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Approximate answers (vorbeireden) are considered pathognomonic of the Ganser syndrome. Controversy has always surrounded the nosological status of this syndrome. Its recent inclusion in the DSM-III-R as a dissociative disorder is supported by this case report. The association of approximate answers, psychogenic amnesia, and dysprosody is reported here for the first time.
This study assessed self and interpersonal dysfunction as well as posttraumatic stress disorder (PTSD) among three groups of women: women sexually assaulted in both childhood and adulthood, women sexually assaulted only in adulthood and women who were never assaulted. Rates of PTSD were high and equivalent in the two assault groups. However, retraumatized women were more likely to be alexithymic, show dissociation scores indicating risk for dissociative disorders, and to have attempted suicide compared to the other two groups, who did not differ from each other. Additionally, only the retraumatized women experienced clinically significant levels of interpersonal problems. The findings suggest that formulations more inclusive than PTSD are required to capture the psychological difficulties experienced by this population. Treatment implications are discussed.
The Dissociative Disorders Interview Schedule was administered to a random sample of 502 adults in the general population of Winnipeg, a midwestern Canadian city. Results showed that paranormal/extrasensory experiences were common in the general population. They were linked to a history of childhood trauma and to other dissociative symptom clusters. A factor analysis of the paranormal experiences identified three factors which together accounted for 44.0% of the combined variance of the scores. A model is proposed in which paranormal experiences are conceptualized as an aspect of normal dissociation. Like dissociation in general, paranormal experiences can be triggered by trauma, especially childhood physical or sexual abuse. Such experiences discriminate individuals with childhood trauma histories from those without at high levels of significance.
The Dissociative Experiences Scale was administered to a non-clinical sample in Shanghai, China (N = 618) and the results were compared with a previous sample of the general population from Winnipeg, Canada (N = 1055). The Dissociative Disorders Interview Schedule was administered to the 618 Chinese participants and results were compared with those of the Canadian participants (N = 502). In addition, both measures were administered to a sample of Chinese psychiatric inpatients (N = 423) and outpatients (N = 304). Rates of childhood trauma and dissociation were far lower in the Chinese non-clinical sample than in the two Chinese psychiatric patient groups, and far lower than in the Canadian general population. Among the 618 respondents in the Chinese non-clinical sample, no childhood sexual abuse was reported and only one person reported childhood physical abuse. These rates of childhood abuse were far lower than in other non-clinical samples from China; for example, rates were 16.7% for sexual abuse of girls and 10.5% for sexual abuse of boys in a previous study. Among the more traumatized Chinese psychiatric patients, and among the Canadian respondents, dissociative experiences were much more common than in the Chinese general population. The data provide a base frequency for dissociation in non-clinical samples reporting little or no childhood physical and sexual abuse.
Using a procedure with suggestions to prompt false memories from an alleged previous life, we hypnotized 16 normal subjects and collected Rorschach data before and during the hypnotic induction. During hypnosis 9 subjects produced memories that they claimed to remember from a former life. The Rorschach findings bore no resemblance to the available data for other dissociative disorders. Rorschach variables during hypnotic trance remained almost unchanged from baseline. These results indicate that the Rorschach poorly reflects hypnotic trance.
This presentation focuses on the disorganized/disoriented (Group D) categories of infant, child, and adult attachment. The infant D category is assigned on the basis of interruptions and anomalies in organization and orientation observed during Ainsworth's strange situation procedure. In neurologically normal low-risk samples, D attachment is not substantially related to descriptions of infant temperament, and usually appears with respect to only one parent. At six, former D infants are often found to be role-inverting (D-Controlling) towards the parent, while drawings and separation-related narratives (D-Fearful) suggest continuing states of fear and disorganization. In adults, marked lapses in reasoning and discourse surrounding the discussion of loss or abuse during the Adult Attachment Interview (AAI) causes a transcript to be assigned to Unresolved/disorganized (U/d) adult attachment status, which predicts infant D attachment. Bowlby's theory is extended, with the proposal that certain forms of frightening parental behavior will arouse contradictory biologically channeled propensities to approach and to take flight from the parent. Maltreated infants are therefore highly likely to be disorganized. Also identified are subtler forms of frightening parental behavior (including dissociative behavior and anomalous forms of frightened behavior) that appear to lead to infant disorganization. This suggests that infant D attachment may at times represent a second-generation effect of the parent's own continuing unresolved responses to trauma. Infant D attachment predicts disruptive/aggressive and dissociative disorders in childhood and adolescence, while U/d adult attachment appears frequently in psychiatric and criminal populations. Clinical implications are discussed.
