조현병 환자의 아동기 외상 유형과 외상 후 스트레스 증상의 관계: 해리 증상의 매개효과
Childhood Trauma Type and PTSS among Patients with Schizophrenia: Mediating Effect of Dissociative Symptoms
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본 연구는 조현병 환자의 아동기 외상 유형(정서적 학대, 신체적 학대, 성적 학대, 정서적 방임, 신체적 방임, 목격)에 따른 외상 후 스트레스 증상에 미치는 영향과 해리 증상의 매개효과를 확인하고자 하였으며, 아동기 외상의 각 유형과 외상 후 스트레스 증상과의 관계에서 해리 증상이 정적으로 매개할 것이라 가정하였다. 한양대학교 구리병원 정신건강의학과에서 조현병 진단을 받은 외래 환자와 입원 환자를 대상으로 진행된 외상연구의 자료를 사용하였으며, 총 94명을 대상으로 아동기 외상설문지(Childhood Trauma Questionnaire), 사건충격척도-개정판(Impact of Events Scale-Revised), 해리 경험 척도(Dissociative Experiences Scale-Taxon), 외상경력 설문지(Trauma Antecedents Questionnaire)를 실시하였다. 연구 결과, 아동기 외상 유형에 따라 해리 증상을 예측하는 정도가 상이하게 나타났다. 아울러 정서적 학대와 외상 후 스트레스 증상의 관계에서 해리 경험의 매개효과가 정적으로 유의하였고, 직접경로는 유의하지 않아 완전매개가 시사되었다. 또한 목격과 외상 후 스트레스 증상의 직접경로가 정적으로 유의하였다. 연구 결과를 바탕으로 시사점과 후속 연구에 대해 논의하였다.
Abstract
This study aimed to explore the effects of childhood trauma type on PTSS(Post-traumatic Stress Symptoms) and the role of a mediation of dissociative symptoms. Specifically, it was assumed that the relationship between type of childhood trauma and PTSS would be mediated by the dissociative symptoms. Data were collected from outpatients and inpatients with schizophrenia in the psychiatry department at Hanyang University Guri Hospital. A total of 94 patients participated in completing Childhood Trauma Questionnaire, Impact of Events Scale-Revised, Dissociative Experiences Scale-Taxon, Trauma Antecedents Questionnaire. The result indicated that dissociative symptoms positively mediated the relationship between EA and PTSS. The direct effect of dissociative symptoms and PTSS was not significant, suggesting that the fully mediating effect exists. The direct effect of Witness and PTSS was positive significant. Implications for future studies are discussed.
참고문헌 (109)
- 김남희, "복합적 외상후 스트레스 장애의 안구운동 민감소실 및 재처리 요법을 이용한 치료-증례보고", 대한불안의학회지, 2(2), pp.142~146 (2006)
- 김동주, "정신건강의학과 환자에서 아동기 외상과 외상 연구 참여 관련 불편감", 박사, pp.2021
- 김은정, "아동기 외상과 초기 성인기 우울수준과의 관계: 초기부적응도식과 정서표현양가성 및 회피대처방식의 매개효과", 한국심리학회지: 상담 및 심리치료, 22(3), pp.605~630 (2010), 한국상담심리학회
- 김정란, "청소년기 자녀의 가정폭력 노출과 심리사회적 부적응중학생 자녀의 아내학대 목격과 자녀학대 피해를 중심으로", 가정과삶의질연구, 21(5), pp.171~180 (2003), 가정과삶의질학회
- 라영선, "정서적 학대와 복합 PTSD 경향성의 관계: 용서의 조절효과를 중심으로", 한국심리학회 학술대회 자료집, 2009(1), pp.180~181 (2009)
- 은헌정, "한국판 사건충격척도 수정판의 신뢰도 및 타당도 연구", 신경정신의학, 44(3), pp.303~310 (2005), 대한신경정신의학회
- 이정식, "대학생에서 해리와 NEOPI-R 로 측정한 성격특성과의 관계", 정신병리학, 18(1), pp.47~56 (2009)
- 주아란, "아동·청소년기 부모 간 폭력 목격 경험이 성인의 데이트 폭력 가해 행동에 미치는 영향", 석사, pp.2019
- 최지원, "아동의 정서적 학대 및 방임경험과 자기 통제력 간의 관계 : 사회적 지지의 조절효과를 중심으로", 석사, 아동·청소년학과 아동·청소년상담및임상심리전공, pp.2014
- Ackner, S., "Emotional abuse and psychosis: a recent review of the literature", Journal of Aggression, Maltreatment & Trauma, 22(9), pp.1032~1049 (2013)
- Allen, J. G., "Coping with trauma: A guide to self-understanding", American Psychiatric Association, ~ (1995)
- Allen, J. G., "Dissociation and vulnerability to psychotic experience : The Dissociative Experiences Scale and the MMPI-2", Journal of Nervous and Mental Disease, 183(10), pp.615~622 (1995)
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders (5th ed.)", American Psychiatric Publishing, ~ (2013)
- Ashcroft, K., "Persecutory delusions and childhood emotional abuse in people with a diagnosis of schizophrenia", Psychosis, 4(2), pp.168~171 (2012)
- Banyard, V. L., "Understanding links among childhood trauma, dissociation, and women's mental health", American Journal of Orthopsychiatry, 71(3), pp.311~321 (2001)
- Baron, R. M., "The moderator-mediator variable distinction in social psychological research : Conceptual, strategic, and statistical considerations", Journal of Personality and Social Psychology, 51(6), pp.1173~1182 (1986)
