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PubMed2002

Reliability and validity of the Turkish version of the adolescent dissociative experiences scale.

The Adolescent Dissociative Experiences Scale (A-DES) is designed to measure dissociation in adolescents. The present study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the A-DES. The Turkish version of the A-DES was administered to 20 patients with a dissociative disorder, 24 patients with post-traumatic stress disorder (PTSD), 31 patients with anxiety disorder, 31 patients with mood disorder, 24 patients with attention deficit-hyperactivity disorder (ADHD), and 201 non-clinical participants. The internal consistency and the test-retest correlation of the A-DES were excellent. The mean total score of A-DES was 6.2 in dissociative disorder, 3.9 in PTSD, 2.1 in anxiety disorder, 2.4 in mood disorder, 2.5 in ADHD groups and 2.4 in non-clinical participants. There was a statistically significant difference between dissociative patients and other diagnostic groups on the A-DES total score. The good psychometric characteristics of the A-DES among Turkish participants support its cross-cultural validity.

Adolescent↗
PubMed2000

Dissociation, hypnotizability, coping styles and health locus of control: characteristics of pseudoseizure patients.

Although literature in this area is relatively sparse, the occurrence of psychogenic non-epileptic seizures (pseudoseizures) has been linked to stress, anxiety and possible dissociative tendencies. An association between dissociation and hypnotic susceptibility has also been proposed and dissociative tendencies have themselves been found to relate to the use of emotion-focused coping strategies. In order to investigate the hypothesis that pseudoseizure patients may exhibit higher levels of dissociation, a more emotion-focused coping style, and greater hypnotic susceptibility than the general population, the questionnaire responses of 20 patients with pseudoseizures were compared with those obtained from a non-clinical control group. As predicted, pseudoseizure patients demonstrated some evidence of higher levels of dissociation and escape-avoidance coping strategies. They also expressed a greater belief in external control over health and higher depression scores, compared to the control group, but the previously reported elevation in hypnotizability scores in the pseudoseizure patients was not found. Possible explanations for this pattern of results are discussed.

Adaptation, Psychological↗
PubMed2004

[The "AMDP scale for dissociation and conversion (AMDP-DK)": development of an observer-rated scale and first psychometric properties].

The AMDP scale for dissociation and conversion (AMDP-DK) represents an observer-rated scale for the assessment of dissociative and conversive phenomena, which closes the gap between available self-report questionnaires and time-consuming structured interviews with their respective disadvantages. The instrument comprises 30 operationalized items, which are rated according to the AMDP rules, and which are theoretically-driven divided into the subscales dissociation (15 items), conversion (9 items) and a "formal" dimension (6 items) to cover associated phenomena. In a sample of psychiatric inpatients (n = 73) the covered symptoms showed a great variety of frequency and intensity. The AMDP-DK and its subscales had good internal consistency (Cronbachs alpha between 0.76 and 0.85). A factor-analysis mostly replicated the theoretically constructed subscales. The convergent and divergent validity of the scale was good, as well as its ability to discriminate between high- and low-dissociating patients. The findings are discussed with regard to the psychometric properties and the relevance for the theories of dissociation and conversion.

Adolescent↗
PubMed2006

[Persistent dissociation as predictor of posttraumatic stress disorder in psychosocial disaster workers].

BACKGROUND: The author prospectively examined the power of persistent dissociation in predicting acute and chronic posttraumatic stress disorder symptoms (PTSD) in psychologists, psychotherapists, crisis intervention teams and clergymen after a disaster. METHODS: 135 psychosocial disaster workers were assessed (6 weeks and 6 months after the catastrophe) with the Acute Stress Disorder Scale (ASDS), the Posttraumatic Stress Diagnostic Scale (PDS) and the German short version of the Dissociative Experience Scale (FDS-20). Correlational analysis and a hierarchical multiple regression analysis were conducted. RESULTS: Persistent dissociation and acute stress symptoms were correlated with later acute and chronic PTSD diagnosis. Together, persistent dissociation und acute stress symptoms accounted for 74 % (m)/36 % (w) of the acute and 58 % (m)/44 % (w) of the variance in PTSD symptoms. CONCLUSIONS: The results support that persistent dissociation is a main predictor of acute and chronic posttraumatic stress symptoms in disaster workers.

Adult↗
PubMed1992

Hypnotic susceptibility, cognitive dissociation, and runner's high in a sample of marathon runners.

