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PubMed1999

Attitudes toward DSM-IV dissociative disorders diagnoses among board-certified American psychiatrists.

OBJECTIVE: The authors assessed the opinions of American psychiatrists regarding the diagnostic status and scientific validity of the DSM-IV categories of dissociative amnesia and dissociative identity disorder. METHOD: A one-page questionnaire was mailed to a random national sample of 367 board-certified American psychiatrists. RESULTS: Three hundred one responses were received-a rate of 82%. Only about one-third of respondents replied that dissociative amnesia and dissociative identity disorder should be included without reservations in DSM-IV; a larger proportion replied that these categories should be included only as proposed diagnoses. Only about one-quarter of respondents felt that diagnoses of dissociative amnesia and dissociative identity disorder were supported by strong evidence of scientific validity. CONCLUSIONS: Among board-certified American psychiatrists, there currently appears to be little consensus regarding the diagnostic status or scientific validity of dissociative amnesia and dissociative identity disorder.

Amnesia↗
PubMed1995

Assessing dissociative symptoms in eating disordered patients: construct validation of two self-report measures.

Dissociative symptomatology has been reported among patients with eating disorders, necessitating the availability of valid assessment instruments. In the current investigation, we examined the construct-related validity of two self-report instruments for assessing dissociative symptoms: the Dissociative Experiences Scale and the Trauma Symptom Checklist-40. The instruments were administered, along with instruments measuring depressive, anorexic, and bulimic symptomatology, to a sample of 125 eating disordered subjects. The dissociation measures demonstrated good convergent and discriminant validity, with a convergent validity coefficient (r = .73) that was approximately equal to that for the instruments measuring each of the three other psychological constructs. A principal components analysis further supported the construct-related validity of the dissociation scales. Severity of dissociative symptoms was generally unrelated to anorexic or bulimic symptomatology, but was significantly associated with depression. The results supported the construct validity of the dissociation instruments and the general status of dissociation as a valid and well-defined psychological phenomenon.

Adolescent↗
PubMed2005

Dissociation: An insufficiently recognized major feature of complex posttraumatic stress disorder.

The role of dissociation in (complex) posttraumatic stress disorder (PTSD) has been insufficiently recognized for at least two reasons: the view that dissociation is a peripheral, not a central feature of PTSD, and existing confusion regarding the nature of dissociation. In this conceptual article, the authors address both issues by postulating that traumatization essentially involves some degree of division or dissociation of psychobiological systems that constitute personality. One or more dissociative parts of the personality avoid traumatic memories and perform functions in daily life, while one or more other parts remain fixated in traumatic experiences and defensive actions. Dissociative parts manifest in negative and positive dissociative symptoms that should be distinguished from alterations of consciousness. Complex PTSD involves a more complex structural dissociation than simple PTSD.

Consciousness↗
PubMedDate not supplied

Correlates of dissociative symptomatology in patients with physical and sexual abuse histories.

Recent studies have demonstrated a high prevalence of sexual and physical abuse histories and high levels of dissociative symptoms in psychiatric inpatients. We examined whether severity, frequency, and age of onset of abuse correlated with subjects' levels of dissociative symptoms. Sixty-four women reporting a lifetime history of physical and/or sexual abuse were recruited from consecutive admissions to three wards of a psychiatric hospital. Subjects completed the Life Experiences Questionnaire (LEQ) and the Dissociative Experiences Scale (DES). Subjects' self-reports of severity, frequency, and age of onset of abuse were analyzed for correlations with DES score. More invasive sexual abuse was associated with more dissociation. Higher-frequency physical abuse was associated with more dissociation, but no conclusion could be drawn about the impact of frequent sexual abuse due to missing data. An inverse correlation was found between age of onset of abuse and degree of dissociative symptomatology. These preliminary findings are consistent with hypotheses linking more severe, more chronic, and earlier abuse to the greater development of dissociative symptoms. The findings further emphasize the importance of recognizing dissociative symptoms in the clinical setting, and of continued study into the effects of childhood trauma.

Adolescent↗
PubMedDate not supplied

The relationship between characteristics of sexual abuse and dissociative experiences.

Childhood sexual abuse has been associated with adult dissociative symptomatology. The purpose of this study was to examine the relationship between specific characteristics of sexual abuse and dissociative experiences in adulthood. Fifty-six female inpatients with a history of physical abuse and severe sexual abuse reported on their history of abuse and dissociative experiences. A logistic regression that controlled for physical revictimization showed that sexual abuse by a greater number of different sex abuse offenders was significantly related to an elevated level of dissociation. In exploring how many sex abuse offenders are associated with dissociative experiences, a logistic regression revealed a significant relationship between four or more sex abuse offenders and greater dissociative symptomatology. The reported age of onset of the sexual abuse was not a significant predictor of dissociation when sexual revictimization was included in the analysis. These findings suggest that severely traumatized patients with a history of multiple sex abuse offenders are highly likely to use dissociation as a primary psychological defense. The implications of the study are discussed.

