Childhood Trauma Exposure in Posttraumatic Stress Disorder and Co-occurring Dissociative Identity Disorder

Abstract

Background: A subgroup of individuals with posttraumatic stress disorder (PTSD) report pathological dissociation resulting in a co-occurring diagnosis of dissociative identity disorder (DID). It is imperative to assess childhood maltreatment and abuse, as untreated traumatic experiences may result in worsened mental and physical health outcomes. Research has shown that those with PTSD and co-occurring DID (PTSD/DID) report higher incidences of neglect and physical, sexual, and emotional abuse in childhood than those with PTSD alone. However, it is unclear whether those with PTSD/DID experience increased levels of specific types of violence exposure and non-verbal emotional abuse than those with PTSD alone. Therefore, we examined the frequency and severity of childhood trauma exposure using the Maltreatment and Abuse Chronology of Exposure Scale (MACE). We hypothesized that individuals with PTSD/DID would have higher scores on measures of abuse, neglect, and violence as compared to those without DID.

Methods: The sample included 121 individuals with PTSD, 34 of whom had PTSD/DID. All participants were recruited from residential, partial, or outpatient psychiatric care at McLean Hospital. Participants completed the MACE as part of a battery of self-report assessments in a larger neuroimaging study. The MACE measures the incidence and extent of childhood maltreatment and trauma exposure across 52-items and 10 subscales.

Results: We conducted 11 independent samples t-tests to assess for group differences in MACE subscales and severity (Bonferroni corrected p = .0045). We found that the PTSD/DID group reported significantly higher total MACE severity scores (M = 51.94, SD = 16.95) than those with PTSD alone (M = 33.93, SD = 18.82). The PTSD/DID group reported greater experiences of sexual abuse, parental physical maltreatment, parental verbal abuse, parental nonverbal emotional abuse, physical neglect, emotional neglect, and witnessing violence to siblings compared to the PTSD group. There were no differences between PTSD and PTSD/DID in peer emotional abuse, peer physical bullying, and witnessing interparental violence. Preliminary results of the reported timing of exposure in both groups will be discussed.

Conclusion: This is the first study to systematically study group differences between those with PTSD and PTSD/DID as measured by the MACE. Our results indicate that individuals with co-occurring DID report higher levels of interpersonal abuse and maltreatment than those with PTSD alone, despite receiving the same level of care at the same hospital. These results suggest that those with varied types of childhood trauma exposure may be at higher risk for dissociative symptoms and DID, particularly if they report witnessing abuse perpetrated toward siblings or physical neglect and maltreatment. Screening and assessment practices that include the MACE may facilitate earlier diagnosis and intervention in line with expert consensus recommendations for those with PTSD/DID. Future research should further examine group differences in trauma exposure and its impact on symptomatology and health outcomes.