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PubMed1998

Dissociative identity disorder: an Australian series.

OBJECTIVE: Series of patients fulfilling diagnostic criteria for Dissociative Identity Disorder (DID), otherwise known as multiple personality disorder, have particularly been reported on in North America and increasingly in other countries. The present study investigated the trauma and past treatment histories, symptom profiles and dissociative phenomenology of 62 patients fulfilling diagnostic criteria for DID seen in Brisbane (Queensland, Australia). METHOD: From 1992, systematic assessments, including the Dissociative Experience Scale and the Dissociative Disorders Interview Schedule, were performed with a personal series of 57 patients with DID seen by one of the authors (WM) and five patients seen by the second author (JB). RESULTS: The histories of childhood trauma, the clinical profiles and dissociative indices of these patients closely approximate those described in series reported in other countries. CONCLUSIONS: Patients fulfilling diagnostic criteria for DID are regularly seen in Australian inpatient and outpatient settings. The dissociative symptomatology of the patients examined in the present study represents a significant component of a complex syndrome associated with a history of severe ongoing developmental trauma dating from early childhood.

Adolescent↗
PubMed1995

Using the SCID-D to assess dissociative identity disorder in adolescents: three case studies.

The authors report on the diagnostic assessment of dissociative identity disorder in three adolescents using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D; Steinberg, 1993b), a semistructured instrument for the diagnosis and assessment of dissociative symptoms and disorders. Although the SCID-D has received good-to-excellent ratings for reliability and validity in the adult population, these three cases are the first reports of the results of its administration to younger patients. Comparison of the three adolescent SCID-D interviews with findings in adults indicates that the profiles of the five dissociative symptoms measured by the SCID-D are virtually identical in adolescents and adults. The authors conclude with suggestions for future research regarding dissociative symptomatology in adolescents and outcome studies.

Adolescent↗
PubMed1998

Dissociative identity disorder in psychiatric inpatients.

OBJECTIVE: The aim of this study was to replicate reports of a high rate of dissociative identity disorder in psychiatric inpatients. METHOD: Subjects were 100 randomly selected women, 16-50 years old, who had recently been admitted to an acute psychiatric hospital. Diagnoses were made by two interviewers through use of the Structured Clinical Interview for DSM-IV Dissociative Disorders. RESULTS: One percent (N = 1) of the interviewed subjects had dissociative identity disorder. CONCLUSIONS: Contrary to previous studies, the authors found a low rate of dissociative identity disorder, perhaps because of the different methodology used.

Adolescent↗
PubMed1995

Positive and negative symptoms in dissociative identity disorder and schizophrenia: a comparative analysis.

A substantial number of patients with dissociative identity disorder have had previous diagnoses of schizophrenia, due to the presence of positive symptoms of schizophrenia. The authors investigated the pattern of positive and negative symptoms in patients with dissociative identity disorder, and compared it with norms in schizophrenia. A total of 108 patients with a clinical diagnosis of dissociative identity disorder were administered the Positive and Negative Syndrome Scale. The positive symptom and general psychopathology scores were significantly more severe in the dissociative identity group than the norms for schizophrenia, while the negative symptoms were significantly more severe in schizophrenia. Since patients with dissociative identity disorder report more positive symptoms of schizophrenia than do schizophrenics, while schizophrenics report more negative symptoms, a primary emphasis on positive symptoms may result in false-positive diagnoses of schizophrenia and false-negative diagnoses of dissociative identity disorder.

Adult↗
PubMed1997

Numbing scale scores in female psychiatric inpatients diagnosed with self-injurious behavior, dissociative identity disorder, and major depression.

Female inpatients engaged in self-injurious behavior (SIB) and females diagnosed with Dissociative Identify Disorder (DID) scored higher on the Glover Numbing Scale (GNS) than female inpatients diagnosed with Major Depressive Disorder (MDD). The DID sample showed a multi-modal distribution of scores, and the MDD sample showed a bimodal distribution with a significant difference between the means of the two subgroups. An additional subsample of outpatient males diagnosed with MDD also evidenced a bimodal distribution of scores with a similar spread between the two means. Scores on the Beck Depression Inventory did not discriminate the latter two subgroups.

Adult↗
PubMed1999

Dissociative identity disorder: diagnosis and treatment in the Netherlands.

