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PubMed1994

Child dissociation and the family context.

Forty boys and their parents completed measures of dissociation, state anxiety, and perceptions of parental behaviors. Mothers completed a behavior problems checklist about their sons. The results indicated a correspondence between fathers' and sons' dissociation scores. In addition, links were found between parental dissociation, parental inconsistency and rejection, and child dissociation. The findings are discussed in the context of several recently proposed models of the etiology of child dissociative disorders.

Anxiety↗
PubMed1996

Traumatic childhood events, perceived availability of emotional support, and the development of dissociative tendencies.

Past research has documented a link between childhood traumatic experiences and dissociative tendencies in adulthood. This study was undertaken to investigate the possibility that the previously reported link is purely an artifact of the level of emotional support available during childhood. A nonclinical sample of Australian adults was surveyed for the incidence of traumatic childhood events, the perceived availability of emotional support from intrafamilial and extrafamilial figures, and the presence of a dissociative coping style. Hierarchical regression analysis revealed that perceived availability of emotional support in childhood was a predictor of current dissociative tendencies, but account of the support factor did not eliminate the relationship between childhood trauma and dissociation. The data are consistent with the view that lack of emotional support is an important mediator, but not a primary cause, of the development of dissociative tendencies.

Adolescent↗
PubMed2004

Family risk factors and prevalence of dissociative symptoms among homeless and runaway youth.

OBJECTIVE: To examine family risk factors associated with dissociative symptoms among homeless and runaway youth. METHOD: Three hundred and twenty-eight homeless and runaway youth were interviewed using a systematic sampling strategy in metropolitan Seattle. Homeless young people were interviewed on the streets and in shelters by outreach workers in youth service agencies. RESULTS: The current study revealed widespread prevalence of dissociative symptoms among these young people. Multivariate analyses revealed that sexual abuse, physical abuse, and family mental health problems were all positively associated with dissociative symptoms. No gender differences were found for any of the models. CONCLUSIONS: Dissociative behavior is widespread among these youth and may pose a serious mental health concern. Some young people experience numerous stressors, and with few resources and little support available, many may invoke maladaptive strategies such as dissociative behavior to handle such situations, which may in turn be detrimental to their mental health. Unless youth are provided with programs and intervention, the cycle of abuse that they have experienced at home is likely to continue on the street.

Adolescent↗
PubMedDate not supplied

Treatment of eating disorders improves eating symptoms but not alexithymia and dissociation proneness.

BACKGROUND: Eating disorders have been reported to increase in frequency, but it is yet unclear what psychological characteristics increase the proneness toward the development of eating disorders. Alexithymia (AL; a difficulty in awareness to one's emotions) and dissociation proneness are 2 such plausible features. METHOD: In this study, we evaluated the efficacy of a combined intervention (group therapy, individual therapy, and pharmacologic therapy) in a group of soldiers with eating disorders (n = 30) in the Israel Defense Forces. Moreover, we examined whether AL and dissociation proneness were frequent in this group and whether clinical improvement was associated with an improvement in these factors as well. RESULTS: High scores on the AL and dissociation measures were noted. The intervention was associated with a 50% decrease in the Eating Attitudes Test and Eating Disorders Inventory scores, consistent with our clinical impression of improvement in the eating symptoms. However, the decrease observed on the Dissociative Experiences Scale and Toronto Alexithymia Scale scores was minimal. CONCLUSIONS: The combined intervention was efficient in our sample of patients with eating disorder despite the small sample size. The aforementioned specific psychometric change may be indicative of the lack of importance of changes in AL or dissociation proneness in the short-term improvement in patients with eating disorder.

Adolescent↗
PubMed2006

Medically unexplained cutaneous sensory symptoms may represent somatoform dissociation: an empirical study.

OBJECTIVE: We examined the relation between medically unexplained cutaneous symptoms and dissociation [measured by the Dissociative Experiences Scale, or DES; Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727-35] among participants with no history of primary dermatologic disorders. METHODS: Three hundred sixty consenting participants (44 psychiatric outpatients and 316 nonclinical participants from the community at large) rated the severity of nine medically unexplained cutaneous symptoms (sum of all ratings comprised the Cutaneous9 variable) and completed the DES. RESULTS: The Cutaneous9 variable correlated significantly (Pearson r=.56, P<.001) with DES scores. Stepwise multiple regression analysis using the nine cutaneous symptoms as independent variables revealed that Pain, Itching, and Numbness were the best predictors of the DES scores (adjusted R2=.34, P<.001). CONCLUSION: Our findings have empirically shown that itching, like pain and numbness, may be a symptom of somatoform dissociation. Second, even milder degrees of dissociation in the nonclinical range may play a role in the genesis of unexplained cutaneous sensory symptoms.

