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PubMed2005

Functional connectivity of dissociative responses in posttraumatic stress disorder: a functional magnetic resonance imaging investigation.

BACKGROUND: The purpose of this study was to assess interregional brain activity covariations during traumatic script-driven imagery in subjects with posttraumatic stress disorder (PTSD). METHODS: Functional magnetic resonance imaging and functional connectivity analyses were used to assess interregional brain activity covariations during script-driven imagery in PTSD subjects with a dissociative response, PTSD subjects with a flashback response, and healthy control subjects. RESULTS: Significant between-group differences in functional connectivity were found. Comparing dissociated PTSD patients and control subjects' connectivity maps in the left ventrolateral thalamus (VLT) [-14, -16, 4] revealed that control subjects had higher covariations between activations in VLT and in the left superior frontal gyrus (Brodmann's area [BA] 10), right parahippocampal gyrus (BA 30), and right superior occipital gyrus (BA 19, 39), whereas greater covariation with VLT in dissociated PTSD subjects occurred in the right insula (BA 13, 34), left parietal lobe (BA 7), right middle frontal gyrus (BA 8), superior temporal gyrus (BA 38, 34), and right cuneus (BA 19). Comparing dissociated PTSD and flashback PTSD connectivity maps in the right cingulate gyrus [3, 16, 30] revealed that dissociated PTSD subjects had higher covariations between activations in this region and the left inferior frontal gyrus (BA 47). CONCLUSIONS: Greater activation of neural networks involved in representing bodily states was seen in dissociated PTSD subjects than in non-PTSD control subjects. These findings might illuminate the mechanisms underlying distorted body perceptions often observed clinically during dissociative episodes.

Accidents, Traffic↗
PubMed2004

Dissociative style and individual differences in verbal working memory span.

Dissociative style is mostly studied as a risk factor for dissociative pathology, but it may also reflect a fundamental characteristic of healthy information processing. Due to the close link between attention and working memory and the previous finding of enhanced attentional abilities with a high dissociative style, a positive relationship was also expected between dissociative style and verbal working memory span. In a sample of 119 psychology students, it was found that the verbal span of the high-dissociative group was about half a word larger than of the medium and low-dissociative groups. It is suggested that dissociative style may be one of only very few individual differences that is directly relevant to consciousness research.

Adolescent↗
PubMed2006

Does dissociation further our understanding of PTSD?

Peritraumatic dissociation, and other dissociative reactions, refer to alterations in awareness in the context of a traumatic experience. This review provides an overview of the current conceptualization of dissociation, critiques methodological approaches to studying dissociation, and reviews the evidence for the purported relationship between dissociative reactions and posttraumatic stress disorder. The evidence challenges the notion that a linear relationship exists between dissociation and psychiatric morbidity. Future research should abandon the global construct of dissociation, and study the specific responses that involve altered awareness under experimental conditions.

Acute Disease↗
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↗
PubMedDate not supplied

The dissociative experiences of borderline patients.

The study objective was to assess the severity and quality of dissociative experiences reported by borderline patients. Two hundred ninety criteria-defined borderline patients and 72 axis II controls completed the Dissociative Experiences Scale (DES), a 28-item self-report measure with demonstrated reliability and validity. Thirty-two percent of borderline patients had a low level of dissociation, 42% a moderate level, and 26% a high level similar to that reported by patients meeting criteria for posttraumatic stress disorder (PTSD) or dissociative disorders. The controls had a significantly different distribution of overall DES scores: 71% reported a low level of dissociation, 26% reported a moderate level, and only 3% reported a high level. In addition, borderline patients had a significantly higher score than the controls on 21 of 28 DES items and a significantly higher overall DES score, as well as the score on the 3 factors that have been found to underlie the DES, absorption, amnesia, and depersonalization. The results of this study suggest that the severity of dissociation experienced by borderline patients is more heterogeneous than previously reported. They also suggest that borderline patients have a wider range of dissociative experiences than are commonly recognized, including experiences of absorption and amnesia, as well as experiences of depersonalization.

Adolescent↗
PubMedDate not supplied

Dissociative symptoms are related to endorsement of vague trauma items.

