Peritraumatic dissociation as a predictor of post-traumatic stress disorder symptom severity: mediating roles of psychological inflexibility and emotional dysregulation
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Abstract
Objective: To investigate the association between peritraumatic dissociation and post-traumatic stress disorder (PTSD) symptom severity and to examine the mediating roles of psychological inflexibility and emotional dysregulation.
Methods: This cross-sectional study was conducted from February to December 2024 in psychiatric departments of public and private tertiary care hospitals and outpatient mental health facilities in Punjab, Pakistan. A total of 206 trauma-exposed adults aged 20-40 years with PTSD symptoms were recruited through purposive sampling. Data were collected using the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Acceptance and Action Questionnaire-II (AAQ-II), Difficulties in Emotion Regulation Scale-Short Form (DERS-SF), and PTSD Checklist for DSM-5 (PCL-5). Pearson correlation, regression, and mediation analyses using the PROCESS macro with bootstrapping were performed.
Results: Peritraumatic dissociation showed a moderate positive correlation with PTSD symptom severity (r=0.547, p<0.001), emotional dysregulation (r=0.408, p<0.001), and psychological inflexibility (r=0.405, p<0.001). Peritraumatic dissociation significantly predicted emotional dysregulation (β=0.407, p<0.001), psychological inflexibility (β=0.404, p<0.001), and PTSD symptoms (β=0.315, p<0.001). Emotional dysregulation (β=0.570, p<0.001) and psychological inflexibility (β=0.605, p<0.001) were independent predictors of PTSD symptom severity. Mediation analyses demonstrated significant partial mediation by emotional dysregulation (indirect effect=0.651, 95% CI: 0.428-0.892) and psychological inflexibility (indirect effect=0.686), while the direct effect of peritraumatic dissociation on PTSD symptoms remained significant.
Conclusion: Peritraumatic dissociation is significantly associated with greater PTSD symptom severity through both direct and indirect pathways. Psychological inflexibility and emotional dysregulation partially mediate this relationship, highlighting potential therapeutic targets for improving outcomes in trauma-exposed individuals.
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