- Berenbaum, H., "Psychological trauma and schizotypal personality disorder", Journal of abnormal psychology, 117(3), pp.502~519 (2008)
- Berenbaum, H., "Psychological trauma and schizotypal symptoms", Schizophrenia Bulletin, 29(1), pp.143~152 (2003)
- Bernstein, D. P., "Childhood Trauma Questionnaire : A retrospective self-report manual", The Psychological Corporation, ~ (1998)
- Bendall, S., "Childhood trauma and psychotic disorders : A systematic, critical review of the evidence", Schizophrenia Bulletin, 34(3), pp.568~579 (2008)
- Bleuler E, "Dementia Praecox or the Group of Schizophrenias" (1950), International Universities Press
- Breslau, N., "Previous exposure to trauma and PTSD effects of subsequent trauma : results from the Detroit Area Survey of Trauma", American journal of Psychiatry, 156(6), pp.902~907 (1999)
- Brown, A. L., "Guided discovery in a community of learners" (1994), The MIT Press
- Browne, A., "Impact of child sexual abuse : A review of the research", Psychological Bulletin, 99(1), pp.66~77 (1986)
- Buckley, P. F., "Psychiatric comorbidities and schizophrenia", Schizophrenia bulletin, 35(2), pp.383~402 (2009)
- Cho, Y., "Prevalence and clinical correlates of childhood trauma among inpatients diagnosed with bipolar disorder : a matched comparison with schizophrenia", Psychosis, 13(1), pp.13~23 (2020)
- Classen, C., "Trauma and dissociation", Bulletin of the Menninger Clinic, 57(2), pp.178~ (1993)
- Cloitre, M., "Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder", Journal of consulting and clinical psychology, 72(3), pp.411~ (2004)
- Cloitre, M., "A developmental approach to complex PTSD : Childhood and adult cumulative trauma as predictors of symptom complexity", Journal of traumatic stress, 22(5), pp.399~408 (2009)
- Cook, A., "Complex trauma", Psychiatric annals, 35(5), pp.390~398 (2005)
- Cui, N., "Physical abuse, emotional abuse, and neglect and childhood behavior problems: a meta-analysis of studies in mainland China", Trauma, Violence, & Abuse, 21(1), pp.206~224 (2020)
- Daalman, K., "Childhood trauma and auditory verbal hallucinations", Psychological medicine, 42(12), pp.2475~ (2012)
- Dalenberg, C. J., "Evaluation of the evidence for the trauma and fantasy models of dissociation", Psychol Bull, 138(3), pp.550~588 (2012)
- De Bellis, M. D., "Developmental traumatology : a contributory mechanism for alcohol and substance use disorders", Psychoneuroendocrinology, 27(1-2), pp.155~170 (2002)
- Dohrenwend, B. P., "The psychological risks of Vietnam for US veterans : a revisit with new data and methods", Science, 313(5789), pp.979~982 (2006)
- Evren, C., "Lifetime PTSD and quality of life among alcohol-dependent men : impact of childhood emotional abuse and dissociation", Psychiatry research, 186(1), pp.85~90 (2011)
- Feerick, M. M., "Long-term effects of witnessing marital violence for women : The contribution of childhood physical and sexual abuse", Journal of Family Violence, 14(4), pp.377~398 (1999)
- Frame, L., "Causes of posttraumatic stress disorder in psychotic patients", Archives of general psychiatry, 58(3), pp.305~306 (2001)
- Gatton, M. J., "Associations of anxiety-related symptoms with reported history of childhood sexual abuse in schizophrenia spectrum disorders", J Clin Psychiatry, 66(10), pp.1279~1284 (2005)
- Ginzburg, K., "Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors", Journal of trauma & dissociation, 7(2), pp.7~27 (2006)
- Green, B. L., "Outcomes of single versus multiple trauma exposure in a screening sample", Journal of traumatic stress, 13(2), pp.271~286 (2000)
