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Depersonalization in a female adolescent.

This paper demonstrates the relationship between the onset and persistent manifestation of the depersonalization phenomenon in a femal adolescent. On the basis of a case report it is postulated that certain external stimuli coinciding with anxiety lead to a physiologically induced altered state of consciousness which defends against the maintenance or repetition of these events. If the state functions effectively, as in the presented case, a symptom pattern develops which resembles very closely that altered state of consciousness. The particular form of the altered state is postulated to depend upon the personality configuration of the individual patient.

Adolescent↗

[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↗

Childhood trauma and dissociation in female patients with schizophrenia spectrum disorders: an exploratory study.

The few studies that have investigated the relationship between trauma and dissociative symptoms in patients with schizophrenia have not assessed the role of the severity of psychotic symptoms. The current study examined correlations among five domains of childhood trauma and dissociative symptoms in 30 female patients with schizophrenia spectrum disorders, using the Dissociative Experiences Scale and the Childhood Trauma Questionnaire. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale. Consistent with previous studies, high levels of childhood traumatic experiences were found (Childhood Trauma Questionnaire total score M = 48.5, SD = 18.3). Physical neglect and emotional abuse showed significant correlations with dissociative symptoms at admission. When patients were stabilized, about a month after admission, emotional abuse still showed a significant correlation with dissociative symptoms. However, in contrast to previous findings, Dissociative Experiences Scale findings were not stable over time. Our results confirm the relevance of childhood trauma in schizophrenic patients but also demonstrate the need to develop appropriate methodologies for measuring dissociation in this population.

Adolescent↗

Psychometric validation of the State Scale of Dissociation (SSD).

Although dissociative phenomena are often transient features of mental states, existing measures of dissociation are designed to measure enduring traits. A new present-state self-report measure, sensitive to changes in dissociative states, was therefore developed and psychometrically validated. Fifty-six items were formulated to measure state features, and sorted according to seven subscales: derealization, depersonalization, identity confusion, identity alteration, conversion, amnesia and hypermnesia. The State Scale of Dissociation (SSD) was administered with other psychiatric scales (DES, BDI, BAI, SCI-PANSS) to 130 participants with DSM-IV major depressive disorder schizophrenia, alcohol withdrawal, dissociative disorders and controls. In these sample populations, the SSD was demonstrated as a valid and reliable measure of changes in and the severity of dissociative states. Discriminant validity, content, concurrent, predictive, internal criterion-related, internal construct and convergent validities, and internal consistency and split-half reliability were confirmed statistically. Clinical observations of dissociative states, and their comorbidity with symptoms of depression and psychotic illness, were confirmed empirically. The SSD, an acceptable, valid and reliable scale measuring state features of dissociation at the time of completion, was obtained. This is a prerequisite for further investigation of correlations between changes in dissociative states and concurrent physiological parameters.

Adult↗

Axis I and II comorbidity and childhood trauma history in chemical dependency.

The authors replicated and extended two former studies on Axis I and II comorbidity and childhood trauma histories in 106 patients admitted to a chemical dependency treatment unit. Sixty-nine subjects reported a history of physical and/or sexual abuse during childhood and 26.4% met criteria for posttraumaic stress disorder. Patients who reported a history of childhood abuse showed more symptoms of depression, dissociation, and borderline personality disorder than those who denied childhood trauma. Dissociative disorders, mood and anxiety disorders, personality disorders, and histories of childhood trauma appear to be common in chemical dependency subjects, and should be inquired about routinely.

Adult↗

Cognition and belief in paranormal phenomena: gestalt/feature-intensive processing theory and tendencies toward ADHD, depression, and dissociation.

Belief in paranormal phenomena and cryptids--unknown animals such as Bigfoot--may predispose individuals to interpret real-world objects and events in the same way that eyewitness identification can be biased by unrelated information (P. James and N. Thorpe, 1999). Psychological tendencies toward attention deficit hyperactivity disorder (ADHD), dissociation, and depression, even at subclinical levels, may be associated systematically with particular paranormal or cryptozoological beliefs. The authors evaluated these psychological tendencies using the Conners Adult ADHD Rating Scales (C. K. Conners, D. Erhardt, and E. Sparrow, 1999), the Dissociative Experiences Scale (L. Coleman & J. Clark, 1999), and the Beck Depression Inventory-II (A. T. Beck, 1996). They performed regression analyses against beliefs in ghosts, unidentified flying objects (UFOs), extrasensory perception (ESP), astrology, and cryptids. ADHD, dissociation, and depression were associated with enhanced tendencies toward paranormal and cryptozoological beliefs, although participants who believed in each of the phenomena differed from one another in predictable and psychologically distinguishable ways. Cognitively biasing influences of preexisting psychological tendencies may predispose individuals to specific perceptual and cognitive errors during confrontation of real-world phenomena.

