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PubMedDate not supplied

Suicidal behavior and abuse in psychiatric outpatients.

The present study examines the relationship between suicidal behaviors and histories of abuse in psychiatric outpatients. Two hundred fifty-one psychiatric outpatients were evaluated for history of abuse, suicidal behavior, demographics, and clinical characteristics using self-report instruments and a face-to-face interview. Logistic regression analysis indicated that physical abuse (battering) in adulthood and histories of a combination of childhood and adulthood abuse were significant predictors of past suicide attempts and current suicidal ideation. Victims of abuse were more likely than nonvictim controls to have been suicidal at a younger age and to have made multiple suicide attempts. Among patients with a history of abuse, suicide attempters could be distinguished from nonattempters on the basis of higher levels of dissociation, depression, and somatization. Abusive experiences in adulthood appear to play an important role in suicidal behavior among psychiatric outpatients. High levels of specific symptoms (i.e., depression, somatization, and dissociation) among patients with a history of abuse can help to identify outpatients at risk for suicidal behavior.

Adolescent↗
PubMed2006

Psychological experience of gambling and subtypes of pathological gamblers.

Clinical experience and some empirical data suggest that different subtypes of gamblers may exist. This study examined psychometric properties of the Gambling Experience Measure (GEM) to establish support for differing subtypes of gamblers. In total, 149 treatment-seeking pathological gamblers completed the GEM and other instruments. A principal component analysis produced a three-factor solution that included gambling as a way to escape negative emotions (Escape), dissociating (Dissociation), and narcissism/seeking attention (Egotism). Multiple regression analyses revealed that being female and general dissociation was associated with Escape gambling. General dissociation was also related to the Dissociation factor. Male gender and impulsivity were associated with the Egotism factor. These data offer preliminary evidence of the validity and reliability of the GEM in distinguishing subgroups of gamblers.

Adult↗
PubMed2005

Traumatic brain injury, dissociation, and posttraumatic stress disorder in road traffic accident survivors.

This study investigated the symptom profiles of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in participants who did and did not sustain traumatic brain injury (TBI), following a road traffic accident. The participants were assessed at three time points: as soon as possible posttrauma as well as at 6 weeks and 3 months posttrauma. At the first assessment, fewer participants from the TBI group recalled feeling fear and helplessness at the time of the trauma, fewer TBI participants reported recurrent intrusive thoughts and images, and more TBI participants reported dissociation since the trauma, relative to the non-TBI group. At the second assessment, fewer participants from the TBI group recalled feeling intense helplessness at the time of the trauma. Fewer TBI participants also reported reliving and physiological reactions on trauma reminders relative to the non-TBI group. At 3 months posttrauma, there was no difference in PTSD symptom profile between non-TBI and TBI groups. Our findings indicate that the presence of TBI is likely to influence the distribution of certain symptoms, but need not be a significant barrier to diagnosing ASD and PTSD.

Accidents, Traffic↗
PubMed1984

Fantasized companions and suicidal depressions: two case reports.

Two acutely suicidal adult patients with fantasized companions integral to the formation of suicide intent are presented. The phenomenon of the fantasized companion is reviewed, differentiated from true hallucinatory or psychotic phenomena, and related to other fantasy and dissociative states, such as daydreaming and multiple personalities. In this regard, the concept of hysterical psychosis is discussed. The functions served by the fantasized companions and their involvement in the successful treatment of the patients are described.

Adult↗
PubMed1996

Dissociation: the clinical realities.

