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Correlates of dissociative symptoms among women with eating disorders.

We examined the relationship between dissociative symptoms and other Axis I and Axis II symptoms among a sample of 53 women diagnosed as having anorexia nervosa (n = 18), bulimia nervosa (n = 27), or eating disorder NOS (n = 8). Dissociative symptoms were measured by the Dissociative Experiences Scale and the dissociation scale from the Trauma Symptom Checklist 40. Severity of dissociative symptoms was generally unrelated to severity of bulimic or anorexic symptomatology but was significantly associated with severity of anxiety and depression. In terms of Axis II symptoms, dissociative symptoms were most highly correlated with schizotypal symptomatology (r = .59), uncorrelated with borderline or antisocial symptomatology, and slightly negatively correlated with histrionic symptomatology.

Adolescent↗

Dissociative detachment relates to psychotic symptoms and personality decompensation.

Previous studies have addressed the prominence of psychotic symptoms in conjunction with multiple personality disorder (now dissociative identity disorder). The present study examines the relation between psychotic symptoms and a more pervasive form of dissociative disturbance, namely dissociative detachment. Two hundred sixty-six women in inpatient treatment for severe trauma-related disorders completed the Dissociative Experiences Scale (DES), and 102 of these patients also completed the Millon Clinical Multiaxial Inventory (MCMI-III). A factor analysis of the DES yielded two dimensions of dissociative detachment: detachment from one's own actions and detachment from the self and the environment. Each of these DES dimensions relates strongly to the thought disorder and schizotypal personality disorder scales of the MCMI-III. We propose that severe dissociative detachment, by virtue of loosening the moorings in inner and outer reality, is conducive to psychotic symptoms and personality decompensation.

Adult↗

Anger, dissociation, and posttraumatic stress disorder among female assault victims.

The goal of the present study was to explore the relationship between anger and dissociation and their relationship to symptoms of post-trauma pathology. One hundred four female assault victims were assessed prospectively 2, 4, and 12 weeks post-assault. Measures of posttraumatic stress disorder (PTSD) severity, social functioning, anger, and dissociation were obtained at all assessments. Results revealed that differentiation between symptoms that predict later PTSD and impaired social functioning first becomes evident at 4 weeks post-assault. At 4 weeks post-assault, anger expression was predictive of later PTSD severity, whereas dissociation was predictive of poorer later functioning.

Adaptation, Psychological↗

Fable or fact?: did Janet really come to repudiate his dissociation theory?

Commencing in the late 1880s Pierre Janet developed the most complete theory of dissociation of his time. It has been suggested that Janet later repudiated his belief in dissociation theory (e.g., Hacking, 1995). Recently this viewpoint has been cited to support skepticism in dissociative identity disorder and researchers and clinicians of dissociation may be faced with such suggestions to challenge their work. The veracity of whether Janet actually recanted, or even lost interest in his dissociation theory is investigated through an examination of his later writings. Although Janet expanded his theoretical interests well beyond phenomena accounted for by dissociation, there is no evidence to indicate he renounced or lost confidence in his dissociation theory.

Dissociative Disorders↗

Association between childhood trauma and dissociation among patients with borderline personality disorder.

OBJECTIVE: To examine the relationship between childhood trauma and dissociative experience in adulthood in patients with borderline personality disorder. METHOD: Dissociative experiences scale scores and subscale scores for the Childhood Trauma Questionnaire were correlated in 139 patients. Patients were dichotomized into high or low dissociators using the Median Dissociative Experiences Scale score as the cut-off. RESULTS: Childhood Trauma Questionnaire Subscale scores for emotional and physical abuse and emotional neglect but not sexual abuse correlated significantly with Dissociative Experiences Scale scores. High dissociators reported significantly greater levels of emotional abuse, physical abuse, emotional neglect and physical neglect but not sexual abuse than low dissociators. CONCLUSION: Patients with borderline personality disorder therefore demonstrated levels of dissociation that increased with levels of childhood trauma, supporting the hypothesis that traumatic childhood experiences engender dissociative symptoms later in life. Emotional abuse and neglect may be at least as important as physical and sexual abuse in the development of dissociative symptoms.

Adolescent↗

Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems.

