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PubMed1995

The eye-roll sign and the PAS dissociation scale.

In the past decade we have seen many new articles devoted to the study of dissociation and its implications in health and illness. The area of dissociative disorders received special attention with many authors pointing out the probability that dissociative disorders may, in fact, be much more pervasive than used to be thought. The need for a reliable measurement of dissociation has become more acute. This paper reports the results of a study comparing the Perceptual Alteration Scale (PAS), a behavioral scale measuring dissociation capacity, with Spiegel's Eye-Roll Sign (ERS) a postulated biological marker for the capacity to dissociate. 107 subjects' PAS scales and eye-roll sign measurements were analyzed. The results showed a mean PAS score of 155, and a mean eye-roll of 3.7. The Pearson Correlation Coefficients were computed for the eye-roll scores vs. the PAS scores, and showed a correlation of 0.55, with a significance of p < 0.0001. These results indicate a high positive correlation between the eye-roll sign and the PAS, spanning through the entire dissociative continuum. Further studies are needed to correlate the eye-roll sign with the Dissociative Experiences Scale (DES), and other measurements of dissociation.

Dissociative Disorders↗
PubMed2000

Trauma and dissociation in delinquent adolescents.

OBJECTIVES: To assess history of trauma and dissociation in a group of juvenile delinquents and to assess how adolescents would respond to a structured interview for dissociative symptoms. METHOD: Sixty-four adolescents in juvenile probation hall participated in 2 investigational sessions in 1996-1997. For session 1 they answered the Childhood Trauma Questionnaire (CTQ), the Response Evaluation Measure for Youth-71 (REMY-71), and the Weinberger Adjustment Inventory. For session 2 they were given the Childhood Trauma Interview (CTI) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). RESULTS: In this sample 28.3% met criteria for a dissociative disorder and 96.8% endorsed a history of traumatic events. There were significant positive correlations between CTI and CTQ trauma scores and SCID-D and REMY-71 dissociative symptoms. All dissociative symptoms were endorsed, but depersonalization was the most common experience. There was a lack of congruence between the different methods of assessing dissociation. CONCLUSIONS: This study provides support for an early link between history of trauma and dissociation. Adolescents were able to answer questions from a structured interview assessing dissociation.

Adolescent↗
PubMed1991

Abuse histories in 102 cases of multiple personality disorder.

The authors interviewed 102 individuals with clinical diagnoses of multiple personality disorder at four centres using the Dissociative Disorders Interview Schedule. The patients reported high rates of childhood trauma: 90.2% had been sexually abused, 82.4% physically abused, and 95.1% subjected to one or both forms of child abuse. Over 50% of subjects reported initial physical and sexual abuse before age five. The average duration of both types of abuse was ten years, and numerous different perpetrators were identified. Subjects were equally likely to be physically abused by their mothers or fathers. Sexual abusers were more often male than female, but a substantial amount of sexual abuse was perpetrated by mothers, female relatives, and other females. Multiple personality disorder appears to be a response to chronic trauma originating during a vulnerable period in childhood.

Adolescent↗
PubMed1998

[Dissociation and schizophrenia. Schizophrenias--a dissociative nosopoietic construct?].

The historical roots of the nosopoietic construct schizophrenia are traced: the nosographic construction by Kraepelin, an act of unification and split at the same time. The name schizophrenia reflects the tradition of the model of dissociation which is aetiologically connected with the idea of weakness of the synthetic power of the psyche: psychasthenia. In the establishment of the supposed nosological entity schizophrenia, the name-giving idea of dissociation was almost forgotten. Thus, nowadays Dissociative Disorders are classified in ICD and DSM separately from schizophrenic disorders, but it must be borne in mind that the schizophrenic disorders represent the most severe of disorders, hypothetically based on dissociation, namely, fragmentation of the ego.

Dissociative Disorders↗
PubMed1998

Animal defensive reactions as a model for trauma-induced dissociative reactions.

Patients with complex dissociative disorders remain in alternating psychophysiological states which are discrete, discontinuous, and resistant against integrative tendencies. In this contribution, a parallel is drawn between animal defensive and recuperative states that are evoked in the face of severe threat and the characteristic responses of dissociative disorder patients as displayed in major dissociative states. Empirical data and clinical observations seem to be supportive of the idea that there are similarities between freezing, concomitant development of analgesia and anesthesia, and acute pain in threatened animals and severely traumatized human beings.

