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PubMed1984

Towards a theory of multiple personality and other dissociative phenomena.

That dissociation and multiple personality occur has been well documented. In this article the guest editor asks the following question: Are they created? To arrive at an answer he brings together various concepts under the rubric of state-dependent learning and presents ideas about how the states come together psychologically, physiologically, neurophysiologically, and physically.

Adrenocorticotropic Hormone↗
PubMed1984

Spontaneous hypnotic age regression: case report.

Age regression--reliving the past as though it were occurring in the present, with age appropriate vocabulary, mental content, and affect--can occur with instruction in highly hypnotizable individuals, but has rarely been reported to occur spontaneously, especially as a primary symptom. The psychiatric presentation and treatment of a 16-year-old girl with spontaneous age regressions accessible and controllable with hypnosis and psychotherapy are described. Areas of overlap and divergence between this patient's symptoms and those found in patients with hysterical fugue and multiple personality syndrome are also discussed.

Adolescent↗
PubMed1978

Amobarbital treatment of multiple personality. Use of structured video tape interviews as a basis for intensive psychotherapy.

The case of a 30-year-old woman with five distinct personalities is presented. The patient was treated, using a system of structured video taped sodium amobarbital interviews, in which areas to be explored were developed in psychotherapy. Tapes were played for the patient after each session. The taped material was used as the basis for psychotherapeutic investigation. The patient evidenced many of the features previously reported in cases of multiple personality, specifically: being the product of an unwanted pregnancy in a repressively rigid family; emotional distancing by one parent; strong sibling rivalry with an adopted sib; family history of mental illness; a traumatic first sexual experience (rape); a marriage to a maladjusted individual in an attempt to escape the parental home; a high internalized standard of performance and an inability to display anger or negative feelings toward the parents. In the course of treatment, the patient's personalties fused and she was able to accept each component as part of herself. No further fragmentation has occurred during the year following discharge. The therapy technique minimized dependency, and the possiblity of addiction to amobarbital interviews permitted more active patient therapy involvement, and set clear-cut goals and expectations for improvement before further amobarbital interviews could be conducted.

Adult↗
PubMed1980

Dissociated state. Status of a case after 38 years.

This is the third report of a patient with dissociated personality followed for 38 years. There has been a gradual integration of the dissociated states. The most remarkable aspect of the clinical course has been the patient's excellent work record in contrast to a severe restriction in her social life. The original diagnosis of hysteria was changed to schizophrenia. Evidence is presented to show that the diagnosis of schizophrenia was incorrect. The authors believe that dissociated states occur more frequently than diagnosed, and that the syndrome should be given independent diagnostic status.

Adult↗
PubMed2005

Dissociation in children and adolescents as reaction to trauma--an overview of conceptual issues and neurobiological factors.

The discovery of trauma as an aetiological factor in mental dissociation is more than a century old, but neurobiological research in the last decade has started to clarify a neurobiological basis that may shed light on the complex symptomatology observed in traumatized children. Dysfunctional stress responses, emotional-based style of functioning, hyperarousal, anxiety, irritability, impulsivity, disengaged attention and educational underachievement may thus begin to be better understood. The aim of this overview is to give an update on the concept of dissociation and the links to new neurobiological findings, hopefully to reduce unawareness, wrong diagnostics or even neglect of dissociative symptomatology by clinicians in child and adolescent psychiatry in the Nordic countries. A systematic overview of studies of mental dissociation in children and adolescents published over the last decade disclosed a total of 1019 references; 309 papers regarding the concept of dissociation, memory, trauma and the neurobiological correlates were studied in detail. The assumption of a trauma-genic basis of dissociation is still most discussed in the literature. The importance of other childhood trauma in addition to sexual abuse is outlined, focusing on childhood interpersonal trauma. Recent research on traumatized children and adolescents has demonstrated some permanent neurochemical as well as functional and structural abnormalities in brain areas that are involved in the integrative process of cognition and memory. This research begins to clarify the cerebral basis and mechanisms for the trauma-related dissociation observed in dissociative (conversion) disorders, post-traumatic stress disorder (PTSD) and somatoform disorders. New perspectives on the nature of subcortical processes linking the phenomena of dissociation and traumatic experiences may have important implications for the understanding of dissociative disorders in children and adolescents. They may be regarded as complex environmentally induced developmental, supporting the view that PTSD and somatization disorders may be specific forms of dissociative processes to be categorized together with dissociative (conversion) disorders as "trauma-related dissociative disorders".

Adolescent↗
PubMed1992

The prevalence of posttraumatic psychopathology in the general and the clinical population.

