{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:05:27Z","timestamp":1787648727497,"version":"build-2736575974"},"reference-count":100,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T00:00:00Z","timestamp":1668729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Dissociative experiences are psychological manifestations characterized by a loss of connection and continuity between thoughts, emotions, environment, behavior, and identity. Lebanon has been facing indescribable events in the last few years, including the COVID-19 pandemic, the Beirut explosion, a crushing economic crisis with the highest inflation rate the country has known in over three decades. The aim of this study was to evaluate the correlation between dissociative experiences and post-traumatic stress symptoms from the economic crisis, the Beirut blast, the COVID-19 pandemic, and other mental health issues in a sample of Lebanese university students.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>This cross-sectional study enrolled 419 active university students (18\u201335 years) from all over Lebanon (May and August 2021). The respondents received the online soft copy of a survey by a snowball sampling technique through social media and messaging apps. The questionnaire included sociodemographic data, the Dissociative Experience Scale (DES-II), the PTSD Checklist Specific Version (PCL-S), the Financial Wellbeing Scale, the Beirut Distress Scale, the Lebanese Anxiety Scale, the Patient Health Questionnaire.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The two-factor model of the DES fitted best according to CFI, RMSEA and \u03c7<jats:sup>2<\/jats:sup>\/df values, but modestly according to TLI. The two factors were absorption and amnesia\/depersonalization. Higher stress (Beta = 0.95) and more PTSD from the Beirut blast (Beta = 0.29) and from the economic crisis (Beta = 0.23) were significantly associated with more absorption. A personal history of depression (Beta = 6.03), higher stress (Beta = 0.36) and more PTSD from the Beirut blast (Beta = 0.27) and from the COVID-19 pandemic (Beta = 0.16) were significantly associated with more amnesia\/depersonalization.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Significant rates of dissociative experiences and their sub-manifestations (amnesia\/depersonalization and absorption) were found among Lebanese university students, with remarkable co-occurrence of a traumatic\/stressful pattern, whether on an individual (history of PTSD) or a collective level (Post-traumatic manifestations from Beirut blast, COVID-19 pandemic and\/or economic crisis), or whether correlated to an acute single event or to certain chronic stressors, or even to a personal history of depression. Such findings must raise the attention to serious mental and psychosocial alteration in the Lebanese national identity.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0277883","type":"journal-article","created":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T18:26:05Z","timestamp":1668795965000},"page":"e0277883","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":31,"title":["Dissociative experiences among Lebanese university students: Association with mental health issues, the economic crisis, the COVID-19 pandemic, and the Beirut port explosion"],"prefix":"10.1371","volume":"17","author":[{"given":"Mariam","family":"Mhanna","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian-Joseph","family":"El Zouki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah","family":"Chahine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Obeid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-5689","authenticated-orcid":true,"given":"Souheil","family":"Hallit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,18]]},"reference":[{"key":"pone.0277883.ref001","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association A.","year":"2013","edition":"5"},{"issue":"1","key":"pone.0277883.ref002","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/bjc.12186","article-title":"Dissociative absorption, mind-wandering, and attention-deficit symptoms: Associations with obsessive-compulsive symptoms.","volume":"58","author":"N. Soffer-Dudek","year":"2019","journal-title":"Br J Clin