In current psychiatric literature, the received view is that dissociative symptoms originate from aversive childhood events. To a large extent, this view is based on cross-sectional studies that do not rule out a scenario in which dissociative tendencies contribute to self-reports of childhood trauma. In two studies, we tested one particular implication of this scenario, namely, that dissociative symptoms are related to endorsement of vague rather than specific items about childhood trauma. In study 1 (N = 43) and study 2 (N = 127), nonclinical participants completed standard measures of dissociation, childhood trauma, and fantasy proneness. We performed correlational and regression analyses on the data. Fantasy proneness and responses to broad trauma items, but not responses to factual trauma items predicted dissociation levels. This pattern of findings shows that the link between trauma and dissociation is considerably more complex than is often assumed. As well, it suggests that at least in nonclinical samples, dissociative symptoms may breed endorsement of vague trauma items.

Adolescent↗
PubMedDate not supplied

Childhood abuse, adult assault, and dissociation.

Recent studies have suggested an association between childhood physical and sexual abuse and adult dissociative experiences. The purpose of this study was to determine the relationship of both childhood and adult-onset abuse and their characteristics for adult dissociative symptoms. One hundred forty-four psychiatric outpatients completed self-report questionnaires on measures of dissociation (Dissociative Experience Scale [DES]) and histories of both past and current sexual and physical abuse (Traumatic Events Questionnaire [TEQ]). Of 114 subjects (30 men and 84 women) who completed both forms, 35% and 43% reported childhood physical and sexual abuse, respectively. Dissociative symptoms were significantly related to ethnicity and multiple episodes or combined types of abuse in childhood and adulthood. In terms of the characteristics of childhood abuse, numerous episodes of physical abuse (P = .01) and father-perpetrated sexual abuse (P = .02) were significantly related to the degree of dissociation. These findings emphasize the role of repeated childhood trauma and the combination of both childhood and adult traumatic experiences in the development of dissociative phenomena.

Adolescent↗
PubMed2003

Wanted: fully operational definitions of dissociations in single-case studies.

In contrast to the careful consideration given to the issue of what we can infer from dissociations in single-case studies, the more basic question of how we decide whether a dissociation is present has been relatively neglected. Proposals are made for fully operational definitions of a deficit, classical and strong dissociations, and double dissociations. In developing these definitions it was assumed that they should be based on the use of inferential rather than descriptive statistical methods. The scope of these definitions is limited to typical single-case studies in which patients are compared to control samples of a modest size. The operational definition of a classical dissociation incorporates a requirement that a patient's performance on Task X is significantly different from Task Y, in addition to the "standard" requirement that the patient has a deficit on Task X and is within normal limits on Task Y. We ran a simulation to estimate the Type I error rates when the criteria for dissociations are applied and found these to be low (Type I errors were defined as identifying an individual from the control population as having a dissociation). The inferential methods for testing whether the various criteria are met make use of t-distributions. These methods are contrasted with the widespread use of z to test for a deficit or a difference between tasks. In the latter approach the statistics of the control sample are treated as parameters; this is not appropriate when, as is normally the case, the control sample size is modest in size.

Dissociative Disorders↗
PubMed1999

Dissociative experiences and psychopathology in conversion disorders.

The concepts of dissociation and conversion are historically linked with the first psychodynamic ideas on hysteria. However, the abolition of "hysterical neurosis" from current nosology has led to independent developments of these theoretical models. Recent studies found a high degree of somatization in dissociative disorders. However, little is known about dissociation in conversion disorders. We assessed 72 patients with conversion disorders for their dissociative and general psychopathology using the German version of the Dissociative Experience Scale (DES) and the Symptom Check List (SCL-90-R). They were compared with a control group of 96 psychiatric patients suffering from various neurotic disorders, who were matched for gender and age. Dissociative symptoms were significantly more frequent in conversion disorder patients than in controls. There were no differences in the SCL-90-R scores between the two groups. Our findings support the theory of similar psychological processes underlying conversion and dissociative disorders despite their descriptive differences.

Adult↗
PubMed1997

Dissociation, somatization, substance abuse, and coping in women with chronic pelvic pain.

OBJECTIVE: To examine the relationships between histories of sexual or physical abuse and current reports of dissociation, somatization, substance abuse, adaptive coping, and maladaptive coping strategies among chronic pelvic pain patients. METHODS: Using a structured interview, we assessed sexual and physical abuse and somatization. The Dissociative Experiences Scale was used to assess dissociation, and an abbreviated version of the COPE scale was employed to assess adaptive and maladaptive coping strategies as well as substance abuse. Participants included 46 women with chronic pelvic pain. RESULTS: Women with self-reported sexual or physical abuse histories were found to have significantly higher dissociation, somatization, and substance abuse scores than women without such a history. Significant positive correlations were found between reports of both dissociation and somatization with maladaptive coping strategies and among dissociation, somatization, and substance abuse. CONCLUSION: These results support the association between a positive abuse history and the high levels of dissociation, somatization, and substance abuse often noted in the chronic pelvic pain population. Findings suggest that such psychological variables are more likely to be associated with abuse than with the general medical condition. These psychological variables are conceptualized as maladaptive coping, which may be addressed as part of a biopsychosocial model of treatment for chronic pelvic pain patients.

