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PubMed1995

Transcultural aspects of dissociative and somatoform disorders.

A brief review of the cross-cultural literature on dissociative and somatoform disorders with emphasis on US Hispanic populations has been provided. A brief description of the psychopathology of somatizing syndromes has been given as have some critiques of current nosologic systems. Cultural influences that may color the expression of somatic manifestations have been outlined. Although it is often difficult to disentangle the contribution of ethnicity from other demographic factors, and although there are plenty of methodologic shortcomings, most studies reinforce the view that culture exerts a powerful influence in shaping symptom presentation and determining health-related attitudes. Future work using instruments such as the Composite International Diagnostic Interview (CIDI) (Rubio-Stipec M: The somatization schedule of the Composite International Diagnostic Interview: The use of the probe in 17 different countries; unpublished manuscript) that include a more culturally congruent list of somatizing symptoms may shed new light on the international distribution and mechanisms at play in these symptom presentations.

Culture↗
PubMed1992

[Functional dysphonia: relation with personality and ICD-10 criteria].

The International Classification of Diseases, 10th. revision (ICD-10) in the category F45 defines the somatoform disorder as a mental disease characterized by the reiterative presentation of somatic symptoms in absence of an organic disease, or the somatic pathology being insufficient to explain the intensity of the symptoms as well as the discomfort and preoccupation of the patient. Fifteen female teachers with functional dysphonia were studied by means of a semistructured interview and psychometric evaluations. Considering dysphonia as the principal symptom, the most frequent diagnosis, in accordance with ICD-10 was "Other somatoform disorder" (F-45.8)(9/15). Five patients were diagnosed as motor dissociative disorder (F-44.4). All the patients had some abnormality of personality (5 with personality disorder and 10 with exacerbation of personality traits). The criteria of ICD-10 to classify the functional dysphonia as Somatoform disorder are discussed. It is suggested that certain personality traits are facilitators for somatization.

Adult↗
PubMed2004

Trauma and dissociation in conversion disorder and chronic pelvic pain.

OBJECTIVE: The purpose of this study was to: a) assess the link between sexual and/or physical abuse and dissociation in conversion disorder and chronic pelvic pain patients; and b) assess whether this effect is independent of level of general psychopathology. METHOD: This report examines data from four separate samples. Fifty-two patients with chronic pelvic pain, 61 patients with non-epileptic seizures, and two samples of patients (102 and 54) with predominantly motor or sensory types of conversion disorder were studied. RESULTS: Using point-biserial correlations no compelling evidence for a consistent and positive association of sexual and/or physical abuse with dissociation was found. After statistically controlling for level of psychopathology using multiple regression analyses, in most of the cases the association of abuse with dissociation was no longer statistically significant. Only physical abuse predicted level of somatoform dissociation over and above level of psychopathology. CONCLUSION: In future clinical studies of dissociation in patients with conversion disorder and chronic pelvic pain more complex models may be needed with less exclusive reliance on historical antecedents such as childhood abuse and more emphasis on recent potentially traumatizing experiences or co-morbid psychiatric disorders.

Adult↗
PubMed1999

The multiple self: working with dissociation and trauma.

This paper describes a patient who appears to have a chronic dissociative personality disorder. Renewed clinical interest in dissociative disorders had arisen in North America in the 1980s, in part due to the influence of the Women's Movement which had highlighted the incidence of child sexual abuse. The early psychological observations of Janet, Freud and Jung on hysterical patients who displayed dissociative phenomena were similar to those displayed by the patient. consideration is given to theoretical understanding of the condition, taking into account the views of the earlier theorists and object-relations theory. The possibility of trauma, in particular childhood sexual abuse, as a causative factor in dissociative disorders is discussed.

Adult↗
PubMed2001

Psychiatric disorders among tortured Bhutanese refugees in Nepal.

BACKGROUND: The impact of torture on the distribution of psychiatric disorders among refugees is unknown. METHODS: We surveyed a population-based sample of 418 tortured and 392 nontortured Bhutanese refugees living in camps in Nepal. Trained interviewers assessed International Classification of Diseases, 10th Revision (ICD-10) disorders through structured diagnostic psychiatric interviews. RESULTS: Except for male sex, history of torture was not associated with demographics. Tortured refugees, compared with nontortured refugees, were more likely to report 12-month ICD-10 posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders. In addition, tortured refugees were more likely to report lifetime posttraumatic stress disorder, persistent somatoform pain disorder, affective disorder, generalized anxiety disorder, and dissociative (amnesia and conversion) disorders. Tortured women, compared with tortured men, were more likely to report lifetime generalized anxiety disorder, persistent somatoform pain disorder, affective disorder, and dissociative (amnesia and conversion) disorders. CONCLUSIONS: Among Bhutanese refugees, the survivors had higher lifetime and 12-month rates of ICD-10 psychiatric disorder. Men were more likely to report torture, but tortured women were more likely to report certain disorders. The results indicate the increased need for attention to the mental health of refugees, specifically posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders among those reporting torture.

