FLUIDOS DE LIMPIEZA

Peritraumatic Dissociation

(Peritraumatic Dissociative Experiences Questionnaire: PDEQ)

Peritraumatic dissociation was measured using the self-report PDEQ (N=29). Each item is rated on a 1-5 scale as follows: 1 = Not at all true, 2 = Slightly true, 3 = Somewhat true, 4 = Very true, and 5 = Extremely true. There are 10-items and the minimum score is 0 and the maximum score is 50. The mean score was 37.0 (SD=4.63) and the range o f scores was 16-48. Participants scored highly across all items.

Peritraumatic dissociation and emotional processing:

Previous researeh has shown intense peritraumatic helplessness to be associated with higher dissociation (Brewin et al, 1998). As hypothesised, helplessness was rated highly by drug-rape participants. However, PDEQ seore was not significantly correlated with peritraumatic helplessness (r = 0.005, p = 0.979), fear (r = -0.213, p = 0.277) or horror (r = -0.074, p = 0.709). PDEQ was also not signifieantly correlated with post-traumatic emotional intensity (p>0.05).

Comparison with published PDEQ scores

The PDEQ scores for the drug-rape participants were eompared with raw PDEQ data for non-drug sexual assault survivors (Griffin et al, 1997). In order to do this, the data was recoded from a 1-5 into a 0-4 seale as used by Griffin et al. In addition, Griffin et al (1997) used only 7 items of the PDEQ, rather than all 10 items so the eorresponding 7 items were compared. The mean score for these 7 items correlated very highly with the

10-item scale (r = 0.95, p < 0.001).

Table 15: Drug rape and non-drug rape PDEQ Scores Group (Drug or non drug) PDEQ Mean (SD)

Drug Rape 19.00 (4.74) Non-drug sexual assault 10.42 (5.47)

t-value (p-value) t (155) = 7.8, p < 0.001

Mean PDEQ score for ‘non-drug’ rape survivors was significantly lower than for the drug-rape group (table 15). This supports the hypothesis that drug-rape survivors would report higher levels o f peritraumatie dissociation than non-drug trauma populations. It also implies that the psychopharmacological effects o f benzodiazepines and GHB may offer a model for a drug-induced dissociative state. The PDEQ score distributions for

d ru g -rap e su rv iv o rs (N = 29) and G riffin et a f s sexual assa u lt p artic ip a n ts (N = 1 3 7 ) are illu strated in th e fig u re 8.

Figure 8:

Bar chart of PDEQ score distribution (by %) compared with Griffin ct al (1997)

Per cen t Group □ Rape N = 137 O Drug rape N = 29 12 15 18 21 24 27

Mean total PDEQ Score (X/28)

C o m p ariso n o f P D E Q scores for individual item s w as m ad e b etw een the tw o groups. T he m ean item and total P D E Q scores are illu strated in figure 9.

T -test an a ly sis sh o w ed that d ru g -rap e P D E Q scores w ere sig n ifican tly h ig h er than the no n -d ru g gro u p fo r all item s (p<0.01 in all cases) ex cep t item 3 (tim e ch an g es) fo r w hich there w as no sig n ifican t d iffe ren c e (t (1 5 5 ) = 0.922, p = 0.358). Interestingly, item 5 ('S p e c ta to r’) w as sig n ifican tly h ig h er for d ru g -rap e su rv iv o rs (t (155) = 2 .8 8 5 , p = 0.004). T h is su g g ests that d e p e rso n a lisa tio n occun*ed to a g re ater ex ten t as w ell as d erealisatio n (sp acin g out, memoiy^ gaps, con fu sio n ).

Figure 9:

Bar chart o f mean PDEQ item & total scores: Drug-rape & non-drug participants:

20 18 16 14 12 10 8

6

PDEQ item (of items 1 - 1 0 )

1.76 „ 1 , 6 3 2.86 ).51 10.42 _{□ ; D rug} ® 'N o n -D ru g 8 Total Score

Post-traumatic appraisals: Post-Traumatic Cognitions Inventory (PTCI)

The Post-Traumatic Cognitions Inventory is a 33-item scale that yields a total maximum score o f 231. A higher score represents a higher degree o f negative appraisals and cognitions. Each item is rated on a 1-7 Likert scale where 1 = totally disagree, 4 = neutral and 7 = agree totally. The questionnaire also gives scores for the following sub­ scales:

4. Negative cognitions about self (N=21, maximum score = 147) 5. Negative cognitions about the world (N=7, maximum score = 49) 6. Self-blame (N=5, maximum score = 35)

Table 16: PTCI scores for drug-rape survivors

PTCI Scale Mean total (SD)

Total 133.22 (36.95)

