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Results for “Dissociative Disorders”

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PubMed2006

Psychological trauma and fixed ideas in Pierre Janet's conception of dissociative disorders.

This article describes Janet's concept of psychological trauma and the formation of rigid thought complexes (fixed ideas). This concept forms the basis for Janet's functional nosology of the neuroses, and is related to his dynamic psychology of conduct or action. It can be viewed as an early self-regulation model, because it contains a stratified bio-, socio-, and psycho-genetic hierarchy of behavioral "tendencies" that produce a more or less adaptive act by means of two hypothesized intervening variables: psychological force and psychological tension. Fixed ideas are viewed within this framework as an outcome of deficient processes of adaptation to psychological trauma. The article closes by pointing out affinities between Janet's psychological concept and modern cognitive and behavioral therapies.

Affect↗
PubMed2002

[Prison psychosis and dissociative disorders].

Through a few clinical case histories stemming from their daily activities at the psychiatric section of the Lantin Prison, the authors propose to revisit the classic concept of Prison psychosis. They broaden its limits to include other psychotic and dissociative phenomena common to the jail population. This requires a strict differential diagnosis, allowing to eliminate some similar pathologies; nevertheless, some difficulties and imperfections persist. The development of the psychosis, the input from the jail architecture and milieu, the predisposing as well as facilitating factors linked to the personality of the inmate, and triggering phenomena are discussed. Finally, the comorbidity between these psychotic/dissociative phenomena and the borderline & histrionic personality disorders is envisaged.

Dissociative Disorders↗
PubMed1999

[Deficit of language comprehension in a child with semantic-pragmatic disorder--dissociation between the phonemic and semantic processing abilities].

We studied the language comprehension deficit of a 11-year-old child with a semantic-pragmatic disorder. We used an original test battery using abstract nouns common to the tasks of repetition, reading aloud, auditory comprehension and comprehension of written words. Although he could repeat and read aloud words as good as normal controls, he could not choose correct pictures from semantically or phonemically resembling pictures by listening to or reading target words. This test demonstrated the dissociation between his phonemic and semantic processing abilities. An examination of the cerebral blood flow with SPECT suggested that the dysfunction of the left temporal lobe caused the deficit in language comprehension.

Brain↗
PubMedDate not supplied

The wreathing protocol: the imbrication of hypnosis and EMDR in the treatment of dissociative identity disorder and other dissociative responses. Eye Movement Desensitization Reprocessing.

Dissociative Identity Disorder (DID), a chronic childhood onset posttraumatic stress disorder, is currently recognized as a treatable condition. It is considered the paradigmatic dissociative condition and carries with it extreme posttraumatic symptomatology. Therapists skilled in the treatment of DID are typically fluent in the uses of hypnosis for stabilization, affect management, building a safe place and grounding to name of few. EMDR, which has come to the forefront of clinical awareness in the last ten years, seems aptly suited for the treatment of trauma, but can be destabilizing. This paper proposes a protocol, called Wreathing Protocol, for the imbricated use of EMDR and hypnosis in the treatment of not only DID (though this will be the primary focus of the paper), but also Dissociative Disorder Not Otherwise Specified (DDNOS) and chronic Posttraumatic Stress Disorder (PTSD). This protocol is useful to advanced clinicians skilled in both modalities independently. The sequential steps of the Wreathing Protocol will be described and illustrated by a clinical vignette on DID. The clinical implications of the use of the Wreathing Protocol will be discussed in DID as well as the chronic post traumatic spectrum.

Adult↗
PubMed2005

Neurophysiological correlates of increased verbal working memory in high-dissociative participants: a functional MRI study.

BACKGROUND: Dissociation, defined as a disruption in usually integrated mental functions, is found not only in DSM-IV dissociative disorders, but also in post-traumatic stress disorder and eating disorders. Dissociative phenomena are also common in the general population, and may reflect a constitutionally determined cognitive style rather than a pathological trait acquired through experiencing adverse life events. In pathological dissociation, evidence has been presented for episodic memory dysfunction. In contrast, in high-dissociative subjects increased performance has been found for episodic memory and dual task performance. These findings have been linked to changes in working memory capacity. METHOD: In the present study, the authors sought to extend these findings by using functional magnetic resonance imaging during performance of two parametric working memory tasks. We tested 21 healthy low- and high-dissociative participants. RESULTS: High-dissociative participants performed slightly better during both tasks. Imaging data showed that both groups activated similar networks for both tasks, i.e. (bilateral) dorsolateral (DL) and ventrolateral prefrontal cortex (PFC), parietal cortex, and supplementary motor area. Group x task interactions were found in the high-dissociative group in L DLPFC and L parietal cortex; in the low-dissociative group in R fusiform gyrus. The differences in the high-dissociative group were independent from performance differences, implying that high-dissociative subjects generally recruit this network to a greater extent. CONCLUSIONS: These results confirm earlier findings using a verbal WM task in high-dissociative participants, and are compatible with the conceptualization of non-pathological dissociation as an information-processing style, characterized by distinct attentional and mnemonic abilities.

