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PubMed2004

[Assessment of the depersonalization-derealization syndrome using the German version of the Dissociative Experiences Scale].

OBJECTIVES: The goal of this study is to investigate the applicability of the German adaptation of the Dissociative Experiences Scale, the "Fragebogen zu dissoziativen Symptomen (FDS)", for research on depersonalization (DP) and derealization (DR), and to elucidate the phenomenology of DP / DR. METHODS: 101 consecutively recruited inpatients were diagnosed with the German version of the Structured Clinical Interview for DSM-IV Dissociative Disorders for depersonalization/derealization. Furthermore, the FDS and the SCL-90-R were administered. RESULTS: 47 of 101 Patients were diagnosed with pathological DP / DR. The mean score of the DES scale of the FDS was 32.00 +/- 15.52. A cut-off score of 17.5 for the DES scale of the FDS yielded a 83.0 % sensitivity and 77.8 % specificity. Depressive disorders, anxiety disorders and trauma-associated disorders were the most common comorbidity. CONCLUSIONS: The findings are comparable to the Anglo-American samples. The FDS was found to be quite effective for screening of DP / DR. The three-factor solution of the FDS was not well supported in this sample.

Adult↗
PubMed2006

Postmodern consciousness in psychotherapy.

Modern consciousness is a cultural and historical achievement in the West and a developmental task for each person now. Modern consciousness consists in the emancipation from the power of community, animistic nature and the unconscious. It is connected with neurosis and psychotherapy because it has to do with inner conflicts. But today there is an increasing number of cases which are characterized by dissociation and acting out, without the feeling of conflicts. Consciousness seems to be changing toward a new conception which might be called 'postmodern consciousness'. The essence of postmodern consciousness is shown by interpreting two dreams internally. The first dream from a case of depersonalization indicates that it is not necessary to be entangled with the object. There is a different kind of coniunctio in the mode of seeing. The second dream from a case of dissociative disorder shows a world which has neither traces of pre-modern cosmology-high and low, here and the beyond-nor modern interiority. There is only surface and self-reflection without content. The discussion of dreams suggests that postmodern consciousness is not to be understood as premature and pathological. It is therapeutically important to refine and deepen postmodern consciousness.

Adult↗
PubMedDate not supplied

Referral pattern of neurological patients to psychiatric Consultation-Liaison Services in 33 European hospitals.

The referral pattern of neurological patients to 33 European psychiatric consultation-liaison (C-L) services in the general hospital was examined. Analyses were conducted on the ECLW CS data set, which consists of 14,717 psychiatric C-L referrals made in 56 European hospitals during 1991. Psychiatric referrals of patients admitted to neurological wards were compared to referrals from other wards. Information was obtained from 33 neurological wards, consisting of 34,506 neurological admissions. Of these admissions, 839 were referred to C-L psychiatry. The median consult rate among the hospitals was 1.8%. Compared to other hospital wards, patients referred from neurology were more frequently diagnosed as suffering from somatoform (P<.01) and dissociative disorders (P<.01), and less from substance abuse (P<.01) and delirium (P<.01). Referral to C-L psychiatry from neurological wards is characterized by an underestimation of psychiatric co-morbidity and a late detection, comparable to other medical specialties. An appeal is made for a standardized referral procedure including admission screening method, detecting patients at risk for nonstandard care during their hospital admission.

Delirium↗
PubMed2005

Childhood physical and sexual abuse in China.

In order to determine the prevalence and characteristics of childhood physical and sexual abuse in China, the authors conducted a survey in Shanghai. The Dissociative Disorders Interview Schedule was administered to 423 inpatients and 304 outpatients at Shanghai Mental Health Center, and to a non-clinical sample of 618 workers at a clothing factory. The results were compared to a previous sample of 502 respondents in the general population in Winnipeg, Canada. The identities of the perpetrators of physical and sexual abuse, and the types of sexual abuse reported were similar in the two countries; however, the rates of reported abuse were lower in China. Childhood sexual abuse appears to be far less common in the general population in Canada than in China.

Adult↗
PubMedDate not supplied

[Depersonalization: from disorder to the symptom].

In contrast with the growing interest in dissociative disorders over the last few years, depersonalization continues to be very scarcely approached. There is no agreement among clinicians regarding the concept of depersonalization, and little is known about its etiology, epidemiology and treatment. This paper has two main aims: first, review the literature on this pathology focusing on nosological, historical, psychophysiological and treatment aspects, and second, explore the incidence of the depersonalization symptom in other psychiatric conditions, in particular in panic disorder. The Medline database over the last 5 years has been used for these purposes, and lack of studies on this subject has been found, especially regarding therapeutic issues. Some of the most relevant findings suggest that depersonalization, when associated to panic disorder, could correspond to the most severe forms of this disorder.

