Understanding Peritraumatic Dissociation

184 Pages·2017·1.52 MB·English

Antioch University
AURA - Antioch University Repository and Archive
Student & Alumni Scholarship, including
Dissertations & Theses
Dissertations & Theses
2014
Understanding Peritraumatic Dissociation:
Evolution-Prepared Dissociation, Tonic
Immobility, and Clinical Dissociation
Laura A. Halvorsen
Antioch University - New England
Follow this and additional works at:http://aura.antioch.edu/etds
Part of theClinical Psychology Commons
Recommended Citation
Halvorsen, Laura A., "Understanding Peritraumatic Dissociation: Evolution-Prepared Dissociation, Tonic Immobility, and Clinical
Dissociation" (2014).Dissertations & Theses. 88.
http://aura.antioch.edu/etds/88
This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch
University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch
University Repository and Archive. For more information, please [email protected], [email protected].
Understanding Peritraumatic Dissociation:
Evolution-Prepared Dissociation, Tonic Immobility, and Clinical Dissociation

by
Laura Halvorsen

B.A., Hamilton College, 2009
M.S., Antioch University New England, 2012

DISSERTATION

Submitted in partial fulfillment for the degree of
Doctor of Psychology in the Department of Clinical Psychology
at Antioch University New England, 2013

Keene, New Hampshire
UNDERSTANDING PERITRAUMATIC DISSOCIATION i i

DDISeSpEaRrtTmAeTnItO oNf CClOinMicMal IPTsTyEchEo PloAgGy E

UNDERSTTAhNeD uINndGe PrEsiRgInTeRdA hUaMveA eTxIaCm DiInSeSdO tChIeA TdiIsOsNer: tEaVtiOoLnU eTnItOitNle-dP:R EPARED
DISSOCIATION, TONIC IMMOBILITY, AND CLINICAL DISSOCIATION

presented on November 14, 2013

Laura Hbayl vorsen
Candidate for the degree of Doctor of Psychology
and hereby certify that it is accepted*.

Dissertation Committee Chairperson:
Victor Pantesco, EdD
Dissertation Committee members:
Barbara Belcher-Timme, PsyD
Amanda Hitchings, PsyD

Accepted by the
Department of Clinical Psychology Chairperson
Kathi A1. 1B/o1r4de/n1,3 P hD

on
* Signatures are on file with the Registrar’s Office at Antioch University New England.
UNDERSTANDING PERITRAUMATIC DISSOCIATION i i i
Acknowledgements
I would like to express my gratitude to the following people for their contributions to this
project and to my journey for the past four years.
Firstly, to my dissertation committee, Amanda Hitchings, Barbara Belcher-Timme, and
Victor Pantesco, for seeing me through with care, patience, thoughtfulness, and good humor.
And to faculty members who have made an enduring imprint on my mind and heart:
To Victor Pantesco, for holding the key through the light and dark. For staying, not
judging, challenging the chatter, and celebrating the passage.
To Colby Smith, for your presence and spirited play, and gentle but persistent
encouragement in dreaming myself up.
To Marti Straus, my loving and steadfast co-pilot. For not letting me climb the mountain
alone.
To my parents, for their unending love and support. I love you.
And finally, to all those friends, family, and faculty who have supported me over these
last four years. You are too many to list, but the gift of your presences was instrumental in
helping me make a heartfelt home in Antioch and in myself, guiding me through the riptides and
holding trust in the worlds to be seen that I could not always see. I am so grateful to each of you
for bearing witness to my journey.
UNDERSTANDING PERITRAUMATIC DISSOCIATION i v
Table of Contents

