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Am J Psychiatry 1996; 153:83-93
Copyright © 1996 by American Psychiatric Association
Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma
BA van der Kolk, D Pelcovitz, S Roth, FS Mandel, A McFarlane and JL Herman
Harvard Medical School, Boston, USA.
OBJECTIVE: A century of clinical research has noted a range of trauma-
related psychological problems that are not captured in the DSM-IV
framework of posttraumatic stress disorder (PTSD). This study investigated
the relationships between exposure to extreme stress, the emergence of
PTSD, and symptoms traditionally associated with "hysteria," which can be
understood as problems with stimulus discrimination, self-regulation, and
cognitive integration of experience. METHOD: The DSM-IV field trial for
PTSD studied 395 traumatized treatment-seeking subjects and 125
non-treatment-seeking subjects who had also been exposed to traumatic
experiences. Data on age at onset, the nature of the trauma, PTSD,
dissociation, somatization, and affect dysregulation were collected.
RESULTS: PTSD, dissociation, somatization, and affect dysregulation were
highly interrelated. The subjects meeting the criteria for lifetime (but
not current) PTSD scored significantly lower on these disorders than those
with current PTSD, but significantly higher than those who never had PTSD.
Subjects who developed PTSD after interpersonal trauma as adults had
significantly fewer symptoms than those with childhood trauma, but
significantly more than victims of disasters. CONCLUSIONS: PTSD,
dissociation, somatization, and affect dysregulation represent a spectrum
of adaptations to trauma. They often occur together, but traumatized
individuals may suffer from various combinations of symptoms 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 impairment and provide
systematic treatment that addresses both unbidden intrusive recollections
and these other symptoms associated with having been overwhelmed by
exposure to traumatic experiences.
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