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PubMed1996

The development and psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20).

According to 19th century French psychiatry and contemporary clinical observations, dissociation pertains to both psychological and somatoform components of experience, reactions, and functions. Because such an instrument was lacking, we aimed to develop a self-reporting questionnaire measuring what we propose to call somatoform dissociation. Patients with dissociate disorder and with other DSM-IV psychiatric diagnoses completed a list of 75 items that, according to clinical experience and expert judgment, could reflect instances of somatoform dissociation. Separate logistic analyses and determination of discriminant indices per item revealed 20 items that best discriminated between those with and without dissociative disorders. Mokken analysis showed that these items are strongly scalable on a dimensional latent scale interpreted to measure somatoform dissociation. Reliability of the scale was high. Construct validity was supported by high intercorrelations with the Dissociation Questionnaire, which measures psychological dissociation, and higher scores of patients with dissociative identity disorder compared with patients with dissociative disorders not otherwise specified. In conclusion, the Somatoform Dissociation Questionnaire (SDQ-20) is a scale of good psychometric quality, which measures somatoform dissociation. The symptoms pertain to negative and positive dissociative phenomena, which were well known in 19th century French psychiatry as the mental stigmata and mental accidents of hysteria.

Adolescent↗
PubMed2006

Dissociative identity disorder presenting as dermatitis artefacta.

Dermatitis artefacta is a rare psychiatric condition characterized by rubbing of skin blisters and denial of self-infliction. Dissociation may be comorbid with self-injurious behavior. A background of emotional disturbances during formative years and in later life often results in feelings of isolation and insecurity, which can lead to dissociation as a primary defense mechanism used to overcome traumatic events. In this case report, we describe a female patient with dermatitis artefacta associated with dissociative identity disorder. The patient was a 14-year-old girl. Multiple large, deep ulcerations with unnatural shapes were seen on her left forearm. The ulcerations were thought to be self-inflicted. Psychiatric examination revealed that she had a different identity, and inflicted the lesions when this was assumed. This case leads us to suggest that patients with dermatitis artefacta might have comorbid dissociative experiences, which cannot be identified easily.

Adolescent↗
PubMed2004

Testing the dissociative taxon.

A dissociative taxon has been proposed by Waller et al. (1996) to help identify individuals experiencing pathological dissociation. We studied the frequency of taxon membership and tested its validity. A total of 276 students and 204 psychiatric inpatients completed the Dissociative Experiences Scale (DES). In patients with higher DES ratings, the Dissociative Disorders Interview Schedule was administered. Taxon classification applied to 2.9% of non-patients and to 12.7% of patients. No statistically significant relationship was found between taxon membership and the clinical diagnosis of a dissociative disorder. Taxon membership indicates a higher frequency of dissociative experiences but cannot be equated with the presence of a dissociative disorder.

Adult↗
PubMed1993

Dissociation & multiple personality disorder. A challenge for psychosocial nurses.

1. Multiple personality disorder (MPD) is a dissociative disorder in which two or more distinct personality states exist within an individual. At least two of these personalities recurrently take full control of the person's behavior. 2. Most MPD clients report histories of severe childhood trauma, particularly physical, sexual, and ritual cult abuse. MPD most likely originates in childhood, but is not usually diagnosed until adulthood. In most reported cases, the first dissociative episode is thought to have occurred at a very young age. 3. Signs and symptoms that may suggest MPD include a history of medical and psychiatric diagnoses; inconsistencies in accounts of elapsed time and physical behaviors; psychophysiological complaints; experiencing voices inside the head; and an individual referring to herself as "we" instead of "I."

Adult↗
PubMed1989

A polysomnographic and clinical report on sleep-related injury in 100 adult patients.

In 100 consecutive adults who came to a sleep disorders center complaining of repeated nocturnal injury, polysomnographic study identified five disorders: night terrors/sleepwalking (N = 54), REM sleep behavior disorder (N = 36), dissociative disorders (N = 7), nocturnal seizures (N = 2), and sleep apnea (N = 1). Ninety-five patients sustained ecchymoses, 30 had lacerations, and nine had fractures. DSM-III axis I disorders (past or current) were found in 48.1% of the group with night terrors/sleepwalking and in 30.6% of the group with REM sleep behavior disorder; these were mainly affective disorders. In these two groups, clonazepam controlled the symptoms of 51 of the 61 patients to whom it was given.

Adolescent↗
PubMed1992

Dissociative experiences, psychopathology and adjustment, and child and adolescent maltreatment in female college students.

Thirty-three female college students who scored in the upper 15% on the Dissociative Experiences Scale (DES) were compared with 33 female students who scored below the mean on the DES on measures of psychopathology (Symptom Checklist-90), college adjustment (Student Adaptation to College Questionnaire), and child and adolescent maltreatment. Compared with controls, high-DES subjects reported more psychopathology, poorer college adjustment, and a greater extent of psychological, physical, and sexual maltreatment. On the basis of the Dissociative Disorders Interview Schedule, 2 high-DES subjects but none of the control subjects met criteria for a dissociative disorder (i.e., multiple personality and psychogenic amnesia). Despite the sensitivity of the DES, 8 subjects who scored in the upper 2% of the population on the DES failed to meet criteria for a dissociative disorder.

Adaptation, Psychological↗
PubMed1991

Patterns of discourse production among neurological patients with fluent language disorders.