Adolescent↗
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↗
PubMed2004

Towards a cognitive model and measure of dissociation.

Dissociation comprises a range of psychological processes, which have largely been the subject of psychodynamic discussion. Dissociative phenomena are for the most part unaddressed by cognitive theorists. Current measures are atheoretical and our understanding of dissociation has been hampered by the absence of clear psychological models. This paper describes a new cognitive model of dissociation and the development and validation of a theoretically based measure-the Wessex Dissociation Scale (WDS). The WDS has adequate internal consistency, shows convergent validity with the Dissociative Experiences Scale (DES-II), and is equivalent to the DES-II in its associations with severe psychopathology. However, the WDS has some advantages over the DES-II, in that it is sensitive to milder manifestations of dissociation, demonstrating links to less severe pathologies. The findings described here provide preliminary support for the usefulness of the cognitive model, and the varied consequences of dissociative processes. The clinical and research utility of the model and the scale are discussed.

Adolescent↗
PubMed2005

Dissociation related to subjective memory fragmentation and intrusions but not to objective memory disturbances.

The present study was a replication of Kindt and Van den Hout (Behaviour Research and Therapy 41 (2003) 167) with several methodological adaptations. Two experiments were designed to test whether state dissociation is related to objective memory disturbances, or whether dissociation is confined to the realm of subjective experience. High trait dissociative participants (N(exp.1)=25; N(exp.2)=25) and low trait dissociative participants (N(exp.1)=25; N(exp.2)=25) were selected from normal samples (N(exp.1)=372; N(exp.2)=341) on basis of scores on the Dissociative Experience Scale (DES). Participants watched an extremely aversive film, after which state dissociation was measured by the Peri-traumatic Dissociative Experience Questionnaire (PDEQ). Memory disturbances were assessed 4h later (Exp. 1) or 1 week later (Exp. 2). Objective memory disturbances were assessed by a sequential memory task, items tapping perceptual representations (Exp. 1), or an open question with respect to the remembrance of the film (Exp. 2). Subjective memory disturbances were measured by means of visual analogue scales assessing fragmentation and intrusions. The two experiments provided a fairly exact replication of an earlier experiment (Behaviour Research and Therapy 41 (2003) 167-178), indicating a relation between dissociation and memory disturbances that appeared to be confined to the subjective experience of memory.

Adult↗
PubMed2003

Dissociation and memory fragmentation: experimental effects on meta-memory but not on actual memory performance.

The relation between state dissociation and fragmentary memory was investigated by assessing both actual memory performance and meta-memory. From a sample of 330 normal subjects, two subsamples were selected on basis of trait dissociation, as measured by the Dissociative Experience Scale. Twenty subjects scoring above 30 and 20 subjects scoring below 10 were selected. Subjects watched an extremely aversive film, after which state dissociation was measured by the Peri-traumatic Dissociative Experience Scale. Four hours later memory fragmentation was assessed in two ways. Actual fragmentation was measured by a sequential memory task, and perceived fragmentation (meta-memory) was measured using a visual analogue scale. Subjects who tended to dissociate during the film judged their recollections of the film as more fragmentary. Although this finding is in line with clinical reports given by trauma victims, it was not sustained by objective evidence. That is, no effect was observed of state dissociation on the sequential memory task. The present findings suggest that the claim that dissociation induces memory fragmentation may have to be confined to meta-memory. Implications of this divergence between actual memory and meta-memory are discussed.

Adult↗
PubMed2001

The causal link between self-reported trauma and dissociation: a critical review.

The idea that traumatic experiences cause dissociative symptoms is a recurrent theme in clinical literature. The present article summarizes evidence that cast doubts on the commonly voiced view that the connection between self-reported trauma and dissociation is a simple and robust one. It is argued that: (1) the correlations between self-reported traumatic experiences and dissociative symptoms reported in the literature are, at best, modest; (2) other factors may act as a third variable in the relationship between trauma and dissociation; and (3) high scores on the Dissociative Experiences Scale are accompanied by fantasy proneness, heightened suggestibility, and susceptibility to pseudomemories. These correlates of dissociation may promote a positive response bias to retrospective self-report instruments of traumatic experiences. Thus, the possibility that dissociation encourages self-reported traumatic experiences rather than vice versa merits investigation. While attractive, simple models in which trauma directly causes dissociation are unlikely to be true.