Animals↗
PubMed1999

[Somatoform disorders. What is wrong when there is "nothing" wrong?].

Patients with somatoform and dissociative disorders complain of symptoms suggesting physical disease. These patients are high utilizers of health services but seldom receive relevant treatment. Recently empirical data have been obtained concerning epidemiology, familiar distribution, and relation to personality in these disorders. Somatoform patients often have comorbid depression and anxiety disorder. These complications are often overlooked, but accessible to psychopharmacological treatment. A number of psychotherapeutic techniques have been developed for treatment in general practice and in hospital settings.

Anxiety Disorders↗
PubMed1991

Psychologic aspects of sexual abuse in adolescence.

This paper reviews psychologic aspects of sexual abuse in female adolescents. It documents that sexual abuse is widespread, occurring at an alarming rate at all socioeconomic levels of society. It is perpetrated principally by adult men in the victim's family. Often its effects are tragic. Adolescent female sexual abuse victims are at high risk for subsequent acting out behavior, sexual promiscuity, physical and sexual abuse, anxiety, depression, low self-esteem, alcohol and drug abuse or dependence, chronic sleep disturbance, dissociative disorders, eating disorders, emotional numbing, dissociation, guilt, shame, hyperalertness, suicidal ideation, and multiple associated psychiatric disorders. Although it may appear at a surface level that sexual abuse victims recover from such abuse, follow-up studies suggest that many remain disabled long after the abuse has ended. Health care professionals should be especially cognizant of the magnitude of the impact of sexual abuse on adolescent girls and recognize the need of these patients for psychologic and medical services.

Adolescent↗
PubMed1989

Somatic symptoms in multiple personality disorder.

A structured interview, the Dissociative Disorders Interview Schedule, was administered to 20 patients with multiple personality disorder, 20 with panic disorder, 20 with eating disorders, and 20 with schizophrenia. The frequencies of somatization disorder and of individual somatic symptoms in the four groups were compared. The multiple-personality patients reported more somatic symptoms than the other groups. Of the 20 multiple-personality patients, seven met the criteria for somatization disorder. The average number of somatic symptoms per multiple-personality patient was 13.5.

Adult↗
PubMed2005

Owning the past, claiming the present: perspectives on the treatment of dissociative patients.

OBJECTIVE: From the early 1990s there has been a growing awareness in Australia of dissociative processes and dissociative disorders. The objective in this paper is to provide a selective overview of the context and process of treatment based on the substantive dissociative disorders literature, ongoing clinical experience and research, and over 8 years as director of a trauma and dissociation unit at Belmont Hospital, Brisbane. CONCLUSIONS: The construct of individual selfhood is of direct relevance in illustrating the psychological damage sustained by patients who have relied on dissociative defences to survive, and in highlighting issues and areas that are a particular focus of informed treatment.

Adult↗
PubMed2005

An open trial of naltrexone in the treatment of depersonalization disorder.

Depersonalization disorder (DPD) remains one of the few disorders in modern psychiatry for which no treatments are established that are even partially effective, whether pharmacological or psychotherapeutic. Depersonalization disorder is a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dissociative disorder characterized by a pervasive subjective sense of unreality and detachment with intact reality testing. Two recent controlled medication trials, one with lamotrigine and one with fluoxetine, failed to show efficacy. There is some evidence for dysregulation of endogenous opioid systems in depersonalization, and a few studies have suggested that opioid antagonists may have efficacy in the treatment of dissociation and depersonalization symptoms. In this prospective open treatment trial, 14 subjects were recruited and treated with naltrexone for 6 weeks to a maximum dose of 100 mg/d (first 7 subjects) or 10 weeks to a maximum dose of 250 mg/d (next 7 subjects). Mean naltrexone dose was 120 mg/d. There was an average 30% reduction of symptoms with treatment, as measured by 3 validated dissociation scales. Three patients were very much improved, and 1 patient was much improved with naltrexone treatment. These findings are potentially promising in a highly treatment-refractory disorder for which no treatment guidelines exist and warrant a randomized controlled trial.

Adult↗