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PubMed1993

Briquet's syndrome, dissociation, and abuse.

OBJECTIVE: To help clarify the complex association between childhood abuse and adult psychopathology, the authors examined the relationship among abuse, Briquet's syndrome (somatization disorder), and dissociative symptoms. METHOD: Ninety-nine female psychiatric clinic outpatients with a history of somatic complaints were assessed for Briquet's syndrome, dissociative symptoms, adult and childhood sexual abuse, childhood physical abuse, and childhood emotional abuse. RESULTS: Women with high dissociation scores and many somatic symptoms were more likely to report abuse than were subjects with low dissociation scores or with few somatic complaints. CONCLUSIONS: Briquet's syndrome, dissociation, and abuse are significantly associated. Awareness of this association may have a significant effect on the treatment of psychiatric patients.

Adult↗
PubMed1994

Dissociative symptoms in media eyewitnesses of an execution.

OBJECTIVE: The first execution in California since 1976 took place recently in the San Quentin Prison gas chamber. Eighteen journalists were invited as media eyewitnesses. The authors postulated that witnessing this execution was psychologically traumatic and that dissociative and anxiety symptoms would be experienced by the journalists. METHOD: To investigate the prevalence and specific nature of these symptoms, questionnaires were sent to all the journalists about a month after the execution. The questionnaire contained 17 items assessing dissociative symptoms from the authors' questionnaire of 35 highly intercorrelated acute stress items. Fifteen of 18 of the witnesses returned the questionnaire. Items were endorsed on a scale of 0 ("have not experienced") to 5 ("very often experienced") and analyzed as being dichotomously present or absent. The mean age of the respondents was 37.6 (SD = 8.6) and mean years as a journalist were 15.2 (SD = 9.0). Nine subjects were men and six were women. RESULTS: Journalists witnessing the execution endorsed an average of 5.0 dissociative items, ranging from "I saw, heard, or felt things that were not really there" (endorsed by no one) to "I felt estranged or detached from other people" (endorsed by 60%). This prevalence of reported dissociative symptoms is comparable to that seen among persons who endured the recent Oakland/Berkeley, Calif., firestorm. CONCLUSIONS: The experience of being an eyewitness to an execution was associated with the development of dissociative symptoms in several journalists.

Adult↗
PubMed1999

Memories of childhood abuse: dissociation, amnesia, and corroboration.

OBJECTIVE: This study investigated the relationship between self-reported childhood abuse and dissociative symptoms and amnesia. The presence or absence of corroboration of recovered memories of childhood abuse was also studied. METHOD: Participants were 90 female patients admitted to a unit specializing in the treatment of trauma-related disorders. Participants completed instruments that measured dissociative symptoms and elicited details concerning childhood physical abuse, sexual abuse, and witnessing abuse. Participants also underwent a structured interview that asked about amnesia for traumatic experiences, the circumstances of recovered memory, the role of suggestion in recovered memories, and independent corroboration of the memories. RESULTS: Participants reporting any type of childhood abuse demonstrated elevated levels of dissociative symptoms that were significantly higher than those in subjects not reporting abuse. Higher dissociative symptoms were correlated with early age at onset of physical and sexual abuse and more frequent sexual abuse. A substantial proportion of participants with all types of abuse reported partial or complete amnesia for abuse memories. For physical and sexual abuse, early age at onset was correlated with greater levels of amnesia. Participants who reported recovering memories of abuse generally recalled these experiences while at home, alone, or with family or friends. Although some participants were in treatment at the time, very few were in therapy sessions during their first memory recovery. Suggestion was generally denied as a factor in memory recovery. A majority of participants were able to find strong corroboration of their recovered memories. CONCLUSIONS: Childhood abuse, particularly chronic abuse beginning at early ages, is related to the development of high levels of dissociative symptoms including amnesia for abuse memories. This study strongly suggests that psychotherapy usually is not associated with memory recovery and that independent corroboration of recovered memories of abuse is often present.

Adolescent↗
PubMed2006

Hippocampal and amygdalar volumes in dissociative identity disorder.