Psychol"},{"key":"pone.0277883.ref003","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.concog.2015.07.013","article-title":"Dissociative absorption: An empirically unique, clinically relevant, dissociative factor.","volume":"36","author":"N Soffer-Dudek","year":"2015","journal-title":"Conscious Cogn"},{"issue":"1","key":"pone.0277883.ref004","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/15299732.2019.1647915","article-title":"The prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies","volume":"21","author":"MA Kate","year":"2020","journal-title":"J Trauma Dissociation"},{"key":"pone.0277883.ref005","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.psychres.2017.01.035","article-title":"The link between dissociation and both suicide attempts and non-suicidal self-injury: Meta-analyses.","volume":"251","author":"R Calati","year":"2017","journal-title":"Psychiatry Res"},{"issue":"1","key":"pone.0277883.ref006","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1176\/appi.ajp.2017.17010025","article-title":"Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale.","volume":"175","author":"L Lyssenko","year":"2018","journal-title":"Am J Psychiatry."},{"issue":"4","key":"pone.0277883.ref007","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1080\/10538712.2013.781094","article-title":"Child sexual abuse survivors with dissociative amnesia: what\u2019s the difference?","volume":"22","author":"MR Wolf","year":"2013","journal-title":"J Child Sex Abus"},{"issue":"3","key":"pone.0277883.ref008","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1080\/15299732.2013.844218","article-title":"Dissociative depression among women with fibromyalgia or rheumatoid arthritis","volume":"15","author":"O Kilic","year":"2014","journal-title":"J Trauma Dissociation"},{"issue":"8","key":"pone.0277883.ref009","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1176\/appi.ajp.158.8.1239","article-title":"Symptoms of dissociation in humans experiencing acute, uncontrollable stress: a prospective investigation.","volume":"158","author":"CA Morgan","year":"2001","journal-title":"Am J Psychiatry."},{"issue":"6","key":"pone.0277883.ref010","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/jclp.20485","article-title":"Temperament, character, and dissociation among detoxified male inpatients with alcohol dependency","volume":"64","author":"C Evren","year":"2008","journal-title":"J Clin Psychol"},{"issue":"9","key":"pone.0277883.ref011","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/070674371405900902","article-title":"Posttraumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment","volume":"59","author":"J. Sareen","year":"2014","journal-title":"Can J Psychiatry"},{"key":"pone.0277883.ref012","doi-asserted-by":"crossref","first-page":"113172","DOI":"10.1016\/j.psychres.2020.113172","article-title":"Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health.","volume":"290","author":"CH Liu","year":"2020","journal-title":"Psychiatry Res."},{"issue":"2","key":"pone.0277883.ref013","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.4081\/jphr.2013.e17","article-title":"Post-traumatic stress disorder in adolescents in Lebanon as wars gained in ferocity: a systematic review.","volume":"2","author":"KH Shaar","year":"2013","journal-title":"J Public Health Res"},{"issue":"1","key":"pone.0277883.ref014","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/00005053-200301000-00004","article-title":"The links between the Adolescent Dissociative Experiences Scale (A-DES), fantasy proneness, and anxiety symptoms.","volume":"191","author":"P Muris","year":"2003","journal-title":"J Nerv Ment Dis"},{"key":"pone.0277883.ref015","doi-asserted-by":"crossref","first-page":"102800","DOI":"10.1016\/j.ajp.2021.102800","article-title":"Prevalence and associated factors of post-traumatic stress disorder in Lebanon: A literature review.","volume":"63","author":"M. El Hajj","year":"2021","journal-title":"Asian J Psychiatr"},{"issue":"1","key":"pone.0277883.ref016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1753-2000-3-29","article-title":"Prevalence and age-of-onset distributions of DSM IV mental disorders and their severity among school going Omani adolescents and youths: WMH-CIDI findings.","volume":"3","author":"S Jaju","year":"2009","journal-title":"Child and Adolescent Psychiatry and Mental Health"},{"issue":"1","key":"pone.0277883.ref017","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1186\/s12888-022-04180-y","article-title":"Rate and correlates of post-traumatic stress disorder (PTSD) following the Beirut blast and the economic crisis among Lebanese University students: a cross-sectional study.","volume":"22","author":"CJ El Zouki","year":"2022","journal-title":"BMC Psychiatry."