The impact of peritraumatic dissociation on mental health outcomes of women with childhood and adult physical abuse histories

Physical abuse, experienced both as a child or an adult, has been shown to have many short- and long-term negative consequences, including poorer mental health outcomes (i.e., Coker et al., 2002; Kolko, 1996). Researchers have focused their attention on revictimization, or when a victim of one type of interpersonal violence experiences a second form of violence. A wealth of knowledge now exists showing how experiencing one form of interpersonal violence increases the risk of experiencing that violent act again (Littleton and Grills-Taquechel, 2011) as well as other forms of violence (Hetzel and McCanne, 2005). In addition, experiencing multiple violent acts increases the risk for a host of mental health issues (Fritz, Dlep, and O'Leary, 2012). One reason for this may be that the victim is engaging in peritraumatic dissociation (Marmar et al., 1994). Peritraumatic dissociation is a strong predictor of posttraumatic stress disorder (PTSD) and seems to be associated with increased risk for other mental health issues and revictimization (Hetzel and McCanne, 2005). However, the field has yet to extensively study the interaction between physical abuse revictimization and peritraumatic dissociation on mental health outcomes. The purpose of the present study is to examine the independent and interactive effects of childhood physical abuse (CPA), adult physical abuse (APA), and peritraumatic dissociation (PD) on long-term mental health outcomes. A total of 2,525 college women (mean age = 18.9, SD = 2.6) were assessed in return for course credit. Trained, female graduate and undergraduate students screened women over a two-hour period in groups of 20-25. As part of a larger battery of questionnaires, the participants completed questionnaires assessing CPA, APA, PD, PTSD, depression, general psychopathology, and chronic stressors. Participants were coded as CPA present (n = 379) and absent (n = 2,115), APA present (n = 425) and absent (n = 2,069), and high (n = 1,257) and low (n = 1,237) PD based on a median split procedure (median = 18.0). The presence of CPA and APA led to significant increases in PTSD, depression, general psychopathology, and chronic stressors. PD had a strong, negative independent impact on all mental health outcomes, but not on chronic stressors. The effect of APA on PTSD was moderated by PD, while three-way interactions among CPA, APA, and PD were found for depression and general psychopathology outcomes where the combination of both forms of physical abuse and PD lead to very negative mental health outcomes. The results add to the literature by showing that engaging in peritraumatic dissociation worsens the mental health effects of physical abuse revictimization but has a different effect on the experience of chronic stressors. By integrating these results with information-processing models of revictimization (Littleton and Grills-Taquechel, 2011), these results show that prevention efforts should focus on decreasing the likelihood of engaging in peritraumatic dissociation during abuse experiences in order to minimize the negative consequences of physical abuse, particularly in those at risk for revictimization.