Traumatic stress after severe injury: The role of peritraumatic dissociation, threat appraisals, and attributional style.

Abstract

Traumatic stress has been recognized as a frequent consequence of severe bodily injury. Symptoms have been shown to persist for years, often developing into Post-Traumatic Stress Disorder (PTSD), which limits functional recovery from injury. Trauma victims' perceptions during a traumatic event, especially their subjective assessment of threat to life and the degree to which they experience peritraumatic dissociation (PD) contribute to long-term symptoms of traumatic stress, regardless of injury severity. PD is characterized by depersonalization, derealization, stupor, and amnesia during a traumatic incident. In addition, an externally oriented attributional style, counterfactual thinking, and the tendency to blame others for one's misfortunes have been shown to be associated with poor coping abilities. This longitudinal study of 154 trauma patients examined the effects of these factors on psychosocial well being in the year following an injury severe enough to require hospital admission. Patients were assessed in the hospital as soon as possible after admission with a semi-structured interview, and again at one, six, and twelve months post-injury with mail-in self-reports. The assessments included two scales written for this study, the Michigan Critical Event Perceptions Scale (MCEPS), a measure of PD, and the External Control Scale (ECS), a measure of attributions, blaming, and counterfactual thinking. Other measures used included the Brief Symptom Inventory (BSI), the Impact of Event Scale (IES), the Dissociative Experiences Scale (DES), and the Revised Civilian Mississippi Scale for PTSD. Sixty patients (39%) experienced peritraumatic dissociation (PD). Fifty-two patients (34%) had diagnostic-level symptoms of PTSD at six months post-injury, and 31 (20%) had PTSD at twelve months. Patients with PD were more likely to develop PTSD at six months than those without, and were 5.28 times more likely to have PTSD at twelve months post-injury. Of those with PD, patients who also had high ECS scores were more likely to have PTSD at six months than patients with PD alone. Trauma patients were studied for one year post-injury. PD and external attributional style had additive effects of the incidence of long-term traumatic stress.