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PubMed2003

Somatoform dissociation in eating-disordered patients.

This study investigated the role of somatoform dissociation in eating disorders and pathological eating behaviour, relative to the established association of eating pathology with psychological dissociation. The participants were 131 women with DSM-IV diagnoses of anorexic or bulimic disorders and 75 women who had no such disorder. Each woman completed measures of psychological and somatoform dissociation, as well as a measure of bulimic attitudes. The current presence or absence of specific bulimic behaviours was identified during the clinical interview. Levels of both forms of dissociation were higher in the women who had diagnoses of disorders with a bulimic component (bulimia nervosa; anorexia nervosa of the binge/purge subtype) than in the non-clinical or restrictive anorexic women. Somatoform dissociation showed particularly strong links with the presence of bulimic behavioural features (excessive exercise, laxative abuse, diet pill abuse, diuretic abuse) and with bulimic attitudes. The formulation and treatment of cases where there are bulimic features is likely to be enhanced by the assessment of somatoform dissociation.

Adult↗
PubMed2002

Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation.

BACKGROUND: The goal of this study was to examine the neuronal circuitry underlying dissociative responses to traumatic script-driven imagery in sexual-abuse-related posttraumatic stress disorder (PTSD). Pilot studies in our laboratory have shown that PTSD patients had very different responses to traumatic script-driven imagery. Approximately 70% of patients relived their traumatic experience and showed an increase in heart rate while recalling the traumatic memory. The other 30% of patients had a dissociative response with no concomitant increase in heart rate. This article focuses on the latter group. METHODS: The neuronal circuitry underlying dissociative responses in PTSD was studied using the traumatic script-driven symptom provocation paradigm adapted to functional magnetic resonance imaging (fMRI) at a 4 Tesla field strength in 7 subjects with sexual-abuse-related PTSD and 10 control subjects. RESULTS: Compared with control subjects, PTSD patients in a dissociative state showed more activation in the superior and middle temporal gyri (BA 38), the inferior frontal gyrus (BA 47), the occipital lobe (BA 19), the parietal lobe (BA 7), the medial frontal gyrus (BA 10), the medial cortex (BA 9), and the anterior cingulate gyrus (BA 24 and 32). CONCLUSIONS: These findings suggest that prefrontal and limbic structures underlie dissociative responses in PTSD. Differences observed clinically, psychophysiologically, and neurobiologically between patients who respond to traumatic script-driven imagery with dissociative versus nondissociative responses may suggest different neuronal mechanisms underlying these two distinct reactions.

Adult↗
PubMedDate not supplied

Comparison of dissociative identity disorder with other diagnostic groups using a structured interview in Turkey.

Twenty patients with dissociative identity disorder (DID), 20 with schizophrenic disorder, 20 with panic disorder, and 20 with complex partial epilepsy were evaluated with the Dissociative Disorders Interview Schedule (DDIS) and the Dissociative Experiences Scale (DES). Subjects with dissociative identity disorder were more frequently diagnosed as having somatization disorder, past or concurrent major depressive episode, borderline personality disorder, depersonalization disorder, and dissociative amnesia than other groups. They reported Schneiderian symptoms and extrasensory perceptions more frequently. In their anamnesis suicide attempts, trance states, sleepwalking, and childhood traumas were more frequent than those in comparison groups. The secondary features of dissociative identity disorder and the DES score differentiated these patients from comparison groups significantly. DID has a set of clinical features different from that of schizophrenic disorder, panic disorder and complex partial epilepsy. The differences are similar to those yielded previously in studies from North America.

Adult↗
PubMedDate not supplied

Dissociative detachment and memory impairment: reversible amnesia or encoding failure?

The authors propose that clinicians endeavor to differentiate between reversible and irreversible memory failures in patients with dissociative symptoms who report "memory gaps" and "lost time." The classic dissociative disorders, such as dissociative amnesia and dissociative identity disorder, entail reversible memory failures associated with encoding experience in altered states. The authors propose another realm of memory failures associated with severe dissociative detachment that may preclude the level of encoding of ongoing experience needed to support durable autobiographical memories. They describe how dissociative detachment may be intertwined with neurobiological factors that impair memory, and they spell out the significance of distinguishing reversible and irreversible memory impairment for diagnosis, patient education, psychotherapy, and research.

Amnesia↗
PubMed1999

Relations among psychological trauma, dissociative phenomena, and trauma-related distress: a review and integration.