The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.4% mean) underscores the discrepancy between epidemiology and the services delivered. The core function of C-L services in general hospitals is a quick, comprehensive emergency psychiatric function. Reasons to see patients were the following. deliberate self-harm (17%), substance abuse (7.2%), current psychiatric symptoms (38.6%), and unexplained physical complaints (18.6%) (all means). A significant number of patients are old and seriously ill. Mood disorders and organic mental disorders are most predominant (17.7%). Somatoform and dissociative disorders together constitute 7.5%. C-L services in European countries are mainly emergency psychiatric services and perform an important bridge function between primary, general health, and mental health care.
This study describes the initial reliability and validity data on the Adolescent Dissociative Experiences Scale (A-DES), a screening measure for pathological dissociation during adolescence. The A-DES showed good scale and subscale reliability, and, as hypothesized, increased scores were associated with reported trauma in a patient population. A-DES scores were able to distinguish dissociative disordered adolescents from a normal sample and from a patient sample with a variety of diagnoses.
We describe two patients with psychogenic seizures of rare semiology. Both patients (a 23-year-old man and a 26-year-old woman) attended the emergency department because status epilepticus with myoclonic seizures had been diagnosed. Seizures were documented with video-electroencephalography. Semiology of seizures were brief myoclonia of both arms resulting in a short elevation of both arms without impairment of consciousness. Ictal EEG registration was without abnormal finding. Psychiatric diagnostic assessment suggested a dissociative disorder and mild depression, respectively. During psychiatric treatment seizures occurred only rarely within a 3-5 months follow-up. One should be aware that juvenile myoclonic epilepsy may be mimicked by psychogenic seizures
In this single case report, I examine the treatment of reflex sympathetic dystrophy (RSD) with hypnosis and ego-state therapy in a subject with a dissociative disorder. RSD is an unusual, debilitating, chronic pain syndrome with a usually poor outcome. The subject achieved temporary symptomatic relief using hypnosis and auto-hypnotic pain-management techniques. Eventually, she achieved permanent relief of RSD symptoms that continued over a two-year follow-up period. She achieved this permanent relief through a process of psychologically integrating physical functions that she experienced as specific to several dissociated ego states. This case illustrates the role of metaphor and imaginative symbolism in constituting a physical condition. It also illustrates how imaginative transformation of the symbolic imagery can induce psychological and physical change.
BACKGROUND: Several prior studies have found reduced hippocampal volume in victims of psychological trauma with post-traumatic stress disorder (PTSD). We were interested to determine if this finding was evident in women who were victimized by severe sexual abuse in childhood. METHODS: In this study, hippocampal volume was measured using quantitative magnetic resonance imaging (MRI) in 21 women who reported being severely sexually abused in childhood and 21 socio-demographically similar women without abuse histories. RESULTS: Women who reported sexual victimization in childhood had significantly reduced (5% smaller) left-sided hippocampal volume compared to the non-victimized women. Hippocampal volume was also smaller on the right side, but this failed to reach statistical significance. Left-sided hippocampal volume correlated highly (rs = -0.73) with dissociative symptom severity, but not with indices of explicit memory functioning. CONCLUSIONS: These findings, which are generally consistent with prior reports of reduced hippocampal volume in combat veterans with PTSD, suggest that diminished hippocampal size may be either a consequence of trauma exposure or a risk factor for the development of psychiatric complications following trauma exposure. The observed relationship between symptom severity and hippocampal volume suggests that mesial temporal lobe dysfunction may directly mediate certain aspects of PTSD and dissociative disorder symptomatology.
144 psychiatric inpatients who reported childhood physical or sexual trauma were administered the Symptom Check List-90-Revised, the Dissociative Experiences Scale, and the Dissociative Disorders Interview Schedule. There was a significant association of reported childhood abuse with psychotic and other symptoms. The findings support the hypothesis that experience of trauma may precede psychiatric symptoms, perhaps including positive symptoms of schizophrenia.
Self-Psychology, as a segment of contemporary psychoanalysis, can claim merit as to having included the vastly accrued body of knowledge of pertinent fields of the human sciences into their clinical reasoning. This, in turn, has set forth a rebound effect which eventually has contributed to Psychoanalysis' still ongoing exodus from its long-lasting "splendid isolation". By presenting selected findings pertaining to attachment- and neuroscientific trauma-research, the author aims at hypothesizing with reference to the interface of early ontogenic attachment disorganization, onset of dissociative disorders and graded traumatic impact. Finally, in considering clinical relevance of the data, the author opts for composite strategies i.e. measures embedded in an overall psychodynamic treatment stance inclusive of occasional employ of EMDR and hypnotherapeutic interventions.