Cognition Disorders↗
PubMed1989

Community-based treatment of the incest family.

A child who has been sexually abused by her father faces a life blighted by self-inflicted dissociative disorders. This prospect can be avoided through treatment of the child and family members aimed at reconstructing the family into a healthy unit. This objective can be realized by the community-based approach of the Child Sexual Abuse Treatment Program, which integrates the interventions of the legal-judicial and human services personnel responsible for incest cases and augments traditional in-office therapy sessions with the peer support services of Parents United. This article also gave a brief description of ICEF's training project, in which clients and therapists jointly train legal, judicial, and human services personnel to work collaboratively toward family reconstruction in their interventions with incest victims and their families. A treatment and training manual that provides a much more thorough presentation of the CSATP and the training project is available from ICEF.

Adolescent↗
PubMed1998

Auditory hallucinations: a comparison between patients and nonpatients.

The form and the content of chronic auditory hallucinations were compared in three cohorts, namely patients with schizophrenia, patients with a dissociative disorder, and nonpatient voice-hearers. The form of the hallucinatory experiences was not significantly different between the three groups. The subjects in the nonpatient group, unlike those in the patient groups, perceived their voices as predominantly positive: they were not alarmed or upset by their voices and felt in control of the experience. In most patients, the onset of auditory hallucinations was preceded by either a traumatic event or an event that activated the memory of earlier trauma. The significance of this study is that it presents evidence that the form of the hallucinations experienced by both patient and nonpatient groups is similar, irrespective of diagnosis. Differences between groups were predominantly related to the content, emotional quality, and locus of control of the voices. In this study the disability incurred by hearing voices is associated with (the reactivation of) previous trauma and abuse.

Adult↗
PubMed1993

Ego-state therapy for self-injurious behavior.

The authors describe the use of ego-state therapy for the treatment of self-injurious behavior (SIB). We propose that for some patients, SIB results from conflict among dissociated ego states. We review the historical and theoretical basis for this position and delineate a specific treatment technique. Our strategy consists of identifying an ego state in which SIB occurs, activating the patient's ego strengths using inner-adviser techniques and facilitating the integration of these resources within the ego state responsible for the behavior. We have used this strategy with favorable results for patients with dissociative symptoms, primarily those suffering from borderline personality disorder, posttraumatic stress disorder, or dissociative disorders.

Adult↗
PubMed2003

Directed forgetting between, but not within, dissociative personality states.

To investigate amnesia between identities in dissociative identity disorder (DID), the authors assessed explicit and implicit memory performance on a directed-forgetting task in 12 DID patients who switched from one state to an "amnesic" state between presentation and memory testing. DID patients were instructed either to remember or to forget neutral and emotional words. Besides an overall decrease in explicit memory, patients demonstrated selective forgetting of to-be-forgotten, but not of to-be-remembered words in the amnesic state. Patients did not exhibit any directed forgetting within the same state. Implicit memory was fully preserved across states. Independent of state, patients recalled more emotional than neutral information. These results may extend the conceptualization of memory processes in DID, suggesting an important role for retrieval inhibition.

Adult↗
PubMed2002

Cultural scripts, memories of childhood abuse, and multiple identities: a study of role-played enactments.

This study compared the reports of satanic, sexual, and physical abuse of persons instructed to role-play either dissociative identity disorder (DID) (n = 33), major depression (n = 33), or a college student who experienced minor adjustment problems ("normal") (n = 33) across a number of trials that included role-played hypnosis. As hypothesized, more of the participants who were asked to role-play DID reported at least one instance of satanic ritual abuse and sexual abuse compared with those who role-played depression or a college student with minor adjustment problems. DID role-players reported more incidents of sexual abuse and more severe physical and sexual abuse than did the major depression role-players. Further, the DID role-players differed from the normal role-players on all the measures of frequency and severity of physical and sexual abuse. Participants in all groups reported more frequent and severe incidents of physical abuse after role-played hypnosis than they did prior to it.

Adjustment Disorders↗
PubMed1991

Historical reliability: a key to differentiating populations among patients presenting signs of multiple personality disorder.