- Haferkamp, L., "Dissociation is associated with emotional maltreatment in a sample of traumatized women with a history of child abuse", Journal of Trauma & Dissociation, 16(1), pp.86~99 (2015)
- Haugaard, J. J., "The sexual abuse of children: A comprehensive guide to current knowledge and intervention strategies" (1988), Jossey-Bass
- Hayes, A. F., "Introduction to mediation, moderation, and conditional process analysis : A regression-based approach" (2013), Guilford Press
- Heim, C., "Neurobiology of early life stress: clinical studies", Seminars in clinical neuropsychiatry, 7(2), pp.147~159 (2002)
- Herman, J. L., "Complex PTSD : A syndrome in survivors of prolonged and repeated trauma", Journal of traumatic stress, 5(3), pp.377~391 (1992)
- Hoffman, R. E., "Auditory hallucinations and dissociative identity disorder", American Journal of Psychiatry, 152(9), pp.1404~1404 (1995)
- Holowka, D. W., "Childhood abuse and dissociative symptoms in adult schizophrenia", Schizophrenia research, 60(1), pp.87~90 (2003)
- Horowitz, M., "Impact of Event Scale : A measure of subjective stress", Psychosomatic medicine, 41(3), pp.209~218 (1979)
- Juster, R. P., "A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development", Development and psychopathology, 23(3), pp.725~776 (2011)
- Karam, E. G., "Cumulative traumas and risk thresholds : 12-month PTSD in the World Mental Health(WMH)surveys", Depression and anxiety, 31(2), pp.130~142 (2014)
- Kendler, K. S., "Childhood sexual abuse and adult psychiatric and substance use disorders in women : an epidemiological and cotwin control analysis", Archives of general psychiatry, 57(10), pp.953~959 (2000)
- 김대호, "Reliability and Validity of the Korean Version of the Childhood Trauma Questionnaire-Short Form for Psychiatric Outpatients", PSYCHIATRY INVESTIGATION, 8(4), pp.305~311 (2011), 대한신경정신의학회
- Kim, D., "Psychometric properties of the Childhood Trauma Questionnaire-Short Form(CTQ-SF)in Korean patients with schizophrenia", Schizophrenia research, 144(1-3), pp.93~98 (2013)
- Kitzmann, K. M., "Child witnesses to domestic violence : a meta-analytic review", Journal of consulting and clinical psychology, 71(2), pp.339~352 (2003)
- Koola, M. M., "Prevalence of childhood physical and sexual abuse in veterans with psychiatric diagnoses", The Journal of nervous and mental disease, 201(4), pp.348~ (2013)
- Kulkarni, M. R., "Witnessing versus experiencing direct violence in childhood as correlates of adulthood PTSD", Journal of interpersonal violence, 26(6), pp.1264~1281 (2011)
- Lanius, R. A., "Emotion modulation in PTSD : Clinical and neurobiological evidence for a dissociative subtype", American Journal of Psychiatry, 167(6), pp.640~647 (2010)
- Levendosky, A. A., "PTSD symptoms in young children exposed to intimate partner violence", Violence against women, 19(2), pp.187~201 (2013)
- Lipsanen, T., "Exploring the relations between depression, somatization, dissociation and alexithymia–overlapping or independent constructs?", Psychopathology, 37(4), pp.200~206 (2004)
- Lysaker, P. H., "Associations of anxiety-related symptoms with reported history of childhood sexual abuse in schizophrenia spectrum disorders", The Journal of clinical psychiatry, 66(10), pp.1279~1284 (2005)
- McElroy, E., "Prevalence and predictors of Axis I disorders in a large sample of treatment-seeking victims of sexual abuse and incest", European journal of psychotraumatology, 7(1), pp.30686~ (2016)
- McGorry, P. D., "posttraumatic stress disorder following recent-onset psychosis : An unrecognized postpsychotic syndrome", The Journal of Nervous and Mental Disease, 179(5), pp.253~258 (1991)
- Middleton, W., "Dissociative identity disorder : An Australian series", Australian & New Zealand Journal of Psychiatry, 32(6), pp.794~804 (1998)
