[Do childhood psychological trauma result in neurobiological changes in the adult brain?]

Since 1995 it is known that aversive and traumatic experiences in childhood, adolescence or adulthood correlate with measurable changes in the brain. Particularly, hippocampus-atrophies as well as reduction in amygdalae volumes have been investigated and documented. Furthermore, experiences of extreme form of early neglect have been associated with general reduction of brain volumes. Recent research documents neural correlates of dissociation.

Primitive processes, metaphor, and recognition in the treatment of traumatic loss

This paper explores how traumatic loss and emotional abuse ruptured a patient's symbolic process and shattered her experience of the reality of her self. In treatment, metaphoric investigation of physical processes of expulsion and incorporation led to a transformation of projective identification into the containment she sought. The therapist's ability to metabolize pain, shame, and the risks of incestuous merger re-experienced in the treatment grew out of his recognition of disturbing experiences of his own that she brought to life. Mutual recognition, linked to the therapist's reverie, was a key treatment factor as both patient and therapist changed.

Psychological consequences of sexual assault

Sexual violence is an important issue worldwide and can have long-lasting and devastating consequences. In this chapter, we outline the psychological reactions to serious sexual assault and rape, including development of post-traumatic stress disorder. Myths and stereotypes surrounding this subject, and their potential effect on the emotional response and legal situation, are discussed.

Peritraumatic and persistent dissociation as predictors of PTSD symptoms in a female cohort

Recent research has investigated peritraumatic and persistent dissociation as a possible predictive factor for posttraumatic stress disorder (PTSD). The current study aimed to add to this literature by examining dissociative responses in female assault survivors (N = 92 at initial assessment; n = 62 at follow-up). Dissociative symptoms experienced at 3 time points were assessed: peritraumatic dissociation (PD), persistent dissociation-initial (M = 28.2 days posttrauma) and follow-up (M = 224.9 days posttrauma), as well as initial and follow-up PTSD symptoms. We hypothesized that PD and persistent dissociative symptoms would predict chronic PTSD symptoms at the follow-up assessment with initial PTSD symptoms and assault type in the model. Hierarchical regression resulted in a significant model predicting 39% of the variance in follow-up PTSD symptom scores (p < .001). Both peritraumatic and follow-up persistent dissociative symptoms significantly and uniquely added to the variance explained in follow-up PTSD symptom score contributing 4% (p = .05) and 8% (p = .008) of the variance, respectively. Results support the predictive value of peritraumatic and persistent dissociative symptoms, and the findings suggest that persistent dissociation may contribute to the development and continuation of PTSD symptoms. We discuss the implications for assessment and possible treatment of PTSD as well as future directions.

[Crime-related amnesia: real or feigned?]

In the context of criminal forensic evaluations, experts are often confronted with the problem of offenders' claims of crime-related amnesia. Because of the far-reaching legal consequences of the expert opinion, the nature of the suspected memory disorder has to be investigated with special care and due consideration of differential diagnoses. While the diagnosis of organic amnesia is comparatively easy to make, the same is not true for dissociative amnesia. Despite existing theoretical explanations such as stress, peritraumatic dissociation or repression, to date there is no sound, scientifically based and empirically supported explanation for the occurrence of genuine, non-organic crime-related amnesia. In the criminal context of claimed amnesia, secondary gain is usually obvious; thus, possible malingering of memory loss has to be carefully investigated by the forensic expert. To test this hypothesis, the expert has to resort to methods based on a high methodological level. The diagnosis of dissociative amnesia cannot be made by mere exclusion of evidence for organic amnesia; instead, malingering has to be ruled out on an explicit basis.

Deliberate self-harm behavior among Italian young adults: correlations with clinical and nonclinical dimensions of personality

This study aims to explore rates of deliberate self-harm (DSH) behaviors and their psychological and psychopathological correlates within a sample of nonclinical young adults (N = 365; 63% women; M age = 23 ± 4.06). Participants completed the Deliberate Self-Harm Inventory and other self-report questionnaires assessing clinical (borderline personality, dissociative, and depersonalization traits) and nonclinical (body perception, behavioral inhibition and activation, cognitive emotional regulation, and the Big Five traits) dimensions of their personality. The rate of DSH in the present sample was 39%, comparable to that found in previous studies of young adults in other countries. Further, consistent with past research, DSH was found to be associated with clinical dimensions of personality pathology, including borderline personality and dissociative symptoms. Finally, results revealed an association between DSH and nonclinical dimensions of personality, including the behavioral activation dimension of fun-seeking, more negative body perception and lower body protection, the use of more nonadaptive cognitive strategies for regulating emotions, higher levels of openness to experience, and lower levels of emotional stability. This pattern of results is consistent with those found for other impulsive behaviors and impulse control disorders.

Dissociation mediates the relationship between childhood trauma and hallucination-proneness

BACKGROUND

It has been proposed that the relationship between childhood trauma and hallucinations can be explained by dissociative processes. The present study examined whether the effect of childhood trauma on hallucination-proneness is mediated by dissociative tendencies. In addition, the influence of dissociative symptoms on a cognitive process believed to underlie hallucinatory experiences (i.e. reality discrimination; the capacity to discriminate between internal and external cognitive events) was also investigated.

METHOD

Patients with schizophrenia spectrum disorders (n=45) and healthy controls (with no history of hallucinations; n=20) completed questionnaire measures of hallucination-proneness, dissociative tendencies and childhood trauma, as well as performing an auditory signal detection task.