Adult↗
PubMed1993

Quality of life and dissociation in anxiety disorder patients with histories of trauma or PTSD.

OBJECTIVE: The purpose of this analysis was to examine quality of life and dissociation in anxiety disorder subjects with histories of trauma, some of whom met criteria for posttraumatic stress disorder (PTSD). METHOD: Subjects came from a prospective, longitudinal study of anxiety disorders. Information was gathered on role, social life, suicide attempts, psychiatric hospitalization, alcohol and substance abuse, depression, and dissociation. RESULTS: Subjects with PTSD had the worst functioning on all of the measures examined except social life. Those with histories of trauma but no PTSD differed from subjects who reported no history of trauma, primarily in high rates of alcoholism and minor depression. CONCLUSIONS: PTSD has severe effects on quality of life in virtually all spheres of life. The high levels of depression, suicide attempts or gestures, and alcohol abuse are of particular concern and show that trauma can have long-lasting effects.

Adolescent↗
PubMed1989

Suicide and parasuicide in multiple personality disorder.

Multiple personality disorder (MPD) has been diagnosed with increasing frequency in the 1980s: according to one estimate 6,000 cases have now been diagnosed in North America (Coons 1986). The diagnosis of MPD can be difficult because patients usually present in a polysymptomatic fashion, and the specific features of their dissociative disorder may be difficult to elicit (Kluft 1985a, 1987). One of the most common presenting features consists of suicidal ideation and suicide attempts. Putnam et al. (1986), for instance, noted suicidality as a presenting symptom in nearly 70% of 100 cases of MPD reported to them by 92 clinicians throughout North America. We have collected a series of 236 cases of MPD reported to us by 203 clinicians throughout North America. Our results show that 72% of the patients attempted suicide. The purpose of this report is to compare 48 cases of MPD from this series with no previous suicide attempts to 167 cases that have attempted suicide to determine features that differentiate the patients who attempt suicide from those who do not.

Adult↗
PubMed1992

Left hemispheric activation in depersonalization disorder: a case report.

Depersonalization disorder is classified in DSM-III-R (APA 1987) as a dissociative disorder characterized by altered perception or experience of the self. To date, there are no known reports of the neurobiological features of this disorder. We report clinical and biological correlates in a patient with depersonalization disorder previously unresponsive to a variety of anticonvulsant, monoamine oxidase inhibitor, and tricyclic antidepressant trials, but for whom fluoxetine partially reduced depersonalization symptoms, but not associated anxiety and depression. Neurophysiological, neuroanatomical and neuropsychological findings revealed left hemispheric frontal-temporal activation and decreased left caudate perfusion. These findings suggest a similarity to the neuropsychiatric data reported in obsessive-compulsive disorder patients.

Adult↗
PubMed1990

Adolescent multiple personality disorder: a preliminary study of eleven cases.

The diagnostic features and treatment histories of 11 adolescents with multiple personality disorder (MPD) are presented. Clinical evaluation revealed that the majority of these adolescents manifested extremely variable school performance, disruptive behavior, trances, amnesias, mood swings, sharp changes in personality, apparent lying, voices heard in the head, and depression. All had a history of childhood trauma: Sexual abuse (73%), physical abuse (73%), and emotional abuse (82%). Seventy-three percent had a parent with a diagnosable dissociative disorder; 36% of the mothers had MPD. These adolescents had a mean number of 24.1 alter personalities and appear to have become multiple at a mean age of 3 years, 1 month. All patients had angry protector alters, depressed alters, scared alters, and child alters. Fifty-four percent of these cases have integrated during treatment or are progressing toward integration. The remaining cases dropped out of therapy.

Adolescent↗
PubMed2005

Sleep-related violence.

