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Am J Psychiatry 1996; 153:94-102
Copyright © 1996 by American Psychiatric Association
Characteristics of emergency services personnel related to peritraumatic dissociation during critical incident exposure
CR Marmar, DS Weiss, TJ Metzler and K Delucchi
Department of Psychiatry, University of California, San Francisco, USA.
OBJECTIVE: The aim of this study was to identify characteristics of
emergency services personnel related to acute dissociative responses at the
time of critical incident exposure, a phenomenon designated "peritraumatic
dissociation." METHOD: The authors studied 157 rescue workers who responded
to the Nimitz Freeway collapse during the 1989 Loma Prieta earthquake in
the San Francisco Bay Area as well as 201 rescue workers who were not
involved in that disaster. Demographics, level of critical incident
exposure, perceived threat at the time of exposure, personality attributes
(assessed by the Hogan Personality Inventory), coping strategies (assessed
by the Ways of Coping Questionnaire), and locus of control were related to
subjects' scores on the Peritraumatic Dissociative Experiences
Questionnaire. RESULTS: According to univariate tests, the subjects with
clinically meaningful levels of peritraumatic dissociation were younger;
reported greater exposure to critical incident stress; felt greater
perceived threat; had lower scores on the adjustment, identify, ambition,
and prudence scales of the Hogan Personality Inventory; had higher scores
on measures of coping by means of escape-avoidance, self-control, and
active problem solving; and had greater externality in locus of control.
Linear modeling with multiple logistic regression analyses indicated that
greater feelings of perceived threat, coping by means of escape-avoidance,
and coping by means of self-control were associated with a greater
likelihood of being in the peritraumatic dissociation group, above and
beyond age and exposure to stress. CONCLUSIONS: Rescue workers who are shy,
inhibited, uncertain about their identity, or reluctant to take leadership
roles, who have global cognitive styles, who believe their fate is
determined by factors beyond their control, and who cope with critical
incident trauma by emotional suppression and wishful thinking are at higher
risk for acute dissociative responses to trauma and subsequent
posttraumatic stress disorder.
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