身体; （4）情绪。本研究的主要目的是评估该模型在合并或者未合并的解离障碍的创伤后应激障碍（PTSD）患者中的有效性。方法： 对142例PTSD患者考察4-D模型的预测性，其中N = 46共病解离障碍，N = 96无共病。结果： 正如4-D模型预测的那样，与NWC的经验相比，TRASC的经验较少出现，并且更具体地与其他解离症状、解离障碍共病证和儿童性虐待史相关。预期的TRASC的内部相关性没有得到支持。结论： 4-D模型代表了一个理解创伤相关疾病中的解离症状的框架。.

Keywords: 4-D model; Dissociation; child abuse and neglect; dissociative disorders; post-traumatic stress disorder; trauma-related altered states of consciousness.

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Figures

Figure 1.
Figure 1.
Mean symptom endorsement for each dimension of trauma-related altered states of consciousness (TRASC) and normal waking consciousness (NWC) compared in patients with and without complex dissociative disorder (CDD).*p < .05, **p < .01.
Figure 2.
Figure 2.
Intercorrelations between the four different dimensions of trauma-related altered states of consciousness (TRASC) and normal waking consciousness (NWC). All correlations are significant at p < .001.
See this image and copyright information in PMC

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