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PubMed2006

The two-part film technique: empowering dissociative clients to alter cognitive distortions and maladaptive behaviors.

This paper describes and illustrates the two-part film (TPF) technique, an intervention characteristic of the Collective Heart model (Krakauer, 2001), a phase-oriented approach to treating dissociative disorders. Emphasis is on the technique's value in interdicting maladaptive interpersonal and intrapersonal patterns which perpetuate depression, anxiety, dissociation, and self-defeating behaviors. The approach is compared with similar internal screen techniques appearing in the hypnotic literature, and distinctive features of the TPF are noted. These include the minimally directive role of the therapist, reliance on the inner wisdom of the client, present and future orientation, and amplification of desired affective and somatic experiences. A verbatim clinical illustration is presented and discussed, with emphasis on the empowering impact of the TPF.

Cognitive Behavioral Therapy↗
PubMed1991

Dissociative experiences in the general population: a factor analysis.

The 28-item Dissociative Experiences Scale was administered to a stratified cluster sample of 1,055 respondents in the general population of Winnipeg. Dissociative experiences were common in the sample and were not related to socioeconomic status, sex, education, religion, or place of birth, although they declined with age in both sexes. A principal components analysis identified three factors accounting for 47.1 percent of the combined variance of the scores. The first factor, absorption-imaginative involvement, is composed of common, benign experiences, such as missing part of a conversation and being able to ignore pain. The other two factors, activities of dissociated states and depersonalization-derealization, composed of less common experiences such as not recognizing friends or family members and not recognizing one's reflection in a mirror, may be powerful predictors of DSM-III-R dissociative disorders.

Adult↗
PubMed1999

Schizotypy, dissociative experiences and childhood abuse: relationships among self-report measures.

OBJECTIVES: The traits and experiences that are seen as defining the schizophrenic and the dissociative disorders have been found to be present in continuously variable, non-pathological forms in the general population. Although the theoretical accounts that have been offered for the two kinds of disorder differ radically, there are reasons to expect that the measures that have been developed to assess schizotypal traits and dissociative experiences will be correlated. The aims of this study were to investigate the degree of correlation between measures and the extent to which the covariation can be explained by questionnaire items with similar content and experiences of childhood sexual and physical abuse. DESIGN: Cross-sectional data from self-report measures completed by 224 participants were subjected to multivariate analyses. METHOD: The Dissociative Experiences Scale (DES), three subscales from the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE) and two items assessing childhood abuse were mailed to all adult members of a volunteer participant panel. RESULTS: Moderately large correlations were found between the DES and both the Cognitive Disorganization and the Unusual Experiences subscales of the O-LIFE. These correlations were hardly affected when items with overlapping content were excluded. Hierarchical multiple regression analyses showed that the measures of abuse accounted for small but significant proportions of the variance in both the DES and the Unusual Experiences subscale, but large proportions of the covariation between the measures of dissociative experiences and schizotypy remained unexplained. CONCLUSION: The substantial correlations between measures point to limitations in the discriminant validity of the DES and two of the O-LIFE subscales. Three possible explanations are offered for the observed associations between dissociative experiences and schizotypal traits.

Adult↗
PubMed1996

Cataplexy and the switch process of multiple personality disorder.

A case history is presented of an 18-year-old male with dissociative disorder and polysubstance abuse. The patient was observed to switch between three personalities, and the personality changes were often associated with symptoms of cataplexy. Both dissociative episodes and cataplexy are associated with strong affective stimuli. Similar reports in the literature are briefly reviewed.

Adolescent↗
PubMed1991

Patients reporting ritual abuse in childhood: a clinical syndrome. Report of 37 cases.

Thirty-seven adult dissociative disorder patients who reported ritual abuse in childhood by satanic cults are described. Patients came from a variety of separate clinical settings and geographical locations and reported a number of similar abuses. The most frequently reported types of ritual abuse are outlined, and a clinical syndrome is presented which includes dissociative states with satanic overtones, severe post-traumatic stress disorder, survivor guilt, bizarre self abuse, unusual fears, sexualization of sadistic impulses, indoctrinated beliefs, and substance abuse. Questions relating to issues of reliability, credibility and verifiability are addressed in depth, and the findings and implications are discussed.

