Page 46 - PIECES OF THE PUZZLE Eline Vissia

CHAPTER 3
therapists of the patients with PTSD-DID reported the following co-morbid disorders based on DSM-IV classification (American Psychiatric Association 1994): somatoform disorder (n=2), recurrent major depression (n=4), dysthymic disorder (n=1), trauma-related specific phobias (n=2), personality disorder- not otherwise specified (n=2), mixed personality disorders (n=2), borderline personality disorder symptoms (n=3), dependent personality disorder symptoms (n=1), histrionic personality disorder symptoms (n=1), eating disorder (n=2), sleeping disorder (n=2), and catalepsy (n=1).
Severity of psychoform and somatoform dissociative symptoms were evaluated using the Dissociative Experiences Scale (DES) (Bernstein, Putnam 1986) and Somatoform Dissociation Questionnaire (SDQ-20) (Nijenhuis et al. 1996), respectively. The 5-item SDQ-5 was derived from the SDQ-20. These five items as a group discriminate best between patients with and without a dissociative disorder (Nijenhuis et al. 1997, Nijenhuis et al. 1998). The cut-off scores that we used for the DES and SDQ-5 were 25 and 7, respectively (Boon, Draijer 1993a, Nijenhuis et al. 1997). Severity of lifetime traumatizing events were assessed with the Traumatic Experiences Checklist (TEC) (Nijenhuis, Van der Hart & Kruger 2002). PTSD-DID patients completed these questionnaires in their predominant identity state and all of them reported experiencing severe traumatizing events starting from their childhood and extended into their adult life including severe emotional neglect and abuse, physical maltreatment or extreme physical punishments, and sexual abuse. Childhood maltreatment was retrospectively assessed using the CTQ (Bernstein et al. 1994). The CTQ is a retrospective 28-item self-report inventory that measures the severity of five different types of childhood traumatization (i.e. emotional abuse and neglect, physical abuse and neglect and sexual abuse) with scores ranging from 5 to 25 for each trauma type. Total childhood traumatization is calculated as the sum of all the five subscores. In PTSD-DID, CTQ scores were obtained from a trauma-conscious state.
In the sixteen PTSD patients, symptom severity was assessed using the Clinician Administered PTSD Scale (CAPS) interview (Blake et al. 1995) conducted by researchers E.V. and M.G.. Eleven of the PTSD patients reported multiple types of interpersonal traumatizing events during childhood (n=6) or starting from childhood and continuing into adult life (n=5). The remaining 5 PTSD patients reported traumatizing events only during adult life. Two PTSD patients scored high on the DES/SDQ-20 and therefore underwent a SCID-D
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