User:Ashley Mullin/Peritraumatic dissociation

Peritraumatic dissociation is a dissociative response that is experienced during and immediately following a traumatic event. This peritraumatic period is said to encompass the moment of the traumatic event and the immediate period following, but research is inconclusive regarding the length of time the peritraumatic period covers. Peritraumatic dissociative responses may involve depersonalization or derealization, two broad categories of dissociation described as experiences of disconnection to the self and one’s surroundings.

History
Dissociation’s connection with trauma began with Pierre Janet, a French psychologist, physician, philosopher, and psychotherapist, who proposed that traumatic events “overwhelm” one’s mental capacity to “integrate sensory and affective elements” of the trauma event, causing a disconnection of oneself from the emotional and physical pain associated with the traumatic event. He proposed that when these elements are not integrated properly, the survivor may then experience intrusive thoughts, nightmares, ruminations, behavioral representations, and altered states of behavior, personality, or consciousness, much like the symptoms of post-traumatic stress disorder (PTSD).

Measurements
There have been multiple proposed scales for the measurement of peritraumatic dissociation. This includes the Peritraumatic Dissociation Index, the Peritraumatic Dissociative Scale , and the Peritraumatic Dissociative Experiences Questionnaire. The Peritraumatic Dissociative Experiences Questionnaire is especially notable in this field of research, as its brief, 10-item format makes it an easily deliverable assessment.

Debate on adaptiveness of peritraumatic dissociation
Some researchers have argued that the experience of peritraumatic dissociation is adaptive in the face of trauma, as it protects the individual from experiencing intense negative emotions during and from the traumatic event, such as fear and helplessness. This dissociative capacity may reoccur with future traumatic events, or when traumatic memories are activated, as a means of down-regulating one’s experience of distress. This type of dissociation is known as persistent dissociation, and differs from peritraumatic dissociation in that persistent dissociation is long-enduring, and reflects patterns of psychological distancing one may utilize to cope with repeated trauma, theoretically making the mind more susceptible to dissociative states following the aftermath of the traumatic event.

Evidence also supports maladaptive effects of peritraumatic dissociation, including the increased risk of developing general psychopathology and in particular, PTSD. One study found that peritraumatic dissociation was the strongest predictor of PTSD when compared to other predictor variables, and may be the best known psychological risk factor for the development of PTSD. Janet himself also proposed that peritraumatic dissociative experiences are indicators of a maladaptive failure of the mind’s integrative system that can lead to more chronic symptoms in the form of PTSD.

Peritraumatic distress
A related concept to peritraumatic dissociation is peritraumatic distress. Peritraumatic distress is described as a set of “physiological, emotional, and cognitive responses that occur at and immediately after the time of a trauma”. Peritraumatic distress encapsulates Criterion A2 for PTSD in the DSM-IV, and has been measured using the Peritraumatic Distress Inventory (PDI). Future research aims to identify how peritraumatic distress influences PTSD development, as well as the development of other, non-trauma related psychopathology. Peritraumatic dissociation may represent a form of peritraumatic distress, as peritraumatic distress is defined as a set of responses to a traumatic event, including the capacity to dissociate.

Future research
Future studies are concerned with the ability of peritraumatic dissociation to predict the development of PTSD. Limited research examines peritraumatic dissociation soon after a traumatic event—most studies have focused on studying dissociative symptoms in trauma survivors’ months or years after the traumatic event. Persistent dissociative responses have also been linked to more severe psychiatric disorders and worse symptoms of posttraumatic stress, depression, and anxiety the longer this coping pattern is endured. Thus, making a distinction on how the duration of dissociation (peritraumatic or persistent) impacts possible future PTSD symptoms still requires further investigation.