An attempt was made by the authors of DSM-III to restrict its focus to the experimental, the observable, and the measurable. The intention was to free the nosology from the influence of unproven theories, and the philosophy was driven largely by the importance of research being able to identify diagnostic categories to facilitate the study of homogeneous groups. So it is of interest that the authors accepted dissociation-an ambiguous event linked to an explicit theoretical concept that had been introduced by Janet-as the basis for classification of clinical presentations that were formerly included under the rubric of hysteria, a similarly unclear category. Since DSM-III, there have been an increasing number of reports of dissociative experiences and dissociative identity disorder (formerly known as multiple personality disorder), but neither of these clinical presentations seems able to withstand the concern that it is dramatically influenced by environmental cues, e.g., the expectations of the therapist. Thus, a restricted phenomenological perspective does not fully appreciate the distorting potential of suggestibility and imagination on the nature of the emerging clinical picture. These factors might well have contributed to and laid the conceptual groundwork for the growth in the number of reports of dissociation.

Adult↗
PubMed1995

Attitudes toward the body in suicidal, depressed, and normal adolescents.

Our purpose was to investigate the hypothesis that suicidal adolescents, compared with depressed nonsuicidal and nonsuicidal normal adolescents, display a more negative attitude toward their bodies. Scales for suicidal tendencies, dissociative tendencies, perception of actual versus ideal body features, and feelings toward the body were administered to the subjects. The suicidal subjects showed a larger perceived discrepancy between actual versus ideal body features and a more negative feeling toward the body, and scored higher on some aspects of dissociation than the normal group. The suicidal group also displayed more negative feelings toward the body and scored higher on some aspects of dissociation than the depressed group. A series of correlations showed that the higher the suicidal tendency, the higher the dissociation, the larger the discrepancy, and the stronger the negative feelings toward the body. The findings were explained as reflecting unique characteristics of suicidal individuals that develop from early trauma and sadomasochistic relationships. These characteristics may facilitate suicidal behavior.

Adolescent↗
PubMedDate not supplied

[Neural bases of perception and recognition of faces].

OBJECTIVE: To analyze the neural bases of perception and the recognition of faces. First of all we consider the concept of functional hemisphere specialization; then we look at the results obtained with regard to the neuroanatomy of processing faces and finally refer to the disorders of recognition of faces in humans. For this we review the clinical evidence obtained from the neuropsychological studies of prosopagnostic patients and the data derived from psychophysiological experiments done using intracranial recordings of nonhuman primates. DEVELOPMENT: The agreement between the results analysed allows us conclude that in both cerebral hemispheres there are neural mechanisms specialized in the perception and recognition of faces, and in particular the ventral and posterior regions of the occipito-temporal cortex play a decisive part in these processes. Similarly experimental findings in nonhuman primates permits explanation of the neural nature of certain neuropsychological disorders seen in man, such as the case of the dissociation between disorders of the recognition of facial identity and disorders of recognition of emotional expression, and also dissociation between the difficulty in recognizing familiar faces and difficulty in recognizing non-familiar faces. CONCLUSION: The use of modern neuroimaging techniques and electrophysiological studies using evoked potentials are necessary for greater understanding of these and other disorders related to processing facial information.

Affect↗
PubMed2001

Attachment disruptions in seriously emotionally disturbed children: implications for treatment.

In this paper, we consider the effect of attachment disruptions on severe adjustment problems in school-age boys. Three groups of 9-11-year-old boys were sampled based on their degree of risk for adjustment difficulties: (1) boys in regular classrooms, (2) boys in regular classrooms who are at risk due to poverty, and (3) boys who have been placed in special education classrooms as a result of serious emotional disturbance (SED). Attachment disruptions were categorized according to the severity of major separations from the biological mother. SED children experienced significantly more severe disruptions of their relationships with their biological mothers and fathers than either the high-risk or comparison boys. Teachers' ratings indicated that both the high-risk and SED boys experienced more externalizing symptoms than comparison boys in regular classrooms. However, SED children were most clearly discriminated from their high-risk and comparison counterparts by higher levels of dissociative symptoms. Regression analyses indicated that children who had experienced maternal attachment disruptions were more likely to show dissociative symptomatology in the classroom setting and were more likely to develop dependent relationships with their teachers after risk group status, child age and family structure were controlled. Implications of these findings for the treatment of SED children are discussed.

