101
|
Dorahy MJ, van der Hart O. DSM-5's posttraumatic stress disorder with dissociative symptoms: challenges and future directions. J Trauma Dissociation 2015; 16:7-28. [PMID: 24983300 DOI: 10.1080/15299732.2014.908806] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, formally recognizes a dissociative subtype of posttraumatic stress disorder (PTSD; PTSD with dissociative symptoms). This nomenclative move will boost empirical and theoretical efforts to further understand the links between dissociation, trauma, and PTSD. This article examines the empirical literature showing that patients with PTSD can be divided into 2 different groups based on their neurobiology, psychological symptom profile, history of exposure to early relational trauma, and depersonalization/derealization symptoms. It then explores the conceptual and empirical challenges of conceiving 1 of these types as reflecting a "dissociative" type of PTSD. First, this classification is based on the presence of a limited subset of dissociative symptoms (i.e., depersonalization, derealization). This sets aside an array of positive and negative psychoform and somatoform dissociative symptoms that may be related to PTSD. Second, empirical evidence suggests heightened dissociation in PTSD compared to many other disorders, indicating that dissociation is relevant to PTSD more broadly rather than simply to the so-called dissociative subtype. This article sets out important issues to be examined in the future study of dissociation in PTSD, which needs to be informed by solid conceptual understandings of dissociation.
Collapse
Affiliation(s)
- Martin J Dorahy
- a Department of Psychology , University of Canterbury , Christchurch , New Zealand
| | | |
Collapse
|
102
|
Kerr IB, Finlayson-Short L, McCutcheon LK, Beard H, Chanen AM. The 'Self' and Borderline Personality Disorder: Conceptual and Clinical Considerations. Psychopathology 2015; 48:339-48. [PMID: 26346462 DOI: 10.1159/000438827] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/20/2015] [Indexed: 11/19/2022]
Abstract
Some concept of self has been used by many, although not all, researchers and clinicians as an 'organising construct' for borderline personality disorder (BPD). There is considerable variation in this usage and how clearly researchers have defined the self. Given this diversity, and that 'self' is often used interchangeably with parallel concepts (e.g., psyche, brain-mind, 'person') or with features of self (e.g., self-awareness, identity), unqualified use of the term is problematic. This is further complicated by the heterogeneity and 'comorbidity' of BPD and the limitations of syndromally based psychiatric nosology. Still, BPD remains in current classification systems and can be reliably diagnosed. A considerable body of research on self and BPD has accrued, including a recent profusion and confluence of neuroscientific and sociopsychological findings. These have generated supporting evidence for a supra-ordinate, functionally constituted entity of the self ranging over multiple, interacting levels from an unconscious, 'core' self, through to a reflective, phenotypic, 'idiographic' and relational self constituted by interpersonal and sociocultural experience. Important insights have been generated regarding emotional and social-cognitive dysregulation, disorder of self-awareness, relationality, identity, and coherence and continuity of the self. Many of these are shared by various trauma-related, dissociative disorders. A construct of the self could be useful as an explanatory principle in BPD, which could be construed as a 'self-state' (and relational) disorder, as opposed to a less severe disorder of aspects of the self (e.g., mood or memory). We offer a tentative description of 'Self' in this context, noting that any such construct will require a clear definition and to be evaluable.