OBJECTIVE: Smaller hippocampal volume has been reported in several stress-related psychiatric disorders, including posttraumatic stress disorder (PTSD), borderline personality disorder with early abuse, and depression with early abuse. Patients with borderline personality disorder and early abuse have also been found to have smaller amygdalar volume. The authors examined hippocampal and amygdalar volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma. METHOD: The authors used magnetic resonance imaging to measure the volumes of the hippocampus and amygdala in 15 female patients with dissociative identity disorder and 23 female subjects without dissociative identity disorder or any other psychiatric disorder. The volumetric measurements for the two groups were compared. RESULTS: Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller in the patients with dissociative identity disorder, compared to the healthy subjects. The ratio of hippocampal volume to amygdalar volume was significantly different between groups. CONCLUSIONS: The findings are consistent with the presence of smaller hippocampal and amygdalar volumes in patients with dissociative identity disorder, compared with healthy subjects.

Adult↗
PubMed2002

Personality factors associated with dissociation: temperament, defenses, and cognitive schemata.

OBJECTIVE: The purpose of this study was to investigate temperamental, psychodynamic, and cognitive factors associated with dissociation. METHOD: Fifty-three subjects with DSM-IV-defined depersonalization disorder and 22 healthy comparison subjects were administered the Dissociative Experiences Scale, the Tridimensional Personality Questionnaire, the Defense Style Questionnaire, and the Schema Questionnaire. RESULTS: Subjects with depersonalization disorder demonstrated significantly greater harm-avoidant temperament, immature defenses, and over-connection and disconnection cognitive schemata than comparison subjects. Within the group of subjects with depersonalization disorder, dissociation scores significantly correlated with the same variables. CONCLUSIONS: Particular personality factors may render individuals more vulnerable to dissociative symptoms. Risk factors associated with dissociative disorders merit further study.

Adult↗
PubMed2003

The predictive power of peritraumatic dissociation and acute stress symptoms for posttraumatic stress symptoms: a three-month prospective study.

OBJECTIVE: The authors prospectively examined the power of peritraumatic dissociation and acute stress symptoms in predicting posttraumatic stress disorder (PTSD) symptoms. METHOD: Thirty-five assault victims were assessed with the Peritraumatic Dissociative Experiences Questionnaire within 24 hours of the assault. Participants were reassessed 2 weeks after the trauma with the Stanford Acute Stress Reaction Questionnaire and 3 months after the trauma with the Clinician-Administered PTSD Scale and the Impact of Event Scale. Correlational analyses and a hierarchical multiple regression were conducted. RESULTS: Peritraumatic dissociation and acute stress symptoms were correlated with later PTSD symptoms and diagnosis. Together, peritraumatic dissociation and acute stress symptoms accounted for 33% of the variance in PTSD symptoms. CONCLUSIONS: These results support earlier findings that peritraumatic dissociative experiences and acute stress are robust predictors of PTSD. Such symptoms may be of use for identifying at an early stage individuals at highest risk of remaining symptomatic. Future studies should investigate the predictive power of specific peritraumatic and acute stress disorder symptom clusters.

Adult↗
PubMed2005

The role of peritraumatic dissociation and gender in the association between trauma and mental health in a Palestinian community sample.

OBJECTIVE: This research focused on gender-specific trauma exposure and mental health symptoms among Palestinians living in conditions of military violence. It also examined the gender-specific role of peritraumatic dissociation in moderating the association between lifetime trauma and mental health. METHOD: A random sample of 311 Palestinian women and 274 men ages 16-60 years from the Gaza Strip participated. The subjects were asked about lifetime trauma and peritraumatic dissociation during their most severe traumatic experience. Mental health was indicated by total scores and diagnostic variables of posttraumatic stress disorder (PTSD), anxiety, mood (depression), and somatization disorders. Symptoms of hostility were assessed as a total score. RESULTS: The women reported a lower level of lifetime trauma than the men, but exposure to trauma was associated with PTSD among both genders. Exposure to lifetime trauma was further associated with anxiety, mood, and somatoform disorders only among women but not among men. No gender differences were found in the level of peritraumatic dissociation. Analyses on moderating effects showed that peritraumatic dissociation made both men and women more vulnerable to symptoms of hostility and men to depressive symptoms when they were exposed to lifetime trauma. CONCLUSIONS: The results are consistent with previous studies in more peaceful conditions: men experience more traumatic events, whereas exposure is associated with more severe psychiatric disorders among women. Peritraumatic dissociation as an acute response to trauma constituted a risk for mental health symptoms in both genders.