},{"key":"pone.0277883.ref018","unstructured":"Consultancy-me.com. Lebanon\u2019s unemployment rate surges past 30% amid meltdown. Available from: https:\/\/www.consultancy-me.com\/news\/2900\/lebanons-unemployment-rate-surges-past-30-amid-meltdown."},{"issue":"2","key":"pone.0277883.ref019","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1080\/13651501.2021.1879159","article-title":"COVID-19 pandemic and mental health in Lebanon: a cross-sectional study.","volume":"25","author":"R El Othman","year":"2021","journal-title":"Int J Psychiatry Clin Pract"},{"key":"pone.0277883.ref020","doi-asserted-by":"crossref","first-page":"113261","DOI":"10.1016\/j.socscimed.2020.113261","article-title":"Psychological resilience, depression, anxiety, and somatization symptoms in response to COVID-19: A study of the general population in China at the peak of its epidemic.","volume":"262","author":"L Ran","year":"2020","journal-title":"Soc Sci Med."},{"key":"pone.0277883.ref021","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.bbi.2020.05.019","article-title":"COVID-19-related information sources and psychological well-being: An online survey study in Taiwan.","volume":"87","author":"NY Ko","year":"2020","journal-title":"Brain Behav Immun"},{"key":"pone.0277883.ref022","first-page":"1","article-title":"Beirut Explosion Effects on COVID-19 Situation in Lebanon.","author":"HT Hashim","year":"2021","journal-title":"Disaster Med Public Health Prep."},{"key":"pone.0277883.ref023","unstructured":"Hussein B. BSI economics. Large Devaluation and Inequality: The Case of Lebanon (Note). http:\/\/www.bsi-economics.org\/1130-large-develuation-inquality-case-of-lebanon. 2020."},{"issue":"8","key":"pone.0277883.ref024","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1097\/NMD.0000000000001017","article-title":"Burnout and Its Relationships With Alexithymia, Stress, Self-Esteem, Depression, Alcohol Use Disorders, and Emotional Intelligence: Results From a Lebanese Cross-Sectional Study.","volume":"207","author":"N Lahoud","year":"2019","journal-title":"J Nerv Ment Dis."},{"issue":"1","key":"pone.0277883.ref025","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s40359-019-0353-5","article-title":"Factors associated with alexithymia among the Lebanese population: results of a cross-sectional study.","volume":"7","author":"S Obeid","year":"2019","journal-title":"BMC Psychol."},{"issue":"1","key":"pone.0277883.ref026","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1186\/s12889-020-8345-1","article-title":"Factors associated with alcohol use disorder: the role of depression, anxiety, stress, alexithymia and work fatigue- a population study in Lebanon.","volume":"20","author":"S Obeid","year":"2020","journal-title":"BMC Public Health."},{"issue":"4","key":"pone.0277883.ref027","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1111\/ppc.12518","article-title":"Factors associated with depression among the Lebanese population: Results of a cross-sectional study.","volume":"56","author":"S Obeid","year":"2020","journal-title":"Perspect Psychiatr Care."},{"issue":"2","key":"pone.0277883.ref028","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1080\/13651501.2020.1723641","article-title":"Factors associated with anxiety among the Lebanese population: the role of alexithymia, self-esteem, alcohol use disorders, emotional intelligence and stress and burnout.","volume":"24","author":"S Obeid","year":"2020","journal-title":"Int J Psychiatry Clin Pract."},{"issue":"1","key":"pone.0277883.ref029","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12888-021-03111-7","article-title":"Suicidal ideation among Lebanese adults: scale validation and correlates.","volume":"21","author":"M Zakhour","year":"2021","journal-title":"BMC Psychiatry."