Adult↗
PubMed2005

[Psychiatric comorbidity in patients with pseudoseizures: retrospective study conducted in a video-EEG center].

INTRODUCTION: Pseudoseizures involve a group of paroxysmal behavioral symptoms mimicking an epileptic seizure, but without modifications of cerebral electrical activity. PATIENTS AND METHOD: In this retrospective study focusing on mental disorders, 37 patients with pseudoseizures were recorded during video-EEG procedure. RESULTS: According to DSM-IV criteria, 70 percent of the patients had at least one mental disorder when evaluated. Diagnoses were, in decreasing order of frequency: post-traumatic stress disorders, other anxious disorders, somatoform disorders, dissociative disorders, and mood disorders. CONCLUSION: The strong association between pseudoseizures and post-traumatic stress disorders is discussed. Our results argue in favor of a systematic evaluation of psychiatric comorbidity.

Adult↗
PubMed1999

Review of psychological issues in victims of domestic violence seen in emergency settings.

When a history of domestic violence is discovered during a universal screening in the emergency department, emergency staff typically feel ill equipped to address the underlying psychological, behavioral, and health problems of the victim. This article reviews the known characteristics of ongoing relationships in which one partner exerts coercive control over another, with emphasis on the effects of abuse on the victim's physical and mental health. These effects include actual injury, multiple stress-related physical conditions, substance abuse, and a variety of psychiatric problems, including depression, anxiety and anxiety disorders, dissociation and dissociative disorders, and post-traumatic stress disorder. A patient-centered approach allows emergency response staff to tailor intervention to victims' real and perceived needs, fulfilling their professional obligation to provide meaningful help to female victims of domestic violence seen in emergency settings.

Adaptation, Psychological↗
PubMed1999

Similarities and differences between incestuous and nonincestuous rape in a French follow-up study.

Clinicians are familiar with the life and psychological difficulties of incest victims, but their observations often are refuted as being retrospective and unsystematic. We aimed to ascertain similarities and differences between incestuous rape and nonincestuous rape. One hundred and two victims consulting a French forensic center were interviewed in a systematic follow-up study over 6 months using structured interview schedules. Stepwise logistic regression analysis adjusted for age, gender, and characteristics of the trauma showed that posttraumatic stress disorder, dissociative disorders, agoraphobia, and low self-esteem were overrepresented in the incest-rape group compared to the nonincest-rape group.

Adolescent↗
PubMed2005

Abnormal regional cerebral blood flow in systemic lupus erythematosus patients with psychiatric symptoms.

OBJECTIVE: Single-photon emission computed tomography (SPECT) studies have demonstrated decreased regional cerebral blood flow (rCBF) in systemic lupus erythematosus (SLE) patients. However, no study has done voxel-based analysis using statistical parametric mapping (SPM) that can evaluate rCBF objectively, and the relationship between rCBF and psychiatric symptoms has not been well investigated. Using L,L-ethyl cysteinate dimer (99mTc ECD) SPECT and SPM, we aimed to clarify the association of rCBF changes with psychiatric symptoms in SLE patients whose magnetic resonance imaging (MRI) showed no morphological abnormalities. METHOD: Twenty SLE patients and 19 healthy volunteers underwent 99mTc ECD SPECT. Data were collected from August 2000 to March 2003. SLE was diagnosed according to American College of Rheumatology criteria, and psychiatric symptoms were diagnosed according to ICD-10 criteria. On the basis of the modified Carbotte, Denburg, and Denburg method, the patients were classified into 3 groups: a group with major psychiatric symptoms (hallucinosis, delusional disorder, and mood disorder), a group with minor psychiatric symptoms (anxiety disorder, dissociative disorder, and emotionally labile disorder), and a group without psychiatric symptoms. Gross organic lesions were ruled out by brain MRI. Group comparisons of rCBF were performed with analysis using SPM99. RESULTS: SLE patients without MRI lesions showed decreased rCBF in the posterior cingulate gyrus and thalamus. The reduction in rCBF was overt in patients with major psychiatric symptoms. CONCLUSION: Our study indicated that SLE patients may have dysfunction in the posterior cingulate gyrus and thalamus and that this may be associated with the severity of psychiatric symptoms.