Collapse
Affiliation(s)
- Ian B Kerr
- NHS Lanarkshire, Department of Psychotherapy, Coathill Hospital, Coatbridge, UK
| | | | | | | | | |
Collapse
|
103
|
Franzke I, Wabnitz P, Catani C. Dissociation as a mediator of the relationship between childhood trauma and nonsuicidal self-injury in females: a path analytic approach. J Trauma Dissociation 2015; 16:286-302. [PMID: 25761222 DOI: 10.1080/15299732.2015.989646] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
New theoretical models of nonsuicidal self-injury (NSSI) postulate that symptoms subsequent to childhood maltreatment rather than childhood maltreatment itself may lead to engagement in NSSI. However, little is known concerning which specific syndromes serve as underlying mechanisms. In this study we sought to examine the mediating effects of dissociative, posttraumatic, and depressive symptoms, 3 often comorbid syndromes following childhood trauma. In addition, we aimed to assess differences between women with and without NSSI. A sample of 87 female inpatients with a history of childhood abuse and neglect was divided into 2 subgroups (NSSI: n = 42, no NSSI: n = 45). The assessment included measures of NSSI characteristics; adverse childhood experiences; and posttraumatic, dissociative, and depressive symptoms. The NSSI group reported significantly more cases of childhood maltreatment and higher levels of current dissociative, posttraumatic, and depressive symptoms than patients without NSSI. The results of a path analysis showed that only dissociation mediated the relationship between a history of child maltreatment and NSSI when all 3 psychopathological variables were included in the model. The findings point toward a strong and rather specific association between dissociative experiences and NSSI and therefore have important implications for clinical practice.
Collapse
Affiliation(s)
- Iris Franzke
- a Evangelisches Krankenhaus Bielefeld , Clinic for Psychotherapeutic and Psychosomatic Medicine , Bielefeld , Germany
| | | | | |
Collapse
|
104
|
Stolovy T, Lev-Wiesel R, Eisikovits Z. Dissociation and the experience of channeling: narratives of Israeli women who practice channeling. Int J Clin Exp Hypn 2015; 63:346-64. [PMID: 25978086 DOI: 10.1080/00207144.2015.1031555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
"Channeling" is a phenomenon in which people describe themselves as receiving messages from another personality or dimension of reality. Channeling is often regarded as dissociation, which is a disruption in the usually integrated functions of consciousness, memory, identity, or perception. This study explored the interface between channeling and dissociation through a phenomenological analysis. Qualitative data were obtained through interviews with 20 Israeli women who practice channeling. The analysis revealed 3 themes: dissociation, absorption, and control. The channelers' descriptions correspond with what is coined as "dissociative states" and enable an emic view of the etic definition of dissociation.
Collapse
Affiliation(s)
- Tali Stolovy
- a Lev Hasharon Mental Health Center, Netanya, affiliated to Sackler Faculty of Medicine, Tel-Aviv University Israel
| | | | | |
Collapse
|
105
|
Ford JD, Gómez JM. The relationship of psychological trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-injury and suicidality: a review. J Trauma Dissociation 2015; 16:232-71. [PMID: 25758363 DOI: 10.1080/15299732.2015.989563] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.
Collapse
Affiliation(s)
- Julian D Ford
- a Department of Psychiatry , University of Connecticut School of Medicine , Farmington , Connecticut , USA
| | | |
Collapse
|
106
|
Jorba-Galdos L. Creativity and dissociation. Dance/movement therapy interventions for the treatment of compartmentalized dissociation. ARTS IN PSYCHOTHERAPY 2014. [DOI: 10.1016/j.aip.2014.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
107
|
de Graaff MC, Schut M, Verweij DE, Vermetten E, Giebels E. Emotional Reactions and Moral Judgment: The Effects of Morally Challenging Interactions in Military Operations. ETHICS & BEHAVIOR 2014. [DOI: 10.1080/10508422.2014.975815] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
108
|
Reinders AATS, Willemsen ATM, den Boer JA, Vos HPJ, Veltman DJ, Loewenstein RJ. Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: a PET study and neurobiological model. Psychiatry Res 2014; 223:236-43. [PMID: 24976633 DOI: 10.1016/j.pscychresns.2014.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 04/27/2014] [Accepted: 05/13/2014] [Indexed: 11/19/2022]
Abstract
Imaging studies in posttraumatic stress disorder (PTSD) have shown differing neural network patterns between hypo-aroused/dissociative and hyper-aroused subtypes. Since dissociative identity disorder (DID) involves different emotional states, this study tests whether DID fits aspects of the differing brain-activation patterns in PTSD. While brain activation was monitored using positron emission tomography, DID individuals (n=11) and matched DID-simulating healthy controls (n=16) underwent an autobiographic script-driven imagery paradigm in a hypo-aroused and a hyper-aroused identity state. Results were consistent with those previously found in the two PTSD subtypes for the rostral/dorsal anterior cingulate, the prefrontal cortex, and the amygdala and insula, respectively. Furthermore, the dissociative identity state uniquely activated the posterior association areas and the parahippocampal gyri, whereas the hyper-aroused identity state uniquely activated the caudate nucleus. Therefore, we proposed an extended PTSD-based neurobiological model for emotion modulation in DID: the hypo-aroused identity state activates the prefrontal cortex, cingulate, posterior association areas and parahippocampal gyri, thereby overmodulating emotion regulation; the hyper-aroused identity state activates the amygdala and insula as well as the dorsal striatum, thereby undermodulating emotion regulation. This confirms the notion that DID is related to PTSD as hypo-aroused and hyper-arousal states in DID and PTSD are similar.