Adolescent↗
PubMed1998

Hypnotizability, pain threshold, and dissociative experiences.

BACKGROUND: There may be an association between pain threshold, hypnotizability, and dissociative experiences. The purpose of the present study was to examine this association. METHODS: Forty-one healthy subjects were included in the study. Pain thresholds were determined using a manual algometer. The Dissociative Experiences Scale was administered to all subjects. Hypnotizability of the subjects was assessed by the eye roll sign of the Hypnotic Induction Profile. There were 14, 15, and 12 subjects in the Grade 1, 2, and 3 groups, respectively. RESULTS: Highly hypnotizable subjects had lower pain thresholds and were more likely to report dissociative experiences than the less hypnotizable subjects. CONCLUSIONS: There is an association between pain threshold, hypnotizability, and dissociative experiences. It may be suggested that dissociative and somatic symptoms may be integrally linked and related to hypnotic suggestibility.

Adult↗
PubMedDate not supplied

Reduction in dissociation due to aging and cognitive deficit.

Our objective was to investigate whether dissociative experiences occur less frequently in older psychiatric patients than in younger adult patients, and to examine the role of cognitive deficits in the frequency of dissociative events. Fifty-two outpatients 60 years and older were administered the Dissociative Experiences Scale (DES) and the Mini-Mental State Exam (MMSE). Their scores were compared with those of 50 outpatients 35 to 55 years old. Each group included patients sampled from the Mental Health Center (MHC) and University Medical Center clinics. Older patients showed significantly lower DES and MMSE median scores than younger patients. Cognitive deficit reflected by reduced MMSE scores also was associated with reduced DES scores for younger and older patients. Older patients with little or no cognitive deficit continued to show reduced DES scores. Decreases in dissociativity continue well beyond the fourth decade and do not rely on age-related cognitive deficit. Factors related to the aging process seem to mediate reductions in dissociativity independent of reductions mediated by cognitive deficit. The use of the DES for screening without adjusting for age and cognitive status is questioned.

Adult↗
PubMed2004

Conversion and somatization disorders; dissociative symptoms and other characteristics.

OBJECTIVE: There is a difference in classification of conversion disorder in ICD-10 and DSM-IV. Conversion disorder is included in dissociative disorders in ICD-10. In view of this, we aimed to clarify this discrepancy in the classification of this diagnosis. METHODS: We assessed 87 patients with conversion disorder and 71 patients with somatization disorder for sociodemographic characteristics, suicide ideation, psychiatric symptoms and dissociative symptoms using the Patient Information Form, the Dissociative Experience Scale (DES), the Symptom Check List (SCL-90-R) and the Suicide Ideation Scale. RESULTS: The number of the high school graduates, singles and students with conversion disorders was higher than the number of patients with the same characteristics who have somatization disorder. In conversion disorder, the SCL-90-R total score and the score in paranoid ideation, psychoticism subgroups were higher than the scores in somatization disorders. There were no statistical differences in suicide ideation and the total score of dissociative symptoms between the two disorders. The number of patients whose total DES score of 30 and above was higher in conversion disorders. DISCUSSION: As a result of this present study, we concluded that to enlighten the concepts of conversion, further somatization and dissociation studies are necessary.

Adult↗
PubMed2003

Childhood abuse and dissociative symptoms in adult schizophrenia.

Dissociative symptoms, occurring in many psychiatric disorders including schizophrenia, are often preceded by traumatic experience. We hypothesized that various types of childhood trauma would correlate with levels of dissociative symptomatology in adult patients. Twenty-six patients completed the Dissociative Experiences Scale (DES) and the Childhood Trauma Questionnaire (CTQ). Dissociation was significantly correlated with emotional abuse (r=0.84, one-tailed p<0.001), and physical abuse (r=0.55, p<0.01). We suggest that emotional abuse may play an important role in the etiology of dissociation in schizophrenia.

Adult↗
PubMed1999

The effect of a dissociative dose of ketamine on the bispectral index (BIS) during propofol hypnosis.