Dissociative Identity Disorder (DID) is a controversial diagnosis and empirical data on the efficacy of treatment modalities are scanty. The objective of this study was to explore the frequency of the diagnosis, the types and efficacy of prevailing treatment practices, and to examine demographic data on patients in the Netherlands. A questionnaire, including questions on one selected DID patient, was mailed to 1,452 Dutch psychiatrists. The response rate was 46.7%. A total of 273 psychiatrists reported having made the diagnosis at least once. The diagnosis was made in a statistically significant manner more frequently by female psychiatrists, by psychiatrists aged 50 years or younger, and by those certified after 1982. No correlation was observed with primary theoretical orientation or the type or topography of work facility. The mean age of the selected patients was 33.2 and the male:female (M:F) ratio 1:9. The majority of patients were seen once a week in an outpatient setting. Individual psychotherapy and adjunctive anxiolytic or antidepressant medications were the most widely endorsed treatment modalities. Hypnosis was rarely used. We conclude that the diagnosis of DID is not to be dismissed as a local eccentricity. It is warranted as an explanatory framework in the context of a psychotherapeutic treatment.

Adult↗
PubMed2004

Ritual homicide during dissociative trance disorder.

A case report is described of a man who developed a single period of recurrent episodes of dissociative trance disorder (DTD) during a family stress. The cultural environment was permeated by thoughts and beliefs in magic. During one trance state, the man performed an exorcism on the 6-month-old baby of his brother-in-law, and the baby died from cerebral hemorrhage. In the 5-year follow-up, no other episodes of DTD developed, and the man is serving an 18-year sentence.

Ceremonial Behavior↗
PubMedDate not supplied

Personality profiles of patients with dissociative trance disorder in Singapore.

This report studies the personality of individuals who suffer from dissociative trance disorder and examines whether the personality profiles could predict the individual's frequency of trance states. A total of 58 cases were given the Eysenck Personality Questionnaire (EPQ) and their personal information harvested from the case notes and through subsequent interviews. The subjects were also reassessed 1 year later to obtain their frequency of trance states. For both sexes, there were lower extraversion scores and higher psychoticism, neuroticism, and lie scores in the sample compared to the Singapore norms. Of the 47 subjects traced, total episodes of trances that occurred over the 1-year period was positively correlated with neuroticism and negatively with extraversion scores. The high lie scores in individuals with dissociative trance disorder could be a reflection of their concern of how others perceive them. The motivation could be that of restoration of self-esteem or "face." The profiles in the EPQ could be used to predict the individual's frequency of trance states. Subjects with personality traits like nervousness, excitability, and emotional instability were more likely to have a higher frequency of trance states.

Adult↗
PubMed1999

Current issues in the diagnosis and management of malingering.

Malingering is a diagnosis that is frequently avoided by physicians. When there is a claim of symptoms or diseases that either are exaggerated or do not exist, the diagnosis of malingering should be entertained. Malingering is associated with a conscious intent to deceive in order to obtain a known gain. Psychoanalytical, criteria-based (DSM-IV) and 'adaptational' models have been advanced to explain malingering. The differential diagnosis of malingering includes factitious disorder, the somatoform disorders, the dissociative disorders, and specific medical conditions without somatoform disorder. Upon consideration of the differential diagnosis, confirmation of the suspicion of malingering is still required in order to make the diagnosis. Confirmation can be achieved by observation or by inferential methods. Observation can be employed with controlled environment observation or with covert, 'real-world' surveillance; inference may involve primary and/or secondary source information. It may be concluded that a greater attempt should be made to identify this diagnosis, as the cost of malingering to society is considerable.

Diagnosis, Differential↗
PubMed1995

Comparative psychopathology of women who experienced intra-familial versus extra-familial sexual abuse.

The Diagnostic Inventory of Personality and Symptoms (DIPS) was used to assess psychopathology in a clinical sample of 30 women with histories of intra-familial sexual victimization, 22 women with histories of extra-familial sexual victimization, and 30 women with no victimization experiences. The present study examines whether the relative/nonrelative issue is significant to the impact of sexual victimization experiences. A clinical comparison of two point code types indicated that both sexually abused groups could be characterized as suffering an Affective Depressed-Dissociative Disorder. However, profile shapes produced for the intra- and extra-familial abused groups differed. A discriminant function developed via step wise selection procedures incorporated 12 of the 14 scales, correctly classifying 94% of the individuals (49 of 52) as members of the extra or intra-familial groups. Profile analyses, discriminant analyses, clinically descriptive comparisons, and post hoc analyses of individual scales all revealed that psychopathology is much more evident in those who have experienced sexual abuse. Methodological considerations are highlighted and implications for treatment and research are addressed.