Since the beginning of psychiatry, there has been a controversy about the consequences of traumatic events. Although there is no real dispute about human suffering caused by extreme stress events, social scientists have wondered whether traumatic events could lead to lasting psychopathology. This dispute was very strong in the first two versions of the the diagnostic and statistical manual of the American Psychiatric Association, which came out in 1952 and 1968. In DSM I (1), trauma could only lead to "gross stress reactions", which were part of "transient situational personality disorders". Extreme stress events were thought to lead only to a transient/temporary disturbance and if there was more disturbance than that, another diagnostic label had to be found. This attitude towards trauma has changed over the years and from 1980, in DSM III, there emerged the Posttraumatic Stress Disorder, a disorder which can be lasting or transient (2). In the past years, it has become clear that posttraumatic stress disorders are not the only form of psychopathology that follows after traumatic events. Major depressive episodes and dissociative disorders can also follow traumatic events. In this article, the results of two studies are reviewed. The first is a survey of the major studies into the prevalence of disorders after traumatic events. The main conclusion of this study shows that about 20% of the people that go through severely distressing events develop severe disorders. The second study focuses on the prevalence of disorders in the process of coping with traumatic events in a psychiatric outpatient clinic. Results of this study showed that clinically significant signs of these disorders were found to be present in 18% of the psychiatric outpatient referrals. In the discussion, the conclusion is drawn that posttraumatic psychopathology is a phenomenon that every clinician is confronted with on a regular basis. We might then wonder why specific treatment for posttraumatic psychopathology is still such a neglected area in psychiatry and psychotherapy.

Adaptation, Psychological↗
PubMed2003

Peritraumatic versus persistent dissociation in acute stress disorder.

The DSM-IV definition of acute stress disorder (ASD) regards dissociation that occurs during a trauma (peritraumatic dissociation) comparably to persistent dissociation. This study investigated the relative contributions of peritraumatic dissociation and persistent dissociation to acute posttraumatic stress reactions. Civilian trauma (N = 53) survivors with either acute stress disorder (ASD), subclinical ASD, or no ASD were administered modified versions of the Peritraumatic Dissociative Experiences Questionnaire that indexed both dissociation during the trauma and dissociation at the time of assessment. Persistent dissociation was more strongly associated with ASD severity and intrusive symptoms than peritraumatic dissociation. These results are consistent with the proposition that persistent, rather than peritraumatic, dissociation is associated with posttraumatic psychopathology.

Adult↗
PubMed1997

Dissociative symptoms in psychotic mood disorders: an example of symptom nonspecificity.

Dissociative symptoms have been the subject of psychiatric inquiry since the beginning of this century (Putnam 1992; Sanders 1986; van der Kolk and van der Hart 1989). Although recent investigations have focused on the four specific dissociative disorders (American Psychiatric Association 1994) and their relationship to early traumatic experiences (Chu and Dill 1990; Putnam 1985; Terr 1991), dissociative symptoms have been reported in virtually every major psychiatric disorder (Bremner et al. 1992; Goff et al. 1992; Steinberg 1992), and, in less severe forms, even in nonpatient populations (Briere 1988; Putnam 1992; Ross and Joshi 1992). These observations raise questions about the clinical significance of dissociative symptoms that occur when other mental disorders are also present (Coons 1984; Fahy 1988).

Adult↗
PubMed1997

REM sleep behaviour disorder: an overview.

REM sleep behaviour disorder (RSBD) is a recently described parasomnia characterised by a history of excessive nocturnal motor activity and absence of muscle atonia during REM sleep. Only limited literature is available on this condition. The exact prevalence is unclear, but recent studies suggest it might not be an uncommon condition. The elderly are more often affected and there is a male preponderance. While transient RSBD can be seen after taking certain drugs or during drug withdrawal, the chronic type is usually idiopathic or associated with an underlying degenerative neurological condition. It can result in considerable distress and/or serious injury to the patients or their bed partners. Differential diagnoses include sleep-walking, night terrors, nightmares, nocturnal seizures, obstructive sleep apnoea, post-traumatic stress disorder, dissociative states and nocturnal confusional states. The dramatic response to clonazepam highlights the importance of recognition and appropriate treatment of this sleep disorder.

Female↗
PubMed2004

Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder.

OBJECTIVE: The aim of this study was to evaluate dissociative disorder and overall psychiatric comorbidity in patients with conversion disorder. METHOD: Thirty-eight consecutive patients previously diagnosed with conversion disorder were evaluated in two follow-up interviews. The Structured Clinical Interview for DSM-III-R, the Dissociation Questionnaire, the Somatoform Dissociation Questionnaire, and the Childhood Trauma Questionnaire were administered during the first follow-up interview. The Structured Clinical Interview for DSM-IV Dissociative Disorders was conducted in a separate evaluation. RESULTS: At least one psychiatric diagnosis was found in 89.5% of the patients during the follow-up evaluation. Undifferentiated somatoform disorder, generalized anxiety disorder, dysthymic disorder, simple phobia, obsessive-compulsive disorder, major depression, and dissociative disorder not otherwise specified were the most prevalent psychiatric disorders. A dissociative disorder was seen in 47.4% of the patients. These patients had dysthymic disorder, major depression, somatization disorder, and borderline personality disorder more frequently than the remaining subjects. They also reported childhood emotional and sexual abuse, physical neglect, self-mutilative behavior, and suicide attempts more frequently. CONCLUSIONS: Comorbid dissociative disorder should alert clinicians for a more chronic and severe psychopathology among patients with conversion disorder.

Adolescent↗