Collapse
Affiliation(s)
- Antje A T S Reinders
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Antoon T M Willemsen
- Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Johan A den Boer
- Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Herry P J Vos
- Outpatient Department Addiction Clinic Groningen/Drenthe, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Richard J Loewenstein
- Sheppard Pratt Health System, Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| |
Collapse
|
109
|
Herkt D, Tumani V, Grön G, Kammer T, Hofmann A, Abler B. Facilitating access to emotions: neural signature of EMDR stimulation. PLoS One 2014; 9:e106350. [PMID: 25165974 PMCID: PMC4148424 DOI: 10.1371/journal.pone.0106350] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 08/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Eye Movement Desensitisation and Reprocessing (EMDR) is a method in psychotherapy effective in treating symptoms of posttraumatic stress disorder. The client attends to alternating bilateral visual, auditory or sensory stimulation while confronted with emotionally disturbing material. It is thought that the bilateral stimulation as a specific element of EMDR facilitates accessing and processing of negative material while presumably creating new associative links. We hypothesized that the putatively facilitated access should be reflected in increased activation of the amygdala upon bilateral EMDR stimulation even in healthy subjects. METHODS We investigated 22 healthy female university students (mean 23.5 years) with fMRI. Subjects were scanned while confronted with blocks of disgusting and neutral picture stimuli. One third of the blocks was presented without any additional stimulation, one third with bilateral simultaneous auditory stimulation, and one third with bilateral alternating auditory stimulation as used in EMDR. RESULTS Contrasting disgusting vs. neutral picture stimuli confirmed the expected robust effect of amygdala activation for all auditory stimulation conditions. The interaction analysis with the type of auditory stimulation revealed a specific increase in activation of the right amygdala for the bilateral alternating auditory stimulation. Activation of the left dorsolateral prefrontal cortex showed the opposite effect with decreased activation. CONCLUSIONS We demonstrate first time evidence for a putative neurobiological basis of the bilateral alternating stimulation as used in the EMDR method. The increase in limbic processing along with decreased frontal activation is in line with theoretical models of how bilateral alternating stimulation could help with therapeutic reintegration of information, and present findings may pave the way for future research on EMDR in the context of posttraumatic stress disorder.