Adolescent↗
PubMed2004

Dissociation, hemispheric asymmetry, and dysfunction of hemispheric interaction: a transcranial magnetic stimulation approach.

The authors investigated the hypothesis that dissociation may represent a functional dysconnectivity syndrome using a transcranial magnetic stimulation (TMS) approach. Transcranial magnetic stimulation investigations that included motor thresholds and the transcallosal conduction time (TCT) reflecting the interhemispheric transfer were performed in 74 right-handed students. All subjects completed the Dissociative Experience Scale. The high dissociators had a significantly lower left hemispheric excitability than right hemispheric excitability. They also had a significantly shorter TCT from the left to the right hemisphere than did the low dissociators. These results suggest that the neural basis of dissociation may involve a cortical asymmetry with a left hemispheric superiority or, alternatively, a lack of right hemispheric integration.

Adolescent↗
PubMed2006

Cognitive function and dissociative disorder status among veteran subjects with chronic posttraumatic stress disorder: a preliminary study.

Twenty-seven veteran subjects with chronic posttraumatic stress disorder (PTSD) were evaluated for dissociative disorders. Ten subjects met criteria for one or more dissociative disorders, and 17 subjects did not meet dissociative disorder criteria. Neurocognitive profiles of the two groups differed in several areas, with veterans meeting diagnostic criteria for both PTSD and a dissociative disorder and demonstrating considerably greater deficits in attention, autobiographical memory, and verbal memory than PTSD subjects without comorbid dissociative disorder diagnosis.

Adult↗
PubMed1994

The dissociative character: a reconsideration of "multiple personality".

The author has interviewed and reviewed the cases of over 100 patients with a suspected diagnosis of multiple personality disorder (MPD). He finds it clinically useful to think of a continuum of character pathology in which dissociative and defensive altered states predominate. At one end of this continuum is MPD, which he considers a lower-level dissociative character. He redefines dissociation as a defensive altered state, due to autohypnosis, which augments repression or splitting. Depending on the degree of integration of the ego, it may result in a broad range of disturbances of alertness, awareness, memory, and identity. Four vignettes are presented which illustrate a transient hypnoid state, "characterological" dissociation in an upper-level dissociative character, and two cases of MPD, including one emerging in analysis.

Dissociative Identity Disorder↗
PubMed2001

Canadian and American psychiatrists' attitudes toward dissociative disorders diagnoses.

OBJECTIVE: To compare the opinions of Canadian psychiatrists regarding dissociative disorder diagnoses with those of previously surveyed American psychiatrists. METHOD: We sent a 1-page questionnaire to a stratified representative sample of 550 Canadian psychiatrists. RESULTS: Eighty percent of Canadian psychiatrists responded. Fewer than one-third replied that dissociative amnesia and dissociative identity disorder should be included without reservations in the DSM-IV; fewer than 1 in 7 felt that the validity of these diagnoses was supported by strong scientific evidence. French- and English-speaking Canadians had similar opinions. Overall, Canadians were significantly less accepting than Americans. CONCLUSION: Both Canadian and American psychiatrists show little consensus regarding the diagnostic status or scientific validity of dissociative amnesia and dissociative identity disorder.

Adult↗
PubMed1999

Validation of a French version of the Dissociative Experiences Scale in a rape-victim population.

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.

Adolescent↗
PubMed2005

The validity of DSM-IV dissociative disorders categories in south-west Uganda.

There is little systematic research on the cross-cultural validity of the dissociative disorders, especially in non-western countries. This study evaluates the fit of the DSM-IV classification and concepts of these disorders with local concepts, experiences and local presentations in south-west Uganda. We conducted focus group discussions with medical students, traditional healers, religious leaders, counselors, community members and other health workers (n=48). They were supplemented by key informant interviews with religious people, traditional healers and leaders (n=11). The responses were subjected to thematic analysis. Dissociative amnesia and depersonalization were generally recognized and seen as the result of traumatic experiences and were useful categories in Uganda. However, dissociative fugue did not match local concepts and was confused with spirit possession and other conditions such as alcoholic fugues and dementia. The description of dissociative identity disorder was always interpreted as a possession trance disorder by the local healers. We found only partial support for the validity of the DSM-IV classification of dissociative disorders in Uganda.