},{"issue":"1","key":"pone.0277883.ref030","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1186\/s12888-020-02726-6","article-title":"Suicidal ideation among Lebanese adolescents: scale validation, prevalence and correlates.","volume":"20","author":"M Chahine","year":"2020","journal-title":"BMC Psychiatry."},{"issue":"1","key":"pone.0277883.ref031","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1186\/s12887-021-02763-4","article-title":"Anxiety among Lebanese adolescents: scale validation and correlates","volume":"21","author":"G Merhy","year":"2021","journal-title":"BMC Pediatr"},{"key":"pone.0277883.ref032","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13034-020-00338-2","article-title":"Alexithymia, aggressive behavior and depression among Lebanese adolescents: A cross-sectional study.","volume":"14","author":"E Sfeir","year":"2020","journal-title":"Child Adolesc Psychiatry Ment Health"},{"issue":"1","key":"pone.0277883.ref033","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1186\/s12887-021-02795-w","article-title":"Sleep disorders in a sample of Lebanese children: the role of parental mental health and child nutrition and activity","volume":"21","author":"E Sfeir","year":"2021","journal-title":"BMC Pediatr"},{"issue":"9","key":"pone.0277883.ref034","doi-asserted-by":"crossref","first-page":"e22817","DOI":"10.2196\/22817","article-title":"Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study.","volume":"22","author":"X Wang","year":"2020","journal-title":"J Med Internet Res"},{"issue":"5","key":"pone.0277883.ref035","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s40596-014-0205-9","article-title":"College Students: Mental Health Problems and Treatment Considerations.","volume":"39","author":"P Pedrelli","year":"2015","journal-title":"Acad Psychiatry."},{"issue":"1","key":"pone.0277883.ref036","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/NMD.0000000000001411","article-title":"Temporal Stability of Dissociative Symptoms in the General Population.","volume":"210","author":"EO Maraldi","year":"2022","journal-title":"J Nerv Ment Dis."},{"issue":"4","key":"pone.0277883.ref037","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1207\/S15328007SEM0904_8","article-title":"How to use a Monte Carlo study to decide on sample size and determine power.","volume":"9","author":"LK Muth\u00e9n","year":"2002","journal-title":"Structural equation modeling."},{"key":"pone.0277883.ref038","article-title":"An update on the dissociative experiences scale","author":"EB Carlson","year":"1993","journal-title":"Dissociation: progress in the dissociative disorders"},{"issue":"7","key":"pone.0277883.ref039","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1002\/da.20837","article-title":"Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions.","volume":"28","author":"KC Wilkins","year":"2011","journal-title":"Depression and anxiety."},{"issue":"1","key":"pone.0277883.ref040","article-title":"InCharge financial distress\/financial well-being scale: Development, administration, and score interpretation.","volume":"17","author":"A Prawitz","year":"2006","journal-title":"Journal of Financial Counseling and Planning."},{"key":"pone.0277883.ref041","article-title":"Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population.","author":"D Malaeb","year":"2021","journal-title":"Perspect Psychiatr Care."},{"issue":"3","key":"pone.0277883.ref042","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1080\/13651501.2020.1744662","article-title":"Construction of the Lebanese Anxiety Scale (LAS-10): a new scale to assess anxiety in adult patients.","volume":"24","author":"S Hallit","year":"2020","journal-title":"Int J Psychiatry Clin Pract."},{"issue":"9","key":"pone.0277883.ref043","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"K Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"pone.0277883.ref044","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.psychres.2016.03.030","article-title":"Adaptation and initial validation of the Patient Health Questionnaire\u20149 (PHQ-9) and the Generalized Anxiety Disorder\u20147 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample.","volume":"239","author":"H Sawaya","year":"2016","journal-title":"Psychiatry Res."