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PubMed1995

[Dissociative hysteria].

Under the term of dissociative hysteria are described a set of clinical syndromes characterized by behavioral disorders and psychic activity anomalies. The nature of the symptoms seems very similar to hysterical conversion. Psychogenic amnesia, psychogenic fugues and multiple personality disorder are described. There is some evidence that the symptoms are related to psychic affective traumatisms and no physiological alteration. Two mechanisms are proposed: dissociation of personality and amnesia. Clinical course generally improves spontaneously. Various forms of psychotherapy may be used.

Amnesia↗
PubMed1996

[Dyssocial identity disorder (double identity) in psychopathology and poetry].

Identity dissociation signifies: there seem to exist two identities in one personality that take turns-apparently without knowing about each other. Descriptions of this rare state are often spectacular. As scientifically proven they depend on culturally specific conditions and iatrogeneous influences. The disorder is to be analysed in this article for the case of both psychiatry and every-day-life-experiences in a matter-of-fact way. The first description of the phenomenon is not found in psychiatric literature but in poetry. The novellas of E.T.A. Hoffmann contain at least eight descriptions of 'double life'. The 'Fräulein von Scuderi' (1820) seems to be the most interesting of these and is therefore focused on in this article. E.T.A. Hoffmann himself was at the same time well respected jurist and significant artist of great versatility: poet as well as musician, composer, painter. Hoffmann's artistic and his civic life stood in sharp contrast, which gives reason to use of the term 'double life'.

Adult↗
PubMed1996

Identity and Introject in dissociative disorders.

The structural analysis of social behavior (SASB) shows promise for systematically examining identity issues in clinical populations. In this study, identity is assessed with the SASB in a sample of women with dissociative disorder (n = 25) and a nonpatient clinical contrast group (n = 25). The SASB Introject--a multivariate measure of identity--effectively differentiated the 2 samples. Despite greater self-directed hostility than the clinical contrast group, dissociative disorder patients showed lower levels of intrapsychic conflict. Implications for further research on identity and psychopathology are discussed.

Conflict, Psychological↗
PubMed1994

Rethinking the comparison of borderline personality disorder and multiple personality disorder.

This article has made a number of points that assert what is today a minority position within the fields of MPD/DID and BPD. We hope our views will stimulate attempts by others to rethink their positions and test our assertions, so that issues surrounding these two disorders can be sharpened. For the sake of the clarity of future work, we summarize in outline form the essence of our viewpoint. 1. BPD and MPD/DID have similar appearing symptoms, such as identity problems, unstable affect modulation, self-destructive behaviors, chaotic impulse control, and troubled interpersonal relationships, but they have decisive differences in underlying dynamics, process, and structure. 2. DSM tends to blur these two disorders by its emphasis on phenomenology over inner structure, thus fostering misleading conclusions when DSM criteria are used to test for comorbidity or overlap between BPD and MPD/DID. 3. BPD and MPD/DID are both described dynamically as using the defense of splitting, but we contend that the splitting in each disorder is fundamentally different from the splitting in the other. BPD uses a polarization form of splitting, whereas MPD/DID uses ego splitting or identity division. 4. Both disorders partake in the process of dissociation, but the quality of dissociation in BPD is a "low-tech" spaced out type, whereas that of MPD/DID is a "high-tech" waking dream. 5. BPD structure is also "low tech," with polarization of self, object, and relationship. MPD/DID structure is "high tech," with heavily symbolic, highly nuanced variations of self, object, and relationship. 6. Although both conditions have etiologic elements of trauma, BPD has a larger degree of developmental deficiency, with a failure to complete the task of entering a repression hierarchy of defenses. MPD/DID, by use of primary process-linked symbolic dissociation, is able to continue development to the repression hierarchy, although at a profound cost of simultaneous suspension of reality testing. BPD patients suffer from the rigid use of too few defenses; MPD/DID patients suffer from the obsolete use of too many defenses. 7. BPD patients grow up in homes in which overtly expressed aggression is more tolerated, or at least more openly experienced. MPD/DID patients grow up in homes in which the fact of aggression is kept a secret. This has consequences for the formation of psychic structure in each disorder.(ABSTRACT TRUNCATED AT 400 WORDS)

Aggression↗
PubMedDate not supplied

Dissociative experiences in obsessive-compulsive disorder and trichotillomania: clinical and genetic findings.

