1. Peritraumatic Dissociation as a Predictor of Posttraumatic Symptomatology among College Women with a History of Childhood Sexual Abuse ©LouAnne Birch Hawkins University of North Florida

2. WHY? * What makes an individual vulnerable? * Early detection of risk factors may result in early intervention.

3. Constructs of Interest peritraumatic dissociationperitraumatic dissociation posttraumatic symptomatologyposttraumatic symptomatology childhood sexual victimizationchildhood sexual victimization trait dissociationtrait dissociation

4. Peritraumatic Dissociation experiences of depersonalization, derealization, alterations in sense of time and/or image extent to which individual dissociates during or immediately after traumatic event

5. Peritraumatic Dissociation natural disaster (Cardena & Spiegel, 1993; Koopman, Classen, & Spiegel, 1994; Marmar, Weiss, Metzler, & Delucchi, 1996) severe childhood physical & sexual abuse (Briere, 1992) combat exposure (Bremner, Southwick, Fontana, Rosenheck, & Charney, 1994) rape (Coons & Milstein, 1986) witnessing an execution (Feinkel, Koopman, & Spiegel, 1994) strong association between peritraumatic dissociation and variety of traumatic events:

6. Constructs of Interest peritraumatic dissociationperitraumatic dissociation posttraumatic symptomatologyposttraumatic symptomatology childhood sexual victimizationchildhood sexual victimization trait dissociationtrait dissociation

7. Posttraumatic Stress Disorder (PTSD) and Posttraumatic Symptomatology 1. symptoms follow exposure to traumatic event 2. must include - fear, helplessness, horror, or (in children) disorganized or agitated behavior children) disorganized or agitated behavior 3. symptoms include - reexperiencing event, persistent avoidance of stimuli, numbing, persistent avoidance of stimuli, numbing, persistent hyperarousal persistent hyperarousal

8. Posttraumatic Stress Disorder (PTSD) and Posttraumatic Symptomatology McLeer, Deblinger, Atkins, Foa, & Ralphe (1988) N = 31 48.4% met criteria for PTSD Many who did not meet full criteria were symptomatic. Epstein, Saunders, Kilpatrick, & Resnick (1998) N = 2,994 women, n = 282 w/ hx. of abuse Ss w/ hx. had twice as many PTSD sx

9. Constructs of Interest peritraumatic dissociationperitraumatic dissociation posttraumatic symptomatologyposttraumatic symptomatology childhood sexual victimizationchildhood sexual victimization trait dissociationtrait dissociation

10. Childhood Sexual Victimization What is childhood sexual victimization? *fondling to intercourse *by an individual 5 or more years older * prior to age 16

11. Prevalence of Childhood Sexual Victimization Estimated at 20% (Briere, 1992; Finkelhor, 1979) First national survey of adults (Finkelhor, Hotaling, Lewis, & Smith, 1989) sample included 1,481 females prevalence among females reported at 27%

12. Consequences of Childhood Sexual Victimization R anxiety R depression R somatization R sexual dysfunction R interpersonal problems R substance abuse R suicidality (Briere, 1992; Fromuth, 1986; Kendall-Tacket, Williams, & Finkelhor, 1993)

13. Consequences of Childhood Sexual Victimization Review of 45 empirical studies of CSV (Kendall-Tacket, et al., 1993) 1. abused children more symptomatic than non-abused 2. no specific symptom characterized sexually abused children 3. most prevalent - fears, posttraumatic stress, behavioral problems, inappropriate sexual behavior, poor self-esteem problems, inappropriate sexual behavior, poor self-esteem

14. Constructs of Interest peritraumatic dissociationperitraumatic dissociation posttraumatic symptomatologyposttraumatic symptomatology childhood sexual victimizationchildhood sexual victimization trait dissociationtrait dissociation

15. Trait Dissociation disconnection of psychological systems (i.e. thoughts, feelings, beliefs) that are normally integrated certain memories may not be assimilated with other info clinical & behavioral manifestations of changes in memory and identity on continuum of severity

16. Trait Dissociation strong association between dissociation and variety of traumatic events: combat exposure (Brende, 1986) witnessing a violent death during childhood (Putnam, Guroff, Silberman, Barban, & Post, 1986) rape (Coons & Milestein, 1986) childhood physical & sexual abuse (Briere, 1992; Chu & Dill, 1990; Frischholz, 1985; Putnam, 1989; Putnam, Guroff, Silberman, Baran, & Post, 1986)

17. Link Between Peritraumatic Dissociation and PTSD and PTSD Peritraumatic dissociation may be an effective mechanism to cope with an event that would otherwise be overwhelming (Spiegel & Cardena, 1991).

18. Peritraumatic dissociation has been identified as a significant risk factor for development of posttraumatic symptomatology among: Link Between Peritraumatic Dissociation and PTSD and PTSD witnesses of violence (Classen, Koopman, Hales, & Spiegel, 1998) MVA victims (Harvey & Bryant, 1998) EMS workers (Marmar, Weiss, Metzler, Ronfeldt, & Foreman, 1996; Marmar, Weiss, Metzler, Delucchi, Best, Wentworth, 1999) natural disaster victims (Koopman, Classen, & Spiegel, 1994)

19. Link Between Peritraumatic Dissociation and PTSD and PTSD Marmar, Weiss, Schlenger, Fairbanks, Jordan, Kulka, and Hough (1994) Ss: 251 male Vietnam combat veterans predictor variable: peritraumatic dissociation criterion variable: posttraumatic symptomatology control variables: severity of combat exposure trait dissociation trait dissociation

20. Link Between Peritraumatic Dissociation and PTSD and PTSD Findings: Greater peritraumatic dissociation resulted in greater incidence of PTSD even after controlling for war zone stress exposure and trait dissociation.