},{"key":"pone.0277883.ref045","doi-asserted-by":"crossref","DOI":"10.4324\/9780203807644","volume-title":"Structural equation modeling with Mplus: Basic concepts, applications, and programming","author":"BM Byrne","year":"2013"},{"issue":"3","key":"pone.0277883.ref046","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1207\/s15328007sem1103_2","article-title":"In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler\u2019s (1999) findings.","volume":"11","author":"HW Marsh","year":"2004","journal-title":"Structural equation modeling."},{"key":"pone.0277883.ref047","volume-title":"SPSS for windows step by step: A simple study guide and reference","author":"D. George","year":"2011"},{"issue":"1","key":"pone.0277883.ref048","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4103\/aca.ACA_157_18","article-title":"Descriptive statistics and normality tests for statistical data.","volume":"22","author":"P Mishra","year":"2019","journal-title":"Ann Card Anaesth"},{"key":"pone.0277883.ref049","volume-title":"Model comparison and the principle of parsimony: eScholarship","author":"J Vandekerckhove","year":"2014"},{"issue":"3","key":"pone.0277883.ref050","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/00029157.1990.10402825","article-title":"A factor analytic study of two scales measuring dissociation","volume":"32","author":"DG Fischer","year":"1990","journal-title":"American Journal of Clinical Hypnosis"},{"issue":"5","key":"pone.0277883.ref051","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/S0191-8869(96)00252-8","article-title":"The assessment of dissociative experiences in a non-clinical population: Reliability, validity, and factor structure of the Dissociative Experiences Scale.","volume":"22","author":"T Holtgraves","year":"1997","journal-title":"Personality and Individual differences"},{"issue":"3","key":"pone.0277883.ref052","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1007\/s10862-013-9347-4","article-title":"Factor structure of the Dissociative Experiences Scale: An examination across sexual assault status.","volume":"35","author":"SA Olsen","year":"2013","journal-title":"Journal of psychopathology and behavioral assessment"},{"key":"pone.0277883.ref053","article-title":"A factor analysis of the Dissociative Experiences Scale (DES) in dissociative identity disorder.","author":"CA Ross","year":"1995","journal-title":"Dissociation: progress in the dissociative disorders"},{"key":"pone.0277883.ref054","article-title":"Dissociation debates: Everything you know is wrong.","author":"RJ Loewenstein","year":"2022","journal-title":"Dialogues in clinical neuroscience"},{"key":"pone.0277883.ref055","doi-asserted-by":"crossref","DOI":"10.1007\/978-0-387-70990-1","volume-title":"Cross-cultural assessment of psychological trauma and PTSD","author":"JP Wilson","year":"2007"},{"issue":"1","key":"pone.0277883.ref056","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1002\/jts.22488","article-title":"A Network Approach to Studying the Associations Between Posttraumatic Stress Disorder Symptoms and Dissociative Experiences","volume":"33","author":"AOJ Cramer","year":"2020","journal-title":"J Trauma Stress"},{"key":"pone.0277883.ref057","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/7854_2017_33","article-title":"The Dissociative Subtype of Post-traumatic Stress Disorder: Research Update on Clinical and Neurobiological Features.","volume":"38","author":"J van Huijstee","year":"2018","journal-title":"Curr Top Behav Neurosci."},{"key":"pone.0277883.ref058","doi-asserted-by":"crossref","first-page":"31509","DOI":"10.3402\/ejpt.v7.31509","article-title":"PTSD and depression construct: prevalence and predictors of co-occurrence in a South Lebanese civilian sample.","volume":"7","author":"LF Farhood","year":"2016","journal-title":"Eur J Psychotraumatol"},{"issue":"9","key":"pone.0277883.ref059","doi-asserted-by":"crossref","first-page":"e108206","DOI":"10.1371\/journal.pone.0108206","article-title":"Risk recognition, attachment anxiety, self-efficacy, and state dissociation predict revictimization.","volume":"9","author":"E Bockers","year":"2014","journal-title":"PLoS One."},{"key":"pone.0277883.ref060","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.chiabu.2018.02.001","article-title":"The role of dissociation in revictimization across the lifespan: A 32-year prospective study.","volume":"79","author":"O Zamir","year":"2018","journal-title":"Child Abuse Negl."