Abreaction↗
PubMed1996

On the interaction of hypnotizability and negative affect in chronic pain. Implications for the somatization of trauma.

The high risk model of threat perception predicts that high hypnotizability is a risk factor for trauma-related somatization. It is hypothesized that high hypnotizability can increase experimentally induced threat or negative affect, as measured by skin conductance level, in a linear or dose-response manner. This hypothesized interaction of hypnotic ability and negative affect was found in a consecutive series of 118 adult patients with chronic pain symptoms. Larger increases in skin conductance levels during cognitive threat were significantly related to higher levels of hypnotizability. In addition, individuals with high hypnotizability retained higher skin conductance levels than individuals with low hypnotizability after stress. The clinical implications of the interaction of hypnotizability and negative affect during threat perception and delayed recovery from threat perception are discussed in terms of cognitive mechanisms in the etiology and therapy of trauma-related dissociative disorders.

Adaptation, Psychological↗
PubMed1990

Structured interview data on 102 cases of multiple personality disorder from four centers.

Patients with multiple personality disorder (N = 102) at four different centers were interviewed with the Dissociative Disorders Interview Schedule. The presenting characteristics of the patients at all four centers were very similar. The clinical profile that emerged included a history of childhood physical and/or sexual abuse in 97 (95.1%) of the cases. The subjects reported an average of 15.2 somatic symptoms, 6.4 Schneiderian symptoms, 10.2 secondary features of the disorder, 5.2 borderline personality disorder criteria, and 5.6 extrasensory experiences; their average score on the Dissociative Experiences Scale was 41.4. The results indicate that multiple personality disorder has a stable, consistent set of features.

Borderline Personality Disorder↗
PubMed2005

[Catatonia].

Catatonia is a neuropsychiatric syndrome characterized by mental, motor and behavioral symptoms. It occurs in up to 18 % of acute admissions and is most frequently associated with affective and psychotic disorders. It is also seen in dissociative disorders, pervasive developmental disorders, mental retardation and organic psychiatric disorders. Catatonic syndromes are impressive states that can be reliably and validly diagnosed both clinically and with psychometric measurements and they can be treated effectively. Despite this, they are often not recognized in clinical practice, are not part of the therapeutic strategy and thus remain untreated. The following article is intended to give a review of the most pertinent questions related to the diagnosis and treatment of catatonia in order to improve clinicians' ability to recognize and treat catatonic symptoms and syndromes adequately.

Benzodiazepines↗
PubMed1993

Dissociative symptoms in a substance abuse population.

OBJECTIVE: This study was intended to examine the extent of dissociative experiences that exist within a substance abuse population and to determine how demographic and clinical variables affect these experiences. METHOD: A total of 265 male veterans being treated on an inpatient substance abuse unit completed a standard test battery that included the MMPI-2, the Shipley-Hartford Institute of Living Scale, and the Dissociative Experiences Scale. Additional demographic and clinical information was obtained from the patients' medical records. RESULTS: Over 41% of the cohort had scores on the Dissociative Experiences Scale that suggested the need for further evaluation of a dissociative disorder. A stepwise multiple regression analysis revealed that level of psychological discomfort, IQ, and race accounted for more than 24% of the variance in Dissociative Experiences Scale scores. CONCLUSIONS: Substance abuse populations may need to be routinely screened for dissociative symptoms just as they are for depression and anxiety.

Adult↗
PubMed2003

Dissociative experiences and anger proneness in late adolescent females with different attachment styles.

The study examined the relationships among dissociative experiences, anger proneness, and attachment styles in late adolescent females. One hundred sixty-two college students (mean age = 17.5 years) were assessed using the Dissociative Experience Scale (DES), the State-Trait Anger Expression Inventory (STAXI), and the Adult Attachment Questionnaire (AAQ), a self-report tool for assessing attachment styles (avoidant, secure, and ambivalent-resistant) in close relationships of youths and adults. Significant correlations were obtained between DES scores (total and factorial) and STAXI scores (State Anger, Trait Anger, Anger/In, and Anger/Expression), confirming in a nonclinical sample the connection between anger proneness and dissociation described in patients with dissociative disorders. Insecure females, particularly ambivalent ones, scored higher on the DES, supporting van der Kolk's hypothesis of an inverse relationship between secure attachment and dissociative tendency. Moreover, insecurely attached females showed more anger proneness, with some differences between ambivalent and avoidant types. Further research should be conducted to examine these relationships in males, as well as to clarify the role of insecure attachment in anger management and the recourse to dissociation in late adolescence as a protective response to trauma and emotional distress.