- Morrison, A. P., "Relationships between trauma and psychosis : A review and integration", The British Journal of Clinical Psychology, 42(4), pp.331~351 (2003)
- Moskowitz, A., "Auditory hallucinations: Psychotic symptom or dissociative experience?", Journal of Psychological Trauma, 6(2-3), pp.35~63 (2008)
- Moylan, C. A., "The effects of child abuse and exposure to domestic violence on adolescent internalizing and externalizing behavior problems", Journal of family Violence, 25(1), pp.53~63 (2010)
- Mueser, K. T., "Treating the trauma of first episode psychosis : A PTSD perspective", Journal of Mental Health, 12(2), pp.103~108 (2003)
- Mueser, K. M., "The trauma recovery group : A cognitive-behavioral program for post-traumatic stress disorder in persons with severe mental illness", Community Mental Health Journal, 43(3), pp.281~304 (2007)
- Mulder, R. T., "Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample", American Journal of Psychiatry, 155(6), pp.806~811 (1998)
- Norman, R. E., "The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis", PLoS medicine, 9(11), pp.e1001349~ (2012)
- Oh, H. Y., "Reliability and validity of the Dissociative Experiences Scale among South Korean patients with schizophrenia", Journal of Trauma & Dissociation, 16(5), pp.577~591 (2015)
- Oshri, A., "Developmental growth trajectories of self-esteem in adolescence : associations with child neglect and drug use and abuse in young adulthood", Journal of youth and adolescence, 46(1), pp.151~164 (2017)
- Özdemir, B, "Assessment of dissociation among combat-exposed soldiers with and without posttraumatic stress disorder", European journal of psychotraumatology, 6(1), pp.26657~ (2015)
- Ozer, E. J., "Predictors of posttraumatic stress disorder and symptoms in adults : a meta-analysis", Psychological bulletin, 129(1), pp.52~73 (2003)
- Perona-Garcelán, S., "A preliminary exploration of trauma, dissociation, and positive psychotic symptoms in a Spanish sample", Journal of Trauma & Dissociation, 11(3), pp.284~292 (2010)
- Rosenberg, M. S., "New directions for research on the psychological maltreatment of children", American Psychologist, 42(2), pp.166~171 (1987)
- Ross, C. A., "Childhood Abuse andthe Positive Symptoms of Schizophrenia", Psychiatric Services, 45(5), pp.489~491 (1994)
- Ross-Gower, J., "Reported sexual abuse and subsequent psychopathology among women attending psychology clinics : The mediating role of dissociation", British Journal of Clinical Psychology, 37(3), pp.313~326 (1998)
- Scheller-Gilkey, G., "Early life stress and PTSD symptoms in patients with comorbid schizophrenia and substance abuse", Schizophrenia research, 69(2-3), pp.167~174 (2004)
- Schumm, J. A., "Cumulative interpersonal traumas and social support as risk and resiliency factors in predicting PTSD and depression among inner‐city women", Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 19(6), pp.825~836 (2006)
- Schäfer, I., "Childhood trauma and dissociation in female patients with schizophrenia spectrum disorders : an exploratory study", The Journal of nervous and mental disease, 194(2), pp.135~138 (2006)
- Shaner, A., "Can schizophrenia cause posttraumatic stress disorder?", American Journal of Psychotherapy, 43(4), pp.588~597 (1989)
- Shevlin, M., "Social, familial and psychological risk factors for endocrine, nutritional and metabolic disorders in childhood and early adulthood : A birth cohort study using the Danish Registry System", Current Psychology, 38(5), pp.1297~1303 (2019)
- Shrout, P. E., "Mediation in experimental and nonexperimental studies : new procedures and recommendations", Psychological Methods, 7(4), pp.422~445 (2002)
- Steele, B. F., "Sexually abused children and their families", pp.223~234 (1987), Pergamon