},{"key":"pone.0277883.ref061","unstructured":"Businesswire. New Payoff Study Finds Nearly 1 in 4 Americans and 1 in 3 Millennials Suffer From PTSD-Like Symptoms Caused by Financially Induced Stress. Available from: https:\/\/www.businesswire.com\/news\/home\/20160420005504\/en\/New-Payoff-Study-Finds-Nearly-1-in-4-Americans-and-1-in-3-Millennials-Suffer-From-PTSD-Like-Symptoms-Caused-by-Financially-Induced-Stress 2016."},{"issue":"1","key":"pone.0277883.ref062","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.cpr.2012.10.005","article-title":"Conditional risk for PTSD among Latinos: a systematic review of racial\/ethnic differences and sociocultural explanations.","volume":"33","author":"C Alcantara","year":"2013","journal-title":"Clin Psychol Rev."},{"issue":"4","key":"pone.0277883.ref063","article-title":"205\u2013208: Dissociative symptoms in a population sample of Hungary.","volume":"8","author":"J Vanderlinden","year":"1995","journal-title":"Dissociation"},{"issue":"9","key":"pone.0277883.ref064","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1038\/s41380-019-0383-7","article-title":"Resilience as a translational endpoint in the treatment of PTSD","volume":"24","author":"G Rakesh","year":"2019","journal-title":"Mol Psychiatry"},{"key":"pone.0277883.ref065","doi-asserted-by":"crossref","first-page":"102458","DOI":"10.1016\/j.ajp.2020.102458","article-title":"Beirut blast and mental health in Lebanon: Finding ways out.","volume":"54","author":"S El Hayek","year":"2020","journal-title":"Asian J Psychiatr"},{"issue":"6","key":"pone.0277883.ref066","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1002\/jts.22144","article-title":"A Paradox in Individual Versus National Mental Health Vulnerability: Are Higher Resource Levels Associated With Higher Disorder Prevalence?","volume":"29","author":"ML Duckers","year":"2016","journal-title":"J Trauma Stress"},{"issue":"1","key":"pone.0277883.ref067","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jbtep.2004.01.002","article-title":"Towards a cognitive model and measure of dissociation.","volume":"35","author":"F Kennedy","year":"2004","journal-title":"J Behav Ther Exp Psychiatry"},{"issue":"2","key":"pone.0277883.ref068","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1080\/13607863.2010.505232","article-title":"Coping in old age with extreme childhood trauma: aging Holocaust survivors and their offspring facing new challenges.","volume":"15","author":"A Fridman","year":"2011","journal-title":"Aging Ment Health."},{"issue":"2","key":"pone.0277883.ref069","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1080\/15299732.2013.724345","article-title":"Dissociation and identity transformation in female survivors of the genocide against the Tutsi in Rwanda: a qualitative research study","volume":"14","author":"DH Sandole","year":"2013","journal-title":"J Trauma Dissociation"},{"key":"pone.0277883.ref070","first-page":"1","article-title":"A Network Analysis to Identify Associations between PTSD and Dissociation among Teenagers","author":"E Cardena","year":"2021","journal-title":"J Trauma Dissociation"},{"issue":"7","key":"pone.0277883.ref071","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/NMD.0b013e3181aaef6b","article-title":"Alexithymia, absorption, and cognitive failures in depersonalization disorder: a comparison to posttraumatic stress disorder and healthy volunteers.","volume":"197","author":"D Simeon","year":"2009","journal-title":"J Nerv Ment Dis"},{"issue":"1\u20133","key":"pone.0277883.ref072","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.psychres.2006.12.012","article-title":"Dissociative experiences on ice\u2014peritraumatic and trait dissociation during the cold pressor test.","volume":"157","author":"T Giesbrecht","year":"2008","journal-title":"Psychiatry Res"},{"issue":"5","key":"pone.0277883.ref073","first-page":"e8289","article-title":"Dissociative Amnesia and Dissociative Fugue in a 20-Year-Old Woman With Schizoaffective Disorder and Post-Traumatic Stress Disorder.","volume":"12","author":"TA Clouden","year":"2020","journal-title":"Cureus"},{"issue":"3","key":"pone.0277883.ref074","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/S2215-0366(14)70279-2","article-title":"Dissociative amnesia.","volume":"1","author":"A Staniloiu","year":"2014","journal-title":"The Lancet Psychiatry"},{"issue":"3","key":"pone.0277883.ref075","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1037\/a0027447","article-title":"Evaluation of the evidence for the trauma and fantasy models of dissociation.","volume":"138","author":"CJ Dalenberg","year":"2012","journal-title":"Psychol Bull."