I studied the hypnotic ability of marathon runners as it relates to cognitive dissociation while running and to runner's high. Dissociating runners use a cognitive style in which they cut themselves off from the sensory feedback they would normally receive from their body. Marathon runners demonstrated high hypnotic susceptibility scores. Additionally, use of dissociation as a running strategy during the marathon was positively related to susceptibility, and runners who dissociated in training had higher susceptibility scores than did other runners. Runner's high was not related to hypnotic susceptibility; however, it was positively related to dissociation. The most common description of runner's high was general relaxation, whereas the least used description was total euphoria. Surprisingly some runners defined runner's high in ambivalent or negative terms. These results were related to the processes of self-hypnosis and to the positive mental health benefits of running.

Adult↗
PubMed1998

Dissociation in hypnosis and frontal executive function.

In a career of many searching conceptual insights, Kenneth Bowers drew an important distinction between 2 different dissociative theories of hypnosis: dissociated experience and dissociated control. We contrast these 2 views and discuss how a dissociated control theory can be integrated with current conceptions of frontal executive function. Then we use this frontal elaboration of the dissociated control theory to sketch out a provisional understanding of memory function associated with hypnosis and hypnotic suggestibility, with particular emphasis on unsuggested effects.

Dissociative Disorders↗
PubMed2005

Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact.

OBJECTIVES: To study the attitudes and experiences of Australian clinicians with dissociative disorders and the paths to diagnosis and experiences of patients. METHOD: The attitudes of Australian clinicians to dissociative disorders and the experiences of patients were assessed by questionnaires. The clinicians were mental health specialists and a small number of general medical practitioners. The patients had all been diagnosed with a dissociative disorder. RESULTS: Of the 250 clinicians, 21% reported experience with more than six cases on average of any one of the dissociative disorders, 38% with less than six, 42% with none; 55% regarded them as valid diagnoses, 35% dubiously valid and 10% invalid. Of the 55 patients, 76% reported delays in diagnosis (57%, >3 years and 25%, >10 years) with adverse consequences in 64%; 80% had experienced sceptical or antagonistic attitudes from clinicians, rated as destructive by 48%. They were disabled (60% rated as >50% impaired) and were heavy consumers of health services (48% hospitalized, 68% >5 times). There was considerable comorbidity including moderate or severe depression (96%), self-harm (68%), suicide attempts (69%), panic disorder (53%), eating disorders (75%), substance abuse (25%), poor physical health (44%), major interpersonal (70%) and sexual problems (90%). Patients rated individual psychotherapy as the most helpful treatment (90%) but medications, such as antidepressants, were also valued (60%). CONCLUSIONS: Although over half of the responding Australian clinicians thought that dissociative disorders were valid, the rest were dubious about their validity with 10% believing them to be invalid. Only 21% had considerable experience with the disorders. These findings may relate to some of the difficulties perceived by patients, which included delays in diagnosis, suboptimal treatment and negative experiences with clinicians.

Adult↗
PubMed2005

Owning the past, claiming the present: perspectives on the treatment of dissociative patients.

OBJECTIVE: From the early 1990s there has been a growing awareness in Australia of dissociative processes and dissociative disorders. The objective in this paper is to provide a selective overview of the context and process of treatment based on the substantive dissociative disorders literature, ongoing clinical experience and research, and over 8 years as director of a trauma and dissociation unit at Belmont Hospital, Brisbane. CONCLUSIONS: The construct of individual selfhood is of direct relevance in illustrating the psychological damage sustained by patients who have relied on dissociative defences to survive, and in highlighting issues and areas that are a particular focus of informed treatment.

Adult↗
PubMed1992

The use of electroconvulsive therapy in patients with dissociative disorders.

The psychiatric literature generally discourages the use of electroconvulsive therapy (ECT) to treat depression in dissociative disorder patients, but contains little data on outcome. This prospective study of ECT in three dissociative disorder patients demonstrates that ECT is indicated for severe treatment-resistant depression in such patients. Their Hamilton Depression Scale scores fell by 50%, they were remarkably clinically improved, and they maintained their gains for at least 4 months. The ECT proved helpful when depression was felt by most of the active alters rather than just by one depressed personality. Mini-Mental State Examination scores and clinical observation revealed no unusual confusion or side effects from ECT. These patients' dissociated condition was not altered by ECT, which indicates that ECT neither treats nor impairs treatment of dissociation. Electroconvulsive therapy can be helpful in the overall treatment of dissociative disorders by alleviating severe depressions which block utilization of psychotherapy.

Adult↗
PubMed2000

Risk factors associated with the dissociative experiences of borderline patients.