The clinical value of inconsistencies in the historical data of patients presenting with signs of multiple personality disorder was assessed. Three major inconsistencies in historical data were identified in 23 patients who were admitted to a Dissociative Disorders Program with a diagnosis of Multiple Personality Disorder. This group showed psychological disturbance that was quite different from 23 patients with a similar discharge diagnosis but who did not exhibit inconsistencies in history. The former group reported less psychological disturbance and fewer dissociative experiences. Patients who are less credible by virtue of inconsistencies in their historical reports may belong to a different diagnostic group. The findings point to the need to chart history carefully in authenticating genuine cases.

Adult↗
PubMed1993

Multiple personality disorder in The Netherlands: a clinical investigation of 71 patients.

OBJECTIVE: The aim of this study was to describe the phenomenology of multiple personality disorder as presented in a group of Dutch patients. METHOD: Seventy-one patients with multiple personality disorder were interviewed with the Dutch version of the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D); following the SCID-D, the Structured Trauma Interview was administered. Before the interview, patients completed the Dissociative Experiences Scale. RESULTS: The presenting characteristics of the patients showed a striking resemblance to those in several large North American series. Patients had spent an average of 8.2 years in the mental health system prior to correct diagnosis. Patients presented with many different symptoms and frequently received other psychiatric or neurological diagnoses. A history of childhood physical and/or sexual abuse was reported by 94.4% of the subjects, and 80.6% met criteria for posttraumatic stress disorder. CONCLUSIONS: Patients with multiple personality disorder have a stable set of core symptoms throughout North America as well as in Europe. To improve the detection of patients at high risk for multiple personality disorder, standardized instruments for inquiry about dissociative pathology should be used as part of routine diagnostic assessment.

Adolescent↗
PubMedDate not supplied

[Schizophrenia diagnostic announcement in a French psychiatric unit].

Announcement of schizophrenia diagnostic to the patients is a topical issue in France. The evolution in clinical practices, a better efficiency in therapeutic procedures and the fundamental right of the patient to obtain information have initialised the discussion of its interest. Spontaneous claim for information from the patient is rarely observed although awareness troubles might be reported at the instauration of the mental disorder or during its evolution. Methodological studies concerning the diagnostic announcement are limited. Except the Bayle studies recently published, only a few publications are available in France about the knowledge of their pathology and their need to be clearly informed. French scientific literature deals generally about medico-legal aspects of this information and consisted of survey about diagnostic announcement. International literature is more abundant and presents positive and negative aspects of the announcement. An information procedure of schizophrenia announcement to the patient has been developed in our hospitalisation unit of psychiatry. This procedure has taken place on the basis of the literature data, our specificity and our clinical experiences. For some Anglo-American psychiatrists who have proceeded to semi-structured interview in order to announce the diagnostic, information to the patients might improve the clinical relationship. Thus, compliance to the treatment is significantly increased. The ability of the patient to recognise the symptoms of the disease and to accept their consequences and the treatments is associated to a better social prognosis, daily activities and response to the treatment. The announcement impact justifies the prescription of neuroleptics, treatment that is notoriously perceived as prejudicial by the patients themselves or more commonly in the basic population. To obtain compliance to the treatment, a satisfactory acceptance of the mental disorder is required. Compliance is based on satisfactory information in order to gain the cooperation of the patient and its relative (10). Atkinson has classified four main types of arguments, the ethical principle to be informed, talk to explain and give sense to the symptoms, reduce the feeling of guilt perceived by the patient and his relative and enhance the collaboration between the patient and the nursing staff. According to Ferreri and Bayle studies French psychiatrists reluctance to announce schizophrenia diagnostic are the following: lack of request or of interrogations asked by the patient about their disease, diagnostic and prognosis uncertainty and irreversibility of the disease, complexity of the pathology and its origin which hinder an accessible explanation, cognitive disorders frequently observed with schizophrenic patients which may be associated with difficulties of understanding information, destabilization of the patient-nursing staff relationship and social stigmatisation risks. Other arguments like reluctance to give a "label" to the disease, too abstract diagnostic, a negative social vision and the possibility of discouragement for the relative are classically retrieved in French literature. In fact, divulgation of the term schizophrenia involves a panel of negative representations and is hindered by the confusion in the social imagination of such a term related with lost of control, quintessence of madness, dangerous behaviour possibilities, evil and incurability. Some psychiatrists do not transmit information arguing that significant obstruction of the future may be consecutive to the information. They prefer to use vague terms more socially acceptable like "nervous breakdown or depression, atypical or emotional disorder, dissociative troubles...". Information to the patient about his mental disorder is more frequent in psychiatry for affective, anxious and additive troubles than for schizophrenia. Our procedure of diagnostic announcement has been elaborated after preliminary discussion with the medical and nursing staff. Diagnostic of schizophrenia announcement has been presented by weighing the pros and cons according to the intemational literature. It clearly appeared that benefits for the patients prevail on the drawbacks. Nevertheless, inclusion and clinical supervision have to be carefully precised in particular to verify the ability to receive information. Short term objectives: deliver progressively information to the patient about his disease by means of an active and educational process with hope and optimism using a accessible language (explanation of each terms used with the intention of being well understood); quantify the impact of diagnostic announcement on the schizophrenic patient using clinical rating scales during a period of one month (clinical interview at day 1, day 7 and day 28). Mid term objectives: improve the global supervision and autonomy of schizophrenic by means of a therapeutic project helping the patient to become an active partner in the monitoring of his mental disorder; enhance a psycho-educational program after the procedure of announcement in order to optimise the observance of his treatment, increase his quality of life and answer to the requests of his relative; 45 patients (age 29.3 +/- 8.8 years old) have been included to be informed on their diagnostic since the elaboration of this procedure during a time period of 24 months. Time interval between the beginning of their pathology and the delivering of this information was 4.7 years. Most of them (56%) presented a paranoid type of schizophrenia. In most of the cases, the patients did not know their diagnostic or declared suffering from a diagnostic, which was erroneous; 80% of the 45 patients have complied with the procedure until its end. On more than 24 of following after the instauration of the diagnostic announcement procedure, these patients ha ve presented satisfactory observance to the medical supervision (medical consultation and drug intake); 60% of the patients were regularly present to their medical appointment. The number of patients included (45 patients) appears small compared to the time interval of the study (24 months) but was significant according to the great changes in our clinical approach. Thus, this procedure was not systematically applied, in particular the patients who did not want to be informed on their disease. Is it clinically relevant or not to announce diagnostic of schizophrenia to the patient? This issue remains questioned according to the few studies published at the present time, any consensus has been clearly presented on formal indications or contra-indications. If on an ethical side, this information appears logical, the medical and nursing staff should require special care. Special care must be taken before delivering information to the patients; each situation must be evaluated in order not to comply with an ideology of total and inadequate information, which could have serious consequences. Nevertheless, it appeared clearly that information must be given to stabilized patients with satisfactory insight. Moreover, psychotherapeutic projects become easier because patients awareness and understanding towards pathological symptoms are greatly improved. Partnership between patient and medical staff is the key of this dynamic and psycho-educative procedure, which opens new horizons in our therapeutic prospect.

