Tonic Immobility and Peritraumatic Dissociation in PTSD

Report on the Relationship Between Perceived Threat, Tonic Immobility, Peritraumatic Dissociation, and Posttraumatic Stress Symptoms

Abstract

The objective of this study was to examine the mediating role of tonic immobility (TI) and peritraumatic dissociation (PD) in the relationship between perceived threat during an episode of rocket shelling and subsequent posttraumatic stress symptoms. Data were collected from 226 Israeli civilians during rocket shelling (T1) and 1 to 2 months after ceasefire (T2). Measures included the Tonic Immobility Scale, Peritraumatic Dissociative Experiences Questionnaire, and PTSD Checklist for DSM-5. Four mediation models were applied for each posttraumatic stress symptom cluster. The results showed that a significant proportion of participants developed posttraumatic stress disorder (PTSD) symptoms at the time of follow-up (18.8%). Both TI and PD fully mediated the relationship between perceived threat and symptoms of intrusion, avoidance, and negative alterations in mood and cognition. However, only PD mediated the relationship with alterations in arousal and reactivity. These findings suggest that TI and PD may serve as mechanisms underlying the link between individuals’ appraisals of threat during the peritraumatic phase and subsequent PTSD symptomatology.

Introduction

Trauma can lead to various psychological reactions, including tonic immobility (TI) and peritraumatic dissociation (PD). These reactions are commonly associated with psychopathology following trauma. Understanding the relationship between perceived threat during traumatic events and subsequent posttraumatic stress symptoms is crucial for developing effective interventions. The present study aimed to investigate whether TI and PD mediate the relationship between perceived threat during an episode of rocket shelling and posttraumatic stress symptoms.

Methods

A prospective study was conducted among 226 Israeli civilians. Data were collected during rocket shelling (T1) and 1 to 2 months after ceasefire (T2). Participants completed measures including the Tonic Immobility Scale, Peritraumatic Dissociative Experiences Questionnaire, and PTSD Checklist for DSM-5. Four mediation models were applied for each posttraumatic stress symptom cluster.

Results

The results showed that a substantial proportion of participants had developed posttraumatic stress disorder (PTSD) symptoms at the time of follow-up (18.8%). Both TI and PD fully mediated the relationship between perceived threat and symptoms of intrusion, avoidance, and negative alterations in mood and cognition. However, only PD mediated the relationship with alterations in arousal and reactivity.

Discussion

These findings suggest that TI and PD may serve as mechanisms underlying the link between individuals’ appraisals of threat during the peritraumatic phase and subsequent PTSD symptomatology. It is important to note that further research is needed to replicate these findings and explore the association between PD and arousal and reactivity symptoms in more depth.

Conclusion

This study contributes to our understanding of the relationship between perceived threat, TI, PD, and posttraumatic stress symptoms. The findings highlight the importance of considering these factors when assessing and treating individuals who have experienced trauma. Future research should aim to replicate these findings and further explore the multifaceted nature of the association between PD and arousal and reactivity symptoms.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; 2013.
2. Ozer EJ, Best SR, Lipsey TL, et al. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Trauma. 2008;S(1):3–36.
3. Bovin MJ, Ratchford E, Marx BP. Peritraumatic dissociation and tonic immobility: clinical findings. In: Lanius UF, Paulsen SL, Corrigan FM, eds. Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self. Springer Publishing Company; 2014:51–67.
4. Hetzel-Riggin MD, Roby RP. Trauma type and gender effects on PTSD, general distress, and peritraumatic dissociation. J Loss Trauma. 2013;18(1):41–53.
5. Gallup GG. Tonic immobility: the role of fear and predation. Psychol Rec. 1977;27(S1):41–61.
6. Marx BP, Forsyth JP, Gallup GG, et al. Tonic immobility as an evolved predator defense: implications for sexual assault survivors. Clin Psychol. 2008;15(1):74–90.
7. Hagenaars MA. Tonic immobility and PTSD in a large community sample. J Exp Psychopathol. 2016;7(2):246–260.
8. Abrams MP, Carleton RN, Asmundson GJG. Tonic immobility does not uniquely predict posttraumatic stress symptom severity. Psychol Trauma. 2012;4(3):278–284.
9. Forsyth JP, Marx B, Fuse TMK, et al. The Tonic Immobility Scale—Adult Form. Department of Psychology, SUNY; 2000.
10. Marmar CR, Weiss DS, Metzler TJ. The Peritraumatic Dissociative Experiences Questionnaire. In: Wilson JP, Keane TM, eds. Assessing Psychological Trauma and PTSD. Guilford Press; 1997:412–428.
11. Weathers F, Litz B, Keane T, et al. The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD; 2013.
12. Hayes AF. PROCESS: A versatile computational tool for observed variable moderation, mediation, and conditional process modeling. http://www.afhayes.com/public/process2012.pdf. Published 2012.
13. World Health Organization. Global Status Report on Violence Prevention. 2014. https://www.who.int/publications/i/item/9789241564793

SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 5: Gender Equality
• SDG 16: Peace, Justice, and Strong Institutions

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
• SDG 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation.
• SDG 16.1: Significantly reduce all forms of violence and related death rates everywhere.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Peritraumatic Dissociative Experiences Questionnaire (PDEQ): This questionnaire measures peritraumatic dissociation, which is relevant to SDG 3.4 as it assesses mental health and well-being.
• Tonic Immobility Scale (TIS): This scale measures tonic immobility, which is associated with trauma and violence, addressing SDG 5.2 and SDG 16.1.
• PTSD Checklist for DSM-5 (PCL-5): This checklist measures posttraumatic stress symptoms, which are relevant to SDG 3.4 and SDG 16.1 as they relate to mental health and violence.

Table: SDGs, Targets, and Indicators

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Source: psychiatrist.com

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