Collapse
Affiliation(s)
- Deborah Herkt
- Department of Psychiatry, Ulm University, Ulm, Germany
| | - Visal Tumani
- Department of Psychiatry, Ulm University, Ulm, Germany
| | - Georg Grön
- Department of Psychiatry, Ulm University, Ulm, Germany
| | - Thomas Kammer
- Department of Psychiatry, Ulm University, Ulm, Germany
| | - Arne Hofmann
- EMDR-Institut Deutschland, Bergisch Gladbach, Germany
| | - Birgit Abler
- Department of Psychiatry, Ulm University, Ulm, Germany
| |
Collapse
|
110
|
Farina B, Speranza AM, Dittoni S, Gnoni V, Trentini C, Vergano CM, Liotti G, Brunetti R, Testani E, Della Marca G. Memories of attachment hamper EEG cortical connectivity in dissociative patients. Eur Arch Psychiatry Clin Neurosci 2014; 264:449-58. [PMID: 24121863 DOI: 10.1007/s00406-013-0461-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/30/2013] [Indexed: 11/24/2022]
Abstract
In this study, we evaluated cortical connectivity modifications by electroencephalography (EEG) lagged coherence analysis, in subjects with dissociative disorders and in controls, after retrieval of attachment memories. We asked thirteen patients with dissociative disorders and thirteen age- and sex-matched healthy controls to retrieve personal attachment-related autobiographical memories through adult attachment interviews (AAI). EEG was recorded in the closed eyes resting state before and after the AAI. EEG lagged coherence before and after AAI was compared in all subjects. In the control group, memories of attachment promoted a widespread increase in EEG connectivity, in particular in the high-frequency EEG bands. Compared to controls, dissociative patients did not show an increase in EEG connectivity after the AAI. Conclusions: These results shed light on the neurophysiology of the disintegrative effect of retrieval of traumatic attachment memories in dissociative patients.
Collapse
|
111
|
Ojserkis R, McKay D, Badour CL, Feldner MT, Arocho J, Dutton C. Alleviation of Moral Disgust, Shame, and Guilt in Posttraumatic Stress Reactions. Behav Modif 2014; 38:801-36. [DOI: 10.1177/0145445514543465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research suggests that moral disgust, shame, and guilt are present in posttraumatic psychopathology. However, it is unclear that these emotional states are responsive to empirically supported interventions for posttraumatic stress symptoms (PTSS). This study explored the relations among moral disgust, shame, guilt, and PTSS, and examined comprehensive distancing (CD) as a novel intervention for these emotional states in undergraduates with elevated PTSS. Participants were randomly assigned to use a CD or a cognitive challenge task in response to personalized scripts of a traumatic event. Both interventions were associated with decreases in disgust, moral disgust, shame, and guilt. Contrary to predictions, there were no significant differences between the exercises in the reduction of negative emotions. In addition, PTSS severity was correlated with trauma-related guilt as well as state guilt and shame, but not trait or state measures of disgust or moral disgust. This proof of concept project sets the stage for further research examining CD as an alternative or adjunctive intervention for posttraumatic stress reactions with strong features of moral disgust, shame, and guilt.
Collapse
Affiliation(s)
| | | | - Christal L. Badour
- University of Arkansas, Fayetteville, AR, USA
- Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Matthew T. Feldner
- University of Arkansas, Fayetteville, AR, USA
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | | |
Collapse
|
112
|
Tekoah SD, Harel-Shalev A. “Living in a movie” — Israeli women combatants in conflict zones. WOMENS STUDIES INTERNATIONAL FORUM 2014. [DOI: 10.1016/j.wsif.2014.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
113
|
Abstract
Psychological trauma can have devastating consequences on emotion regulatory capacities and lead to dissociative processes that provide subjective detachment from overwhelming emotional experience during and in the aftermath of trauma. Dissociation is a complex phenomenon that comprises a host of symptoms and factors, including depersonalization, derealization, time distortion, dissociative flashbacks, and alterations in the perception of the self. Dissociation occurs in up to two thirds of patients with borderline personality disorder (BPD). The neurobiology of traumatic dissociation has demonstrated a heterogeneity in posttraumatic stress symptoms that, over time, can result in different types of dysregulated emotional states. This review links the concepts of trauma and dissociation to BPD by illustrating different forms of emotional dysregulation and their clinical relevance to patients with BPD.