Self-blame 19.78 (7.55)

Negative cognitions re: self 77.89 (8.51)

Negative eognitions re: world 35.56 (8.51)

Posttraumatic appraisals and emotional processing: fear

It was hypothesised that negative posttraumatic cognitive appraisals would be associated with intense posttraumatic affect. PTCI score shared a similar relationship with fear as PTSD severity. It was negatively associated with fear at the time o f the assault (r = - 0.466, p = 0.012), but positively eorrelated with fear post-trauma (r = 0.375, p = 0.04). Furthermore, negative appraisals were positively eorrelated with the level o f distress associated with intrusive memories (r = 0.373, p = 0.05). In summary, impaired fear response during the trauma was associated with higher negative appraisals, distress, fear and PTSD post-trauma.

O f the evaluative emotions, guilt was very significantly associated with the extent o f negative appraisals (r = 0.501, p = 0.008), but was not signifieantly related to PTSD severity. Anger and shame were not significantly associated with PTCI score (p >0.05), but this could reflect the questions asked in the PTCI, rather than the lack o f a relationship.

Comparison with published PTCI scores

Foa et al (1999) have published the only psychometric data for the PTCI. They investigated PTCI scores for individuals who had experienced a Criterion A trauma but did not have PTSD (N=185), those with PTSD (N=170) and those who had not experieneed any trauma (N=162). This ineluded a range o f traumas, ineluding sexual

assault (N=25) and violent assault. Table 17 shows the median scores for individual items on the PTCI for drug-rape survivors as compared with published norms. The data is split into two groups:

1. Those who scored <15 on the PTDS (predictive o f PTSD diagnosis) 2. Those who scored >15

Table 17:

Median PTCI scores by PTSD diagnosis: Comparison with Foa et al (1999) Foa et al (1999)N= 162 Foa et al (1999) N = 185 Drug Rape N = 4 Foa et al (1999) N=170 Drug-rape N = 23 PTCI No Trauma Trauma,

no PTSD No PTSD (PDS<15) PTSD PTSD (PDS > 15) Self 1.08 (0.76) 1.05 (0.65; 1.43 (127) 3.6 (7.4,^ 3.86 (1.06) World 2.07 (L43) 1.43 (2.45; 3.71 (167) 5.0 (7.25; 5.29 (1.04) Blame 1.00 (F45) 1.45 (7.00) 2.20 (0.90) 3.2 (A 74; 4.20 (1.49) Total 45.5 (34.74) 49.0 (25.5^ 74.50 (37.33) 133.0 (44.7); 138.0 (29.2)

Drug-rape survivors who scored >15 for PTSD severity on the Post-Traumatic Diagnostic Scale showed comparable, but slightly higher, scores on the PTCI to Foa et aPs ‘non drug-rape’ sample o f traumatised individuals. This data suggests that survivors o f drug-rape show higher scores for negative appraisals than other non-PTSD populations and show a similar severity and pattern o f negative post-traumatic appraisals to other PTSD populations. This was with the exception that negative cognitions about the world (e.g. safety) were somewhat higher for the drug-rape population.

Pre-trauma mental health status and post-trauma counselling:

Relationship with PTSD, PTCI and PDEQ scores

Pre-assault mental health problems: As anticipated, PTSD severity was significantly higher for participants who reported having experienced mental health difficulties (depression and anxiety) prior to the assault (table 18), but there was no difference for peritraumatic dissociation, depression, anxiety or post-traumatic appraisals.

Table 18:

Relationship between Mental Health and PTSD, HADS, PDEQ, and PTCI No prior mental health

problems (N=9)

Prior mental health problems (N=20) Statistical analysis (t-test) Mean (SD) Mean (SD) t. d.f. _P- PTSD 23.20(10.37) 31.33 (7.22) 2.136 27 0.042 PTCI 127.53 (37.70) 146.75 (33.40) 1.248 25 0.224 PDEQ 36.16(4.62) 38.77 (4.35) 1.426 26 0.166 HADS-A 19.94 (3.52) 21.0 (4.55) 0.673 26 0.507 HADS-D 14.63 (3.42) 17.44 (3.84) 1.955 26 0.061

Psvchological therapv/ counselling: Frequency (none, weekly, fortnightly, monthly, occasional) o f counselling/ psychological therapy was not significantly related to severity o f PTSD symptoms (r = -0.082, p = 0.674). In addition, there was no significant difference in mean severity score in relation to whether therapy was ongoing, t (27) = 0.131, p = 0.897. This was also the case for PTCI score and frequency o f counselling (r = -0.155, p = 0.440) and whether counselling is ongoing (t (25) = 0.999, p = 0.327).