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PubMed2005

[Dissociative disorders].

There are problems with dissociative and conversion disorders with respect to classification, diagnosis, and therapeutic strategies which can only be understood in the historic context of hysteria. Even current diagnostic systems such as the DSM-IV and ICD-10 differ in the classification of such disorders. High prevalence rates ranging from 3% in the general population to 30% in clinical samples underscore their clinical relevance, and traumatic experiences play a major role in the pathogenesis. High rates of comorbid psychiatric disorders, the tendency to chronicity, and concepts of somatization (particularly in patients with conversion disorders) complicate psychotherapeutic approaches. Depending on the treatment goals, both psychodynamic and cognitive-behavioral methods can be applied, supplemented by specific techniques from trauma therapy, e.g. EMDR.

Cognitive Behavioral Therapy↗
PubMed1986

Dissociated taste disorder.

Dissociated taste disorder is a special symptom occurring when only one or two taste qualities of the four primary taste are disturbed. Eleven % of all cases of taste disorders complain of this symptom. The subjects of this investigation were 46 patients due to be examined. We used our filter-paper disc method invented for clinical qualitative and quantitative gustometry by taste examination. True dissociated taste disorder was confirmed in 12 patients only with respect to sweetness. No dissociated taste disorder was found for the other types of taste. Sweetness differs from the other three primary tastes in that it is brought about by a protein acting as a receptor. In patients suffering from true dissociated taste disorders, the predominant cause of the condition is zinc deficiency. When zinc is not available in adequate quantities, the synthesis of the protein at the sweet-sensitive receptor site can no longer be achieved smoothly, and this may lead to the development of the complaint.

Aged↗
PubMed1995

A therapy group for mothers with dissociative disorders.

This paper describes the evolution of a therapy group for mothers with dissociative disorders. Although the group is for survivors of childhood trauma, its focus is on the present dilemmas of child rearing rather than on past traumas. It uses mothering as a common bond to improve parenting and interpersonal skills and to propel forward each member's individual therapy. The article summarizes the relevant literature, provides a rationale for such a group, and discusses the issues of cotherapy, combined therapy, group process, transference, countertransference, and thematic material.

Adult↗
PubMed1999

The tactical-integration model for the treatment of dissociative identity disorder and allied dissociative disorders.

The ebb and flow of the diagnosis of Dissociative Identity Disorder (DID) and other dissociative conditions has led to the evolution of theories and treatment modalities to resolve the fluctuating and ephemerous symptoms of these conditions. This paper summarizes the structured cognitive-behavioral-based treatment of dissociative disorders that will foster not only symptom relief but also an integration of the personalities and/or ego states into one mainstream of consciousness. This model of DID therapy is called the tactical integration model; it promotes proficiency over posttraumatic and dissociative symptoms, is collaborative and exploratory, and conveys a consistent message of empowerment to the patient.

Dissociative Identity Disorder↗
PubMed2006

Becoming one person: living with dissociative identity disorder.

Dissociative identity disorder is a rare diagnosis, although people currently with a diagnosis of psychosis may in fact be experiencing what is associated with the disorder. This article is co-authored by a nurse and a person who has lived with alters (multiple personalities) for nearly all of her life. Because of the rarity of the diagnosis, there is much misunderstanding and ignorance among lay people and mental health professionals. This article therefore clarifies historical and contemporary issues surrounding this particular mental health problem both through examining the literature and through narrative of the person's experience. Special attention is given to the reality of coping with the difficulties that dissociative identity disorder create.

Adaptation, Psychological↗
PubMed2006

Neural correlates of enhanced working-memory performance in dissociative disorder: a functional MRI study.

BACKGROUND: Memory functioning has been highlighted as a central issue in pathological dissociation. In non-pathological dissociation, evidence for enhanced working memory has been found, together with greater task-load related activity. So far, no imaging studies have investigated working memory in dissociative patients. METHOD: To assess working memory in dissociative patients functional magnetic resonance imaging was used during performance of a parametric, verbal working-memory task in patients with a dissociative disorder (n=16) and healthy controls (n=16). RESULTS: Imaging data showed that both groups activated brain regions typically involved in working memory, i.e. anterior, dorsolateral and ventrolateral prefrontal cortex (PFC), and parietal cortex. Dissociative patients showed more activation in these areas, particularly in the left anterior PFC, dorsolateral PFC and parietal cortex. In line with these findings, patients made fewer errors with increasing task load compared to controls, despite the fact that they felt more anxious and less concentrated during task performance. CONCLUSIONS: These results extend findings in non-pathological high dissociative individuals, suggesting that trait dissociation is associated with enhanced working-memory capacities. This may distinguish dissociative patients from patients with post-traumatic stress disorder, who are generally characterized by impaired working memory.

Adult↗
PubMed2006

Hypothalamic-pituitary-adrenal axis function in dissociative disorders, post-traumatic stress disorder, and healthy volunteers.