Adaptation, Psychological↗
PubMedDate not supplied

Memory for murder. A psychological perspective on dissociative amnesia in legal contexts.

There is currently a complex and inconsistent state in the law relating to dissociation and dissociative amnesia (McSherry, 1998). Although dissociative amnesia in defendants is relevant to both competency to stand trial and criminal responsibility in principle, courts have typically assumed a skeptical stance toward such claims in practice. However, there is considerable evidence from both nonoffender and offender populations to support the validity of dissociative amnesia in defendants. Further, there is information available to aid in the evaluation of amnesia, such as the quality of the report itself and characteristics of the person reporting the amnesia (e.g., psychopathy). When consideration is given to the legal response to reports of dissociative amnesia by complainants, the situation becomes even more complex. While some courts have rejected recovered memory evidence, others have convicted defendants of historical offenses based on such evidence. In some cases, judges have argued that jurors should be left to decide on the validity of recovered memories based on their common sense and experience. The uncritical acceptance of the validity of repressed memories in complainants by many courts stands in stark contrast to the response to claims of amnesia from defendants. It seems apparent that the courts need better guidelines around the issue of dissociative amnesia in both populations. We think that the increasing scientific understanding of memory in the past decade (see Schacter, 1999) can meaningfully contribute to the development of such guidelines. Responsible, nonpartisan expert testimony from mental health professionals would be one step in the direction of rectifying the current state of law in regards to dissociation.

Amnesia↗
PubMed2003

Attention as a characteristic of nonclinical dissociation: an event-related potential study.

Individual differences in dissociative style (which is generally considered a risk factor for dissociative pathology) were studied in a nonclinical sample. It was hypothesized that high-dissociative participants would show enhanced attentional abilities toward both relevant and irrelevant stimulus features. In the experiment, threatening and affectively neutral words were classified on their affective valence and the presence of the letter A. To facilitate the full deployment of dissociative abilities, a feature (i.e., negative valence) was included that would automatically attract attention but not interfere with the processing of the central feature. Both the behavioral measures (i.e., reaction time) and the central neural measures (i.e., event-related potentials) showed that the ability to direct attention to the central feature was enhanced in the high dissociators. The high dissociators, moreover, showed evidence of directing attention to both affective valence and the letter A in the letter detection task. It is concluded that dissociative style does not correspond to a damaged or disturbed function but to an enhanced ability to direct and divide attention.

Adult↗
PubMed1998

Somatoform dissociative symptoms as related to animal defensive reactions to predatory imminence and injury.

The authors hypothesized that there would be a similarity between animal defensive responses to variable predatory imminence and injury and certain somatoform dissociative symptoms of trauma-reporting patients who have dissociative disorder. As a first test of this hypothesis, 12 somatoform symptom clusters consisting of clinically observed somatoform dissociative phenomena were constructed. All clusters discriminated between patients with dissociative disorders (n = 50) and patients with other psychiatric diagnoses (n = 50). Those expressive of the hypothesized similarity--freezing, anesthesia-analgesia, and disturbed eating--belonged to the 5 most characteristic symptoms of dissociative disorder patients. Anesthesia-analgesia, urogenital pain, and freezing symptom clusters independently contributed to predicted presence of dissociative disorder. Using an independent sample, it appeared that anesthesia-analgesia best predicted presence of dissociative disorder after controlling for symptom severity. The results were largely consistent with the hypothesized similarity.

Adult↗
PubMed2003

Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems.