Adult↗
PubMed2005

The language of dissociation.

Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.

Child↗
PubMed2006

The influence of current stress on dissociative experiences: an exploratory study in a non-clinical population.

In this study, the relationship between current stress, as perceived by an individual, and dissociative phenomena is explored. All subjects were in an acute and naturally caused stress-situation-sudden threat of dismissal from their jobs in a large multinational corporation. Dissociation and stress were measured at two different times over three months. Since information campaigns and psychological support programs were offered to all participants, levels of stress were expected to decrease significantly. The data show that dissociative experiences are elevated when subjects experience high levels of current stress, though scores fall within the normal non-pathological range. Furthermore, it appears that a decrease in stress level is associated with a significant decrease of dissociative symptoms. The results support a one-directional causal relationship: a decrease in perceived stress leads to a decrease in dissociative phenomena.

Adult↗
PubMed2006

Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors.

This study examined evidence for a dissociative subtype of post-traumatic stress disorder (PTSD) among women seeking psychotherapy for childhood sexual abuse (CSA). One hundred and twenty-two women seeking treatment for CSA completed a battery of questionnaires assessing PTSD, dissociative symptoms, and child maltreatment. Using signal detection analysis, we identified high and low dissociation PTSD subgroups. A constellation of three PTSD symptoms-hypervigilance, sense of foreshortened future, and sleep difficulties-discriminated between these two subgroups (OR = 8.15). Further evidence was provided by the finding of a nonlinear relationship between severity of childhood maltreatment and dissociation in the women with PTSD. These results provide support for a dissociative subtype of PTSD that may stem from more severe childhood experiences of neglect and abuse.

Adolescent↗
PubMed2006

Dissociative experiences in China.

The Dissociative Experiences Scale was administered to a non-clinical sample in Shanghai, China (N = 618) and the results were compared with a previous sample of the general population from Winnipeg, Canada (N = 1055). The Dissociative Disorders Interview Schedule was administered to the 618 Chinese participants and results were compared with those of the Canadian participants (N = 502). In addition, both measures were administered to a sample of Chinese psychiatric inpatients (N = 423) and outpatients (N = 304). Rates of childhood trauma and dissociation were far lower in the Chinese non-clinical sample than in the two Chinese psychiatric patient groups, and far lower than in the Canadian general population. Among the 618 respondents in the Chinese non-clinical sample, no childhood sexual abuse was reported and only one person reported childhood physical abuse. These rates of childhood abuse were far lower than in other non-clinical samples from China; for example, rates were 16.7% for sexual abuse of girls and 10.5% for sexual abuse of boys in a previous study. Among the more traumatized Chinese psychiatric patients, and among the Canadian respondents, dissociative experiences were much more common than in the Chinese general population. The data provide a base frequency for dissociation in non-clinical samples reporting little or no childhood physical and sexual abuse.

Adult↗
PubMed2006

Evaluation of the Swedish version of Dissociation Questionnaire (DIS-Q), Dis-Q-Sweden, among adolescents.

The aim of this study was to investigate the psychometric properties of the Swedish version of the Dissociation Questionnaire in a normative adolescent population and also to investigate dissociative symptoms associated with trauma including sexual and physical abuse. A normative sample of 449 adolescents between the ages of 12 and 19 and a clinical group of 74 adolescents with known experiences of trauma, sexual and/or physical abuse was given Dis-Q-Sweden. A mixed group of 22 abused and non-abused adolescents who answered Dis-Q-Sweden was also interviewed by using the Structural Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability concerning both internal consistency and test-retest stability. Validity was tested in several ways (criterion, predictive, construct and concurrent) and found to be satisfactory. Significant differences for the total sum scores of Dis-Q-Sweden were found between the normative group and the clinical group with known sexual abuse (p < 0.001). The prevalence of dissociative symptoms (cut-off score > 2.5) was 2.3% in the normative group and 50% in the clinical group. Dis-Q-Sweden has proven to be a screening instrument with good psychometric properties and has proven to be able to capture dissociative symptoms in adolescents with self-reported trauma and known trauma (sexual abuse).

Adolescent↗