At the core of relational vs. non-relational post-traumatic stress disorders: Distinct profiles of dissociative and emotion regulation mechanisms

Background: Theoretical and clinical models have suggested a distinction between post-traumatic stress disorder (PTSD) due to relational (e.g., sexual and physical violence; PTSD-R) and non-relational (e.g., natural disasters, accidents; PTSD-NR) traumatic experiences. A further differentiation exists between Disorders of Extreme Stress Not Otherwise Specified (DESNOS) and complex PTSD (CPTSD) from "simple" PTSD. On the one hand, dissociation and alterations of emotion regulation (ER) processes play a key role in these conditions. On the other hand, there are no studies that have clarified how these mechanisms might be differentially involved in CPTSD/DESNOS, PTSD-R and PTSD-NR. Methods: A multilevel meta-analysis was conducted of studies evaluating the associations between dissociation, adaptive and maladaptive ER processes with clinical features of CPTSD/DESNOS, PTSD-R and PTSD-NR. Comparisons among effect sizes of dissociation and ER processes were conducted within and between groups. Results: A total of 189 studies (i.e. , cptsd/desnos: N = 48; PTSD-R: N = 71; PTSD-NR: N = 70) were included. Dissociation emerged as a key psychopathological dimension for both CPTSD/DESNOS and PTSD-R. In the PTSD-NR group, aversive cognitive perseveration mechanisms showed a larger pooled effect size than dissociation. CPTSD/DESNOS, PTSD-R and PTSD-R groups were quantitatively distinguishable based on their levels of dissociation and deficits in adaptive ER. Conclusions: These findings support the diagnostic differentiation between CPTSD, PTSD-R, and PTSD-NR, based on the specific impacts of dissociation and ER. Furthermore, this evidence suggests the need for tailored treatment approaches for these trauma-related conditions, specifically designed to target underlying dissociation and ER mechanisms.