Acknowledgements ........................................................................................................................ iii
List of Tables .................................................................................................................................. ix
List of Figures ................................................................................................................................. x
Abstract ........................................................................................................................................... 1
Chapter 1: Statement of the Problem .............................................................................................. 2
Proposed Theory and Study ........................................................................................................ 4
Chapter 2: Review of the Literature ................................................................................................ 6
Historical Themes and Current Controversy in the Study of Dissociation ................................. 6
Janet and Freud ....................................................................................................................... 6
Taxon and continuum models of dissociation ......................................................................... 9
Hypnotic Susceptibility ............................................................................................................. 12
Absorption................................................................................................................................. 14
Definitions of Peritraumatic Dissociation ................................................................................. 16
Post-Traumatic Stress Disorder and Acute Stress Disorder ...................................................... 18
Delayed Post-Traumatic Stress Disorder .................................................................................. 20
Risk Factors for Post-Traumatic Stress Disorder ...................................................................... 21
Traumatic Stress and Resilience ............................................................................................... 22
Correlation Between Peritraumatic Dissociation and Posttraumatic Symptoms ...................... 23
Contribution of Persisting Dissociation to Posttraumatic Symptoms ....................................... 28
Taxonomies of Dissociative Experiences ................................................................................. 30
Detachment ........................................................................................................................... 32
Compartmentalization ........................................................................................................... 32
UNDERSTANDING PERITRAUMATIC DISSOCIATION v
Methodological and Measurement Limitations in Current Research of Peritraumatic
Dissociation............................................................................................................................... 34
Operationalization ................................................................................................................. 34
Distinguishing between peritraumatic and persisting dissociation ....................................... 35
Limitations of dissociation measures .................................................................................... 35
Measurement of confounding variables ................................................................................ 36
Retrospective overendorsement ............................................................................................ 37
Limitations of Retrospective Reporting .................................................................................... 37
Peritraumatic Dissociation and Potential Underlying Defensive Subsystems .......................... 39
Summary ................................................................................................................................... 41
Chapter 3: Theory of Peritraumatic Dissociation Clusters ........................................................... 43
Overview of Theory .................................................................................................................. 43
Cluster Definitions and Characteristics .................................................................................... 43
Evolution-prepared dissociation ........................................................................................... 43
Tonic immobility ................................................................................................................... 44
Clinical dissociation .............................................................................................................. 46
Phenomenological Differences ................................................................................................. 47
Evolution-prepared dissociation ........................................................................................... 47
Tonic immobility ................................................................................................................... 48
Clinical dissociation .............................................................................................................. 50
Neurobiological Differences ..................................................................................................... 54
Evolution-prepared dissociation ........................................................................................... 54
Tonic immobility ................................................................................................................... 56
UNDERSTANDING PERITRAUMATIC DISSOCIATION v i
Clinical dissociation .............................................................................................................. 57
Evolutionary or Adaptive Differences ...................................................................................... 60
General principles of evolution ............................................................................................. 60
Evolution-prepared dissociation ........................................................................................... 62
Tonic immobility ................................................................................................................... 63
Clinical dissociation .............................................................................................................. 63
Factors that Influence the Experience and Type of Peritraumatic Dissociation ....................... 66
The nature of the traumatic event ......................................................................................... 66
Age ........................................................................................................................................ 68
Frequency and repetition....................................................................................................... 69
Differential Risk for Posttraumatic Symptomatology and Sequelae ........................................ 70
Persisting dissociation ........................................................................................................... 70
Post-Traumatic Stress Disorder............................................................................................. 71
Dissociative subtype of PTSD .............................................................................................. 74
Summary of Theory .................................................................................................................. 76
Chapter 4: Application of the Theory ........................................................................................... 80
Examples of Evolution-Prepared Dissociation ......................................................................... 80
Examples of Tonic Immobility ................................................................................................. 86
Examples of Clinical Dissociation ............................................................................................ 89
Summary ................................................................................................................................... 96
Chapter 5: Research Design .......................................................................................................... 99
Proposed Study Procedure ........................................................................................................ 99
Participant Recruitment ............................................................................................................ 99
UNDERSTANDING PERITRAUMATIC DISSOCIATION v i i
Ethical Considerations ............................................................................................................ 101
Time Discriminants of Peritraumatic Dissociation ................................................................. 101
Measures ................................................................................................................................. 101
Peritraumatic Dissociative Experiences Questionnaire (PDEQ) ........................................ 105
Tonic Immobility Questionnaire (TIQ) ............................................................................... 106
Clinician-Administered Dissociative States Scale (CADSS) ............................................. 106
Somatoform Dissociation Questionnaire—Peritraumatic (SDQ—P) ................................. 107
Multiscale Dissociation Inventory (MDI) ........................................................................... 107
Dixon’s Depersonalization Questionnaire (DDQ) .............................................................. 108
Traumatic Experiences Checklist (TEC) ........................................................................... 109
Statistical Analysis .................................................................................................................. 109
Exploratory factor analysis .................................................................................................. 111
Calculating composite variables and rationale ....................................................................118
Cluster analysis ................................................................................................................... 120
Multiple regression ............................................................................................................. 131
Evaluation of Results and Discussion ..................................................................................... 134
Chapter 6: Summary and Discussion .......................................................................................... 138
Summary and Relationship Between Theory and Research Design ....................................... 138
Implications............................................................................................................................. 139
Limitations of Theory ............................................................................................................. 142
Limitations of Research Design .............................................................................................. 144
Limitations of methodology ................................................................................................ 144
Feasibility limitations.......................................................................................................... 147
UNDERSTANDING PERITRAUMATIC DISSOCIATION v i i i
Conclusion .............................................................................................................................. 149
References ................................................................................................................................... 151
UNDERSTANDING PERITRAUMATIC DISSOCIATION i x
List of Tables
Table 1. Summary of Core Differences Between Theorized Peritraumatic Dissociation
Clusters ................................................................................................................................77
Table 2. Peritraumatic Dissociation Reactions and Corresponding Measure Items ....................10 3
Table 3. Demographic Characteristics of the Sample (N = 200) .................................................110
Table 4. Correlation Matrix, Means, and Standard Deviations of Factor Analysis .....................113
Table 5. Total Variance Explained by the Extracted Factors .......................................................115
Table 6. Factor Loadings From the Rotated Factor Structure Matrix ..........................................116
Table 7. Rotated Factor Pattern Matrix for the Factor Solution ..................................................117
Table 8. Factor Correlations and Factor Alpha Coefficients (N = 200) .......................................118
Table 9. Mean and Standard Deviation of EFA-Derived Variables Included in Cluster
Analysis................................................................................................................................120
Table 10. Variables and Associated Clusters ................................................................................122
Table 11. Predicting PTSD Severity From Peritraumatic Dissociation Composite Score in
Multiple Regression Analysis ..............................................................................................134