},{"issue":"4","key":"pone.0277883.ref076","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1080\/15299730903143618","article-title":"Peas, please: a case report and neuroscientific review of dissociative amnesia and fugue","volume":"10","author":"K MacDonald","year":"2009","journal-title":"J Trauma Dissociation"},{"issue":"Suppl 1","key":"pone.0277883.ref077","doi-asserted-by":"crossref","first-page":"S132","DOI":"10.1016\/j.neuroimage.2003.09.010","article-title":"Psychogenic amnesia.","volume":"20","author":"HJ Markowitsch","year":"2003","journal-title":"Neuroimage."},{"issue":"2","key":"pone.0277883.ref078","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1080\/15299732.2019.1572043","article-title":"Relationships Between Maltreatment, Posttraumatic Symptomatology, and the Dissociative Subtype of PTSD Among Adolescents","volume":"20","author":"KR Choi","year":"2019","journal-title":"J Trauma Dissociation"},{"key":"pone.0277883.ref079","first-page":"18","article-title":"COVID-19 Stress and Mental Health of Students in Locked-Down Colleges.","author":"X Li","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"pone.0277883.ref080","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1080\/13651501.2021.1900872","article-title":"Psychological distress experienced by self-quarantined undergraduate university students in Lebanon during the COVID-19 outbreak.","volume":"25","author":"G Kassir","year":"2021","journal-title":"Int J Psychiatry Clin Pract"},{"key":"pone.0277883.ref081","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jad.2017.02.004","article-title":"Evidence of the dissociative PTSD subtype: A systematic literature review of latent class and profile analytic studies of PTSD","volume":"213","author":"M Hansen","year":"2017","journal-title":"J Affect Disord"},{"issue":"2","key":"pone.0277883.ref082","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/00223890701845492","article-title":"Is there really a dissociative taxon on the dissociative experiences scale?","volume":"90","author":"RD Merritt","year":"2008","journal-title":"J Pers Assess."},{"issue":"3","key":"pone.0277883.ref083","doi-asserted-by":"crossref","first-page":"171","DOI":"10.9758\/cpn.2014.12.3.171","article-title":"The many faces of dissociation: opportunities for innovative research in psychiatry.","volume":"12","author":"V. Sar","year":"2014","journal-title":"Clin Psychopharmacol Neurosci"},{"issue":"2","key":"pone.0277883.ref084","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jand.2017.10.015","article-title":"Stress, Anxiety, and Weight Gain among University and College Students: A Systematic Review.","volume":"118","author":"SA Haidar","year":"2018","journal-title":"J Acad Nutr Diet"},{"issue":"2","key":"pone.0277883.ref085","doi-asserted-by":"crossref","first-page":"e0246676","DOI":"10.1371\/journal.pone.0246676","article-title":"College students\u2019 stress and health in the COVID-19 pandemic: The role of academic workload, separation from school, and fears of contagion.","volume":"16","author":"C Yang","year":"2021","journal-title":"PLoS One."},{"key":"pone.0277883.ref086","author":"World Health Organization","journal-title":"The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research"},{"issue":"6","key":"pone.0277883.ref087","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1038\/nrn2639","article-title":"Effects of stress throughout the lifespan on the brain, behaviour and cognition.","volume":"10","author":"SJ Lupien","year":"2009","journal-title":"Nat Rev Neurosci."},{"key":"pone.0277883.ref088","doi-asserted-by":"crossref","first-page":"403","DOI":"10.3389\/fpsyg.2012.00403","article-title":"Towards solving the riddle of forgetting in functional amnesia: recent advances and current opinions.","volume":"3","author":"A Staniloiu","year":"2012","journal-title":"Front Psychol."