STUDY OBJECTIVE: To compare the effect of a standardized stimulus during propofol-only hypnosis on the bispectral index (BIS) value with the effect of the injection of local anesthesia for surgery during ketamine plus propofol hypnosis (dissociative monitored anesthesia care). To determine whether ketamine increases the level of propofol hypnosis when used in dissociative doses. DESIGN: Descriptive case study. SETTING: Private practice office plastic surgery suites. PATIENTS: 30 nonpremedicated ASA physical status I and II adult female (23) and male (7) patients scheduled for elective cosmetic surgery. INTERVENTIONS: Hypnosis was induced via slow (60 to 80 drops [gtts]/min), dilute (5 mg/ml) propofol solution. Hypnosis was induced using the BIS monitor as an adjunct to traditional vital signs and verbal contact. Patients were engaged in conversation and note was taken of the BIS value when verbal contact was lost and when BIS appeared to stabilize (BIS1). A standardized stimulus (0.3 ml 1% lidocaine plain via 30-gauge needle) was applied to the area of the supraorbital nerve. Note was taken of the highest BIS value (BIS2) in the patient response. The BIS returned to baseline hypnosis (BIS1) and a 50-mg dissociative dose (independent of body weight) of ketamine was administered. Two minutes were allowed to elapse and then the surgeon was allowed to inject the local anesthesia for the proposed surgery. Note was taken of the BIS value (BIS3) in response to the surgeon's injection. MEASUREMENTS AND MAIN RESULTS: The average delta (BIS2 - BIS1) was 9.5 + 6.9. Patients did not move in response to the surgeon's injection: BIS3 = BIS1. When movement occurred, the injection was terminated and additional ketamine was given before resuming the injection. Sixteen patients received ketamine 50 mg, 12 received ketamine 100 mg, one received ketamine 150 mg, and one received ketamine 200 mg. Men required an average 19% less propofol than women in this group. CONCLUSION: This study demonstrated a positive BIS response to a standardized local anesthetic stimulus during propofol-only hypnosis and a zero response during ketamine plus propofol hypnosis (dissociative anesthesia). Ketamine administered in dissociative doses does not deepen the level of propofol hypnosis. Hypnosis alone does not imply general anesthesia. Patients move in response to inadequate local anesthesia. Because the ketamine analgesia is only transitory and the primary analgesia is not given intravenously, propofol-ketamine technique is not a total intravenous anesthetic technique (TIVA). Instead, propofol-ketamine technique may be classified as a form of monitored anesthesia care (MAC).

Adult↗
PubMed1999

Autobiographical memory and dissociation in borderline personality disorder.

BACKGROUND: This study investigated whether individuals with borderline personality disorder (BPD) tend to be overgeneral in their autobiographical recall and whether the extent of their overgeneral recall covaries with their susceptibilities to dissociative experiences, as expected on theoretical grounds. METHODS: Twenty-three patients with BPD and 23 matched controls completed the Autobiographical Memory Test (AMT) and self-report measures of depression, anxiety, trait anger and dissociative experiences. RESULTS: Participants with BPD scored significantly higher than the control group on the measures of depression, anxiety, trait anger, and dissociative experiences and also retrieved significantly more general memories on the AMT. The number of general memories retrieved by the BPD group correlated significantly with their dissociation scores but not with their scores on mood measures. CONCLUSIONS: Patients with BPD have difficulties in recalling specific autobiographical memories. These difficulties are related to their tendency to dissociate and may help them to avoid episodic information that would evoke acutely negative affect.

Adolescent↗
PubMed2000

Trauma severity and initial reactions as precipitating factors for posttraumatic stress symptoms and chronic dissociation in former political prisoners.

This study explores the relationships among trauma severity, initial trauma reactions, posttraumatic stress disorder (PTSD) symptoms, and dissociation in a group of 98 former East-German political prisoners. Trauma severity and initial reactions were assessed using a persecution checklist and a coping process questionnaire. PTSD symptoms were assessed through a structured clinical interview. Chronic dissociation was evaluated using the Dissociative Experiences Scale. The two assumptions of the study were confirmed by structural equation modeling: (1) Lifetime PTSD symptoms were predominantly predicted by initial reactions to trauma and (2) chronic dissociation was predominantly predicted by trauma severity. The first finding is discussed in relation to the participants' initial trauma processing. The second finding is discussed especially in the context of trauma duration and dissociation-prone coping attempts. Limitations concerning the long-term interval between traumatization and data collection are discussed.

