Complex posttraumatic stress disorder (Complex PTSD), also known as Disorders of Extreme Stress, Not Otherwise Specified (DESNOS; Herman, 1992a), refers to associated features of PTSD listed in the fourth text edition of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV,TR), where symptoms include affect dysregulation, dissociation, psychosomatic complaints, impaired sense of self and relationships with others (Van der Kolk et al., 1996). Complex PTSD / DESNOS symptoms have important implications for outcomes of trauma treatment but are rarely assessed, because comorbid conditions are a typical exclusion criteria for PTSD treatment efficacy studies. The main purpose of the current study was to demonstrate convergent and concurrent validity for DESNOS using the self-report version of the Structured Interview for Disorders of Extreme Stress (SIDES-SR; Pelcovitz et al., 1997) with an ethnically diverse sample of 54 mothers who have been exposed to a diverse range of traumas. Convergent validity was established for the Affect Dysregulation and Dissociation / Amnesia domains of SIDES-SR. Concurrent validity was demonstrated by the significant association of DESNOS symptom severity with the cumulative exposure to interpersonal trauma and not with exposure to non-interpersonal types of trauma. Suprisingly, dissociation was not uniquely associated with cumulative interpersonal trauma. The secondary goal was to further the clinical relevance of DESNOS by testing the hypothesis that DESNOS symptom severity would predict intrusive and hostile caregiving, as measured by the Emotional Availability Scales (EAS; Biringen, 2008), and would mediate any observed relationship between cumulative interpersonal trauma exposure and these negative caregiving behaviors (n = 52). While DESNOS was related to negative caregiving, DESNOS did not predict negative caregiving above and beyond cumulative interpersonal trauma, suggesting that negative caregiving is better accounted for by cumulative interpersonal trauma history than by DESNOS.
Overall, results support the use of SIDES-SR as a clinical tool in trauma assessment with community samples of adult women and substantiates DESNOS as a valid and clinically useful framework to understand the long-term impact of complex trauma. Clinical implications of findings and suggestions for future research are discussed.
|Commitee:||Padron, Elena, Porter, Natalie|
|School:||Alliant International University|
|Department:||San Francisco, CSPP|
|School Location:||United States -- California|
|Source:||DAI-B 73/12(E), Dissertation Abstracts International|
|Subjects:||Mental health, Clinical psychology|
|Keywords:||Caregiving, Cumulative trauma, Emotional availability, Interpersonal trauma, Posttraumatic stress disorder|
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