RESULTS

Compared to both healthy and non-hallucinating clinical controls, hallucinating patients reported both significantly higher dissociative tendencies and childhood sexual abuse. Dissociation positively mediated the effect of childhood trauma on hallucination-proneness. This mediational role was particularly robust for sexual abuse over other types of trauma. Signal detection abnormalities were evident in hallucinating patients and patients with a history of hallucinations, but were not associated with pathological dissociative symptoms.

CONCLUSIONS

These results are consistent with dissociative accounts of the trauma-hallucinations link. Dissociation, however, does not affect reality discrimination. Future research should examine whether other cognitive processes associated with both dissociative states and hallucinations (e.g. deficits in cognitive inhibition) may explain the relationship between dissociation and hallucinatory experiences.

Dissociation and emotion regulation in borderline personality disorder

BACKGROUND

Although some evidence suggests that borderline personality disorder (BPD) is primarily a disorder of the emotion regulation system, findings remain inconsistent. One potential explanation for this is the moderating role of dissociation.

METHOD

In this study, 33 female subjects with BPD and 26 healthy controls (HC; matched by education level and nicotine intake) were presented idiographic aversive, standard unpleasant and neutral scripts. Modulation of startle reflex and electrodermal responses (skin conductance level; SCL) were measured during imagery of emotional and neutral scripts. Additionally, self-reports of emotional experience (valence and arousal) and present-state dissociation were assessed.

RESULTS

Patients with BPD showed elevated levels of dissociative experiences during testing. Present-state dissociation mediated group differences in SCL and startle response between the HC and BPD groups.

CONCLUSIONS

These results suggest that careful attention must be paid to the moderating effect of dissociative symptoms on the psychophysiological responses of BPD patients. Furthermore, the findings have important implications for the assessment and treatment of BPD, including the need to carefully assess BPD patients for dissociative symptoms and to incorporate the treatment of dissociation.

The role of impulsivity in the association between childhood trauma and dissociative psychopathology: mediation versus moderation

Previous studies on survivors of childhood trauma documented associations between psychological dysregulation, impulsivity, and both behavioral and emotional manifestations of distress. Yet, the mechanism that links these variables remains unclear. The current study aims to examine the pattern of relations between a history of child abuse, impulsivity and dissociation. More specifically, it examines whether impulsivity serves as a moderator or mediator in the association between childhood trauma and dissociation. Eighty-one inpatients from the acute wards of two psychiatric hospitals participated in this study. Data were collected by clinician-administered questionnaires. A highly significant linear hierarchical regression analysis revealed that both psychiatric comorbidity and childhood trauma made unique contributions to the variance of dissociation. Yet, the significant association between childhood trauma and dissociation decreased when impulsivity was entered into the regression model. Our findings suggest that impulsivity mediates the association between childhood trauma and dissociative psychopathology and imply that the identification and treatment of impulsivity could be a potentially valuable clinical target in individuals with dissociative disorders.

[Epidemiological and clinical characteristics of dissociative disorders and somatoform disorders in Burkina Faso]

OBJECTIVE

The aim of this study was to determine the epidemiological and clinical features of dissociative and somatoform disorders in the psychiatry department of the Centre Hospitalier Universitaire Yalgado Ouédraogo, in Burkina Faso.

METHOD

We carried out a retrospective and descriptive study over five years, from January 2003 to December 2007, of patients admitted in the psychiatric department for dissociative and somatoform disorders. The data were extracted from the medical notes and registers of consultation. After identification of the patients, the medical notes were exploited with a structured collect form for data on sociodemographic characteristics, life events and ICD-10 diagnoses. All the data were recorded by the same person. Data analysis was performed with Epi info 2007.

RESULTS

During a period of 5 years, 3967 patients were registered, 179 had the diagnosis of dissociative and somatoform disorders (3.65% of the admissions) and 145 were included in our study. The majority of the patients were followed as outpatients (71%). Women were more represented with a sex ratio of four women to one man. The majority of the patients were young with an average age of 30 and mostly single (57.9%). The majority of the patients had a low academic standard, in connection with young age of the population. A striking biographic event was found in the majority of the cases; essentially family difficulties and death. Neurological symptoms were the most frequent in 63% of the cases. According to ICD-1O, dissociative disorders were most frequent (65.6%). Depression was mainly associated in15 cases.

DISCUSSION

Dissociative disorders and somatoform disorders are frequent in our hospital; we must overcome the difficulties due to the complexity of the diagnosis and the cultural resistances to modern health care to determine the real prevalence of these disorders among the population in Burkina Faso.

Neurocognitive deficits in borderline personality disorder: implications for treatment

The cognitive dimension of Borderline Personality Disorder has received relatively little attention in the clinical literature and is poorly understood. This article illustrates how a range of cognitive problems including attention deficit disorder and learning disabilities may contribute to the cognitive disturbances identified in the disorder including dissociation, paranoia, all or nothing thinking, overvalued ideas, and denial and splitting. A review of relevant research supporting the presence of cognitive deficits is summarized along with a developmental pathway for the expression of the cognitive dimension. Clinical examples are provided. Recommendations for inclusion of assessment and treatment strategies that address cognitive deficits within a psychodynamically based psychotherapy are discussed.

[Faith vs. science: soul's possession or dissociative disorder? A case study]

The aim of this paper is to discuss the impact and significance of religious beliefs on the dissociation and somatization symptoms presented by a hospitalised female patient. A 16-year-old girl was hospitalised at the Developmental Age Psychiatry and Psychotherapy Clinical Ward (The Clinical PiPWR Ward) for observation; she had been referred from the Regional Acute Poisoning Centre where she had been admitted upon taking some medications. For two years she had been subjected to exorcisms due to "possession by the Evil". Religious convictions had been sustained and enhanced by the patient's parents as well as a local Catholic community. The observation and diagnosis at the PiPWR Clinical Ward revealed mixed dissociation and somatization disorders as well as an abnormally shaping personality. The presented case, on the basis of the clinical observation and the analysis of literature on the subject, led to the following conclusions: the emotional issues and the system of religious beliefs influenced the shape of symptomatology, enforced the functioning of immature defensive mechanisms and intensified the dissociation and somatization disorders in the patient. The diagnosed mental disorders require that the girl should undergo individual and family psychotherapy.