Adult↗

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↗

Relation of dissociative phenomena to levels of cerebrospinal fluid monoamine metabolites and beta-endorphin in patients with eating disorders: a pilot study.

Dissociation is made manifest by a failure to integrate thoughts, feelings, memories, and actions into a unified sense of consciousness. Although dissociation is presumed to be a special state of consciousness manifested by state-dependent memory and physiology, the psychobiology of dissociation is poorly understood. In this study, we examined cerebrospinal fluid levels of the major monoamine metabolites and beta-endorphin in patients with eating disorders (11 with anorexia nervosa, 16 with bulimia nervosa), while they were acutely ill. Dissociative capacity was measured using the Dissociative Experiences Scale (DES). We provide evidence that neurochemical changes in dopaminergic, serotonergic, and opioid systems may be associated with the clinical expression of dissociation in patients with eating disorders during the acute phase of their illness. These preliminary results are compatible with previous studies of neurochemical disturbances in the eating disorders and suggest that future work in dissociation should specifically include examination of these neurobiologic systems.

Adolescent↗

Attention-deficit disorder (attention-deficit/ hyperactivity disorder without hyperactivity): a neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity).

Most studies of attention-deficit/hyperactivity disorder (ADHD) have focused on the combined type and emphasized a core problem in response inhibition. It is proposed here that the core problem in the truly inattentive type of ADHD (not simply the subthreshold combined type) is in working memory. It is further proposed that laboratory measures, such as complex-span and dual-task dichotic listening tasks, can detect this. Children with the truly inattentive type of ADHD, rather than being distractible, may instead be easily bored, their problem being more in motivation (underarousal) than in inhibitory control. Much converging evidence points to a primary disturbance in the striatum (a frontal-striatal loop) in the combined type of ADHD. It is proposed here that the primary disturbance in truly inattentive-type ADHD (ADD) is in the cortex (a frontal-parietal loop). Finally, it is posited that these are not two different types of ADHD, but two different disorders with different cognitive and behavioral profiles, different patterns of comorbidities, different responses to medication, and different underlying neurobiologies.

Attention Deficit Disorder with Hyperactivity↗

Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques.

OBJECTIVE: Acute stress disorder permits an early identification of trauma survivors who are at risk of developing chronic posttraumatic stress disorder (PTSD). This study aimed to prevent PTSD by an early provision of cognitive behavior therapy. Specifically, this study indexed the relative efficacy of prolonged exposure and anxiety management in the treatment of acute stress disorder. METHOD: Forty-five civilian trauma survivors with acute stress disorder were given five sessions of 1) prolonged exposure (N = 14), 2) a combination of prolonged exposure and anxiety management (N = 15), or 3) supportive counseling (N = 16) within 2 weeks of their trauma. Forty-one trauma survivors were assessed at the 6-month follow-up. RESULTS: Fewer patients with prolonged exposure (14%, N = 2 of 14) and prolonged exposure plus anxiety management (20%, N = 3 of 15) than supportive counseling (56%, N = 9 of 16) met the criteria for PTSD after treatment. There were also fewer cases of PTSD in the prolonged exposure group (15%, N = 2 of 13) and the prolonged exposure plus anxiety management group (23%, N = 3 of 13) than in the supportive counseling group (67%, N = 10 of 15) 6 months after the trauma. Chronic PTSD in the supportive counseling condition was characterized by greater avoidance behaviors than in the prolonged exposure condition or the prolonged exposure plus anxiety management condition. CONCLUSIONS: These findings suggest that PTSD can be effectively prevented with an early provision of cognitive behavior therapy and that prolonged exposure may be the most critical component in the treatment of acute stress disorder.

Acute Disease↗