Dissociative Disorders↗
PubMedDate not supplied

Frequency of dissociative disorders among psychiatric outpatients in Turkey.

The aim of this study was to determine the frequency of dissociative disorders among psychiatric outpatients in Turkey. One hundred fifty consecutive outpatients admitted to the psychiatry clinic of a university hospital were screened with the Dissociative Experiences Scale (DES). Twenty-three patients (15.3%) with a DES score greater than 30 and a comparison group selected from the same outpatient population who scored less than 10 on the scale were then interviewed with the Dissociative Disorders Interview Schedule (DDIS) in a blind fashion. According to the DDIS, 18 patients (12.0%) received a diagnosis of dissociative disorder; 83.3% (n = 15) of the dissociative patients reported neglect, 72.2% (n = 13) emotional abuse, 50.0% (n = 9) physical abuse, and 27.8% (n = 5) sexual abuse during childhood. Dissociative disorders are not rare among psychiatric outpatients. Self-rating instruments and structured interviews can be used successfully for screening dissociative disorders, which are usually underrecognized. Neglect was the most frequently reported type of childhood trauma, suggesting the importance of other childhood experiences in addition to sexual and/or physical abuse in the development of dissociative psychopathology.

Adolescent↗
PubMed2000

Dissociation as a mediator between child abuse history and adult abuse potential.

OBJECTIVE: It has commonly been found that abused children are at risk for later becoming abusive parents (Kaufman & Zigler. 1987; Oliver, 1993) and observational learning has been discussed as a mechanism that perpetuates this intergenerational cycle of abuse. However, two thirds of abused children do not become abusive (Kaufman & Zigler, 1987). Thus, the goal of the current study was to examine whether dissociation functions as an additional mechanism mediating the relation between a history of child abuse and abusiveness as an adult. METHOD: A cross-sectional design was used to examine physical abuse history, dissociation, and physical abuse potential in a sample of 190 college students. Questionnaires were utilized to assess the three constructs. RESULTS: Findings indicated that the three constructs were intercorrelated. In particular, a newly established association was found between dissociation and physical abuse potential (r = .54, p < .0001). The primary finding was that the relation between physical abuse history and physical abuse potential was significantly mediated (z = 2.19, p < .05) by level of dissociation, with dissociation accounting for approximately half of the observed relation between history of abuse and abuse potential. CONCLUSION: Results suggested that dissociation may be one mechanism that helps to perpetuate the intergenerational cycle of abuse. Although dissociation promotes psychological survival during children's abuse experiences, it may result in the development of abusive tendencies in later life. Reducing parental dissociation may assist clinicians in preventing or terminating physical child abuse.

Adolescent↗
PubMed1999

Memory dissociation: the approach to the study of retrieval processes.

The phenomenon of dissociated memory retrieval is observed when some influences (for example, pharmacological) on the brain result in specific changes of long-term memory. The purpose of present paper is to reveal possibilities of the phenomenon for study of long-term memory retrieval. Pharmacologically-induced dissociated states could be identified when the retrieval of responses learned before treatment is temporarily blocked by the drug influence, but the ability of the animals to learn new tasks is intact. Furthermore, memory traces that were formed in drugged state are not accessible for the retrieval in normal state and only the same drug treatment allows retrieving them. In the present work, dissociated learning of food-motivated tasks was carried out in Wistar rats with cholinesterase inhibitor physostigmine (0.5 mg/kg, intraperitonealy) or general anaesthetic sodium pentobarbital (15 mg/kg, intraperitonealy.). The retrieval of dissociated responses was studied under the influence of various doses of the same drugs. The results revealed the asymmetry of memory dissociation with physostigmine in contrast to pentobarbital-induced memory dissociation. Gradual access for the retrieval of dissociated memory traces after pharmacological modulation of cholinergic and GABA-ergic brain systems was shown. It was suggested an important role of hippocampus in memory dissociation, as a structure-performing match-mismatch operations between different retrieved memory traces.

Amnesia↗
PubMed2002

Dissociative and associated psychopathological symptoms in patients with epilepsy, pseudoseizures, and both seizure forms.

PURPOSE: A controversy currently exists regarding the significance of dissociation and conversion in the pathogenesis of pseudoepileptic seizures. After the abolition of the term "hysterical neurosis" from the current diagnostic systems, these seizures were diagnosed as either Dissociative Disorders (ICD-10) or in the DSM IV as Somatoform disorder, most often of conversion type. Recent studies of patients with Dissociative Disorders found that most patients also had conversion symptoms. METHODS: In the present study, 60 patients of an outpatient clinic for epilepsy were assessed for the presence of dissociative symptoms and general psychopathologic symptoms by using the German version of the Dissociative Experience Scale (DES) and the Symptom Check List (SCL-90-R). RESULTS: The patients with pseudoepileptic seizures showed a significantly higher incidence of dissociation (p < 0.0098) and general psychopathologic symptoms (p < 0.0083). Depression, anxiety, and obsession were dominating psychopathologic symptoms in all patients. CONCLUSIONS: The significantly higher incidence of dissociation in the patients with pseudoepileptic seizures suggests dissociation in the pathogenesis of these seizures.