The objective of this study was to identify the risk factors associated with the dissociative symptomatology of borderline patients. The Dissociative Experiences Scale--a 28-item self-report measure that has well documented reliability and validity--was administered to 290 criteria-defined borderline patients and 72 axis II comparison subjects. Semistructured interviews pertaining to difficult childhood experiences and adult experiences of being a victim of violence were administered to these patients blind to diagnostic status. In the sample of borderline patients alone, multiple regression analyses revealed that four risk factors were found to be significantly associated with the level of dissociation reported by these 290 patients: inconsistent treatment by a caretaker, sexual abuse by a caretaker, witnessing sexual violence as a child, and adult rape history. In the combined sample of axis II patients, the borderline diagnosis joined these four "traumatic" factors as a significant predictor of the overall level of dissociation reported by these 362 personality-disordered inpatients. The results of this study suggest that both sexual trauma and something intrinsic to the borderline diagnosis itself are risk factors for dissociative phenomena among borderline patients.

Adult↗
PubMed2000

Dissociative symptomatology and traumatogenic factors in adolescent psychiatric patients.

This study describes the relation of different types of childhood trauma to the degree of dissociative experiences. Subjects were 198 consecutively admitted adolescent psychiatric patients, 11 to 19 years old (89 inpatients and 109 outpatients). All patients completed the Adolescent Dissociative Experiences Scale. A Checklist of Traumatic Childhood Events was filled out by clinicians. The results showed an increase in the degree of dissociative experiences in patients with a history of sexual abuse, physical abuse, neglect, and stressful life events. With the exception of life events, a moderate form of traumatic experience had the same effect on dissociative experiences as severe forms. The strongest effect was found for emotional neglect, which seems to be an important pathogenic risk factor. The results suggest that therapists and researchers should be aware that even less severe forms of abuse and neglect may have a significant impact on the development of dissociative psychopathology in adolescents.

Adolescent↗
PubMed2000

Psychiatric symptomatology in borderline and other personality disorders: dissociation and fragmentation as mediators.

This study considered the role of dissociation and personality fragmentation as psychological factors that might distinguish borderline and personality disorder (BPD) patients, and that might explain why BPD patients have higher levels of other psychiatric symptomatology than those with other personality disorders. Two groups of personality-disordered patients (personality disorders including BPD; personality disorders other than BPD) completed measures of dissociation, personality fragmentation, and psychiatric disturbance. The BPD group had higher levels of a number of aspects of psychiatric symptomatology. Those differences were mediated by aspects of dissociation. Personality fragmentation differentiated the two groups but was not related to the higher levels of other aspects of psychiatric disturbance. Treating the syndrome of BPD may depend on addressing both dissociation and personality fragmentation. In contrast, reducing the level of comorbid psychiatric disturbance in BPD is likely to be more strongly dependent on reducing levels of different aspects of dissociation. Psychotherapeutic techniques and targets for achieving such change are discussed.

Adult↗
PubMed2001

Relationship between dissociative symptomatology and declarative and procedural memory in adolescent psychiatric patients.

The purpose of this study was to examine the relationship between dissociative symptomatology and declarative and procedural memory. Subjects were 41 consecutively admitted adolescent psychiatric patients, 13 to 19 years old. Each subject completed the Adolescent Dissociative Experiences Scale (A-DES). Declarative memory was assessed by the California Verbal Learning Test and procedural memory by the Tower of Toronto puzzle. All subjects were controlled for IQ and severity of psychiatric illness. Data analysis was done by multiple regression. Multiple regression analysis revealed a model in which 71% variance of the A-DES scores was explained by psychiatric illness and specific memory variables. This study confirms a strong interrelationship between clinical dissociation and severity of psychiatric illness. Moreover, clinical dissociation seems to be associated with specific memory dysfunctions, indicating that dissociation exerts an impact on basic information processing.

Adolescent↗
PubMed2005

Replication of dissociation-psychosis link in New Zealand students and inmates.

To assess the relationship between dissociative and psychotic experiences, New Zealand university students (N = 119) and prison inmates (N = 42) were administered the Dissociative Experiences Scale (DES) and Symptom Checklist-90-Revised (SCL-90-R). Strong correlations were found between DES scores and the psychoticism and paranoid ideation subscales of the SCL-90-R (students: r = .520, .517, respectively; inmates: r = .637, .649, respectively). While other correlations were also significant (but smaller), these results are consistent with previous studies that have used a range of measures of psychosis or schizotypy with a variety of clinical and nonclinical populations. Such consistent findings in the face of methodological diversity offer strong support for the validity of a link between the concepts of dissociation and psychosis. While this relationship has previously been interpreted indirectly, as dissociative experiences predisposing to psychotic symptoms, we suggest a direct route: that dissociative experiences of various forms may underlie some (or even all) psychotic symptoms.