[Pain disorders in traumatized individuals - neurophysiology and clinical presentation]

This overview portrays the salient physiological mechanisms being involved in the clinical manifestation of chronic pain in traumatized patients. A «hypermnesia-hyperarousal-model» is purported to support the neurophysiologic plausibility of the trauma-pain-relationship. We discuss seven characteristic clinical pain entities which alone or in combination can be found in patients with a previous psychological trauma.

[Traditional and modern views of dissociation]

Dissociation is a failure to integrate aspects of identity, memory, perception, and consciousness. Dissociation is conceptualized as a dimensional process existing along a continuum from normal and relatively common dissociative experiences to severe and clinically relevant forms. There is a growing body of clinical and empirical evidence that dissociation may occur especially as a defense during trauma. In case of traumatic events dissociation considered as an attempt to maintain mental control just as physical control is lost. Dissociation can be either a symptom of some complex mental disorder or a distinct clinical entity categorized among dissociative and somatoform disorders in DSM-IV. The article describes the conceptual issues of dissociation and presents a new classification by Nijenhuis where the so-called somatoform dissociative symptoms are included as well in the list of dissociative symptoms. Finally, this paper summarizes the measures of dissociative phenomena and the cognitive-behavioral approaches of dissociation, and highlights the main features of the new structural dissociation model.

PTSD as a criminal defense: a review of case law

Posttraumatic stress disorder (PTSD) has been offered as a basis for criminal defenses, including insanity, unconsciousness, self-defense, diminished capacity, and sentencing mitigation. Examination of case law (e.g., appellate decisions) involving PTSD reveals that when offered as a criminal defense, PTSD has received mixed treatment in the judicial system. Courts have often recognized testimony about PTSD as scientifically reliable. In addition, PTSD has been recognized by appellate courts in U.S. jurisdictions as a valid basis for insanity, unconsciousness, and self-defense. However, the courts have not always found the presentation of PTSD testimony to be relevant, admissible, or compelling in such cases, particularly when expert testimony failed to show how PTSD met the standard for the given defense. In cases that did not meet the standard for one of the complete defenses, PTSD has been presented as a partial defense or mitigating circumstance, again with mixed success.

[Be in role. Examination of dissociative experiences of theatrical actors]

INTRODUCTION

In spite of the fact that acting makes great demands on the personality, there is lack of research dealing with the psychological status of actors. Resulted from their profession actors often experience dissociation, since absorption and changing of their identity is a routine task for them. They are acting on the stage, and they are acting in private.

METHOD

36 theatrical actors completed the DISQ-H version of the Dissociation Questionnaire measuring four subscales: Identity Confusion, Amnesia, Loss of Control and Absorption. In order to understand their experiences deeper, nine actors were interviewed. The sample consisted of 21 men and 15 women and their ages ranged from 23 to 60. Higher ages implied longer career as an actor, thus the youngest subject had been working for 2 years, while the oldest one had been working for 39 years.

RESULTS

DISQ-H total score results of the actors were significantly higher compared to the Hungarian standard scores. As we expected, the two non-pathological subscales (Loss of Control and Absorption) showed significant differences compared to the standard scores of the subscales. In the case of Identity Confusion subscale we found no significant differences, however the results indicate that the tendency observed emphasizes the importance of further research of this phenomenon.

CONCLUSION

To sum up, dissociative experiences proved to be important elements of acting.

Dissociation, PTSD, and substance abuse: an empirical study

Few studies have examined the relationship between posttraumatic stress disorder (PTSD), substance use disorder, and dissociation. We studied 77 women with current PTSD and substance dependence, classified into high- versus low-dissociation groups per the Dissociative Experiences Scale. They were compared on trauma- and substance-related symptoms, cognitions, coping skills, social adjustment, trauma history, psychiatric symptoms, and self-harm/suicidal behaviors. We found the high-dissociation group consistently more impaired than the low-dissociation group. Also, the sample overall evidenced relatively high levels of dissociation, indicating that even in the presence of recent substance use, dissociation remains a major psychological phenomenon. Indeed, the high-dissociation group reported stronger expectation that substances could manage their psychiatric symptoms. The high-dissociation group also had more trauma-related symptoms and childhood histories of emotional abuse and physical neglect. The discussion addresses methodology, the "chemical dissociation" hypothesis, and the need for a more nuanced understanding of how substances are experienced in relation to dissociative phenomena.

Motivated forgetting and misremembering: perspectives from betrayal trauma theory

Individuals are sometimes exposed to information that may endanger their well-being. In such cases, forgetting or misremembering may be adaptive. Childhood abuse perpetrated by a caregiver is an example. Betrayal trauma theory (BTT) proposes that the way in which events are processed and remembered will be related to the degree to which a negative event represents a betrayal by a trusted, needed other. Full awareness of such abuse may only increase the victim's risk by motivating withdrawal or confrontation with the perpetrator, thus risking a relationship vital to the victim's survival. In such situations, minimizing awareness of the betrayal trauma may be adaptive. BTT has implications for the larger memory and trauma field, particularly with regard to forgetting and misremembering events. This chapter reviews conceptual and empirical issues central to the literature on memory for trauma and BTT as well as identifies future research directions derived from BTT.