The aim of this study was to investigate the psychometric properties of the Swedish version of the Dissociation Questionnaire in a normative adolescent population and also to investigate dissociative symptoms associated with trauma including sexual and physical abuse. A normative sample of 449 adolescents between the ages of 12 and 19 and a clinical group of 74 adolescents with known experiences of trauma, sexual and/or physical abuse was given Dis-Q-Sweden. A mixed group of 22 abused and non-abused adolescents who answered Dis-Q-Sweden was also interviewed by using the Structural Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability concerning both internal consistency and test-retest stability. Validity was tested in several ways (criterion, predictive, construct and concurrent) and found to be satisfactory. Significant differences for the total sum scores of Dis-Q-Sweden were found between the normative group and the clinical group with known sexual abuse (p < 0.001). The prevalence of dissociative symptoms (cut-off score > 2.5) was 2.3% in the normative group and 50% in the clinical group. Dis-Q-Sweden has proven to be a screening instrument with good psychometric properties and has proven to be able to capture dissociative symptoms in adolescents with self-reported trauma and known trauma (sexual abuse).
Dissociative identity disorder and borderline personality disorder resemble each other in trauma histories and comorbidity. Each disorder is frequently comorbid with the other. Treatment outcome data for Dialectical Behavior Therapy of borderline personality disorder and Trauma Model Therapy of dissociative identity disorder are reviewed. The author proposes a psychotherapy treatment study in which there are three subject groups and two treatment conditions. The subject groups are borderline personality disorder without dissociative identity disorder; dissociative identity disorder without borderline personality disorder; and both conditions present concurrently. Subjects would be randomized to receive Dialectical Behavior Therapy or Trauma Model Therapy. Such a study could provide answers to controversies in the field about a better treatment approach for dissociative identity disorder and potentially could broaden and strengthen the indications for Dialectical Behavior Therapy.
Storms of affect, states of panic, and other apparently dysregulated affect states may not be as dysregulated as they seem. While initial states of panic during a rape, etc. may have the quality of chaos and be associated with dissociative experience, rekindled affect may actually burst forth in an unconsciously scripted manner, telling a story for which words have not yet been found. The story of abusive experience may only appear to be dysregulated. The patient with an apparent dysregulation of affect may be suffering from complex affect scripts to which she is subject via unconscious attempts to tell a story based on experience that has been nonverbally encoded. The interaction of neurobiological systems of affect and memory to produce decontextualized experience, which leaves a person bereft of understanding but reeling from storms of affect, is described. While more work remains to be done to delineate the kind of model described here, the efficacy of such an approach and the blamelessness of the neurobiological givens may be a useful construct. Rather than thinking of people who demonstrate affective dysregulation as being subject to psychic disorganization, attention to the sequences and repetition of affect states may lead to analysis of previously unknowable model scenes and their resolution. This framework brings some hope to an area of inquiry that is strewn with despair for both patient and clinician. The treatment of dissociative disorders teaches us much about how we all are much more alike than we are different. If only we are willing to immerse ourselves in the milieu of the affective chaos our patients bring to treatment, then we can begin to study the repetitive scripts of experience that act like the strange attractors of chaos theory.
OBJECTIVE: In contrast to the recent surge of interest in other dissociative disorders, DSM-III-R depersonalization disorder has not been thoroughly investigated and characterized. The authors systematically elucidated its phenomenology, comorbidity, traumatic antecedents, and treatment history. METHOD: Thirty adult subjects (19 women and 11 men) were consecutively recruited and administered various structured and semistructured interviews as well as the self-rated Dissociative Experiences Scale. An age- and sex-matched normal comparison group was also recruited. RESULTS: The mean age at onset of depersonalization disorder was 16.1 years (SD = 5.2). The illness had a chronic course that was usually continuous but sometimes episodic. Severe distress and high levels of interpersonal impairment were characteristic. Unipolar mood and anxiety disorders were common, but none emerged as specifically related to the depersonalization. A wide variety of personality disorders was manifested; avoidant, borderline, and obsessive-compulsive were most common. Although not highly traumatized, the subjects with depersonalization disorder reported significantly more childhood trauma than the normal comparison subjects. Depersonalization had been typically treatment refractory; only serotonin reuptake inhibitors and, to a lesser extent, benzodiazepines had been of any therapeutic benefit. CONCLUSIONS: This study supports the conceptualization of depersonalization disorder as a distinct disorder with a characteristic course that is independent of mood, anxiety, and personality symptoms. A subtle relationship may exist between childhood trauma and depersonalization disorder that merits further investigation. The disorder appears to be highly treatment refractory, and prospective treatment trials are warranted.
Coma is present when the patient appears asleep, is unrousable, and unresponsive. Where no underlying medical condition is found, the role of the psychiatrist may become prominent. We present a clinical case and review the literature on psychogenic coma. According to DSM-IV-TR, psychogenic coma is a dissociative disorder not otherwise specified. Management is largely supportive. Principles include speaking in a reassuring manner and avoiding repeated painful stimuli. Education of family and other professionals that symptoms are real and not consciously feigned may be important. There may be a short-term role for anxiolytic and/or antipsychotic medication to assist return to consciousness.