A link between dissociation proneness in adulthood and self-reports of childhood traumatic events (including familial loss in childhood, sexual/physical abuse and neglect) has been documented. Several studies have also provided evidence for an association between dissociative experiences and trauma in patients with various psychiatric disorders, including post-traumatic stress disorder, borderline personality, dissociative identity and eating disorders. Based on the relative paucity of data on dissociation and trauma in obsessive-compulsive disorder (OCD) and trichotillomania (TTM), the primary objective of this study was to examine the relationship between trauma and dissociative experiences (DE) in these two diagnostic groups. Furthermore, the availability of clinical and genetic data on this sample allowed us to explore clinical and genetic factors relevant to this association. A total of 110 OCD and 32 TTM patients were compared with respect to the degree of dissociation (using the Dissociative Experiences Scale [DES]) and childhood trauma (using the Childhood Trauma Questionnaire [CTQ]). Patients were classified on the DES as either "high" (mean DES score >/= 30) or "low" (mean DES score < 30) dissociators. Additional clinical and genetic factors were also explored with chi-square and t tests as appropriate. A total of 15.8% of OCD patients and 18.8% of TTM patients were high dissociators. OCD and TTM groups were comparable on DES and CTQ total scores, and in both OCD and TTM groups, significant positive correlations were found between mean DES scores and mean CTQ subscores of emotional abuse, physical abuse, sexual abuse, and physical neglect. In the OCD group, high dissociators were significantly younger than low dissociators, and significantly more high dissociators than low dissociators reported a lifetime (current and past) history of tics (P <.001), Tourette's syndrome (P =.019), bulimia nervosa (P =.003), and borderline personality disorder (P =.027). In the TTM group, significantly more high dissociators than low dissociators reported (lifetime) kleptomania (P =.005) and depersonalisation disorder (P =.005). In the Caucasian OCD patients (n = 114), investigation of genetic polymorphisms involved in monoamine function revealed no significant differences between high and low dissociator groups. This study demonstrates a link between childhood trauma and DE in patients with OCD and TTM. High dissociative symptomatology may be present in a substantial proportion of patients diagnosed with these disorders. High dissociators may also be differentiated from low dissociators on some demographic features (e.g., lower age) and comorbidity profile (e.g., increased incidence of impulse dyscontrol disorders). Additional work is necessary before conclusions about the role of monoaminergic systems in mediating such dissociation can be drawn.

Adult↗
PubMed1990

The Structured Clinical Interview for DSM-III-R Dissociative Disorders: preliminary report on a new diagnostic instrument.

The authors describe the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D), which investigates five groups of dissociative symptoms (amnesia, depersonalization, derealization, identity confusion, and identity alteration) and systematically rates both the severity of individual symptoms and the evaluation of overall diagnosis of dissociative disorder. Preliminary findings from a study of 48 subjects with and without psychiatric diagnoses indicate good to excellent reliability and discriminant validity for the SCID-D as a diagnostic instrument for the five dissociative disorders and as a tool for the evaluation of dissociative symptoms encountered within nondissociative syndromes.

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↗
PubMed1983

Multiple personality and primary affective disorder.

This report describes a young woman who met research criteria for both primary depression and multiple personality. Abnormal dexamethasone suppression test results supported the former diagnosis and returned to normal during electroconvulsive therapy in anticipation of depressive symptom resolution. This suggests that multiple personality may occur as an epiphenomenon of affective disorder or of other illnesses.

Adult↗
PubMed1985

Group psychotherapy with multiple personality patients.

Group psychotherapy with multiple personality patients is an infrequently utilized technique. In a homogeneous group composed of multiple personality patients, the technique of group psychotherapy is examined in detail. The group setting, selection of patients, and group composition are described. Therapeutic issues involving group process, intrapersonal dynamics, transference, countertransference, co-therapy, and termination are examined. Finally, psychotherapy with the group of multiple personality patients is contrasted with group psychotherapy with borderline patients and incest victims.

Adolescent↗
PubMed1986

Chance discovery of multiple personality disorder in a depressed patient by amobarbital interview.

Although the diagnosis of multiple personality disorder (MPD) has been receiving renewed interest in the literature, it presents a number of clinical problems and challenges. A case study is reported in which this diagnosis was uncovered by chance during an amobarbital interview on a psychotically depressed young male patient. The patient had previously been only minimally responsive to pharmacotherapy for a major depressive episode with mood-congruent psychotic features. When the multiple personality disorder was diagnosed, treatment emphasis shifted toward psychotherapeutic modalities with marked clinical improvement. Several unique aspects of the case, including diagnostic methodology, results of serial dexamethasone suppression tests, and psychosomatic symptomatology, are discussed as well as the implications of this case within a larger clinical context.

Adult↗
PubMed1985

Suicidal and parasuicidal behavior in borderline personality disorder.

One of the most perplexing and dangerous aspects of borderline personality disorder is the wide array of suicidal and parasuicidal behaviors. Close phenomenologic evaluation of these behaviors reveals that they can be differentiated into various subcategories. Approaching these behaviors with a biologic perspective may prove helpful in elucidating the underlying etiologies and therapeutic approaches.

Adolescent↗