Adolescent↗
PubMed2001

Ganser syndrome after solitary confinement in prison: a short review and a case report.

A short review of the Ganser syndrome is given. The condition is a rare, probably dissociative, disorder with transient Vorbeireden as the central symptom. The case of a middle-aged man developing a transient Ganser syndrome after long-term solitary confinement in a remand prison is presented. Systematic investigation of 268 remand prisoners confirms the rarity of the syndrome, as only the case subject had this disorder.

Attention↗
PubMed1995

The North Carolina Dissociation Index: a measure of dissociation using items from the MMPI-2.

The development of a new measure of dissociation using items from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) is described. In Experiment 1, 525 college students were administered a measure of hypnotic susceptibility and completed several specialized measures of dissociation or dissociation-like experiences. The new measure, the North Carolina Dissociation Index (NCDI) demonstrated adequate internal consistency and good convergent validity. In Experiment 2, the NCDI demonstrated adequate internal consistency and test-retest reliability with a different sample of college students. Moreover, NCDI scores showed a relatively strong correlation with an interview-based measure of dissociative symptoms. In addition, a small sample of students with dissociative disorders had significantly higher NCDI scores than students with anxiety disorders and normal control subjects. In Experiment 3, 19 gang combat veterans were administered a semistructured diagnostic interview and the MMPI-2. Subjects who were diagnosed with Posttraumatic Stress Disorder (PTSD) scored significantly higher on the NCDI than subjects who did not have PTSD. The NCDI is intended primarily as a tool in settings where the MMPI-2 is routinely administered.

Adolescent↗
PubMed2004

Procedural memory in dissociative identity disorder: when can inter-identity amnesia be truly established?

In a serial reaction time task, procedural memory was examined in Dissociative Identity Disorder (DID). Thirty-one DID patients were tested for inter-identity transfer of procedural learning and their memory performance was compared with 25 normal controls and 25 controls instructed to simulate DID. Results of patients seemed to indicate a pattern of inter-identity amnesia. Simulators, however, were able to mimic a pattern of inter-identity amnesia, rendering the results of patients impossible to interpret as either a pattern of amnesia or a pattern of simulation. It is argued that studies not including DID-simulators or simulation-free memory tasks, should not be taken as evidence for (or against) amnesia in DID.

Amnesia↗
PubMed2006

Behavior therapy in dissociative convulsions disorder.

OBJECTIVE: To compare the remission in symptoms achieved with behavior therapy and routine clinical care to that with routine clinical care given alone to patients having dissociative disorder. DESIGN: A randomized controlled trial. PLACE AND DURATION OF STUDY: Psychiatry Unit, Lady Reading Hospital, Peshawar from April 2004 to September 2004. SUBJECTS AND METHODS: A total sample of 100 patients was recruited through Psychiatric OPD and Emergency unit. Patients were randomly allocated to the intervention or control group. The number of fits were recorded each day during admission. The patients were followed-up for four weeks after discharge. Hospital anxiety and depression scale and clinical global impression scales were applied. The two-sample Kolmogorov-Smirnov test was used to show the differences in relative frequencies of fits between the two groups. RESULTS: There were no statistically significant differences in sociodemographic and clinical variables in the intervention and control groups at baseline. There was a highly significant difference between the two groups in frequency of fits at discharge, on the first follow-up and on the fourth follow-up (p=0.000). Similarly, patients in the intervention group showed more improvement on hospital anxiety and depression scale compared to the control group, (p=0.000) at the end of four weeks. CONCLUSION: Behavioral intervention in the management of conversion disorder is more effective than the methods applied in our daily practice.

Adolescent↗
PubMed1998

Identifying dissociative identity disorder: a self-report and projective study.

This study compared 21 female adult psychiatric patients diagnosed with dissociative identity disorder (DID) with 21 female adult nondissociative psychiatric patients to determine whether DID patients exhibit a distinguishing set of clinical features, and perceptual, attentional, and cognitive processes. Participants were assessed with the Dissociative Disorders Interview Schedule to assess diagnostic status. Group scores on the Dissociative Experiences Scale, Tellegen Absorption Scale, Childhood Trauma Questionnaire, Brief Symptom Inventory, and the Rorschach test were compared. DID participants reported earlier and more severe childhood trauma, more dissociative symptoms, and a greater propensity for altered states of consciousness. The DID participants also exhibited increased projective and imaginative activity, a diminished ability to integrate mental contents, a complex and driven cognitive style, and a highly unconventional view of reality.

Adult↗