Jactatio corporis nocturna and dissociative disorder: a case report

Jactatio corporis nocturna is a type of parasomnia. Rhythmic body movements during sleep are commonly observed in infancy and early childhood, and spontaneous resolution is expected after the age of 4 years. Rarely, the body movements persist until adulthood. Rhythmic body movements characteristically occur during the wake-sleep transition period, rather than during other sleep stages. Some psychiatric diseases can co-occur with sleep-related movement disorders. A relationship between parasomnias and dissociative disorders has been recently reported. Herein we present a 33-year-old male with nocturnal repetitive rolling body movements and daytime fatigue. The patient also had loss of memory of some important events (such as the day his daughter underwent surgery), and reported that he sometimes confused reality with dreams had fantasies during which he experienced his spirit rising above to watch his body and fantasy. Detailed neuropsychological assessment showed that the patient also had a dissociative disorder. Video-polysomnographic recordings showed repetitive, rolling body movements that occurred only during rapid eye movement (REM) sleep.

Perceptual processing advantages for trauma-related visual cues in post-traumatic stress disorder

BACKGROUND

Intrusive re-experiencing in post-traumatic stress disorder (PTSD) comprises distressing sensory impressions from the trauma that seem to occur 'out of the blue'. A key question is how intrusions are triggered. One possibility is that PTSD is characterized by a processing advantage for stimuli that resemble those that accompanied the trauma, which would lead to increased detection of such cues in the environment.

METHOD

We used a blurred picture identification task in a cross-sectional (n=99) and a prospective study (n=221) of trauma survivors.

RESULTS

Participants with acute stress disorder (ASD) or PTSD, but not trauma survivors without these disorders, identified trauma-related pictures, but not general threat pictures, better than neutral pictures. There were no group differences in the rate of trauma-related answers to other picture categories. The relative processing advantage for trauma-related pictures correlated with re-experiencing and dissociation, and predicted PTSD at follow-up.

CONCLUSIONS

A perceptual processing bias for trauma-related stimuli may contribute to the involuntary triggering of intrusive trauma memories in PTSD.

Dissociation, trauma, and the role of lived experience: toward a new conceptualization of voice hearing

Voice hearing (VH) is often regarded as pathognomic for schizophrenia. The purpose of this article is to review and integrate historical, clinical, epidemiological, and phenomenological evidence in order to suggest that VH may be more appropriately understood as a dissociative rather than a psychotic phenomenon. First, we discuss the lifetime prevalence of VH in the general population, which is estimated to range between 1% and 16% for adult nonclinical populations and 2% and 41% in healthy adolescent samples. Second, we demonstrate how the ubiquity of VH phenomenology, including variables like voice location, content, and frequency, limits its diagnostic and prognostic utility for differentiating psychotic from trauma-spectrum and nonclinical populations. Finally, we report on the empirical associations between VH, measures of dissociation, and trauma particularly (though not exclusively) childhood sexual abuse. There are 2 main conclusions from this review. First, we argue that available evidence suggests that VH experiences, including those in the context of psychotic disorders, can be most appropriately understood as dissociated or disowned components of the self (or self-other relationships) that result from trauma, loss, or other interpersonal stressors. Second, we provide a rationale for clinicians to use psychotherapeutic methods for integrating life events as precipitating and/or maintaining factors for distressing voices. Potential mechanisms for the relationship between trauma, dissociation, VH, and clinical diagnosis are described, including the relevance of literature from the field of attachment in providing a diathesis for dissociation. Suggestions for future research are also discussed.

PTSD in children and adolescents: toward an empirically based algorithma

In considering potential revisions for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), describing developmental influences on symptomatic expression is a high priority. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Research conducted in the past 15 years is reviewed that pertains to expressions of posttraumatic stress disorder (PTSD) symptoms in preschool and school age children and in adolescents. This research has attempted to determine the usefulness of the DSM-IV criteria for PTSD in children and adolescents. Based on the studies of preschool children, evidence supports two sets of suggestions: first, we suggest that developmental manifestations are warranted in A-D criteria of PTSD; and second, we suggest that a developmental preschool PTSD subtype is warranted that lowers the C threshold from three to one symptom. For school-age children and young adolescents, the evidence is more limited. Nevertheless, there is also evidence suggesting that modifications in PTSD criteria A-D, including fewer Cluster C symptoms, may facilitate accurate diagnosis in this age group.

Peritraumatic dissociation and experiential avoidance as prospective predictors of posttraumatic stress symptoms

Peritraumatic dissociation (PD) and experiential avoidance (EA) have been implicated in the etiology of posttraumatic stress symptomatology (PTSS); however, the function of these two factors in the onset and maintenance of PTSS following a potentially traumatic event is unclear. The temporal relationships between EA, PD, and the four clusters of PTSS proposed by the Simms/Watson dysphoria model (Simms, Watson, & Doebbeling, 2002) were examined in a three-wave prospective investigation of 532 undergraduate women participating in an ongoing longitudinal study at the time of a campus shooting. Path analyses indicated that preshooting EA predicted greater PD, intrusions, and dysphoria symptoms approximately one month postshooting. PD was associated with increased symptomatology across all four clusters 1-month postshooting, while 1-month postshooting EA was associated with higher dysphoria and hyperarousal symptoms eight months postshooting. PD had a significant indirect effect on all four PTSS clusters eight months postshooting via 1-month postshooting symptom reports. The results suggest that both EA and PD show unique influences as risk factors for PTSS following a potentially traumatic event.

