Trauma-Related Altered States of Consciousness (TRASC) and Functional Impairment I: Prospective Study in Acutely Traumatized Persons

A theoretical 4-D model distinguishes posttraumatic stress symptoms that occur in normal waking consciousness (NWC) from those that involve dissociative experiences, called trauma-related altered states of consciousness (TRASC). This prospective study of 180 people assessed in emergency departments after traumatic events found that both TRASC and NWC-distress symptoms measured at 6 weeks independently predicted social and occupational impairment at 12 weeks. The results largely supported the 4-D model, but contrary to hypotheses, childhood trauma history correlated more strongly with NWC-distress than with TRASC symptoms.

Study at a glance

Abstract

A theoretical framework referred to as a 4-D model has been described for classifying posttraumatic stress symptoms into those potentially occurring within normal waking consciousness (NWC) versus those thought to intrinsically exemplify dissociative experiences, specifically, trauma-related altered states of consciousness (TRASC). As a further test of this theoretical distinction, this prospective study evaluated whether TRASC and NWC forms of distress incrementally and prospectively predicted functional impairment at 6 and 12 weeks following presentation at hospital emergency departments in the acute aftermath of traumatic events in 180 persons. Establishing the clinical significance of both TRASC and NWC-distress symptoms, we found that 6-week markers of TRASC and NWC-distress independently predicted 12-week self-reported levels of social and occupational impairment. We also observed broad support for various predictions of the 4-D model except that, in contrast with hypotheses, childhood trauma history was generally more strongly correlated with symptoms of NWC-distress than with TRASC. Future research directions are discussed.