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Hypnotic techniques can add to effective therapy with self-cutting patients, but only in the context of a strong, communicative, and flexible relationship. "Neutral hypnosis" and relaxation techniques can be employed to counteract the frightening depersonalization that leads to the cutting. In turn, techniques of uncovering and controlled regression are possible.
Medical advances in obstetrics and gynecology, combined with the depersonalization of health care and changes in sexual and reproductive behaviors in the general population, lead to challenging new problems for the psychiatric consultant who deals with reproductive issues. The author describes contemporary issues encountered in consultation-liaison work with the obstetrics and gynecology service in a general hospital. They include the reproductive implications of medical illnesses, the stress of deciding whether to continue a pregnancy known to carry genetic risk, the intrusiveness of certain options for dealing with infertility, parental expectations for a perfect baby, and the difficulties some traditional practitioners have in adapting their practice styles to the changing needs of the patient population.
The 28-item Dissociative Experiences Scale was administered to a stratified cluster sample of 1,055 respondents in the general population of Winnipeg. Dissociative experiences were common in the sample and were not related to socioeconomic status, sex, education, religion, or place of birth, although they declined with age in both sexes. A principal components analysis identified three factors accounting for 47.1 percent of the combined variance of the scores. The first factor, absorption-imaginative involvement, is composed of common, benign experiences, such as missing part of a conversation and being able to ignore pain. The other two factors, activities of dissociated states and depersonalization-derealization, composed of less common experiences such as not recognizing friends or family members and not recognizing one's reflection in a mirror, may be powerful predictors of DSM-III-R dissociative disorders.
OBJECTIVE: The health, personal life, and attitudes of case managers providing intensive services to severely mentally ill clients were evaluated to see how the managers changed over their first 18 months on the job. The authors report here on changes on major variables related to health status and job attitudes. METHODS: A cohort of 82 case managers newly hired during the first year of New York State's intensive case management program was followed for 18 months. A battery of measures of health, life events, life satisfaction, social support, job situation, and job attitude was administered by mail questionnaire at job entry and at three, 12, and 18 months to case managers who remained employed in the program. RESULTS: Approximately 80 percent of the eligible (still-employed) case managers responded at each time point; 64 were still employed at the end of the study. Over time they experienced increasing amounts of job stress and emotional exhaustion, depersonalized clients more, and reported significantly more stress-related physical symptoms and depressive symptoms. However, their sense of personal accomplishment and their job satisfaction remained stable. CONCLUSIONS: Case managers appeared able to overcome job pressures and persevere in their professional commitment. What difficulties they had appeared to level off after one year, at least among those who continued in their positions. Although the findings do not indicate that case managers need intensive help, early support and preventive intervention for job difficulties would be helpful.
Koro has been described as an acute anxiety state related to the fear of penile shrinkage into the abdomen with resultant death. This partial depersonalization disorder is found primarily among the people of the Malay Archipelago and Southern Chinese, with extremely rare incidences documented in the West. The symptomology of Koro is commonly said to be linked to ancient Chinese medical beliefs on sexual functioning and is therefore referred to as a culturally bound syndrome. Our paper summarized the case of an American male with Koro-like symptoms. It compares the Western concept of penis loss to the Chinese or Malaysian concept, and then proposes a combined hypothesis for the development of Koro.
The symptomatology of Turkish urban and rural schizophrenic patients was compared in 94 consecutive hospital admissions. These were rated on two rating scales by psychiatrists, using a structured interview. Urban patients were more frequently anxious, tense, stiff, rigid, perseverating and depersonalized than rural patients; urban patients also exhibited more frequent symptoms of outbursts, blocking, thought pressure, depressed mood and somatic concern than their rural counterparts. Rural patients were more often withdrawn, disoriented, confused/delirious and lacking contact in communication than urban patients; rural patients also showed more frequent symptoms of flight of ideas and consciousness lapses than their urban counterparts.