Adolescent↗
PubMedDate not supplied

Relationship between alexithymia, dissociation and personality in psychiatric outpatients.

BACKGROUND: The relationship between alexithymia and dissociation is not known. Both mechanisms ward off overwhelming affective states; hence, this report examines the relationship between dissociation, alexithymia, depressed mood and the five-factor model of personality in a sample of psychiatric outpatients. METHODS: One hundred and sixteen outpatients were evaluated using the Toronto Alexithymia Scale (TAS), the Dissociative Experiences Scale (DES), NEO Five-Factor Inventory and visual analog scales assessing depression and anxiety. Data was analyzed using multivariate analysis of variance, logistic regression and linear regression techniques. RESULTS: Depressed mood accounted for the group differences between the global TAS and DES scores. Using DES both dimensionally and categorically with regression models, there was minimal contribution of DES or its subfactors to predict TAS. CONCLUSIONS: These data reaffirm previous findings that dissociation fundamentally differs from alexithymia. Dissociation involves a change of one's sense, of self, whereas alexithymia reflects a cognitive state of externally oriented thinking with an inability to identify and report discrete emotions.

Adult↗
PubMedDate not supplied

Dissociative symptoms in obsessive-compulsive dimensions.

Previous studies have described co-occurrence between obsessive-compulsive disorder (OCD) and dissociation. We intended to evaluate the phenomenological association between different obsessive-compulsive and dissociative symptoms more precisely. Seventy patients with OCD (DSM-IV) were evaluated with the Hamburg Obsessive-Compulsive Inventory (HZI) and the Dissociation Experience Scale. Correlation and discriminant analysis were performed. The dimensions 'Checking' and 'Symmetry and Ordering' were significantly related to dissociative symptomatology. A clear-cut lack of association was found in 'Washing and Cleaning', 'Counting and Touching' and 'Aggressive Impulses and Fantasies'. HZI dimensions significantly discriminated patients with high from patients with low dissociative symptomatology. Psychodynamic and therapeutical aspects of these findings are discussed.

Adult↗
PubMed2006

Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder.

BACKGROUND: Previous studies have found a strong association between dissociation and obsessive-compulsive disorder (OCD). The purpose of the present study was to evaluate whether dissociation is a predictor of cognitive behavior therapy (CBT) outcome in patients with OCD. METHODS: Fifty-two patients with OCD were assessed using the Dissociative Experience Scale (DES), the Yale-Brown Obsessive-Compulsive Scale and the Beck Depression Inventory. CBT lasted on average 9.5 weeks and included exposure therapy. RESULTS: Patients who dropped out due to noncompliance had higher baseline DES scores and depression scores compared to the 43 patients (83%) who completed the study. Significant OCD symptom reduction at posttreatment was observed in study completers with a large effect size (d = 1.7). More severe OCD symptoms at posttreatment were associated with higher DES scores at baseline, and treatment nonresponders had significantly higher baseline DES scores compared to responders. These associations with outcome were mainly due to the DES subfactor absorption-imaginative involvement. In regression analyses, higher absorption-imaginative involvement scores at baseline predicted poorer CBT outcome, even after controlling for depressive symptoms, comorbid axis I disorders and concomitant psychotropic drugs. CONCLUSIONS: Results from this preliminary study suggest that higher levels of dissociation (particularly absorption-imaginative involvement) in patients with OCD might predict poorer CBT outcome. If our results can be replicated, treatment outcome might be improved by additional interventions for those patients with OCD who indicate high levels of dissociation, for example by using interventions aimed at improving coping with emotionally stressful situations.

Adult↗
PubMed1990

Hypnotizability and dissociation.

The author describes the multidimensionality of hypnosis itself and hence of hypnotizability. He also points to the lack of clarity regarding the concept of dissociation and the extent to which its roots lie in the clinical experience of hypnosis. The concept of dissociation increasingly preempts repression and other defense mechanisms in current nosological thinking. The author cautions against equating hypnotizability scores with dissociative capacity and advocates a clearer elaboration of the concept of dissociation. Meanwhile, restraint in the use of the term "dissociation" is recommended.

Dissociative Disorders↗