Recently, there has been a resurgence of interest in relations among psychological trauma, dissociative phenomena, and various forms of trauma-related distress that has spawned a prolific amount of research. To date, a relatively comprehensive review of this recent research is lacking. Thus, this paper provides such a review to help summarize and synthesize recent findings, illuminate study limitations, and offer suggestions for future research. In general, findings have revealed fairly strong and consistent relations among the constructs of trauma, dissociation, and trauma-related distress (e.g., posttraumatic stress disorder, borderline personality disorder, bulimia); individuals who have experienced a traumatic event are more likely to dissociate than individuals who have not, and individuals who experience more dissociative phenomena are more likely to also experience higher levels of trauma-related distress. It is theorized here that dissociative phenomena and subsequent trauma-related distress may relate to fears about death and fears about loss or lack of control above and beyond the occurrence of the traumatic event itself. Such fears about death and loss/lack of control may also help differentiate traumatized individuals who psychologically suffer to varying degrees. Possible functions of dissociation in response to trauma and in relation to forms of trauma-related distress are considered and discussed.

Acute Disease↗
PubMed2006

Dissociation following traumatic medical treatment procedures in childhood: a longitudinal follow-up.

Chronic illnesses often involve repeated hospitalization and invasive treatment procedures that can have a traumatic impact on child development. To explore possible consequences of treatment procedures, three groups of patients with congenital anomalies were examined longitudinally. At first admission, adolescents (ages 10-20, mean 15) with anorectal anomalies (n = 14), adolescents with Hirschsprung disease (n = 14), and hospitalized controls (n = 14) were assessed for treatment procedures, somatic function, mental health, and dissociative experiences. The assessment included the Adolescent Dissociative Experiences Scale (A-DES). At 10-year follow-up, the patients completed the Dissociative Experiences Scale (DES) and the Somatoform Dissociative Questionnaire (SDQ-20). Anal dilatation, an invasive medical treatment procedure performed daily by the parents the first 4 years, was correlated with the frequency and severity of persisting dissociative symptomatology. The procedure was the only significant predictor of A-DES and SDQ-20 scores, and one of two significant predictors of DES scores. This "experiment of nature" permitted a specific and unique opportunity to examine the impact of early traumatic exposure on child development in the absence of parental malevolence, and on later dissociative outcome in adolescence and adulthood. The findings might be valuable theoretically to our understanding of the development of psychopathology, and may lend itself for comparison with data on sexually abused children.

Adolescent↗
PubMed2002

Peritraumatic dissociative experiences, trauma narratives, and trauma pathology.

Peritraumatic dissociation, i.e., dissociation during or immediately after a traumatic event, has been associated with persistence of trauma-related pathology. Peritraumatic dissociation may interfere with encoding of traumatic memories and this style may impede recovery. This study examines this hypothesis by analyzing trauma narratives from 28 female sexual and nonsexual assault victims who reported either high or low peritraumatic dissociation. Participants were asked to recount their assault. Narratives were videotaped, transcribed, and coded. Narratives of individuals with high peritraumatic dissociation had higher grade levels and a trend toward lower reading ease than those with low peritraumatic dissociation. Both higher grade levels and lower reading ease of prethreat sections of trauma narratives were related to posttreatment reexperiencing and anxiety symptoms.

Adult↗
PubMed2003

Abuse, dissociation, and somatization in irritable bowel syndrome: towards an explanatory model.

This study tested a preliminary model of the role of dissociation and somatization in linking abuse to irritable bowel syndrome (IBS). Outpatients with IBS (N = 64) or bowel symptoms explained by physical disease (N = 61) completed questionnaires to assess recollections of abuse as children or adults and current dissociation, somatization, and emotional distress. By comparison with physically diseased patients, patients with IBS recalled more sexual abuse as children and adults, more physical abuse as children, and more psychological abuse as adults. They were more anxious and depressed, and somatized and dissociated more. Analyses indicated a causal chain linking, in turn, abuse, dissociation, somatization, and IBS. The results are consistent with a model in which childhood abuse is linked to IBS because it causes a tendency to dissociate, and because dissociation causes a general increase in physical symptoms. Future research should identify factors that explain why a generally increased level of physical symptoms should, in some patients, lead specifically to IBS.

Adolescent↗
PubMed1999

Dissociative processes and symptoms of posttraumatic stress in Vietnam veterans.