OBJECTIVE: To examine the associations of childhood traumatic experiences and childhood neglect with dissociative experiences and posttraumatic stress disorder (PTSD) in a population of female borderline personality disorder (BPD) patients with and without substance abuse. METHOD: The sample included 64 female patients with BPD. Childhood traumatic experiences and childhood neglect were measured using the Structured Trauma Interview, dissociative experiences with the Dissociative Experiences Scale, and PTSD with the Structured Clinical Interview for DSM-IV. RESULTS: In general, dissociation scores were higher among those with a history of childhood trauma and neglect, in particular among those who reported both sexual and physical abuse before age 16, more than one perpetrator and severe maternal dysfunction. The prevalence of PTSD was clearly associated with the severity of childhood sexual abuse (CSA) in terms of the occurrence of penetration during CSA, intrafamilial CSA, a duration of CSA longer than 1 year and more than one perpetrator. Comorbid substance abuse problems modified the observed associations such that the associations mentioned above were also present or even more pronounced among those without substance abuse, whereas no associations were found in those with substance abuse. CONCLUSIONS: The results suggest a moderately strong association between childhood trauma and neglect with dissociation and PTSD. However, trauma-dissociation and trauma-PTSD links were only observed among BPD patients without addictive problems. The findings are largely consistent with the literature. Potential explanations for the lack of a trauma-dissociation and trauma-PTSD link in the addicted subgroup are discussed.

Adult↗
PubMed2003

[The connection between trauma and dissociation: a critical evaluation].

Dissociation is often considered to be a psychological defense mechanism used by victims of traumatic events (e. g., sexual abuse, physical punishment, or emotional abuse). Evidence for this view comes from studies that found a connection between self-reported traumatic childhood experiences and high levels of dissociation. However, there are some problems with this causal interpretation. The aim of this review is to summarize evidence that casts doubts on the commonly voiced view that the connection between self-reported trauma and dissociation is a simple and robust one. First, we briefly summarize studies that looked at the link between trauma and dissociation as well as studies that identified factors that may modulate this link. Second, we review studies that explored the psychological correlates of dissociation. Over the past few years, our knowledge of these correlates has increased considerably. Some of these correlates (e. g., fantasy proneness, suggestibility, and frontal lobe dysfunction) are especially relevant because they may undermine the accuracy of retrospective self-reports of trauma. Finally, we conclude that the link between trauma and dissociation is more complex than many clinicians seem to assume. In particular, the possibility that dissociation acts as an antecedent of self-reported trauma warrants serious attention.

Adult↗
PubMed1994

Does trauma-linked dissociation vary across ethnic groups?

This investigation assessed the relationship between traumatic stress exposure and dissociation in male Vietnam theater veterans from three ethnic groups. Subjects were African-American (N = 61), Caucasian (N = 91), and Hispanic (N = 73) veterans who completed the Dissociative Experience Scale and a measure of war zone stress exposure, and who were rated on the Peritraumatic Dissociative Experiences Questionnaire-Rater Version. Greater exposure to war zone stress was associated with reports of more dissociation at the time of trauma and with more general dissociative experiences both when the data were pooled and when examined separately for each group. After controlling for the effects of war zone stress exposure, the significant differences found in peritraumatic and general dissociative experiences across the three ethnic groups no longer were evident. This investigation demonstrated that among American Vietnam veterans, greater exposure to traumatic stress is related to more dissociative experiences, regardless of ethnicity.

Adult↗
PubMed1996

Patterns of dissociation in clinical and nonclinical samples.

Research has consistently found elevated mean dissociation scores in particular diagnostic groups. In this study, we explored whether mean dissociation scores for different diagnostic groups resulted from uniform distributions of scores within the group or were a function of the proportion of highly dissociative patients that the diagnostic group contained. A total of 1566 subjects who were psychiatric patients, neurological patients, normal adolescents, or normal adult subjects completed the Dissociative Experience Scale (DES). An analysis of the percentage of subjects with high DES scores in each diagnostic group indicated that the diagnostic group's mean DES scores were a function of the proportion of subjects within the group who were high dissociators. The results contradict a continuum model of dissociation but are consistent with the existence of distinct dissociative types.

Adolescent↗
PubMed2000

Dissociation, schizotypy, and fantasy proneness in undergraduate students.

Previous research has noted a robust correlation between dissociation and schizophrenia-like symptoms. One way to interpret the relationship between dissociation and schizotypy is to assume that it is an artifact of fantasy proneness. In the present study, 152 undergraduates completed measures of dissociation, schizotypy, and fantasy proneness. Dissociative tendencies were found to be related to the full range of schizotypal features. Regression analysis showed that schizotypy still contributed to the prediction of dissociative tendencies when variance related to fantasy proneness was extracted. These results indicate that the close connection between dissociation and schizotypy cannot be interpreted in terms of an artifact produced by fantasy proneness. Thus, the overlap between dissociation and schizotypy warrants systematic study.

Adolescent↗