Adult↗
PubMed1997

Depersonalization: a conceptual history.

As with other clinical phenomena, the historical analysis of the term, concepts and behaviours involved in the construction of 'depersonalization' should provide researchers with an essential frame for its empirical study. Before the term was coined in 1898, and under a variety of names, behaviours typical of 'depersonalization' were reported by Esquirol, Zeller, Billod, and Griesinger. The word 'depersonnalisation, derived from a usage in Amiel's Journal intime, was first used in a technical sense by Ludovic Dugas. The new disorder has since been explained as resulting from pathological changes in the sensory system, memory, affect, body image and self-experience. During the 1930s, evolutionary views became popular, particularly in the work of Mayer-Gross. The unclear conceptual boundaries of depersonalization still invite confusion and often enough fragments of what used to be its core-behaviour are used to diagnose the disorder. Depersonalization has of late become subsumed under the dissociative disorders. The definitional instability of the latter, however, has caused further complications to the study of depersonalization. It is recommended that the term is used to refer only to the original core-behaviour as this has shown adequate stability.

Depersonalization↗
PubMed1994

Dissociative states and disordered eating.

To investigate the relationship between eating problems and dissociation, 142 college women completed the Eating Disorders Inventory, the Bulimia Test, the Dissociative Experiences Scale, the Perceptual Alteration Scale, and a demographic information worksheet. The two eating-disorder inventories were strongly correlated (rs = .71). The two dissociation scales, however, were only moderately correlated (rs = .32), suggesting they are measuring different underlying experiences. The pattern of the correlations of the subscales of the dissociation scales with the eating disorder scales suggested that cognitive distortions were not as important in the relationship with eating disorders (all correlations were less than .21) as were dissociation of feelings and loss of control (the correlations for eating related subscales ranged as high as .51). These results were interpreted to suggest that dissociation of feelings might underlie eating problems. These results indicate the value of the use of hypnotherapy in working with eating-disordered clients.

Adolescent↗
PubMed1993

[Multiple personality--a phenomenon also in Norway?].

Dissociative disorders are little known and seldom referred to in the Norwegian medical literature. Our paper describes signs and criteria for multiple personality and dissociative syndromes, and reviews the recent literature. Three cases are briefly presented.

Adult↗