The diagnostic taxonomy of posttraumatic stress disorder (PTSD) is a contentious issue. Commentators are divided as to whether PTSD should remain grouped with the anxiety disorders or conceptualized as a dissociative disorder. This study sought to clarify the issue by investigating the extent to which anxiety and dissociative processes differentially predict the severity of each of the three symptoms clusters in PTSD. Seventy-four Australian veterans of the Vietnam War were assessed on measures of dissociation, trait anxiety, and posttraumatic stress symptomatology. Multiple regression analyses showed that all three symptoms clusters were predicted by anxiety, but the clusters differed in the pattern of their relationship with dissociation variables. The failure of pathological dissociation to predict PTSD symptoms prompts a reconsideration of the point at which dissociative mechanisms may impact on this disorder. The findings are consistent with current classification of combat-related PTSD as an anxiety disorder.

Anxiety↗
PubMed2003

Predictors of nonpathological dissociation in Northern Ireland: the affects of trauma and exposure to political violence.

Recent work has identified an empirical distinction between pathological and nonpathological dissociation. This study examined the correlates of nonpathological dissociation in a Northern Irish sample. The Dissociative Experiences Scale, the Traumatic Experiences Checklist, the Guilt Inventory, and the General Health Questionnaire, as well as two open-ended questions assessing exposure to political violence were completed by 119 participants. Nonpathological dissociation was predicted by age, perceived impact of traumatic events, and adherence to moral standards. Moreover, dissociation was found to be significantly higher in those exposed directly to political violence and those experiencing childhood emotional abuse. Results are consistent with previous theoretical and empirical work and it is proposed that nonpathological dissociation is related to traumatic experience in Northern Ireland.

Adult↗
PubMed2002

Reappraising the link between peritraumatic dissociation and PTSD symptom severity: evidence from a longitudinal study of community violence survivors.

Cross-lagged panel analysis of longitudinal data collected from young adult survivors of community violence was used to examine the relationship between recall of peritraumatic dissociation and posttraumatic stress disorder (PTSD) symptom severity. Recollections of peritraumatic dissociation assessed within days of exposure differed from recollections measured at 3- and 12-month follow-up interviews. Peritraumatic dissociation was highly correlated with PTSD symptoms within each wave of data collection. Baseline recollections of peritraumatic dissociation were not predictive of follow-up PTSD symptom severity after controlling for baseline PTSD symptom severity. This pattern of results replicates previous work demonstrating a correlation between peritraumatic dissociation and subsequent symptom severity. However, findings are not consistent with the prevailing view that peritraumatic dissociation leads to increased PTSD symptom severity.

Adolescent↗
PubMed1996

The relationship of peritraumatic dissociation and posttraumatic stress: findings in female Vietnam theater veterans.

This study examined the relationship of dissociation at the time of trauma, as assessed by the Peritraumatic Dissociation Experiences Questionnaire, Rater Version (PDEQ-RV; C.R. Marmar, D.S. Weiss, & T.J. Metzler, in press), and posttraumatic stress symptoms in a group of 77 female Vietnam theater veterans. PDEQ-RV ratings were found to be associated strongly with posttraumatic stress symptomatology, as measured by the Impact of Event Scale (M.J. Horowitz, N. Wilner, & W. Alvarez, 1979), and also positively associated with level of stress exposure and general dissociative tendencies, measured by the Dissociative Experiences Scale. The PDEQ-RV was unassociated with general psychiatric symptomatology, as assessed by the clinical scales of the Minnesota Multiphasic Personality Inventory-2 (J.N. Butcher, W.G. Dahlstrom, J.R. Graham, A. Tellegen, & B. Kaemmer, 1989). The PDEQ-RV was predictive of posttraumatic stress symptoms beyond the contributions of level of stress exposure and general dissociative tendencies. The findings provide further support for the reliability and validity of the PDEQ-RV as a measure of peritraumatic dissociation.

Adult↗
PubMed2000

Cognitive, dissociative and psychotogenic effects of ketamine in recreational users on the night of drug use and 3 days later.