},{"issue":"7","key":"pone.0277883.ref089","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1001\/archgenpsychiatry.2011.2287","article-title":"Genome-wide epigenetic regulation by early-life trauma.","volume":"69","author":"B Labonte","year":"2012","journal-title":"Arch Gen Psychiatry"},{"issue":"6","key":"pone.0277883.ref090","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1176\/appi.ajp.2013.12070950","article-title":"Decreased cortical representation of genital somatosensory field after childhood sexual abuse.","volume":"170","author":"CM Heim","year":"2013","journal-title":"Am J Psychiatry"},{"issue":"3","key":"pone.0277883.ref091","first-page":"265","article-title":"Daily Elevations in Dissociative Absorption and Depersonalization in a Nonclinical Sample Are Related to Daily Stress and Psychopathological Symptoms.","volume":"80","author":"N. Soffer-Dudek","year":"2017","journal-title":"Psychiatry"},{"issue":"4","key":"pone.0277883.ref092","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/01.nmd.0000253822.60618.60","article-title":"Depersonalization experiences in undergraduates are related to heightened stress cortisol responses.","volume":"195","author":"T Giesbrecht","year":"2007","journal-title":"J Nerv Ment Dis"},{"issue":"1","key":"pone.0277883.ref093","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19010206","article-title":"Acute Stress in Health Workers during Two Consecutive Epidemic Waves of COVID-19","volume":"19","author":"K Jauregui Renaud","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"pone.0277883.ref094","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5539\/ijps.v2n2p26","article-title":"The circumplex structure of depersonalization\/derealization","volume":"2","author":"RG Sacco","year":"2010","journal-title":"International Journal of Psychological Studies"},{"key":"pone.0277883.ref095","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780195170221.001.0001","volume-title":"Feeling unreal: Depersonalization disorder and the loss of the self:","author":"D Simeon","year":"2006"},{"issue":"8","key":"pone.0277883.ref096","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1001\/archpsyc.61.8.819","article-title":"Relationships among plasma dehydroepiandrosterone sulfate and cortisol levels, symptoms of dissociation, and objective performance in humans exposed to acute stress.","volume":"61","author":"CA Morgan","year":"2004","journal-title":"Arch Gen Psychiatry"},{"issue":"1","key":"pone.0277883.ref097","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/15299732.2010.514847","article-title":"Are major dissociative disorders characterized by a qualitatively different kind of dissociation?","volume":"12","author":"F Rodewald","year":"2011","journal-title":"J Trauma Dissociation"},{"issue":"1","key":"pone.0277883.ref098","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1017\/S1092852913000588","article-title":"Dissociable brain correlates for depression, anxiety, dissociation, and somatization in depersonalization-derealization disorder.","volume":"21","author":"E Lemche","year":"2016","journal-title":"CNS Spectr."},{"issue":"1\u20133","key":"pone.0277883.ref099","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jad.2006.08.025","article-title":"The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: a critical reappraisal","volume":"99","author":"M Mula","year":"2007","journal-title":"J Affect Disord"},{"key":"pone.0277883.ref100","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jad.2020.04.018","article-title":"Symptoms of depersonalization\/derealization are independent risk factors for the development or persistence of psychological distress in the general population: Results from the Gutenberg health study","volume":"273","author":"J Schlax","year":"2020","journal-title":"J Affect Disord"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277883","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T11:33:21Z","timestamp":1701430401000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277883"}},"subtitle":[],"editor":[{"given":"Supat","family":"Chupradit","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,18]]},"references-count":100,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0277883","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,18]]}}}