Dissociations between impairments in microlinguistic and macrolinguistic abilities were examined in brain-damaged patients to assess whether these abilities are psychologically and neurologically distinct. The discourse productions of three groups of patients with equally severe fluent language disorders, but varying neuropathology and varying profiles of associated nonlinguistic cognitive impairments, were analyzed. Patients with fluent aphasia secondary to a single left-hemisphere CVA showed the greatest impairment on syntactic and lexical error measures taken to reflect microlinguistic abilities, but normal performance on measures of macrolinguistic organization (i.e., thematic coherence). Patients with probable Alzheimer's Disease were impaired on thematic coherence measures, but not on measures reflecting microlinguistic syntactic and phonological processes. Closed head injury patients whose primary clinical symptom was a fluent language disorder were impaired on both microlinguistic and macrolinguistic measures, which appears to parallel their deficits both in language-specific and in nonspecific, higher-order, diffusely organized cognitive processes.

Adult↗
PubMed1996

Dissociative mothers' subjective experience of parenting.

This study examined to what extent the symptoms of dissociative mothers interfered with their parenting and their subjective experiences of mothering. A group of 54 dissociative inpatient or day-patient mothers, 20 nondissociative inpatient mothers, and 20 hospital staff mothers were screened for Dissociative Disorders using the Structured Clinical Interview for Dissociative Disorders (SCID-D). They were then asked to fill out a self-report questionnaire on various aspects of mothering. This questionnaire, the Subjective Experiences of Parenting Scale (SEPS), examined 14 parenting characteristics: parenting partner support; relative support; abusiveness towards the child; extent to which symptoms interfered with parenting; constructive parenting traits; supportive versus hurtful discipline; extent of showing affection; ability to express affection; attachment behaviors; cognitive distortions; regulation of anger; self versus mother in parenting; subjective experience of mothering; and actions to promote the developmental growth of the child Dissociatives presented significantly more negative parenting behavior and related attributes than staff controls on 13 of the 14 parenting characteristics. Compared to nondissociative patients, the dissociative cohort presented poorer parenting behavior and related attributes on 9 of the 14 characteristics. Overall, the dissociatives experienced more problems with parenting attitudes and behaviors than either comparison group. Dissociative mothers manifested affective, behavioral, and cognitive difficulties in parenting.

Adult↗
PubMed1999

Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past.

In a recent article in this journal, D. H. Gleaves (1996) criticized the sociocognitive model (SCM; N. P. Spanos, 1994) of dissociative identity disorder (DID) and argued in favor of a posttraumatic model (PTM) in which DID is conceptualized as a consequence of childhood abuse and other traumatic events. The present authors demonstrate that (a) many of Gleaves's arguments were predicated on misunderstandings of the SCM, (b) scrutiny of the evidence regarding the psychopathology and assessment of DID raises questions concerning the PTM's conceptual and empirical underpinnings, (c) the treatment literature suggests that iatrogenic factors play an important role in the etiology of DID, and (d) the evidence linking child abuse to DID is more problematic than implied by Gleaves. The present authors conclude that Gleaves's analysis underemphasized the cultural manifestations of multiple role enactments and that the history of DID imparts a valuable lesson to contemporary psychotherapists.

Adult↗
PubMedDate not supplied

Dissociative symptoms in schizophrenic patients with positive and negative symptoms.

Given the close historical relationship between schizophrenia and dissociative disorders, namely multiple personality disorder, we assessed 27 ICD-10 diagnosed schizophrenic inpatients for dissociative symptoms using the German version of the Dissociative Experience Scale and compared them to a nonclinical control group matched for gender and age. Other self-report instruments covering general psychopathology, and an expert rating on the predominance of positive or negative schizophrenic symptoms, were also administered. Schizophrenic patients have significantly more dissociative symptoms than controls. Moreover, patients with a plus type of schizophrenia show significantly higher levels of dissociation than patients mainly exhibiting less productive symptoms. However, dissociative phenomena are only significantly correlated with delusions and hallucinatory behavior, and do not show any correlation with other positive symptoms of schizophrenia. Severe dissociative psychopathology is also associated with impairment in other psychopathological dimensions. The implications of these findings are discussed with regard to the theory of dissociation, the differential diagnosis between schizophrenia and dissociative disorders and a possible contribution of dissociative phenomenology to the clinical heterogeneity of schizophrenia.

Adult↗
PubMed1996

[Hysteria, dissociation and conversion. A review of concepts, classification and diagnostic instruments].

Modern theories on hysteria are presented by describing the historical context of various scientific approach to hysterical phenomena as well as the concepts of dissociation and conversion which are closely linked. The subdivision of the classical hysterical neurosis into the dissociative disorders and the somatoform disorders within the diagnostic classifications of ICD-10 and DSM-III-R respectively DSM-IV is illustrated and discussed. These new theories have prompted the development of some instruments such as diagnostic interviews (SCID-D) and self-measuring questionnaires (DES). The scientific value and importance of these instruments is discussed, especially with regard to further studies on dissociative disorders, particularly in the German-speaking countries.

Conversion Disorder↗
PubMed2001

Multimodal assessment of dissociation in adolescents: inpatients and juvenile sex offenders.

Two samples of adolescents were studied to assess the validity of several measures of dissociation. The first sample included 70 males from a residential treatment program for adolescent sex offenders (ASO). The second were 47 psychiatric inpatients. The measures included the DSM-IV field trial questionnaire for Dissociative Disorders of Childhood, Child Dissociative Checklist, Adolescent-Dissociative Experiences Schedule, Trauma Symptom Checklist for Children, and the Dissociation Research scale. Ten of the 70 adolescent sex offender subjects (14.3%) were identified as meeting DSM-IV criteria for a Dissociation-spectrum disorder diagnosis and two (4.2%) of the psychiatric patients. Between-groups analyses with the ASO revealed significant differences on the Child Dissociative Checklist and the Dissociation Research Scale. Cumulative trauma did not differ significantly between the dissociative and nondissociative groups of ASO, but physical abuse was related to a diagnosis of dissociation in this sample. The dissociation measures were highly intercorrelated for both groups, and suggest that they measure a similar construct.

Adolescent↗