AIMS: Recreational use of the N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine, is increasing. The present study aimed to examine both the acute and residual effects of this drug on cognitive function, dissociation and schizotypal symptomatology in recreational users. DESIGN AND PARTICIPANTS: A parallel group design was used to compare 20 volunteers who reported having taken ketamine with 19 volunteers who reported no consumption of ketamine on the relevant night (day 0). All 39 participants were tested on day 0 and again 3 days later. On each test occasion a battery of tests was administered which tapped a wide range of memory functions, attention, dissociation, schizotypal symptomatology and mood. FINDINGS: Groups were broadly matched for polydrug use apart from ketamine. Acute effects on day 0 replicated previous laboratory studies showing a broad spectrum of cognitive impairments following ketamine administration as well as marked dissociative effects and schizotypal symptomatology. Three days later, ketamine users had significantly higher scores than controls on both dissociation and schizotypal symptomatology. On some cognitive measures there were no group differences on day 3; however, on tests tapping semantic memory, the ketamine users showed persisting impairments compared with controls. CONCLUSIONS: Ketamine appears to induce acute and severe impairments of working, episodic and semantic memory as well as psychotogenic and dissociative effects. Three days after drug ingestion, recreational users display semantic memory impairment and dissociative and schizotypal symptomatology which could reflect chronic or residual effects of taking the drug or pre-existing differences in ketamine users.

Adolescent↗
PubMedDate not supplied

[Screening and Measurement of Change of Dissociative Psychopathology: Psychometric Properties of the Short Version of the Fragebogen zu Dissoziativen Symptomen (FDS-20)].

Given the clinical and scientific relevance of dissociative experiences our study aimed to assess the psychometric properties of a short version of the German Dissociative Experience Scale (called FDS-20) as well as its ability to measure changes in dissociation. In a large sample (N = 1289) the FDS- 20 showed good internal consistency. A factor analysis indicated that the scale measures one single factor reflecting the general degree of dissociative psychopathology. Between-group-comparisons suggested a good discriminant validity between high and low dissociators; however, due to high standard deviations the FDS-20 is not well suited for an individual diagnosis and therefore, it should be used as a screening device. Low effect sizes (d < 0,3) between scores at the beginning and the end of inpatient treatment as well as low micro -indices pointed to a temporal stable construct and a trait scale, respectively. Alternatively to group comparisons, individual parameters of treatment success (statistical and clinical significance) were calculated. They proved to be more appropriate in measuring changes in dissociation.

Adolescent↗
PubMed1995

Quantitative analysis of the interactions between prenyl Rab9, GDP dissociation inhibitor-alpha, and guanine nucleotides.

Rab9 is a Ras-like GTPase required for the transport of mannose 6-phosphate receptors between late endosomes and the trans Golgi network. Rab9 occurs in the cytosol as a complex with GDP dissociation inhibitor (GDI), which we have shown delivers prenyl Rab9 to late endosomes in a functional form. We report here basal rate constants for guanine nucleotide dissociation and GTP hydrolysis for prenyl Rab9. Both rate constants were influenced in part by the hydrophobic environment of the prenyl group. Guanine nucleotide dissociation and GTP hydrolysis rates were lower in the presence of lipid; detergent stimulated intrinsic nucleotide exchange. GDI-alpha inhibited GDP dissociation from prenyl Rab9 by 2.4-fold. GDI-alpha associated with prenyl Rab9 with a KD of 60 nM in 0.1% Lubrol and 23 nM in 0.02% Lubrol. In 0.1% Lubrol, GDI-alpha inhibited GDP dissociation half maximally at 72 +/- 18 nM, consistent with the KD determinations. These data suggest that GDI-alpha associates with prenyl Rab9 with a KD of < or = 23 nM under physiological conditions. Finally, a previously uncharacterized minor form of GDI-alpha inhibited GDP dissociation from prenyl Rab9 by 1.9-fold and bound prenyl Rab9 with a KD of 67 nM in 0.1% Lubrol.

Animals↗
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↗
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↗
PubMedDate not supplied

Testing Cermak's hypothesis: is dissociation the mediating variable that links substance abuse in the family of origin with offspring codependency?

This is a pilot study of substance abuse in the family of origin and its relation to offspring dissociation and offspring codependency. Cermak contends that substance abuse in the family of origin exposes offspring to trauma, that exposure to trauma in the family of origin engenders offspring dissociation, and that dissociation is the process underlying offspring codependency. Assuming that substance abuse in the family of origin exposes offspring to trauma, this experiment tested the hypothesis that dissociation mediates the relationship between substance abuse in the family of origin and offspring codependency. Although it was found that substance abuse in the family of origin, offspring dissociation, and offspring codependency were associated, no support was found for the prediction that dissociation mediates the relationship between substance abuse in the family of origin and offspring codependency. Replications are called for.

Adolescent↗