Most violent behaviors arise from wakefulness. It is important to realize that violent behaviors that may have forensic science implications can arise from the sleep period. By virtue of the fact that these behaviors arise from sleep, they are executed without conscious awareness, and, therefore, without culpability. The most common underlying conditions arising from sleep are disorders of arousal (sleepwalking and sleep terrors), the rapid eye movement sleep behavior disorder, and nocturnal seizures. In addition, there are a number of psychiatric conditions (dissociative disorders, malingering, and Munchausen syndrome by proxy) that actually arise from periods of wakefulness occurring during the sleep period. The clinical and medico-legal evaluation of such cases is outlined, and should be performed by a multidisciplinary team of experienced sleep medicine practitioners.

Humans↗
PubMed2006

Psychomotor development and psychopathology in childhood.

The sensorimotor developmental phase, leading to a gradual acquisition of skilled actions, is of crucial importance for the young child and its growing sense of competence. Three vital steps in motor development are mentioned: first, the smooth and spontaneous movements of the "graceful and elegant" baby, expression of his well-being and vitality, with their profound effect on the mother-infant relationship; second, the emergence of intentional and goal-oriented acts leading to Funktionslust and playful repetitions; and finally, the development of symbolic acts and increasing technical capacity to use playthings in imaginative play. The psychodynamic significance of the most important motor milestones for the child's ego development is set out. Motility is one of the most important avenues for exercising such functions as mastery, integration, reality testing (self-preservation), and control of impulses. One may consider this early childhood period of rapid motor development as the motor phase of ego and libido development. Hence, many forms of developmental psychopathology are attended with motor impairment or insufficient motor mastery and integration. From that clinical perspective pass in review: perinatal complications and motor disturbance, attention deficit/hyperactivity disorder, dissociated motor development, low birth weight children and their developmental difficulties, developmental coordination disorder, aspects of pervasive developmental disorder, and stereotypic movement disorder.

Child↗
PubMed2000

[Psychopathological phenomena and personality disorders (the issue of dynamic aspects of psychopathologies)].

An analysis of the interaction between pathocharacterological and psychopathological (affective, anxious-phobic and hysterical) phenomena within "borderline psychiatry" (reactions, phases, development) gives evidence to the existence of 2 clinically heterogeneous variations of comorbid interactions. The first variation: primary psychopathological syndromes manifesting without any significant correlation with personality disorders and transform into pathocharacterological ones (neurotic, postreactive) personality development by means of "amalgamating" mechanism. The second variation: secondary (in regard to personality disorders) psychopathological phenomena forming on the basis of constitutional personality traits by means of "splitting off" mechanism and are defined as personality disorders with predisposition to manifest positive psychopathological symptomatology. Formation of isolated obsessive and dissociative disorders within the structure of "basic" pathocharacterological phenomena (variation 2) predicts a future absence of growing severity of personality disorders (i.e. a dynamics traditionally defined as the development--variation 1) and stabilization of psychopathic traits with features of compensation of the latter. The possibilities of pathological dynamics in psychopathic personality with a "splitting off" of the isolated psychopathological syndromes exhausted; for decades neither growing severity of personality disorders, nor an exacerbation of those psychopathological complexes which provided a primary base for manifestation of positive symptomatology may be observed.

Adult↗
PubMed1992

[Neurotic symptoms of borderline patients: a case review study].