Acute panicogenic, anxiogenic and dissociative effects of carbon dioxide inhalation in patients with post-traumatic stress disorder (PTSD)

BACKGROUND

Increased anxiety and panic to inhalation of carbon dioxide (CO(2)) has been described in patients with anxiety disorders, especially panic disorder, compared to healthy subjects. Post-traumatic stress disorder (PTSD) has been hypothesised to resemble panic disorder and is currently classified as an anxiety disorder in DSM-IV. However, there are only very few data available about the sensitivity of patients with PTSD to CO(2).

METHODS

In 10 patients with PTSD, 10 sex- and age-matched healthy subjects and 8 patients with panic disorder we assessed anxiety, panic, dissociative and PTSD symptoms before and after a single vital capacity inhalation of 35% CO(2).

RESULTS

Patients with PTSD showed an increased anxiety, panic and dissociative reaction to the inhalation of 35% CO(2) compared to healthy participants. PTSD subjects' responses were indistinguishable from those of panic patients. Additionally, PTSD-typical symptoms like post-traumatic flashbacks were provoked in patients with PTSD after the inhalation of CO(2).

CONCLUSIONS

In our sample, PTSD was associated with an increased CO(2) reactivity, pointing to an increased susceptibility of PTSD patients to CO(2) challenge.

Can maltreated children inhibit true and false memories for emotional information?

The authors examined 284 maltreated and nonmaltreated children's (6- to 12-year-olds) ability to inhibit true and false memories for neutral and emotional information using the Deese/Roediger-McDermott (DRM) paradigm. Children studied either emotional or neutral DRM lists in a control condition or were given directed-remembering or directed-forgetting instructions. The findings indicated that children, regardless of age and maltreatment status, could inhibit the output of true and false emotional information, although they did so less effectively than when they were inhibiting the output of neutral material. Verbal IQ was related to memory, but dissociative symptoms were not related to children's recollective ability. These findings add to the growing literature that shows more similarities among, than differences between, maltreated and nonmaltreated children's basic memory processes.

Tandem hypnosis with identical bulimic twins: case report

Hypnosis has been used in the treatment of bulimia nervosa from the early 1980s. Dissociation theory identified a certain subgroup of eating disordered patients with dissociative signs and symptoms. These patients react well to hypnotherapy. Simultaneous hypnosis ("tandem hypnosis") in the treatment of two female 19-year-old monozygotic twins led to a very successful outcome after 6 sessions. During the therapy, attempts were made to work through the physical abuse the subjects suffered from their father. Hypnobehavioural methods were used and treatment was combined with five individual sessions. In the cases presented here, the subjects' traumatic history, their high hypnotic susceptibility, and the effectiveness of hypnotherapy seem to support the dissociative mechanism of symptom development. A systemic approach involving the integration of family therapeutical and hypnotherapeutical interventions proved to be useful. The role of these types of hypnotherapy interventions is still undervalued.

Solving crimes with hypnosis

Following a brief review of the literature on hypnosis and memory, this paper overviews the procedures that are used in conducting forensic hypnosis interviews. Ten forensic hypnosis cases are then described. These real world cases are in stark contrast to research done in an artificial laboratory setting where the information to be recalled lacks personal relevance and was not associated with emotionally arousing situations. These cases illustrate how forensic hypnosis can result in obtaining important additional investigative leads which lead to the solving of crimes.

[Significance of and considerations relating to the diagnosis of dissociation]

Dissociation involves a variety of clinical concepts, and some disorders are also similar to but not the same as dissociation. Dissociative disorder is considered to be a pathological phenomenon based on a psychological mechanism. Accurate diagnosis is very important to ensure that patients receive adequate treatment, although such consideration is not unique to dissociative disorder. Accordingly, there is a need to carefully distinguish dissociation from other disorders. In this article, we outline a number of dissociative and dissociative-like states from the symptoms of amnesia, depersonalization and switching. In particular, we highlight the differences between transient global amnesia and dissociative amnesia, and imaginary companions and dissociative alter personality. Additionally, as the symptoms of conditions such as dissociative amnesia and dissociative identity disorder are easily confused, we also made efforts to organize them.

[Differential diagnosis between dissociative disorders and schizophrenia]

The differential diagnosis of dissociative disorders includes many psychiatric disorders, such as schizophrenia, bipolar disorders (especially bipolar II disorder), depressive disorder (especially atypical depression), epilepsy, Asperger syndrome, and borderline personality disorder. The theme of this paper is the differential diagnosis between dissociative disorders and schizophrenia. Schneiderian first-rank symptoms in schizophrenia are common in dissociative disorders, especially in dissociative identity disorder (DID). Many DID patients have been misdiagnosed as schizophrenics and treated with neuroleptics. We compared and examined Schneiderian symptoms of schizophrenia and those of dissociative disorders from a structural viewpoint. In dissociative disorders, delusional perception and somatic passivity are not seen. "Lateness" and "Precedence of the Other" originated from the concept of "Pattern Reversal" (H. Yasunaga)" is characteristic of schizophrenia. It is important to check these basic structure of schizophrenia in subjective experiences in differential diagnosis between dissociative disorders and schizophrenia.

[Sleepiness predicts an increase in dissociative symptoms: a field study]

BACKGROUND

In laboratory studies, sleepiness has been found to increase dissociative symptoms.

AIM

To explore the link between sleepiness and dissociation in a natural setting.

METHOD

A longitudinal study was performed among volunteers at a pop festival. Information was collected via self-report scales at four successive test moments spread over a 12-hour period.

RESULTS

Sleepiness was the only variable that could predict the increase in dissociative symptoms. This result was not mediated by a deteriorated mood.

CONCLUSION

Our data suggest that sleepiness intensifies dissociative symptoms, even if it occurs outside a laboratory environment. Studies focusing on sleep normalisation may provide insights into new ways of treating dissociative symptoms.