Adolescent↗
PubMed1991

[Sexual child abuse: definition, prevalence and sequelae].

This review focuses on two aspects of research on sexual child abuse during the last ten years, namely prevalence and long-term effects. Differing results for prevalence (6-62% for female subjects) have been found depending on the concept of sexual child abuse (incest vs. extra-familial child sexual abuse, child sexual abuse with or without physical contact, child sexual abuse with or without violence and sexual actions between adults and children) and depending on the method, and features of the subject. Long-term effects are complex (affective, somatic, eating and sleeping disorders, dissociations, disorders in interpersonal relationships, problems in sexuality and social functioning). The main syndrome seems to be a pattern of affective disorders.

Adaptation, Psychological↗
PubMed2000

Dissociative Spectrum Disorders in the Primary Care Setting.

Dissociative disorders have a lifetime prevalence of about 10%. Dissociative symptoms may occur in acute stress disorder, posttraumatic stress disorder, somatization disorder, substance abuse, trance and possession trance, Ganser's syndrome, and dissociative identity disorder, as well as in mood disorders, psychoses, and personality disorders. Dissociative symptoms and disorders are observed frequently among patients attending our rural South Carolina community mental health center. Given the prevalence of mental illness in primary care settings and the diagnostic difficulties encountered with dissociative disorders, such illness may be undiagnosed or misdiagnosed in primary care settings. We developed an intervention model that may be applicable to primary care settings or helpful to primary care physicians. Key points of the intervention are identification of dissociative symptoms, patient and family education, review of the origin of the symptoms as a method of coping with trauma, and supportive reinforcement of cognitive and relaxation skills during follow-up visits. Symptom recognition, Education of the family, Learning new skills, and Follow-up may be remembered by the mnemonic device SELF. We present several cases to illustrate dissociative symptoms and our intervention. Physicians and other professionals using the 4 steps and behavioral approaches will be able to better recognize and triage patients with dissociative symptoms. Behaviors previously thought to be secondary to psychosis or personality disorders may be seen in a new frame of reference, strengthening the therapeutic alliance while reducing distress and acting-out behaviors.

Journal Article↗
PubMed1997

Two-year follow-up of inpatients with dissociative identity disorder.

OBJECTIVE: A group of 135 inpatients with dissociative identity disorder was followed for 2 years to monitor treatment outcome. METHOD: Fifty-four of the patients were located and reassessed after a 2-year period through the use of the same self-report measures and structured clinical interviews that had been initially administered. RESULTS: The patients showed marked improvement on Schneiderian first-rank symptoms, mood and anxiety disorders, dissociative symptoms, and somatization, with a significant decrease in the number of psychiatric medications prescribed. Patients who were treated to integration were significantly more improved than those who had not yet reached integration. CONCLUSIONS: These findings, although preliminary, provide empirical validation of previous clinical impressions that patients with dissociative identity disorder may respond well to treatment.

Adult↗
PubMed1998

ECT in dissociative identity disorder and comorbid depression.

Dissociative identity disorder (DID), previously named multiple personality disorder, is a diagnosis often complicated by comorbid major depression. We report on four cases of DID associated with severe self-destructive behavior and comorbid major depression treated with electroconvulsive therapy (ECT). In three of the patients, ECT appeared to be helpful in treating the comorbid depression without adversely affecting the DID. The potential risks of using ECT in patients with DID are reviewed.

Adult↗
PubMed2005

Transfer of newly acquired stimulus valence between identities in dissociative identity disorder (DID).

Patients with Dissociative Identity Disorder (DID) frequently report episodes of interidentity amnesia, that is amnesia for events experienced by other identities. The goal of the present experiment was to test the implicit transfer of trauma-related information between identities in DID. We hypothesized that whereas declarative information may transfer from one identity to another, the emotional connotation of the memory may be dissociated, especially in the case of negative, trauma-related emotional valence. An evaluative conditioning procedure was combined with an affective priming procedure, both performed by different identities. In the evaluative conditioning procedure, previously neutral stimuli come to refer to a negative or positive connotation. The affective priming procedure was used to test the transfer of this acquired valence to an identity reporting interidentity amnesia. Results indicated activation of stimulus valence in the affective priming task, that is transfer of emotional material between identities.

Amnesia↗