Dissociation and PTSD in women with a history of childhood sexual abuse: a pilot examination of a specialized inpatient unit

Women with histories of childhood sexual abuse (CSA) and co-occurring psychiatric disorders admitted to a specialized integrative inpatient unit in Israel showed that dissociative symptoms, particularly maladaptive absorption, were strongly linked to PTSD severity. In a cross-sectional phase with 108 women, all facets of dissociation correlated positively with PTSD symptoms. In a smaller treatment phase with 28 women, PTSD symptoms decreased after the program, and reductions in absorption were tied to improvements in overall PTSD and hyperarousal. The findings suggest dissociation should be a key therapeutic target, though larger controlled trials are needed.

Study at a glance

Abstract

Background Worldwide, there are relatively few specialized inpatient units dedicated to women with histories of childhood sexual abuse (CSA) and comorbid psychiatric disorders. This pilot study examined dissociation and PTSD among women admitted to such a specialized integrative inpatient unit in Israel. We conduct an in-depth analysis of the role of dissociation in these women’s clinical picture, as well as in their treatment response. Methods The study included two phases. Phase 1 used a cross-sectional design to assess the complex inter-relationships between PTSD and various facets of dissociation in women with CSA histories admitted to a specialized inpatient unit ( N = 108). Phase 2 focused on a sub-sample of participants (N = 28) who completed the inpatient program and completed admission and discharge assessments. Measures included the PTSD Checklist for DSM-5 (PCL-5) and the Dissociative Experiences Scale (DES-II). Results In Phase 1, dissociative symptoms were positively correlated with overall PTSD severity and all PTSD symptom clusters, with the dissociative sub-measure of Absorption showing the strongest associations. In Phase 2, PTSD symptoms significantly decreased following treatment. In line with phase 1, reductions in Absorption were associated with improvements in overall PTSD severity and specifically in Hyperarousal symptoms. Conclusions Findings from this pilot study indicate the therapeutic potential of a specialized integrated inpatient unit for women with CSA histories. Importantly, our results indicate that dissociation should be regarded as a major therapeutic target, most notably patients’ tendency for maladaptive absorption. These preliminary results should be expanded upon in larger, controlled clinical trials, further elucidating the role of dissociation and other mechanisms of change in similar units.