Adolescent↗
PubMed1999

Pathological and nonpathological dissociation: the relevance of childhood trauma.

Although previous research has implicated a history of childhood trauma in the development of dissociative tendencies, insufficient cognizance (in this context) has been taken of the distinction between pathological and nonpathological dissociation. In this study, the relationship between childhood trauma and both pathological and nonpathological dissociation was investigated in a sample of 100 Australian adults. Pathological dissociation was positively predicted by dimensions of childhood trauma, but no such relationship was found for nonpathological dissociation (psychological absorption). The data are consistent with the traumagenic model of the dissociative disorders, but factors other than childhood trauma may also be pertinent.

Adolescent↗
PubMed1990

Dissociative experiences in the general population.

The Dissociative Experiences Scale was administered to a random sample of 1,055 adults in the city of Winnipeg. Results showed that scale scores did not differ between men and women and were not influenced by income, employment status, education, place of birth, religious affiliation, or number of persons in the respondent's household. Dissociative experiences are common in the general population and decline with age. The findings suggest that dissociative disorders may also be common in the general population.

Adult↗
PubMed1999

Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients.

OBJECTIVE: Research on the etiology of dissociation in adults has focused primarily on childhood sexual abuse. The role of co-occurring childhood stressors and of more chronic adverse conditions such as neglect is less clear. This study examined the level of dissociation in relation to childhood trauma (sexual/physical abuse, witnessing interparental violence), early separation from a parent, and perceived parental dysfunction. METHOD: One hundred sixty inpatients consecutively admitted to a general psychiatric hospital were administered the Dissociative Experiences Scale and the Structured Trauma Interview. RESULTS: The mean Dissociative Experiences Scale score was 17.4; 18.0% of the patients scored beyond 30. Early separation was reported by 26.4% of the patients; 30.1% had witnessed interparental violence; 23.6% reported physical abuse; 34.6% reported sexual abuse; 11.7% reported rape before age 16; and 42.1% reported sexual and/or physical abuse. The level of dissociation was primarily related to reported overwhelming childhood experiences (sexual and physical abuse). When sexual abuse was severe (involving penetration, several perpetrators, lasting more than 1 year), dissociative symptoms were even more prominent. Highest dissociation levels were found in patients reporting cumulative sexual trauma (intrafamilial and extrafamilial) or both sexual and physical abuse. In particular, maternal dysfunction was related to the level of dissociation. With control for gender and age, stepwise multiple regression analysis indicated that the severity of dissociative symptoms was best predicted by reported sexual abuse, physical abuse, and maternal dysfunction. CONCLUSIONS: These findings indicate that dissociation, although trauma-related, is neglect-related as well. This implies the importance of object relations and attachment in the diagnosis and treatment of patients with dissociative disorders.

Adolescent↗
PubMed1995

Assessment of the prevalence of psychiatric disorder in young adults.

BACKGROUND: The effectiveness of different assessment procedures for determining prevalence rates of psychiatric disorder in young adults was investigated. METHOD: In a two-stage multi-method procedure, the Young Adult Self-Report, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the Structured Interview for Personality Disorders (Revised), and the Global Assessment of Functioning (GAF) Scale were used to assess prevalence rates in 706 19-24-year-olds from the general population. Furthermore, individuals' subjective perception of distress and referral to mental health services were assessed. RESULTS: The prevalence of any SCAN/DSM-III-R disorder was 19.3% (95% confidence interval: 11.2-27.4%). Most subjects who received a SCAN/DSM-III-R diagnosis were only mildly impaired. The highest prevalence rates of dysfunctioning (GAF score below 61) without referral to mental health services were for dissociative disorder (2.3%), sleep disorder (2.1%), alcohol dependence (1.3%) and affective disorder (1.8%). CONCLUSION: Instruments that assess functional impairment in addition to DSM-III-R diagnoses are indispensable in prevalence studies.

