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Latent profile analysis of PTSD and dissociation, and relations with anger

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Abstract

Demographic and traumatic event-related risk factors for PTSD and dissociative symptoms have been examined in prior research. However, less research has examined this issue from a person-centered statistical approach to report subgroups of clinical presentations identified based on endorsed symptoms. The present study examined the relationship between PTSD, dissociation, and anger using this approach. We utilized a sample (N = 360) of trauma-exposed adults recruited via Amazon’s Mechanical Turk. Latent profile analysis (LPA) identified distinct profiles based on the indicators of PTSD subscale scores and a dissociation total score. The following latent profiles were identified: 1) low PTSD/low dissociation, 2) moderate PTSD/moderate dissociation, and 3) high PTSD/high dissociation. Additional analyses found differential relationships between the three profiles and anger, with individuals in the high PTSD/high dissociation profile exhibiting more anger. Results shed light on the high co-occurrence between anger and PTSD symptoms.

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References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Armour, C., Karstoft, K., & Richardson, J. D. (2014). The co-occurrence of PTSD and dissociation: Differentiating severe PTSD from dissociative-PTSD. Social Psychiatry and Psychiatric Epidemiology, 49, 1297–1306. https://doi.org/10.1007/s00127-014-0819-y.

    Article  PubMed  Google Scholar 

  • Armour, C., Tsai, J., Durham, T. A., Charak, R., Biehn, T. L., Elhai, J. D., & Pietrzak, R. H. (2015). Dimensional structure of DSM-5 posttraumatic stress symptoms: Support for a hybrid Anhedonia and externalizing behaviors model. Journal of Psychiatric Research, 61, 106–113. https://doi.org/10.1016/j.jpsychires.2014.10.01.

    Article  PubMed  Google Scholar 

  • Asparouhov, T., & Muthén, B. (2010). Weighted least squares estimation with missing data. Mplus Technical Appendix, 1-10.

  • Asparouhov, T., & Muthén, B. (2014). Auxiliary variables in mixture modeling: Three-step approaches using Mplus. Structural Equation Modeling: A Multidisciplinary Journal, 21(3), 329–341. https://doi.org/10.1080/10705511.2014.915181.

    Article  Google Scholar 

  • Bennett, D. A. (2001). How can I deal with missing data in my study? Australian and New Zealand Journal of Public Health, 25, 464–469.

    Article  Google Scholar 

  • Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–734. https://doi.org/10.1097/00005053-198612000-00004.

    Article  Google Scholar 

  • Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489–498. https://doi.org/10.1002/jts.22059.

    Article  PubMed  Google Scholar 

  • Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychological Assessment, 28, 1379–1391. https://doi.org/10.1037/pas0000504.

    Article  PubMed  Google Scholar 

  • Boyd, J. E., Protopopescu, A., O’Connor, C., Neufeld, R. W., Jetly, R., Hood, H. K., Lanius, R. A., & McKinnon, M. C. (2018). Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD. European Journal of Psychotraumatology, 9, 1–16. https://doi.org/10.1080/20008198.2018.1463794.

    Article  Google Scholar 

  • Briere, J. (2006). Dissociative symptoms and trauma exposure: Specificity, affect dysregulation, and posttraumatic stress. The Journal of Nervous and Mental Disease, 194(2), 78–82. https://doi.org/10.1097/01.nmd.0000198139.47371.54.

    Article  PubMed  Google Scholar 

  • Carlson, E. B., & Putnam, F. W. (1993). An update on the dissociative experiences scale. Dissociation: Progress in The Dissociative Disorder, 6, 16–27. https://doi.org/10.4088/jcp.v64n0903.

    Article  Google Scholar 

  • Clifton, E. G., Feeny, N. C., & Zoellner, L. A. (2017). Anger and guilt in treatment for chronic posttraumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 54, 9–16. https://doi.org/10.1016/j.jbtep.2016.05.003.

    Article  PubMed  Google Scholar 

  • Durham, T. A., Byllesby, B. M., Armour, C., Forbes, D., & Elhai, J. D. (2016). Relations between anger and DSM-5 posttraumatic stress disorder symptoms. Psychiatry Research, 24, 403–409. https://doi.org/10.1016/j.psychres.2016.08.004.