OBJECTIVE: To examine the associations of childhood traumatic experiences and childhood neglect with dissociative experiences and posttraumatic stress disorder (PTSD) in a population of female borderline personality disorder (BPD) patients with and without substance abuse. METHOD: The sample included 64 female patients with BPD. Childhood traumatic experiences and childhood neglect were measured using the Structured Trauma Interview, dissociative experiences with the Dissociative Experiences Scale, and PTSD with the Structured Clinical Interview for DSM-IV. RESULTS: In general, dissociation scores were higher among those with a history of childhood trauma and neglect, in particular among those who reported both sexual and physical abuse before age 16, more than one perpetrator and severe maternal dysfunction. The prevalence of PTSD was clearly associated with the severity of childhood sexual abuse (CSA) in terms of the occurrence of penetration during CSA, intrafamilial CSA, a duration of CSA longer than 1 year and more than one perpetrator. Comorbid substance abuse problems modified the observed associations such that the associations mentioned above were also present or even more pronounced among those without substance abuse, whereas no associations were found in those with substance abuse. CONCLUSIONS: The results suggest a moderately strong association between childhood trauma and neglect with dissociation and PTSD. However, trauma-dissociation and trauma-PTSD links were only observed among BPD patients without addictive problems. The findings are largely consistent with the literature. Potential explanations for the lack of a trauma-dissociation and trauma-PTSD link in the addicted subgroup are discussed.

Adult↗

Dissociative symptoms in patients with obsessive-compulsive disorder.

To clarify the relationship between dissociative symptoms and obsessive-compulsive disorder (OCD), 100 patients with OCD were assessed with standardized instruments measuring symptoms of OCD, dissociation, and depression. Diagnoses of personality disorders and dissociative disorders were made using structured interviews. Compared with a previous study, OCD patients had dissociation scores slightly higher than normal controls and comparable to patients with other anxiety disorders. Patients with elevated dissociation scores had more severe OCD symptoms, were more depressed, and were more likely to have a personality disorder than patients with low dissociation scores. Although dissociative symptoms were frequently reported by OCD patients, symptoms of OCD may also mimic dissociation in some patients.

Adult↗

Major mental disorders in Addis Ababa, Ethiopia. III. Neurotic and somatoform disorders.

This report presents estimates of the lifetime and point (one-month) prevalence of phobic anxiety, dissociative, other anxiety and somatoform disorders based on a survey conducted in Addis Ababa between September and December of 1994. An Amharic version of the CIDI was used to collect data from a random community sample of 1420 individuals aged 15 and above. Phobic anxiety disorders were found to be the most common of all anxiety disorders, with lifetime prevalence of 4.8%. The lifetime prevalence for dissociative disorders was 0.8% and for other anxiety disorders it was 2.7%. The prevalence of somatoform disorders was 3.1%. The lifetime prevalence for all the above neurotic and somatoform disorders was 10.8%. Point prevalence estimates (percent) for the disorders were as follows: phobic anxiety disorders, 4.4; other anxiety disorders, 1.2; dissociative disorders, 0.4; and somatoform disorders, 2.5. After adjusting for several potential confounders, women had over a two-fold risk of having neurotic and somatoform disorders compared to men, odds ratio (OR), 95% confidence interval (CI) = 2.38 (1.78, 3.12). Age was also inversely associated with the disorders. Those aged 60 and above had a 60% lower risk compared to those aged 15-24 years, OR (95% CI): 0.41 (0.20, 0.81). The 25% decreased risk for the employed, compared to the unemployed, was also not statistically significant. Education, marital status, and ethnicity were not significantly associated with neurotic and somatoform disorders.

Adolescent↗

Dissociative states in multiple personality disorder: a quantitative study.

Multiple personality disorder (MPD) patients may experience themselves as several discrete alter personalities who do not share consciousness or memories with one another. In this study, we asked whether MPD patients are different from controls in their ability to learn and remember, and their ability to compartmentalize information. MPD patients were not found to differ from controls in overall memory level. Learning of information by MPD patients in disparate personality states did not result in greater compartmentalization than that of which control subjects were capable. However, there were qualitative differences between the cognitive performance of patients and that of controls attempting to role-play alter personalities. Our results suggest that simple confabulation is not an adequate model for the MPD syndrome, and we consider a possible role for state-dependent learning in the phenomenology of MPD.

Adult↗

Systemic treatment of multiple personality: response to a chronic disorder.

Multiple Personality Disorder (MPD) is a more and more frequently diagnosed disorder. In this article, MPD is considered the result of a dissociative defense in response to severe trauma during the formative period of personality formation. As the child dissociates to defend against the trauma, the fragments of personality develop as separate entities. The traditional focus of therapy is integration, or fusion of the various fragments of personality. The current article does not dispute this therapeutic goal, but does offer an alternative treatment process. Borrowing from the theoretical concepts of the family therapy literature, the person with MPD is described as a system. Therapy, then, must attempt to maintain balance within the system as a short-term goal, as well as striving for integration as a long-term goal. This article delineates the systemic approach, first from a theoretical, then a practical perspective. The concepts of coconsciousness (or awareness by all aspects of the system) and coexistence (a state of mutual cooperation between various personalities) are described, and fitted within the systemic model. Practical aspects of life with MPD, including activities of daily living and relationships, are then outlined within this model.

Activities of Daily Living↗