BACKGROUND: This study investigated basal and stress-induced hypothalamic-pituitary-adrenal (HPA)-axis alterations in dissociative disorders (DDs). METHODS: Forty-six subjects with DD without lifetime post-traumatic stress disorder (PTSD), 35 subjects with PTSD, and 58 healthy comparison (HC) subjects, free of current major depression, were studied as inpatients. After a 24-hour urine collection and hourly blood sampling for ambient cortisol determination, a low-dose dexamethasone suppression test was administered, followed by the Trier Social Stress Test. RESULTS: The DD group had significantly elevated urinary cortisol compared with the HC group, which was more pronounced in the absence of lifetime major depression, whereas the PTSD and HC groups did not differ. The DD group demonstrated significantly greater resistance to, and faster escape from, dexamethasone suppression compared with the HC group, whereas the PTSD and HC groups did not differ. The three groups did not differ in cortisol stress reactivity, but both psychiatric groups demonstrated a significant inverse correlation between dissociation severity and cortisol reactivity, after controlling for all other symptomatology. The PTSD subgroup with comorbid DD tended to have blunted stress reactivity compared with the HC group. CONCLUSIONS: The study demonstrates a distinct pattern of HPA-axis dysregulation in DDs, emphasizing the importance of further study of stress-response systems in dissociative psychopathology.

Adult↗
PubMed2006

Tracking scientific interest in the dissociative disorders: a study of scientific publication output 1984-2003.

OBJECTIVE: We attempted to track scientific interest in dissociative amnesia and dissociative identity disorder by estimating the annual output of publications regarding these entities over the last 20 years. METHODS: Using a standard medical index, PsycINFO, we counted the number of indexed publications involving dissociative amnesia and dissociative identity disorder listed for each year. We then compared these rates with those of well-established diagnoses such as anorexia nervosa, alcohol abuse, and schizophrenia. We also systematically reviewed all publications involving dissociative amnesia that appeared in 2003. RESULTS: Annual publications involving dissociative amnesia and dissociative identity disorder rose from low levels in the 1980's to a sharp peak in the mid 1990's, followed by an equally sharp decline to only about one quarter of their peak levels by 2002 and 2003. In contrast, all of the 25 comparison diagnoses in our survey showed constant or steadily rising publication rates; none showed the 'bubble' pattern of the dissociative disorders. Of the 34 papers involving dissociative amnesia identified by PsycINFO for 2003, 10 (32%) appeared skeptical of the validity of dissociative amnesia and/or recovered-memory therapy. Despite a detailed search using multiple medical indices and search terms, we could find only 13 explicit cases of individuals with dissociative amnesia worldwide in the 2003 literature. CONCLUSIONS: Dissociative amnesia and dissociative identity disorder have not generated consistent scientific interest over the years, but instead apparently enjoyed a brief period of fashion that now has waned. Overall, our observations suggest that these diagnostic entities presently do not command widespread scientific acceptance.

Amnesia↗
PubMed2000

The evolving standard of care in the practice of trauma and dissociative disorder therapy.

The standard of care for the delivery of mental health services has recently undergone a dramatic change spurred on by hundreds of lawsuits against therapists and by erupting controversies in the science of trauma and dissociative disorders. The nature of these changes and the forces that created them are discussed. Risk management suggestions are provided.

Disasters↗
PubMed1984

The Ganser syndrome: evidence suggesting its classification as a dissociative disorder.

The past and present nosology of Ganser's syndrome is discussed. The anomaly is defined as the presence of approximate answers with hallucinations, clouded sensorium, somatic conversion, and amnesia. The characteristic symptom of the syndrome, paralogia, is appreciated as an associated feature of Factitious Disorder with Psychological Symptoms. It is suggested that Ganser syndrome may be linked inappropriately with the concept of factitious illness. Two new cases of the Ganser syndrome are presented, and an additional forty-one case reports are reviewed. A high correlation between the presence of paralogia and amnesia is revealed, which suggests that paralogia and related psychological symptoms are better classified as associated features of Atypical Dissociative Disorder.

Adult↗
PubMed2003

Posttraumatic stress disorder, dissociation, and sexual abuse history in epileptic and nonepileptic seizure patients.

Rates of posttraumatic stress disorder (PTSD), dissociative symptoms, and childhood sexual abuse (CSA) are believed to be higher among patients with nonepileptic seizures (NES) than those with epileptic seizures (ES). However, women have higher rates of CSA and sexual assault than men. Comparisons of seizure type controlling for gender may produce different results. Data from an opportunity sample of 34 patients with ES and 17 with NES evaluated during or following phase 1 video-EEG monitoring demonstrated that patients with NES had statistically higher rates of PTSD and CSA and higher Dissociative Experiences Scale (DES) scores than patients with ES. No differences were found between women with NES and ES for histories of PTSD or CSA. Mean between-group DES score differences remained. Results indicated that PTSD, dissociation, and CSA may be common among women presenting to a tertiary epilepsy referral center for both ES and NES. Neither a positive history of CSA nor a history of PTSD was evidence against epilepsy.

Adult↗
PubMed1999

An overview of the psychotherapy of dissociative identity disorder.

Dissociative Identity Disorder (DID) is identified and studied with increasing frequency. However, the controversy that often surrounds DID can make it difficult to approach its treatment in a circumspect manner. This paper will provide an overview of DID treatment as it is practiced by those experienced and skilled in the treatment of this group of patients. The treatment of DID resembles the treatment of other traumatized populations in that it is stage-oriented, beginning with supportive and strengthening work. Various stances toward the treatment of DID are reviewed, and specific issues that arise in the psychotherapy of DID are addressed, such as pragmatic arrangements, informed consent, work with alters, and the use of specific techniques, such as hypnosis. The employment of therapeutic modalities and ancillary therapies is discussed. The heterogeneity of DID patients is reviewed, and the characteristics of three general groups of DID patients, high, intermediate, and low in both function and prognosis, are explored. Considerations in the matching of DID patients to either exploratory or supportive treatments are discussed, and observations are made about both trauma work and the supportive psychotherapy of DID.

Adaptation, Psychological↗