The author investigated neurotic symptoms of borderline patients by reviewing the clinical charts of twenty-six patients of longer than one year treatment period (8 men, 18 women; 23 patients with DSM III-R borderline personality disorder (BPD), 14 with schizotypal personality disorder (SPD), (11 BPD-SPD overlaps); age at the first contact: mean = 24.3 y. o., SD = 6.7 y. o.; treatment period: mean = 51 months, SD = 35 months). The diagnoses of the comorbid neurotic disorders were obsessive compulsive disorder: 5 cases (19% (BPD: 22%, SPD: 7%)), somatoform disorder: 5 (19% (BPD: 22%, SPD: 21%)), panic disorder: 4 (15% (BPD: 17%, SPD: 14%)), social phobia: 2 (8% (BPD: 9%, SPD: 7%)), dissociative disorder: 2 (8% (BPD: 9%, SPD: 0%)), and generalized anxiety disorder: 1 (4% (BPD: 4%, SPD: 7%)). The neurotic symptoms identified in the charts of the subjects were as follows; symptoms of social phobia: 11 cases (42% (BPD: 43%, SPD: 43%)) including 6 with anthropophobic symptoms (23% (BPD: 26%, SPD: 36%)), obsessive compulsive symptoms and diffuse and floating anxiety: 9 (35% (BPD: 39%, SPD: 38%)), panic attacks: 8 (31% (BPD: 35%, SPD: 36%)), conversion symptoms: 7 (27% (BPD: 30%, SPD: 21%)), dissociative episodes: 6 (23% (BPD: 26%, SPD: 7%)), depersonalization: 5 (19% (BPD: 22%, SPD: 14%)), multiple apprehensive expectations: 4 (15% (BPD: 17%, SPD: 14%)), derealization: 3 (12% (BPD: 13%, SPD: 14%)), hyperventilation attacks: 3 (12% (BPD: 13%, SPD: 7%)), and somatization: 1 (4% (BPD: 4%, SPD: 7%)). In short, 54% (BPD: 61%, SPD: 43%) of the subjects had comorbid neurotic disorders, and 92% (BPD: 91%, SPD: 93%) reported at least one, and 54% (BPD: 61%, SPD: 50%), more than two kinds of neurotic symptoms, though no specific symptom correlating with BPD or SPD diagnosis was found. These findings suggest that neurotic symptoms and neurotic disorders cannot be ignored as peripheral in the borderline symptomatology. By analyzing in detail the neurotic experiences, the author pointed out as their characteristics, ego syntonicity, deterioration of reality sense and symptomatic polymorphism, ambiguity and multiplicity (panneurosis). In the symptoms the author observed signs of defective personality functioning such as disavowal of reality, low anxiety tolerance, various forms of identity disturbances. The findings counted above, suggest that the borderline neurotic symptoms are more severe in nature than those of neurotics, and could be situated in between neurotic and psychotic levels of symptomatic severity. The results indicate that the neurotic experiences of borderline patients are, as a whole, deeply ingrained in the borderline psychopathology.

Adolescent↗
PubMed1998

[REM sleep behavior disorder (RBD) and dissociated REM sleep].

REM sleep behavior disorder (RBD) is characterized by the appearance of somnambulism-like behavior associated with dream mentation, and the intermittent loss of muscle atonia during REM sleep (stage 1-REM with tonic EMG; stage 1-REM). RBD is caused symptomatically or idiopathically, and its manifestation of symptoms sometimes associated with psychosocial stress. Muscle tone is often augmented during impared REM sleep observed in RBD patients. Animal experimental studies suggest that dysfunction or lesions of muscle inhibitory system in brain stem is rerated with pathogenesis of RBD. Clonazepam is effective for organic behavior and nightmare, but not remarkable for dissociated REM sleep. Other benzodiazepines and tricyclic antidepressants can be one of the choices of medications. Directions for safe-bedroom and psychotherapy is sometimes necessary.

Animals↗
PubMedDate not supplied

Health-related quality of life and symptom profiles of female survivors of sexual abuse.

OBJECTIVES: To determine the association between severity of sexual abuse and psychiatric or medical problems in a sample of female patients from primary care medical settings and to assess the relationship between sexual abuse severity and health-related quality of life before and after controlling for the effects of a current psychiatric or medical diagnosis. DESIGN: Structured interview and self-report questionnaire. SETTING: Three family practice outpatient clinics. SUBJECTS: A total of 252 women selected by somatization status using a screen for unexplained physical symptoms. MAIN OUTCOME MEASURES: Patient assessment after administering the Medical Outcomes Study 36-item Short-Form Health Survey and self-report medical problems questionnaire; the quality-of-life scale developed by Andrews and Withey; Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, diagnoses and symptom counts from the Diagnostic Interview Schedule; the Dissociative Experiences Scale; and the modified Dissociative Disorders Interview Schedule. RESULTS: A history of sexual abuse is associated with substantial impairment in health-related quality of life and a greater number of somatized symptoms (P < .001), medical problems (P < .01), and psychiatric symptoms and diagnoses (P < .001). In regression analyses, sexual abuse severity was a significant predictor of high scores on 6 of the 8 subscales of the Medical Outcomes Study Short-Form Health Survey (P < .05) and all of the quality-of-life subscales developed by Andrews and Withey (P < .01), with average decrements of up to 0.41 SDs for moderately abused women and 0.56 SDs for severely abused women. Furthermore, sexual abuse severity remained a significant predictor of high scores on the subscales mental health (P < .05), social functioning (P < .05), and quality of life (P < .05), even after adjusting for the presence of several common psychiatric diagnoses. CONCLUSIONS: Female primary care patients with a history of sexual abuse have more physical and psychiatric symptoms and lower health-related quality of life than those without previous abuse. In addition, a linear relationship exists between the severity of sexual abuse and impairment in health-related quality of life, both before and after controlling for the effects of a current psychiatric diagnosis.

Child↗