Affective Symptoms↗
PubMed2006

The dissociative processing style:a cognitive organization activated by perceived or actual threat in clinical dissociators.

This paper proposes a cognitive organization that operates during times of perceived or actual threat in individuals with dissociative psychopathology. This organization, referred to as the dissociative processing style (DPS), serves as a threat monitoring system. It is characterized by (1) a shift from selective attention processing to multiple streams of information processing, (2) weakened cognitive inhibitory functioning which allows these streams to be operational and (3) the directing of awareness towards some and away from other information streams. Whilst DPS activation has the potential for adaptive and protective functions, it also heightens the likelihood of dissociative symptom experience and dissociation itself. Dissociation is understood as a failure to integrate encoded information from multiple input streams. The DPS is argued to be activated by top-down processes which signal danger, such as the appraisal of contextual cues. A clinical example is used to highlight the characteristics of the DPS.

Adult↗
PubMed2004

Habitual self-mutilation in Japan.

The purpose of the present study was to clarify the relationship between bulimic behavior, dissociative phenomenon and sexual/physical abuse histories in Japanese subjects with habitual self-mutilation. Subjects consisted of 34 female outpatients who had cut their wrists or arms on more than 10 occasions. Two age-matched groups, which consisted of 31 general psychiatric outpatients and 26 non-clinical volunteers, served as controls. They were assessed with the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, Adolescent Dissociative Experience Scale, and an original self-reporting questionnaire concerning various problematic behaviors and sexual/physical abuse histories. The habitual self-mutilation and the two control groups were compared. The habitual self-mutilation group had significantly higher scores on the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, and Adolescent Dissociative Experience Scale than either of the two control groups (P < 0.001). Furthermore, the habitual self-mutilation group more frequently had a history of illicit psychoactive drug use (P = 0.001), shoplifting (P < 0.001), suicide attempts (P < 0.001), overdosing with medicine (P < 0.001), sexual abuse (P = 0.011), and childhood physical abuse (P = 0.001) than the general psychiatric controls. These results are consistent with those in Western studies. Habitual self-mutilation is likely to coexist with depression, bulimia, and dissociation. Such patients frequently have clinical features similar to those of 'multi-impulsive bulimia'. Evidence supports the association between habitual self-mutilation and sexual/childhood physical abuse in Japan.

Adolescent↗
PubMed1993

Trauma and dissociation.

The stress associated with experiencing or witnessing physical trauma can cause abrupt and marked alterations in mental state, including anxiety and transient dissociative symptoms. Intense manifestations of this pattern of response to trauma are described in a new diagnostic category proposed for DSM-IV: acute stress disorder. Severe dissociative symptoms may predict subsequent posttraumatic stress disorder. Persons who experience a series of traumatic events may be especially vulnerable to a variety of dissociative states, including amnesia, fugue, depersonalization, and multiple personality disorder. Treatment for these symptoms emphasizes strengthening supportive interpersonal relationships and developing insight that reduces psychological pain by integrating the trauma into a meaningful, less self-blaming perspective.

Adaptation, Psychological↗
PubMed1987

The role of distractions in the maintenance of dissociative mental states.

I have sought to illustrate how distractions are in certain cases employed to mask a radical withdrawal from symbolically organized forms of self experience and communication. This dissociative use of distractions, by means of which regressive shifts in mental state are disguised, should be distinguished from the more conventional resistance function of acting in the therapeutic setting. Furthermore, consistent deployment of decoys and distractions for the purposes of dissociation may have the effect of producing in the patient a 'twilight' mental state, a defensive middle-ground of pseudo-integration (manifested in dissociative activities and in attenuated and impoverished forms of sleep, dreaming, metaphorical thought and repression). By recognizing the ways in which this pseudo-integrated mental state is maintained, and how it provides a stable sanctuary, the therapist may be alerted to the abiding fear in these patients of more fully integrated modes of experience.

