Co-occurrence of severe PTSD, somatic symptoms and dissociation in a large sample of childhood trauma inpatients: a network analysis

Abstract

Co-occurrence of mental disorders including severe PTSD, somatic symptoms, and dissociation in the aftermath of trauma is common and sometimes associated with poor treatment outcomes. However, the interrelationships between these conditions at symptom level are not well understood. In the present study, we aimed to explore direct connections between PTSD, somatic symptoms, and dissociation to gain a deeper insight into the pathological processes underlying their comorbidity that can inform future treatment plans. In a sample of 655 adult inpatients with a diagnosis of severe PTSD following childhood abuse (85.6% female; mean age = 47.57), we assessed symptoms of PTSD, somatization, and dissociation. We analyzed the comorbidity structure using a partial correlation network with regularization. Mostly positive associations between symptoms characterized the network structure. Muscle or joint pain was among the most central symptoms. Physiological reactivation was central in the full network and together with concentrations problems acted as bridge between symptoms of PTSD and somatic symptoms. Headaches connected somatic symptoms with others and derealization connected dissociative symptoms with others in the network. Exposure to traumatic events has a severe and detrimental effect on mental and physical health and these consequences worsen each other trans-diagnostically on a symptom level. Strong connections between physiological reactivation and pain with other symptoms could inform treatment target prioritization. We recommend a dynamic, modular approach to treatment that should combine evidence-based interventions for PTSD and comorbid conditions which is informed by symptom prominence, readiness to address these symptoms and preference.

Psychometric Properties of the Dissociative Subtype of Posttraumatic Stress Disorder Scale: Replication and Extension in Two German-Speaking Samples

“…Yet, correlations between the DSPS and measures of depression, anxiety, and somatic symptoms were still of medium to large size, which could suggest a substantial overlap between measures. However, as a substantial body of research has linked dissociative symptoms to higher levels of depression, anxiety, and somatic symptoms (Deen et al, 2022;Hansen et al, 2017;Kratzer et al, 2022;Stein et al, 2013), it might just as well reflect the high comorbidity between these syndromes, which might inflate correlations in samples with varying levels of psychopathology. In line with this notion, correlations between the DSPS and measures of other psychopathology were, as expected, only small to medium in Study 2, i.e., a sample more homogenous in overall psychopathology.…”

What makes inpatient treatment for PTSD effective? Investigating daily therapy process factors

“…Whereas nodes reflect constructs, the strength of the edges indicates the strength of the association between the constructs and the colour indicates whether the association is positive or negative. Several studies have recently used cross-sectional symptom-level data of PTSD symptoms and adjacent symptoms like somatic symptoms, sexual symptoms, dissociative symptoms, or Borderline symptoms (Knefel et al, 2016;Kratzer et al, 2021Kratzer et al, , 2022.…”

Mental health during the COVID-19 pandemic, impact of childhood trauma in psychiatric disorders, and predictable biomarkers for bipolar disorder

“…Co-occurrence of psychiatric disorders including severe post-traumatic stress disorder (PTSD), somatic symptoms, and dissociation in the aftermath of trauma is associated with poor treatment outcome. In this issue, Kratzer and colleagues explored direct connections between PTSD, somatic symptoms, and dissociations to gain a deeper insight into the pathological processes underlying their comorbidity that can inform future treatment plans [ 5 ]. Using a partial correlation with regularization, they found that muscle or joint pain was among the most central symptoms.…”

“…Traumatic events had a severe and detrimental effect on mental and physical health, and their consequences worsen each other trans-diagnostically on a symptom level. Collectively, strong connections between physiological reactivation and pain with other symptoms could inform treatment target prioritization [ 5 ].…”