Adaptation, Psychological↗
PubMed1999

Dissociative symptoms in acute stress disorder.

This study provides a profile of symptoms, and particularly dissociative symptoms, in the diagnosis of acute stress disorder (ASD) following motor vehicle accidents (MVAs). Consecutive adult non-brain-injured admissions to a major trauma hospital (N = 92) were assessed between 2 days and 4 weeks following an MVA. Presence of ASD was determined by a structured clinical interview. The occurrence of full and subsyndromal ASD was approximately 13% and 21%, respectively. The majority of those who met criteria for subsyndromal ASD did not meet the ASD criteria for dissociation. At least 80% of individuals who reported derealization also reported reduced awareness and depersonalization. This significant overlap between dissociative symptoms questions the discriminatory power and conceptual independence of the dissociative criteria. These findings suggest the need for a more refined conceptual and operational understanding of dissociative symptoms in the acute trauma stage.

Accidents, Traffic↗
PubMed2004

Relationships of dissociation and childhood abuse and neglect with heart rate in delinquent adolescents.

This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.

Adolescent↗
PubMed2004

Shame-proneness as a diathesis for dissociation in women with histories of childhood sexual abuse.

This study examined whether shame-proneness is associated with dissociation among abused women. Participants were 99 hospitalized women with and without reported histories of childhood sexual abuse. Hypotheses were that childhood sexual abuse and shame-proneness would each be associated with dissociation, and that the relationship between sexual abuse and dissociation would be greater among women with higher shame-proneness. Multiple regression analysis indicated that shame-proneness was independently related to dissociation, but childhood sexual abuse was not. As predicted, the combination of shame-proneness and childhood sexual abuse was associated with dissociation.

Adult↗
PubMed2000

Dissociative disorders in the Sultanate of Oman.

OBJECTIVE: To study the clinical manifestations and psychosocial aspects of dissociative (conversion) disorders (DD) in the Sultanate of Oman. METHOD: A retrospective analysis was made of data derived from case records of patients admitted as in-patients to the Sultan Qaboos University Hospital, Oman, over a period of 8 years. RESULTS: A higher prevalence of DD was noted in Oman compared to western countries. The female preponderance was less marked in Oman. The most common presentations were dissociative convulsions, dissociative motor and dissociative trance disorders. Interpersonal difficulties with family and academic problems were the important identified precipitants. CONCLUSION: The study highlights the characteristic clinical and psychosocial features of the dissociative phenomena in Oman.

Adult↗
PubMed2000

Prevalence of dissociative disorders in psychiatric in-patients: the impact of study characteristics.

OBJECTIVE: Prevalence rates for dissociative disorders among psychiatric in-patients vary widely. The aim of this meta-analysis is to offer an explanation for these differences. METHOD: Prevalence studies using a clinical diagnostic interview among psychiatric in-patients were included. Hypotheses concerning the impact of blind versus not blind designs, choice of diagnostic instrument and continental background were tested. RESULTS: Nine studies met the inclusion criteria. In blind studies the prevalence rate for dissociative disorders was significantly lower (but not for DID). Studies using the SCID-D (compared to the DDIS) and European studies had significantly lower prevalence rates for both dissociative disorders as well as for DID. CONCLUSION: The choice of diagnostic instrument and cultural differences in interpretation of symptoms are major explanations for differences in prevalence of dissociative disorders and DID. Comparative, blind research using both DDIS and SCID-D in the assessment of dissociative disorders is advised.

Cultural Characteristics↗
PubMed1999

Trauma-induced dissociative amnesia in World War I combat soldiers. II. Treatment dimensions.

OBJECTIVE: This is the second part of a study of posttraumatic amnesia in World War I (WW I) soldiers. It moves beyond diagnostic validation of posttraumatic amnesia (PTA), to examine treatment findings, and relates these to contemporary treatment of dissociative amnesia, including treatment of victims of civilian trauma (e.g. childhood sexual abuse). METHOD: Key WW I studies are surveyed which focus on the treatment of PTA and traumatic memories. The dissociation-integration and repression-abreaction models are contrasted. RESULTS: Descriptive evidence is cited in support of preferring Myers' and McDougalls' dissociation-integration treatment approach over Brown's repression-abreaction model. CONCLUSION: Therapeutic findings in this paper complement diagnostic data from the first report. Although effective treatment includes elements of both the dissociative-integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while emotional release is secondary.

Abreaction↗