    Article  Google Scholar 

  • Elhai, J. D., Miller, M. E., Ford, J. D., Biehn, T. L., Palmieri, P. A., & Frueh, B. C. (2012). Posttraumatic stress disorder in DSM-5: Estimates of prevalence and symptom structure in a nonclinical sample of college students. Journal of Anxiety Disorders, 26(1), 58–64. https://doi.org/10.1016/j.janxdis.2011.08.013.

  • Enders, C. K. (2001). A primer on maximum likelihood algorithms available for use with missing data. Structural Equation Modeling, 8, 128–141.

    Article  Google Scholar 

  • Feeny, N. C., Zoellner, L. A., & Foa, E. B. (2000). Anger, dissociation, and posttraumatic stress disorder among female assault victims. Journal of Traumatic Stress, 13, 89–100. https://doi.org/10.1023/A:1007725015225.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Riggs, D. S., Masie, E. D., & Yarczower, M. (1995). The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behavior Therapy, 26, 487–499. https://doi.org/10.1016/S0005-7894(05)80096-6.

    Article  Google Scholar 

  • Forbes, D., Hawthorne, G., Elliott, P., McHugh, T., Biddle, D., Creamer, M., & Novaco, R. W. (2004). A concise measure of anger in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 17, 249–256. https://doi.org/10.1023/B:JOTS.0000029268.22161.bd.

    Article  PubMed  Google Scholar 

  • Forbes, D., Alkemade, N., Mitchell, D., Elhai, J. D., McHugh, T., Bates, G., Novaco, R. W., Bryant, R., & Lewis, V. (2014). Utility of the dimensions of anger reactions–5 (DAR-5) scale as a brief anger measure. Depression and Anxiety, 31, 166–173. https://doi.org/10.1002/da.22148.

    Article  PubMed  Google Scholar 

  • Frischholz, E. J., Braun, B. G., Sachs, R. G., Hopkins, L., Shaeffer, D. M., Lewis, J., Leavitt, F., Pasquotto, J. N., & Schwartz, D. R. (1990). The dissociative experiences scale: Further replication and validation. Dissociation, 3, 151–153.

    Google Scholar 

  • Goodman, L., Corcoran, C., Turner, K., Yuan, N., & Green, B. L. (1998). Assessing traumatic event exposure: General issues and preliminary findings for the stressful life events screening questionnaire. Journal of Traumatic Stress, 11(3), 521–542. https://doi.org/10.1023/A:1024456713321.

  • Hansen, M., Műllerová, J., Elklit, A., & Armour, C. (2016). Can the dissociative PTSD subtype be identified across two distinct trauma samples meeting caseness for PTSD? Social Psychiatry and Psychiatric Epidemiology, 51, 1159–1169. https://doi.org/10.1007/s00127-016-1235-2.

    Article  PubMed  Google Scholar 

  • Kulkarni, M., Porter, K. E., & Rauch, S. A. (2012). Anger, dissociation, and PTSD among male veterans entering into PTSD treatment. Journal of Anxiety Disorders, 26, 271–278. https://doi.org/10.1016/j.janxdis.2011.12.005.

    Article  PubMed  Google Scholar 

  • Landers, R. N., & Behrend, T. S. (2015). An inconvenient truth: Arbitrary distinctions between organizational, Mechanical Turk, and other convenience samples. Industrial and Organizational Psychology, 8(2), 142–164. https://doi.org/10.1017/iop.2015.13.

  • McLachlan, G. J., & Peel, D. (2000). Finite mixture models. New York: Wiley.

    Book  Google Scholar 

  • Műllerová, J., Hansen, M., Contractor, A. A., Elhai, J. D., & Armour, C. (2016). Dissociative features in posttraumatic stress disorder: A latent profile analysis. Psychological Trauma: Theory, Research, Practice, and Policy, 8, 601–608. https://doi.org/10.1037/tra0000148.

    Article  Google Scholar 

  • Muthén, B. O. (2008). Latent variable hybrids: Overview of old and new models. In G. M. Hancock & K. M. Samuelsen (Eds.), Advances in latent variable mixture models (pp. 1–24). Charlotte: Information Age Publishing, Inc..

    Google Scholar 

  • Paolacci, G., & Chandler, J. (2014). Inside the Turk: Understanding Mechanical Turk as a participant pool. Current Directions in Psychological Science, 23(3), 184–188. https://doi.org/10.1177/0963721414531598

  • Price, M., & van Stolk-Cooke, K. (2015). Examination of the interrelations between the factors of PTSD, major depression, and generalized anxiety disorder in a heterogeneous trauma-exposed sample using DSM 5 criteria. Journal of Affective Disorders, 186, 149–155. https://doi.org/10.1016/j.jad.2015.06.012.