Adult↗
PubMed1995

Dissociative and hypnotic experiences in eating disorder patients: an exploratory study.

Hypnotizability, subjective experiences during hypnotizability assessment, and dissociation were studied in 53 eating disorder patients in order to explore the relationship between these phenomena. Dissociation was measured with a newly developed self-reporting Dissociation-Questionnaire (DIS-Q), level of hypnotizability was assessed with the Stanford Hypnotic Clinical Scale (SHCS), subjective experiences during hypnosis with the Dutch Phenomenology of Consciousness Inventory (DPCI), and the Dutch Resistance to Hypnosis Scale (DRHS). Compared with normals, eating disorder patients scored significantly higher on the DIS-Q and SHCS. Compared with restricting anorexics, anorexics of the mixed type as well as bulimics report higher scores on both the DIS-Q and SHCS, but a significant difference was found only for the DIS-Q subscale loss of control. Although positive correlations between the DIS-Q and SHCS were found, the magnitude of the correlations shows that both instruments probably are measuring different constructs. Some implications of these findings are discussed.

Adult↗
PubMed2000

Personality profiles, dissociation, and absorption in women reporting repressed, recovered, or continuous memories of childhood sexual abuse.

Women reporting either repressed, recovered, or continuous memories of childhood sexual abuse or no abuse history completed questionnaires tapping personality traits, absorption (fantasy proneness), dissociation, depression, and posttraumatic stress. Planned contrasts indicated that recovered memory participants scored higher on absorption and dissociation than did those reporting either continuous memories or no abuse history; repressed memory participants scored nonsignificantly higher than did recovered memory participants. On measures of distress, continuous memory participants were indistinguishable from nonabused participants, repressed memory participants scored highest, and recovered memory participants scored midway between continuous and repressed memory participants.

Adolescent↗
PubMed2005

Family-based and case-control association studies of glutamate receptor GRIK3 Ser310Ala polymorphism in Polish patients and families with alcohol dependence.

The aim of this study was to evaluate the role of the GRIK3 functional polymorphism (Ser310Ala) in the pathogenesis of alcoholism. This polymorphism was investigated in two types of studies: (1) the association study in a whole group of alcoholics (116 patients fulfilling ICD-10 alcohol dependence (AD) criteria and 255 controls, Polish descent) and homogenous overlapping subgroups of patients with: a history of delirium tremens and/or alcohol seizures, early age of onset of alcoholism (AOO<26 years), a co-occurrence of dissocial personality disorder, a history of familial alcoholism; (2) the family-based study (using Transmission Disequilibrium Test (TDT) in 100 Polish families with alcohol dependence). The history of alcoholism was obtained using SSAGA (Polish version). GRIK3 functional polymorphism was determined using PCR. TDT revealed an adequate transmission of both alleles to the affected offspring in the whole group of alcohol families (29 x Ser, 24 x Ala; chi2=0.472; d.f.=1; p=0.492) and in the homogenous subgroups of families. No significant associations between any of the above mentioned alcohol phenotypes and Ser310 allele were observed (the whole AD group: p=0.66 AD with delirium and/or seizures: p=0.521; early onset AD: p=0.868; AD with familial history of alcoholism: p=0.798 and AD with dissocial personality disorder: p=0.618). These findings do not seem to support the hypothesis of the role of this polymorphism in the pathogenesis of alcoholism.

Adult↗
PubMed1997

'Free to be' peer group supports patients with MPD/DD.

1. During the last decade, dissociative identity disorder increasingly has been recognized as a relatively common post-traumatic syndrome. 2. Individuals with MPD/DD often are estranged from abusive families and have difficulty with social connection; an urgent therapeutic task is the re-creation of a sense of human interdependency and community. 3. Group therapy can be a useful and successful adjunct to individual psychotherapy for relatively stable clients with MPD/DD; the group's focus should be here-and-now, supportive, and psychoeducative in nature.

Dissociative Disorders↗