[Dissociative disorder and self-injury]

Both the number of patients with dissociative disorder and that of those with self-injury have been increasing since the end of the twentieth century, suggesting that dissociation and self-injury might be closely related. When dissociative disorder coexists with self-injury, it implies self-punishment and a wish to be understood by others. Although many cases of self-injury observed since 2000 lacked traumatic experiences and were not accompanied by pathological dissociative symptoms, the patients did have dissociative tendencies. According to the results of our study examining self-injury in patients with eating disorders, we observed that self-injury, dissociative tendency and insulation from others are related to each other. This suggests that affects, sensations and representations are dissociated, losing their normal response order, and that the pervasive idea that "pain=secure" is formed in a patient from childhood based on influence from their parents. Self-injury appears to be an activation of this pervasive idea that is triggered by a stressful situation, when the dissociative psychological segmentation of effects and their representations are present in the background.

[Dissociative disorder--the concept and its history]

Dissociative disorder is both an old and a new mental disorder. Its forerunner, hysteria, was a poorly understood and often grossly misconceived notion that might date back as far as human societies existed, but it has been treated as a new disorder since it emerged in the DSM-III. A century ago, Sigmund Freud and Pierre Janet, two giants in the history of dynamic psychiatry, were deeply influenced by dissociative phenomena, and created their own theory of human mind with very different orientations. The reemergence of dissociative disorders in the current psychiatry has several implications. It helps clinicians understand mental conditions that they did not know how to define and classify based on the traditional psychiatry. It also allows clinicians to identify a population that was misdiagnosed with other diagnostic categories, such as borderline personality disorder and schizophrenia.

[Understanding dissociation in patients with borderline personality disorder]

Dissociation is a disturbing psychiatric concept fraught with controversy. It is however encountered in clinical contexts and has to be understood by clinicians. This article based on a Pubmed/Ovid on line research with key words dissociation and borderline personality disorder and other references, describes the clinical aspects of the dissociative phenomena in patients with borderline personality disorder. Psychodynamic hypotheses and neurophysiological data are examined to explain dissociation. Neurophysiological and neuroanatomical variables provided by cerebral imagery controlled studies support hypotheses brought forward. The article concludes with a defence mechanism developed within a context of biological predisposition, deprived psychological development and in reaction to trauma. In conclusion, emerging psychotherapeutic solutions are summarized.

Mood, dissociation and false memories using the Deese-Roediger-McDermott procedure

Who is likely to have a false memory? Does being in a certain transient state, such as a negative mood, mean that a person is more like to have a false memory? These important questions are examined using the Deese-Roediger-McDermott (DRM) procedure. The amount of false memories was compared with people's score on a dissociation measure and by mood. Unlike past research, which has used different procedures to explore false memories, we found that dissociation was not associated with false memories. We argue that this is because the DRM procedure requires two processes for a false memory (the generation of the critical lure and mistaking its source), while most false memory procedures only require one process (source monitoring error) because the errant information is suggested to the participant. This pattern of results suggests that only errors with the source monitoring process are associated with dissociation. We found that mood was related to false memories, but it was dependent on the specific task demands. If participants were told to recall as many words as they could, then people in a negative mood had more false memories. However, if they were told to recall as many words as they felt like recalling, then there were more false memories for people in a positive mood. This can be explained by the mood-as-input hypothesis. Results are discussed in relation to both theories and applications of memory.

Dissociational body experiences: Differences between respondents with and without prior out-of-body-experiences

Many people report having had an experience in which they felt as if their phenomenal self was separated in Cartesian space from their physical body. This phenomenon is often referred to as an 'out-of-body' (OBE) experience. Prior work has found OBE experients to score higher on measures of dissociation and to differ in regards to the perceptual experience of their body. Based upon this work, we theorized that the daily bodily experiences of people with and without a prior OBE would differ along a number of dimensions. In order to test this theory a questionnaire study was conducted. Of 243 respondents, 62 reported at least one prior OBE. Six scales on different aspects of bodily experience were administered. Respondents reporting a previous OBE were found to score significantly higher on measures of somatoform dissociation, self-consciousness, body dissatisfaction, and lower on a measure of confidence in their physical self-presentation than respondents without a previous OBE. The findings are discussed as supporting a dissociational theory of the OBE.

The role of panic in acute dissociative reactions following trauma

OBJECTIVE

'Peritraumatic dissociation' refers to alterations in awareness and memory for events that occur during and shortly after a traumatic experience. Despite the prevalence of reported peritraumatic dissociation, little is known about the mechanisms that mediate dissociative responses in the initial period after trauma. One theory suggests that peritraumatic dissociation may be a response to elevated arousal and panic symptoms during trauma. This study investigated panic symptoms that occurs at the time of the trauma and their relationship to ongoing dissociation in acute stress disorder.

DESIGN

A sample of traumatized people with acute stress disorder or controls were administered a range of psychopathology measures within one month of their trauma.

METHOD

Fifty-one civilian trauma survivors with either acute stress disorder or no acute stress disorder were administered the acute stress disorder interview, the Impact of Event Scale, the Beck Anxiety Inventory, the Peritraumatic Dissociative Experiences Questionnaire, and the Physical Reactions Scale to index panic reactions during the trauma.

RESULTS

Hierarchical regression analysis found that panic reactions during the trauma accounted for nearly half of the variance (47%) of peritraumatic dissociation, and subsequent stress reactions accounted for an additional 3% of the variance.

CONCLUSIONS

These findings are consistent with proposals that acute dissociation is associated with panic symptoms that occur during the traumatic experience. Possible mechanisms for the association of panic and dissociation are discussed.

