Psychiatry - July 2008 - (Page 55)

TABLE 1. Increased dissociation is associated with increased likelihood of failure: any symptom endorsement Fail SFAS No Dissociation (CADSS = 0) CADSS > 1 Total 236 220 456 Pass SFAS 189 129 318 Total 425 349 774 Chi-square=4.5; df=1 asymp. sig (2-sided): p<0.035 TABLE 2. Increased dissociation is associated with increased likelihood of failure: CADSS score of 5 or greater Fail SFAS CADSS 5 Total 376 80 456 Pass SFAS 287 31 318 Total 663 111 774 Chi-square=9.3; df=1 asymp. sig (2-sided): p<0.002 TABLE 3. Increased dissociation is associated with increased likelihood of failure: CADSS score of 11 or greater Fail SFAS CADSS 11 Total 419 37 456 Pass SFAS 310 8 318 Total 729 45 774 Chi-square=10.8; df=1 asymp. sig (2-sided): p<0.001 right (sensitivity) or of being wrong (1 minus the specificity) in predicting whether a subject who endorsed any particular score on the CADSS would fail the SFAS course. As noted in Table 4, the probability of being wrong in predicting that a candidate who obtains a particular dissociation score on the CADSS can be calculated. For example, using these Signal Detection Methods, the likelihood of being wrong in predicting that a candidate obtaining a score of 5 or more on the CADSS will fail SFAS is approximately 9.0 percent; similarly, the probability of error in predicting that a candidate who obtains a score of 11 or greater on the CADSS will fail SFAS is less than 2.0. DISCUSSION Soldiers who endorsed experiencing any symptoms of dissociation on the CADSS at baseline were significantly less likely to be successful in Special Forces Assessment and Selection (SFAS). Indeed, the greater the number of symptoms of dissociation endorsed at baseline, the greater the likelihood of failure in the course. Fewer than nine in 100 candidates who had a baseline CADSS score of greater than 5 and fewer than two in 100 with a score greater than 11 (maximum score of 79 possible) passed the course. Thus, tendency to dissociate at baseline served as a significant predictor of military training performance under highly demanding and stressful conditions. These data may help to explain our earlier finding that elite Special Forces troops exhibited fewer stress-induced symptoms of dissociation than general troops during high-intensity training. It appears likely that the SFAS process “weeds out” soldiers who tend to dissociate and selects those who do not tend to dissociate. That said, it is important to underscore the fact that we were not able to assess other life experiences in this particular sample (for example, history of traumatic stress exposure). It is possible that this or other variables contributed to the present findings. In the future, we anticipate having permission from the military to assess other variables of interest. With the increased operational tempo of special operations units in support of the Global War on Terror, US military leaders continue to look for ways to maximize throughput of SFAS programs. With student attrition a primary concern, directors of SFAS programs are faced with the choice of lessening requirements, introducing remedial interventions for poor performers, or improving candidate selection protocols. Many believe that lowering the criteria for successful completion of such programs would be imprudent. However, assessment of candidates for baseline dissociation could help to identify those who may benefit from remedial efforts or be better suited for other military occupations. Screening out candidates who are unlikely to succeed would better focus training resources on candidates more likely to successfully complete the course. Signal Detection Methods may significantly assist in decision[JULY] Psychiatry 2008 55

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Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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