Collapse
Affiliation(s)
- Eric Vermetten
- Department Psychiatry, Leiden University Medical Center, Utrecht, The Netherlands,
| | | |
Collapse
|
114
|
van der Kruijs SJM, Bodde NMG, Carrette E, Lazeron RHC, Vonck KEJ, Boon PAJM, Langereis GR, Cluitmans PJM, Feijs LMG, Hofman PAM, Backes WH, Jansen JFA, Aldenkamp AP. Neurophysiological correlates of dissociative symptoms. J Neurol Neurosurg Psychiatry 2014; 85:174-9. [PMID: 23175855 DOI: 10.1136/jnnp-2012-302905] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Dissociation is a mental process with psychological and somatoform manifestations, which is closely related to hypnotic suggestibility and essentially shows the ability to obtain distance from reality. An increased tendency to dissociate is a frequently reported characteristic of patients with functional neurological symptoms and syndromes (FNSS), which account for a substantial part of all neurological admissions. This review aims to investigate what heart rate variability (HRV), EEG and neuroimaging data (MRI) reveal about the nature of dissociation and related conditions. METHODS Studies reporting HRV, EEG and neuroimaging data related to hypnosis, dissociation and FNSS were identified by searching the electronic databases Pubmed and ScienceDirect. RESULTS The majority of the identified studies concerned the physiological characteristics of hypnosis; relatively few investigations on dissociation related FNSS were identified. General findings were increased parasympathetic functioning during hypnosis (as measured by HRV), and lower HRV in patients with FNSS. The large variety of EEG and functional MRI investigations with diverse results challenges definite conclusions, but evidence suggests that subcortical as well as (pre)frontal regions serve emotion regulation in dissociative conditions. Functional connectivity analyses suggest the presence of altered brain networks in patients with FNSS, in which limbic areas have an increased influence on motor preparatory regions. CONCLUSIONS HRV, EEG and (functional) MRI are sensitive methods to detect physiological changes related to dissociation and dissociative disorders such as FNSS, and can possibly provide more information about their aetiology. The use of such measures could eventually provide biomarkers for earlier identification of patients at risk and appropriate treatment of dissociative conditions.
Collapse
|
115
|
Roberts NA, Reuber M. Alterations of consciousness in psychogenic nonepileptic seizures: emotion, emotion regulation and dissociation. Epilepsy Behav 2014; 30:43-9. [PMID: 24196398 DOI: 10.1016/j.yebeh.2013.09.035] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 09/26/2013] [Indexed: 11/19/2022]
Abstract
Impairment of consciousness and reduced self-control are key features of most psychogenic nonepileptic seizures (PNESs), although, compared with patients with epilepsy, those with PNESs demonstrate greater conscious awareness during their seizures. The neurobiological underpinnings of PNESs and of alterations of awareness associated with PNESs remain relatively unknown. We suggest that an understanding of conscious experiences and discrepancies between subjective impairment of consciousness and the lack of objectifiable neurobiological changes in PNESs may benefit from an examination of emotion processing, including understanding sensory, situational, and emotional triggers of PNESs; emotional and physiological changes during the attacks; and styles of emotional reactivity and regulatory capacity. We also suggest that in addition to the typical comparisons between patients with PNESs and those with epilepsy, studies of PNESs would benefit from the inclusion of comparison groups such as those with PTSD, dissociation, and other forms of psychopathology where dissociative and emotion regulatory mechanisms have been explored more fully. We conclude that current evidence and theory suggest that impairment of consciousness in PNESs is only "dissociative" in one subgroup of these seizures, when consciousness is suppressed as a collateral effect of the excessive inhibition of emotion processing. We propose that PNES behaviors and experiences of reduced control or awareness may also represent direct behavioral manifestation of overwhelming emotions, or that minor emotional fluctuations or relatively neutral stimuli may trigger PNESs through conditioning or other preconscious processes. Future studies exploring the neurobiological mechanisms underpinning PNESs are likely to be more fruitful if researchers bear in mind that it is unlikely that all PNESs result from the same processes in the brain.