Adult↗
PubMed1997

Ca2+/calmodulin causes Rab3A to dissociate from synaptic membranes.

The GTPase Rab3A has been postulated to cycle on and off synaptic membranes during the course of neurotransmission. Moreover, a Rab guanine nucleotide dissociation inhibitor has been shown to cause Rab3A to dissociate from synaptic membranes in vitro. We demonstrate here that Ca2+/calmodulin also can cause Rab3A to dissociate from synaptic membranes in vitro. Like Rab guanine nucleotide dissociation inhibitor, it forms a 1:1 complex with Rab3A that requires both the lipidated C terminus of Rab3A and the presence of bound guanine nucleotide. In addition, a synthetic peptide corresponding to the Lys62-Arg85 sequence of Rab3A can prevent the dissociating effect of each protein and disrupt complexes between each protein and Rab3A. However, Ca2+/calmodulin's effect differs from that of Rab guanine nucleotide dissociation inhibitor not only in being Ca2+-dependent but also in having a less stringent requirement for GDP as opposed to GTP and in involving a less complete dissociation of Rab3A. The functional significance in vivo of Ca2+/calmodulin's effect remains to be determined; it may depend in part on the relative amounts of Ca2+/calmodulin and Rab guanine nucleotide dissociation inhibitor that are available for binding to Rab3A in individual, activated nerve termini.

Amino Acid Sequence↗
PubMed1992

Dissociative symptoms in patients with obsessive-compulsive disorder.

To clarify the relationship between dissociative symptoms and obsessive-compulsive disorder (OCD), 100 patients with OCD were assessed with standardized instruments measuring symptoms of OCD, dissociation, and depression. Diagnoses of personality disorders and dissociative disorders were made using structured interviews. Compared with a previous study, OCD patients had dissociation scores slightly higher than normal controls and comparable to patients with other anxiety disorders. Patients with elevated dissociation scores had more severe OCD symptoms, were more depressed, and were more likely to have a personality disorder than patients with low dissociation scores. Although dissociative symptoms were frequently reported by OCD patients, symptoms of OCD may also mimic dissociation in some patients.

Adult↗
PubMed2000

Peritraumatic dissociation following motor vehicle accidents: relationship to prior trauma and prior major depression.

Individuals who dissociate at the time of a traumatic event (peritraumatic dissociation) are more likely to develop acute and chronic posttraumatic stress disorder (PTSD). However, little is known about who is at risk of peritraumatic dissociation. Motor vehicle accident subjects (N = 122) were systematically recruited and followed over 12 months. We used the Structured Clinical Interview for DSM-III-R (SCID) and the Peritraumatic Dissociative Experiences Questionnaire-Rater Version (PDEQ-RV). Younger subjects were more likely to experience peritraumatic dissociation as were white versus nonwhites, and single versus married subjects. Younger subjects reported a greater number of peritraumatic dissociative symptoms as did subjects with an injured passenger. After adjusting for age and passenger injury, prior major depression was significantly related to more peritraumatic dissociative symptoms. An interaction of age and prior major depression indicated that those who were younger and reported a history of major depression had the greatest number of peritraumatic dissociative symptoms.

Accidents, Traffic↗
PubMed2003

Prevalence of dissociative experiences in a community sample: relationship to gender, ethnicity, and substance use.

This study examined the relationship between gender, ethnicity, substance use, and dissociation in a community sample of adults. Telephone interviews were conducted using, among others, measures of dissociation (Dissociative Experiences Scale-Taxon [DES-T]) and alcohol use (Alcohol Use Disorders Identification Test [AUDIT]) to screen a representative sample of 1007 adults in Memphis, Tennessee. Six percent of respondents endorsed four or more lifetime dissociative symptoms, whereas approximately one third of respondents endorsed at least one symptom. Only 2% were identified as having pathological dissociation on the DES-T. DES-T scores were significantly associated with gender (male), ethnicity (African-American), and harmful alcohol use. Dissociative symptoms appear to be relatively common in the population, but only a small proportion of individuals suffer from significant levels of dissociation. Further assessment of the link between demographic factors and the severity and expression of dissociative phenomena in nonclinical samples is warranted.

Adolescent↗