Cognitive dysfunction, dissociation and quality of life in bipolar affective disorders in remission

BACKGROUND

Bipolar disorders are often associated with cognitive deficits, which have an influence on social functioning and the course of the illness. These deficits have an impact on occupational ability and social integration.

SUBJECTS AND METHODS

To ascertain cognitive function, level of dissociation and quality of life and their interrelations in patients with bipolar affective disorder in remission. Data from D2 Attention Test, Verbal Fluency Test and Trial Making Test, Dissociative Experiences Scale (DES). Quality of Life Satisfaction and Enjoyment (Q-LES-Q) and M.I.N.I. (MINI-international neuropsychiatric interview were statistically analyzed.

RESULTS

There are no significant correlations between applied cognitive tests and dissociation scale DES. There are no significant correlations between applied cognitive tests and dissociation scale DES. There were no differences between employed and unemployed patients in DES, pathological DES and in any of Q-.LES-Q domains.

CONCLUSIONS

We need further research to explore the role of cognitive functions and dissociation in bipolar affective disorder and its relationship to cognitive functions, emotional regulation, biological factors and therapy outcome.

Functional focal retrograde amnesia: Lost access to abstract autobiographical knowledge?

We describe three patients exhibiting an acute reversible amnesia characterised by an impaired recollection of past events with preserved anterograde memory, thus consistent with a focal retrograde amnesia (FRA). This occurred after variable events: state of fugue, road accident, post-traumatic headache. Retrograde amnesia affected autobiographical memory so severely as to cover all of the patients' lives and to erase knowledge of their own identity. The retrieval of public events was variably affected, ranging from normality to severe impairment. No lesions were found on neuroimaging, and neurophysiological findings were unimpressive. FRA subsided in a few days, leaving a gap for the onset. The hypothesis of a psychogenic amnesia is considered, but overcoming the organic/psychogenic dichotomy the episodes appear as examples of "functional" memory inhibition, potentially triggered by different conditions, including events classifiable as psychic trauma. The clinical and neuropsychological traits of functional FRA are discussed. According to a current theory of autobiographical memory, the memory profile may be explained by a lost access to abstract autobiographical knowledge. Given some analogies with the more common transient global amnesia, a mechanism of spreading depression may also be hypothesised for functional FRA.

Exploring posttraumatic stress disorder symptom profile among pregnant women

Posttraumatic stress disorder (PTSD) is more prevalent in perinatal than general samples of women (6-8% vs. 4-5%). To explore potential causes, we examined the symptom profiles of women belonging to two separate samples: a perinatal clinic sample (n = 1581) and a subsample of women in a similar age range from the U. S. National Women's Study (NWS) (n = 2000). Within the perinatal sample, risk ratios were higher for all 17 PTSD symptoms among women with current PTSD compared with unaffected women, suggesting that higher rates are not likely due to measurement error. The younger age and greater social disadvantage in the perinatal clinic sample contributed only a small proportion of variance in symptom levels compared with extent of trauma exposure and pre-existing PTSD. Compared with the national study sample's symptom profile, the perinatal sample had higher rates of occurrence of five symptoms: detachment, loss of interest, anger and irritability, trouble sleeping, and nightmares. This analysis confirms that PTSD rates are higher in perinatal samples, which is likely due to exacerbation of pre-existing PTSD among women of a younger age and greater social disadvantage. Further elucidation is warranted, including identifying triggers and determining if there are needs for pregnancy-specific interventions.

Pain and emotional processing in psychological trauma

Extreme psychological and physical traumas cause dramatic symptom patterns which are insufficiently described by the psychiatric diagnostic criteria of post traumatic stress disorders (PTSD). Additionally, due to the neurobiological proximity and similarity of processing mechanisms of physical and psychological pain stimulation and extremely negative emotions, the patients often suffer from persistent pains even after the somatic healing process is completed. Epidemiological studies confirm the joint occurrence of pain and PTSD. The close relationship and the etiological and behavioral similarities of both disorders have led to the development of joined vulnerability and mutual maintenance models. The particular suffering of patients with PTSD due to chronic pain necessitates pain-therapeutic interventions. On the other hand, in chronic pain patients, the etiological role of severe traumas should be considered.

[Appraisal of somatoform disorders]

The investigation of test persons with asserted physical discomfort lacking objectifiable causes or at least without adequate organic correlative confronts all participants with considerable problems. It involves showing an appreciation for the affected person's discomfort while at the same time seeking to ascertain the true picture of the complaint. It is also necessary to reject unjustified requests for care while giving appropriate consideration to specific features of the complaint. This is particularly difficult in such cases, as the situation is invariably blurred, frequently as a result of the interaction between expert and test person.

Childhood experiences of sexual abuse and later parenting practices among non-offending mothers of sexually abused and comparison girls

OBJECTIVE

The primary goal of this study was to explore the relationship between childhood sexual abuse and parenting practices among non-offending mothers of sexually abused girls. Guided by a developmental-ecological perspective of parenting, several models with different potential pathways starting from the mothers' childhood experiences of sexual abuse and culminating in their parenting practices (e.g., direct, spurious, indirect effect) were hypothesized and explored in the context of the mothers' past and current psychosocial risks and resources. Two dimensions of parenting were considered: providing positive structure (i.e., ratings of how consistent, fair, easygoing), and using punitive discipline.

METHODS

This study utilized a sample from a longitudinal, multigenerational study in which sexually abused girls, demographically similar comparison girls, and the mothers of both groups of girls participated. For the current study, the data regarding the mothers of the two groups of girls was of primary importance.