Adolescent↗
PubMed2000

[Failure to recover after anesthesia attributed to a transient dissociative state].

Failure of a patient to recover rapidly after anaesthesia is a rare event, due to various causes, including medication related effects, metabolic disturbances or neurologic insults. We report a case in a middle aged physically healthy woman who failed to recover promptly after intravenous anaesthesia. Propofol was administered for 20 minutes. Results of neurologic assessment were normal, as were laboratory tests and CT-scan. Four hours after completion of the anaesthesia, return to consciousness occurred spontaneously. The patient had a history of depressive symptoms. However the psychiatric assessment was unremarkable. We hypothesise that she developed a transient dissociative disorder.

Anesthesia Recovery Period↗
PubMed1997

Limited utility of ICD-10 and DSM-IV classification of dissociative and conversion disorders in India.

Studies of psychiatric out-patients from India have found that diagnosis of some of the subcategories of the dissociative and conversion disorders of the ICD and DSM classificatory systems are rarely made in this setting. Moreover, it was found that a significant percentage of patients seen in psychiatric practice may not fit into the defined subcategories of dissociative (conversion) disorders of these systems of classification. We studied the prevalence of various ICD-10 and DSM-IV categories of dissociative (conversion) disorders and our own proposed category of 'brief dissociative stupor' (BDS), among all the in-patients of a psychiatric unit in a general teaching hospital, over a 2-year period. There were 18 patients who fulfilled our criteria for BDS and 18 patients in the second group which included all of the remaining subjects with a diagnosis of any other subcategory of dissociative disorder according to ICD-10. Our analysis revealed that there were no patients with a diagnosis of dissociative amnesia, fugue, stupor, trance and possession disorders or identity disorders. There were significantly more female patients in the BDS group, and they also had significantly more comorbid Axis-I diagnoses and panic attacks. Since 50% of our patients fulfilled the criteria for BDS, there is clearly a need for further studies to establish the prevalence of this subcategory in patients from other centres. The classification of these patients with this phenomenology is problematic. Inclusion of a subcategory of dissociative non-epileptic seizures, instead of dissociative convulsions, should improve the classification of dissociative (conversion) disorders.

Adolescent↗
PubMed1992

Psychiatrist, traditional healer and culture integrated in clinical practice in Bali.

This paper considers the psychiatrist-traditional healer relationship in clinical management of mental disorders in Bali. It also concerns the role of sociocultural factors in the etiology and management of mental disorder. The basic concepts and therapeutic strategies of Western psychiatry co-exist with the beliefs and methods of traditional healers. Often psychiatrists and traditional healers are involved with the same patients. A clinical case study of an episode of mass dissociative disorder (trance state) in which psychiatrists acted as consultants illustrates the integration of concepts of Western psychiatry and Balinese culture in the diagnostic evaluation and therapeutic strategies.

Child↗
PubMed2005

[Psychogenic Disorders in German soldiers during World War I and II].

In the First and Second World War German soldiers frequently suffered from psychogenic disorders. By comparison a change in the prevalences can be noted: in the First World War dissociative disorders dominated the clinical impression ("shell shock"), in the Second World War they could rarely be seen but were replaced by somatoform and psychosomatic diseases. The discussion about numerous reasons for this development has not been completed yet and is still not free from political attitudes. To achieve a more scientific point of view, the perspective of psychotraumatology might be helpful. According to psychotraumatic research, dissociative and somatoform disorders can emerge in a close relation to a Posttraumatic Stress Disorder. The choice of symptoms depends on personality traits of the victim, but also on specific factors that characterise the situation in which the trauma appears. The mixture of pathogenetic and protective influences includes e. g. the possibility of flight- or fight reactions, feelings of trauma-associated guilt and group cohesion in the military unit. These factors can be useful to help explain the change of symptoms between both wars. In addition the analysis of situational conditions in former wars can give hints to actual planning and prophylaxis strategies in modern military psychiatry, that has to adjust to very different military operation fields.

Culture↗