- Stevens, N. R., "Emotion regulation difficulties, low social support, and interpersonal violence mediate the link between childhood abuse and posttraumatic stress symptoms", Behavior therapy, 44(1), pp.152~161 (2013)
- Soloff, P. H., "Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder", Journal of personality disorders, 16(3), pp.201~214 (2002)
- Spertus, I. L., "Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice", Child abuse & neglect, 27(11), pp.1247~1258 (2003)
- Spitzer, C., "Pathologische Dissoziation bei Patienten mit einer Borderline-Personlichkeitsstorung", Psychotherapeut, 66(4), pp.299~305 (2021)
- Spitzer, C., "Dissociative symptoms in schizophrenic patients with positive and negative symptoms", Psychopathology, 30(2), pp.67~75 (1997)
- Sugaya, L., "Child physical abuse and adult mental health : a national study", Journal of traumatic stress, 25(4), pp.384~392 (2012)
- Teicher, M. H., "The neurobiological consequences of early stress and childhood maltreatment", Neuroscience & biobehavioral reviews, 27(1-2), pp.33~44 (2003)
- Tomison, A. M., "Emotional abuse: The hidden form of maltreatment" (1997), Australian Institute of Family Studies, for National Child Protection Clearing House
- Tsai, J., "Dissociative subtype of DSM-5 posttraumatic stress disorder in US veterans", Journal of Psychiatric Research, 66-67(2), pp.67~74 (2015)
- Twaite, J. A., "Childhood sexual and physical abuse and adult vulnerability to PTSD : The mediating effects of attachment and dissociation", Journal of Child Sexual Abuse, 13(1), pp.17~38 (2004)
- Van der Hart, O., "Trauma-related dissociation : Conceptual clarity lost and found", Australian & New Zealand Journal of Psychiatry, 38(11-12), pp.906~914 (2004)
- Van der Kolk, B. A., "Dissociation, somatization, and affect dysregulation: The Complexity of adaption to trauma", The American journal of psychiatry, 153(Suppl), pp.83~93 (1996)
- Vogel, M., "Differential effects of childhood abuse and neglect: mediation by posttraumatic distress in neurotic disorder and negative symptoms in schizophrenia?", Psychiatry research, 189(1), pp.121~127 (2011)
- Waelde, L. C., "A taxometric investigation of dissociation in Vietnam veterans", Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 18(4), pp.359~369 (2005)
- Waller, N., "Types of dissociation and dissociative types : A taxometric analysis of dissociative experiences", Psychological methods, 1(3), pp.300~321 (1996)
- Watson, S., "Association between childhood trauma and dissociation among patients with borderline personality disorder", Australian & New Zealand Journal of Psychiatry, 40(5), pp.478~481 (2006)
- Weiss, D. S., "Cross-cultural assessment of psychological trauma and PTSD", pp.219~238 (2007), Springer
- Whitfield, C. L., "Adverse childhood experiences and hallucinations", Child abuse & neglect, 29(7), pp.797~810 (2005)
- Williams-Keeler, L., "Psychosis as precipitating trauma for PTSD : A treatment strategy", The American Journal of Orthopsychiatry, 64(3), pp.493~498 (1994)
- Woo JP., "In : Concepts and understanding of structural equation modeling", pp.180~423 (2012), Hannarae Publishing Co
- Yehuda, R., "Childhood trauma and risk for PTSD : Relationship to intergenerational effects of trauma, parental PTSD, and cortisol excretion", Development and psychopathology, 13(3), pp.733~753 (2001)
- Zhao, X., "Reconsidering Baron and Kenny : Myths and truths about mediation analysis", Journal of Consumer Research, 37(2), pp.197~206 (2010)
- Zlotnick, C., "Differences in dissociative experiences between survivors of childhood incest and survivors of assault in adulthood", The Journal of nervous and mental disease, 184(1), pp.52~54 (1996)