In an effort to examine paradoxes involving self-awareness, deindividuation, and social identity, this article reports the results of a study that examines the effects of a range of manipulation operationalizations of self and social identity on a complement of measurement operationalizations of self and social identity. Specifically, participants completed measures of self-awareness and ethnic social identity while confronted with their mirror image, while wearing a mask, or while exposed to a family tree delineating their ethnicity. Patterns of mean levels of self-awareness and ethnic social identity are used to examine the paradox of depersonalization and deindividuation, the paradox of (a)symmetrical activation of components of identity, and the paradox of deindividuation and the search for identity. Discussion considers the limitations of this approach and considers the implications of these results for the long-standing study of the interplay between self and social identity.
Two experiments explored differences in depersonalized trust (trust toward a relatively unknown target person) across cultures. Based on a recent theoretical framework that postulates predominantly different bases for group behaviors in Western cultures versus Eastern cultures, it was predicted that Americans would tend to trust people primarily based on whether they shared category memberships; however, trust for Japanese was expected to be based on the likelihood of sharing direct or indirect interpersonal links. Results supported these predictions. In both Study 1 (questionnaire study) and Study 2 (online money allocation game), Americans trusted ingroup members more than outgroup members; however, the existence of a potential indirect relationship link increased trust for outgroup members more for Japanese than for Americans. Implications for understanding group processes across cultures are discussed.
It has been previously established that human service workers often suffer from emotional exhaustion, which has been conceptualized by Maslach and Jackson as burnout. Burnout may be a particularly great risk in workers providing long-term geriatric care. The current study evaluated the effects of a series of three 3-hour sessions designed to address team building, communication skills, self-esteem, and stress management on a random sample of 51 of the 188 long-term care staff who participated. Using a retrospective pretest design, a statistically significant improvement from "then" to "today" was found for the three components of burnout: Depersonalization, Emotional Exhaustion, and Personal Accomplishment. Responses to an open-ended question about workshop effects corroborated the quantitative data, and effects noted were highly related to the defined objectives of the workshops.
Ketamine hydrochloride is a safe and rapid-acting non-opioid, lipid soluble anaesthetic with a short elimination half-life that is used for medical and veterinary purposes. It produces a state of "dissociative anaesthesia", probably from action on N-methyl-D-aspartate (NMDA) receptors. The psychotropic effects of ketamine range from dissociation and depersonalization to psychotic experiences and include a sensation of feeling light, body distortion, absence of time sense, novel experiences of cosmic oneness and out-of-body experiences. Abuse of ketamine has been reported, the typical abuser being an individual who uses multiple drugs and has some contact with medical agencies. This case demonstrates the effects of large doses of ketamine in a person with polysubstance abuse. The case also highlights development of significant tolerance to ketamine without prominent withdrawal symptoms. Caution in use of ketamine is reiterated in light of its abuse liability.
Comparison of a series of twenty-four wrist-cutters with a control group of self-poisoners showed a number of significant differences. The wrist-cutters were younger and their acts were regarded as being of low lethality; they are no more likely to have made previous suicide attempts; they complain less often of depression, and more frequently of 'emptiness' and tension as primary complaints. Sudden, unpredictable mood swings are common and there is a greater tendency for their physicians to diagnose personality disorders, often in pejorative terms. They frequently have substantial medical interests and paramedical occupations. A high proportion complain of dysorectic symptoms (anorexia or overeating or combinations of both), use drugs and/or alcohol in excess; show sexual disturbance and distress, and also promiscuity. They more frequently have a negative reaction to menarche and menstruation; have come from broken homes and have experienced parental deprivation. A proportion of the group exhibit difficulty in verbal communication, and absconding from hospital was more common in the group of cutters. Painless cutting after a period of depersonalization, followed by relaxation and repersonalization after bleeding, was the typical pattern.
An adolescent was implied in a car accident in which he suffered a head trauma without any substantial loss of consciousness. The posttraumatic syndrome was characterized by headaches and mental symptoms: nervousness, feelings of depersonalization, impaired memory, difficulty in concentration. Neurological examination and laboratory tests have always been normal but for a large perduring asymmetry at the Cortical Auditory Evoked Response. This finding is commented in the light of a review of the literature and of some neuropsychological findings.