21. Rationale Why do some people develop posttraumatic symptoms while others do not? Dissociation was originally viewed as psychological adaptation that protected victims. There is growing evidence that peritraumatic dissociation may be maladaptive and predictive of future problems. Peritraumatic dissociation has been found to be significantly predictive of posttraumatic symptomatology while controlling for other variables for several populations.

22. Rationale The purpose of this study is to examine the relationship between peritraumatic dissociation and posttraumatic symptomatology among college women with a history of childhood sexual victimization.

23. Hypothesis Participants reporting greater peritraumatic dissociation would also report greater posttraumatic symptomatology, even after controlling for severity of childhood sexual victimization and trait dissociation.

24. Method Participants N = 73 college women with a history of CSV age: 18 to 54 (M = 25.45; SD = 8.39; median = 22) ethnicity: 74% Caucasian (n = 53) marital status: 58% single (n = 42) incomes: 31% >$50,000 (n = 23)

25. Method Measures Childhood Sexual Victimization Questionnaire adapted from Finkelhor, 1979 Asks participants to respond “yes” or “no” to questions regarding: specific sexual experiences before age 16 if experiences were with someone > 5 years older If the participant responds affirmatively, she is asked to respond to follow-up questions about the most significant experience.

26. Method Measures Childhood Sexual Victimization intercourse or attempted intercourse vs. other than intercourse or attempted intercourse (i.e. fondling) perpetrator was a parental figure (i.e. parent, step-parent) vs. other than a parental figure (i.e. sibling, neighbor) physical force or threat of physical force vs. no physical force or threat of physical force. higher scores = greater severity

27. Method Measures Dissociative Experiences Scale (Bernstein & Putnam, 1986) 28-item self-report questionnaire most widely used measure (test-retest reliability Pearson r =.84; good internal consistency; good criterion-referenced and construct validity) indicate % of time experience emotion or exhibit behavior score reflects mean of all items higher scores = greater trait dissociation

28. Method Measures Stanford Acute Stress Reaction Questionnaire (Koopman, Cardena, Classen, & Spiegel, 1993) good internal consistency, high reliability, good concurrent validity list of statements indicative of dissociative symptoms Likert scale score reflects mean item scores with range from 5 to 10 higher scores = greater peritraumatic dissociation

29. Method Measures PTSD Checklist (Weathers, Litz, Huska, & Keane, 1993) high test-retest reliability, internal consistency, acceptable criterion validity 17-item self-report correspond to DSM-IV diagnostic criteria how much bothered by PTSD symptoms within last month Likert scale higher scores = greater posttraumatic symptomatology

30. Method Procedure approved by UNF IRB conducted in accordance with APA guidelines administered and debriefed by trained research assistants in groups of 10 to 20 participants 73 female college students were identified via self-report as having hx. of CSV from 304 participants

31. Results Sample Characteristics prevalence rate of 24% is consistent with literature mean scores for DES & PCL-C are consistent with literature modified version of SASRQ could not be compared to previous data

32. Results Relationship Between Trait Dissociation and Peritraumatic Dissociation Pearson r =.32 distinct constructs

33. Results Relationship Between Peritraumatic Dissociation and Posttraumatic Symptomatology Analysis - hierarchical regression Why?

34. Results Hierarchical regression or sequential multiple regression 1. is used when the researcher has developed a model. 2. permits the researcher to determine the unique contribution of the variable of interest. (Cohen & Cohen, 1975; Tabachnick & Fidell, 1996)

35. Results predictor variable: peritraumatic dissociation criterion variable: posttraumatic symptomatology control variables: CSV severity trait dissociation trait dissociation

36. CSV PTSD Symptomatology

37. CSV Trait Dissociation PTSD Symptomatology

38. CSV Trait Dissociation Peritraumatic Dissociation PTSD Symptomatology

39. CSV Trait Dissociation Peritraumatic Dissociation PTSD Symptomatology Unique Predictive Contribution of Peritraumatic Dissociation

40. Variable  Step 1 CSV.14R 2 =.02 Step 2 CSV.12 DES.45***  R 2 =.20 (p <.001) Step 3 CSV.06 DES.36*** SASRQ.29**  R 2 =.07 (p =.01) **p <.01; ***p <.001.

41. Discussion The findings of this study indicate that peritraumatic dissociation is predictive of posttraumatic symptomatology among college women with a reported history of childhood sexual victimization.

42. Discussion Findings are consistent with those for other populations. A better understanding of this relationship may increase early identification of individuals at risk for PTSD and posttraumatic symptomatology.

43. Limitations and Recommendations retrospective reports examine relationship between measures and specific items further substantiate this emerging concept and provide additional evidence of construct validity