    Article  PubMed  Google Scholar 

  • Putnam, F. W. (1989). Pierre Janet and modern views on dissociation. Journal of Traumatic Stress, 2, 413–429. https://doi.org/10.1007/BF00974599.

    Article  Google Scholar 

  • Resick, P. A., Suvak, M. K., Johnides, B. D., Mitchell, K. S., & Iverson, K. M. (2012). The impact of dissociation on PTSD treatment with cognitive processing therapy. Depression and Anxiety, 29, 718–730. https://doi.org/10.1002/da.21938.

    Article  PubMed  Google Scholar 

  • Ross, J., Baník, G., Dedová, M., Mikulášková, G., Armour, C. (2018). Assessing the structure and meaningfulness of the dissociative subtype of PTSD. Social Psychiatry and Psychiatric Epidemiology, 53, 87–97. https://doi.org/10.1007/s00127-017-1445-2.

  • Shapiro, D. N., Chandler, J., & Mueller, P. A. (2013). Using mechanical Turk to study clinical populations. Clinical Psychological Science, 1, 213–220. https://doi.org/10.1177/2167702612469015.

    Article  Google Scholar 

  • Spiegel, D. (1986). Dissociating damage. American Journal of Clinical Hypnosis, 29, 123–131. https://doi.org/10.1080/00029157.1986.10402695.

    Article  Google Scholar 

  • Spiegel, D., & Cardeña, E. (1990). Dissociative mechanisms in posttraumatic stress disorder. In M. E. Wolf & A. D. Mosnaim (Eds.), Posttraumatic stress disorder: Etiology, phenomenology, and treatment (pp. 23–34). Arlington: American Psychiatric Association.

    Google Scholar 

  • Tsai, J., Armour, C., Southwick, S. M., & Pietrzak, R. H. (2015). Dissociative subtype of DSM-5 posttraumatic stress disorder in U.S. veterans. Journal of Psychiatric Research, 66, 67–74. https://doi.org/10.1016/j.jpsychires.2015.04.017.

    Article  PubMed  Google Scholar 

  • van der Hart, O., & Dohary, M. J. (2009). History of the concept of dissociation. In P. F. Dell, J. O’Neil, & E. Somer (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 3–26). New York: Guilford Press.

    Google Scholar 

  • van der Hart, O., Nijenhuis, E. S., & Steele, K. (2005). Dissociation: An insufficiently recognized major feature of complex posttraumatic stress disorder. Journal of Traumatic Stress, 18, 413–423. https://doi.org/10.1002/jts.20049.

    Article  PubMed  Google Scholar 

  • van Stolk-Cooke, K., Brown, A., Maheux, A., Parent, J., Forehand, R., & Price, M. (2018). Crowdsourcing trauma: Psychopathology in a trauma-exposed sample recruited via mechanical Turk. Journal of Traumatic Stress, 31, 549–557. https://doi.org/10.1002/jts.22303.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vermunt, J. K. (2010). Latent class modeling with covariates: Two improved three-step approaches. Political Analysis, 18, 450–469. https://doi.org/10.1093/pan/mpq025.

    Article  Google Scholar 

  • Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Retrieved from https://www.ptsd.va.gov.

  • Wolf, E. J., Miller, M. W., Reardon, A. F., Ryabchenko, K. A., Castillo, D., & Freund, R. (2012). A latent class analysis of dissociation and posttraumatic stress disorder: Evidence for a dissociative subtype. JAMA Psychiatry, 69, 698–705. https://doi.org/10.1001/archgenpsychiatry.2011.

    Article  Google Scholar 

  • Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P., Dodanville, K. A., Hall-Clark, B., et al. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment, 28(11), 1392–1403. https://doi.org/10.1037/pas0000260.

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Correspondence to Jon D. Elhai.

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Tory A. Durham and Brianna M. Byllesby was collected online while the first and second authors were affiliated with the University of Toledo.

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Durham, T.A., Byllesby, B.M., Elhai, J.D. et al. Latent profile analysis of PTSD and dissociation, and relations with anger. Curr Psychol 41, 1595–1602 (2022). https://doi.org/10.1007/s12144-020-00693-5

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