RESULTS

The results from a series of model comparison tests supported the spurious effect of mothers' childhood sexual abuse on the positive structure dimension. A direct, inverse relationship was found as the most accurate model with the punitive discipline dimension. Overall, childhood experience of punitive discipline, current dissociative symptoms, and satisfaction with social support were indicated as possible correlates of parenting practices among the mothers.

CONCLUSIONS

The significance of these findings is discussed in the context of theories concerning childhood trauma and parenting, as well as the intergenerational process of child maltreatment. Practice implications of the findings are also presented and discussed in terms of intervention programs for families where intrafamilial child sexual abuse occurs.

[Dissociative symptoms in patients with mood and anxiety disorders]

AIM

The objective of this study was to evaluate the occurrence of dissociative symptoms in outpatients affected by mood or anxiety disorder and their potential implication in general psychopathology and treatment response.

METHODS

The sample was recruited at Italian and Spanish psychiatric outpatient services. The sample consisted in 40 (13 Male, 27 Female) outpatients, 22 Italians (55%) and 18 Spanish (45%). Inclusion criteria were the Axis I diagnosis of any DSM-IV-TR mood or anxiety disorder and Clinical Global Impression/Global Severity Index (CGI) baseline scores > or = 3 and Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A) baseline scores > or = 18. General psychopathology, dissociative symptoms and personality traits were respectively assessed by the self-report symptom inventory Symptom Check-List 90 (SCL-90), the Dissociative Experience Scale (DES) and the Cloninger's Temperament and Character Inventory (TCI).

RESULTS

Dissociative symptoms emerged as relatively frequent in mood and anxiety disorders. Globally, depression symptoms seem to correlate positively with the dissociative experiences and the severity of global psychopathology. Dissociative symptoms seem to correlate positively with some personality traits and the severity of global psychopathology and should receive further investigation in clinical practice, as might be a predictor of poor response to conventional drug treatment.

Dissociation in eating disorders: relationship between dissociative experiences and binge-eating episodes

OBJECTIVE

Several findings support the hypothesis that there is a relationship between dissociation and eating disorders (EDs). The aims of this study were as follows: (1) to assess whether ED patients show a higher level of dissociation than healthy control (HC) individuals or psychiatric control patients with anxiety and mood disorders and (2) to investigate the effects of dissociation on ED symptoms, specifically binge eating behavior.

METHOD

Fifty-four ED patients, 56 anxiety and mood disorders control patients, and 39 HC individuals completed the Eating Disorder Examination Questionnaire and the Dissociation Questionnaire. Each participant was asked about the number of binge eating episodes he or she had experienced in the past 4 weeks.

RESULTS

The ED patients had higher levels of dissociation than both the psychiatric control group and the HC group. In the ED group, the number of binge episodes was related to the level of dissociation.

DISCUSSION

Dissociative experiences are relevant in EDs, and binge eating is related to dissociation. In patients affected by the core psychopathologic beliefs of EDs (overevaluation of shape and weight), dissociation may allow an individual to initiate binging behavior, thus decreasing self-awareness and negative emotional states, without having to deal with the long-term consequences of their actions.

Association between psychosomatic and traumatic symptoms in early adolescence

INTRODUCTION

This study investigates association between psychosomatic and traumatic symptoms among adolescents.

SUBJECTS AND METHODS

This cross-sectional survey using self-completion questionnaires was conducted among 868 adolescent in grade 6th, 7th and 8th of primary schools in Mostar (Bosnia and Herzegovina).

RESULTS

Psychosomatic symptoms are strongly associated with traumatic symptoms, with exception of symptom of anger. The association is the highest between anxiety, depression and PTS symptoms on the one side and cardiovascular symptoms on the other side.

CONCLUSION

According to our results, psychosomatic symptoms are strongly associated with psychosomatic symptoms in early adolescence.

[Disruptive nocturnal behavior in elderly subjects: could it be a parasomnia?]

Parasomnias are sleep-related abnormal behaviors. They are frequent and overlooked causes of nocturnal disruptive behavior in the elderly, especially when patients are cognitively impaired. Confusion and violence can result in sleep disruption, injuries for the patients or their bed partners, caregivers distress, and they can be a motive for institutionalization. Parasomnias include the NonREM sleep disorders of arousal (sleepwalking, sleep terrors, confusional arousals and sleep-related eating disorder), the REM sleep behavior disorder (RBD) and more rarely the parasomnia overlap syndrome, which associates both NREM and REM parasomnias. Patients with NREM sleep parasomnias are confused, eyes open, with a glazed look during their nocturnal behaviors, and they have a post-episode amnesia. They shout and bolt from the bed (night terrors), look about in a confused manner, walk and speak (sleepwalking), and eat peculiar or inedible food (sleep-related eating disorders). These behaviors, which are frequent in young adults, may be triggered by short-half live hypnotics in elderly. During the parasomnia, the brain is partially awake (enough to perform complex motor and verbal action), and partially asleep (without conscious awareness or responsibility). RBD is characterized by a loss of the normal muscle atonia that accompanies REM sleep. Patients have excessive motor activity such as punching, kicking, or crying out in association with dream content. RBD are frequent in Parkinson's disease and dementia with Lewy bodies and may precede the cognitive or motor symptoms of these diseases by 5 to 10 years. RBD can also be promoted by antidepressants. When combined with thorough clinical interviews, the video-polysomnography is a powerful tool, especially for discriminating the parasomnia from nocturnal frontal lobe epilepsy, sleep apneas and periodic leg movements. Ensuring safety and withdrawing deleterious treatments are useful in patients with violent activities, potential injurious or bothersome to other household members. Clonazepam and melatonin (3-12 mg) are highly effective for treating RBD.