OBJECTIVE: To appreciate the extent and the features of dissociation in a hypothesized highly dissociated population, rape trauma victims, while assessing construct validity and internal consistency of a French version of the Dissociative Experiences Scale (DES), a simple screening instrument for dissociative symptoms. METHODS: One hundred and forty rape victims (mean age 23.6 years, 9% male) consecutively attending a Consultation for Victims of Psychological Trauma at the university hospital in Tours, France, were assessed through a French version of the 28-item self-rated DES. RESULTS: The mean score (24.1) was high, and 33% of the scores exceeded a threshold set at 30. The Principal Components Analysis of the DES ratings yielded a 3-factor solution: depersonalization-derealization, amnestic fragmentation of identity, and absorption-imaginative involvement. DES reliability was studied through computation of Cronbach's alpha coefficient (0.94). CONCLUSION: During validation of a French version of the DES, the study showed that dissociation is considerably linked to rape-trauma victim populations.
Interest in the concept of caring and the ethics of caring has grown as technology and depersonalization of health care delivery have increased. Major concepts of the ethics of caring are reviewed, with special focus on relating caring and virtue ethics. Assuming that caring is a virtue, it is concluded that ethically virtuous nurses must possess the caring attributes and demonstrate caring actions.
Historically, nursing practice has been grounded in the objective, analytic philosophy of the natural sciences. Over the past decades, caring--a humanistic concept--has been espoused as the essence of nursing. Paradoxically, practice based on the theme of caring remains aligned with the philosophy of the natural sciences and continues to use tools such as nursing process and nursing diagnosis, products of the natural sciences paradigm. The authors have outlined the foundation for a philosophy of caring. The encounter between caregiver and patient is the central aspect of this philosophy and is elaborated with the related concepts of openness, nonreductionism, immediacy, and meaning. In addition, holistic nursing practice requires attention by caregivers to their own self-awareness and the personal growth that is necessary for the demands of encountering patients. Practice based on such a philosophy maintains the primacy of the caregiver-patient relationship and permits the incorporation of analytic tools without depersonalizing effects.
1 We have reviewed the clinical features and management of 44 consecutive patients presenting to hospital over a 5 week period during an outbreak of ingestion of psilocybin containing mushrooms. 2 Patients presented to hospital usually because of dysphoric effects an average of 3.8 h after ingesting mushrooms. 3 Mydriasis was present in 40 patients but fewer than half showed other sympathomimetic features--tachycardia, hypertension or hyperreflexia. 4 Twenty-three patients experienced nausea and vomiting. 5 Distortions of perception chiefly visual were frequent as were paraesthesiae and feelings of depersonalization. 6 The effects of the mushrooms were short-lived and had worn off within 12 h in all but one patient. 7 Inducing emesis did not appear to hasten recovery from the effects of the mushrooms.
Previous research on the Dissociative Experiences Scale (DES) has demonstrated that (a) dissociation is quantifiable in both clinical and nonclinical samples and (b) a three-factor structure (amnesia, depersonalization, and absorption) is tenable for clinical samples. The factor structurefor nonclinical samples is less clear, with one- and multiple-factor solutions proposed. To clarify the DESfactor structure in nonclinical samples, confirmatory factor analyses were conducted on (a) one-, two-, three-, and four-factorfirst-order models and (b) two bifactor (hierarchical) models of DES scoresfor two samples of nonclinical university students. Results of delta(chi2) and goodness-of-fit indices support the three-factor (first-order) model as bestfitting of the datafor these samples. The utility of this DES model for screening both dissociative pathology and elevated normal dissociative behavior in clinical and nonclinical populations is discussed.
A continuing challenge in the treatment of sexual offenders involves the identification of measurement instruments that can be used to monitor treatment progress. This paper provides evidence that the Facets of Sexual Offender Denial (FoSOD; pronounced "façade") Scale maps critical aspects of treatment progress, yet avoids problems typically associated with self-report measures. Fifty-three child molesters completed the FoSOD twice with an 18-month interval between administrations. The Time 1 and Time 2 FoSOD scores were analyzed as a function of advancement through a court-sanctioned sexual offender treatment program. Results demonstrated not only that advancement in treatment corresponded with predictable changes in FoSOD scores, but also that FoSOD component scores, representing denial associated with refutation, minimization and depersonalization of the offense, revealed critical patterns indicative of the issues with which offenders contend at various points within treatment. These results are discussed within a conceptual framework that recognizes the relationships between denial in its various forms and the explanations that offenders develop to limit their accountability for alleged offenses, associated thoughts or behaviors, and deviant predispositions.