Collapse
Affiliation(s)
- Nicole A Roberts
- School of Social and Behavioral Sciences, Arizona State University, Glendale, AZ, USA.
| | | |
Collapse
|
116
|
Pullin MA, Webster RA, Hanstock TL. Psychoform and somatoform dissociation in a clinical sample of Australian adolescents. J Trauma Dissociation 2014; 15:66-78. [PMID: 24377973 DOI: 10.1080/15299732.2013.828149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Psychoform dissociation has been researched more than somatoform dissociation. The Somatoform Dissociation Questionnaire (SDQ-20), a commonly used adult measure of somatoform dissociation, is increasingly being used with adolescents internationally. We compared psychoform and somatoform dissociation in a mixed clinical adolescent sample. A total of 71 adolescents (12-18 years old) attending Australian community mental health and counseling services completed the SDQ-20 and the Adolescent Dissociative Experiences Scale, a commonly used measure of adolescent psychoform dissociation. The participants' treating clinicians provided participants' demographic details and mental health diagnoses. We found that 41% of participants reported high levels of psychoform dissociation and 21% reported high levels of somatoform dissociation. Both dissociation types were positively correlated. Neither was significantly related to participants' age, gender, or mental health diagnoses. Participants with more than 1 Axis I mental health diagnosis had higher levels of somatoform dissociation than participants with only 1 or no Axis I mental health diagnosis. This study is the first to examine somatoform dissociation in Australian adolescents and enables initial international comparisons.
Collapse
Affiliation(s)
- Melanie A Pullin
- a School of Psychology , University of Newcastle , Callaghan , New South Wales , Australia
| | | | | |
Collapse
|
117
|
van der Hart O, Groenendijk M, Gonzalez A, Mosquera D, Solomon R. Dissociation of the Personality and EMDR Therapy in Complex Trauma-Related Disorders: Applications in Phases 2 and 3 Treatment. JOURNAL OF EMDR PRACTICE AND RESEARCH 2014. [DOI: 10.1891/1933-3196.8.1.33] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Eye movement desensitization and reprocessing (EMDR) psychotherapy can play a major role in phase-oriented treatment of complex trauma-related disorders. In terms of the theory of structural dissociation of the personality and its related psychology of action, a previous article described Phase 1 treatment—Stabilization, Symptom Reduction, and Skills Training—emphasizing the use of EMDR procedures in this phase. Phase 2 treatment mainly involves applications of EMDR processing in overcoming the phobia of traumatic memories and their subsequent integration. Phase 3 treatment focuses on further integration of the personality, which includes overcoming various phobias pertaining to adaptive functioning in daily life. This article emphasizes treatment approaches that assist therapists in incorporating EMDR protocols in Phases 2 and 3 of phase-oriented treatment without exceeding clients’ integrative capacity or window of tolerance.
Collapse
|
118
|
Bob P, Selesova P, Raboch J, Kukla L. 'Pseudoneurological' symptoms, dissociation and stress-related psychopathology in healthy young adults. BMC Psychiatry 2013; 13:149. [PMID: 23705894 PMCID: PMC3667100 DOI: 10.1186/1471-244x-13-149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 05/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Somatoform dissociation is a specific form of dissociation with somatic manifestations represented in the form of 'pseudoneurological' symptoms due to disturbances or alterations of normal integrated functions of consciousness, memory or identity mainly related to trauma and other psychological stressors. With respect to the distinction between psychological and somatoform manifestations of dissociation current data suggest a hypothesis to which extent mild manifestations of 'pseudoneurological' symptoms in healthy young population may be linked to stress-related psychopathological symptoms or whether these symptoms more likely could be attributed to unexplained somatic factors. METHODS With this aim we have assessed the relationship between somatoform dissociation and stress-related psychopathology (i.e. anxiety, depression, symptoms of traumatic stress, alexithymia) in a group of 250 healthy non-psychiatric and non-clinical young adults. RESULTS Results of this study show that the symptoms of somatoform dissociation are significantly linked to stress-related psychopathology. CONCLUSIONS Findings of this study show that the 'pseudoneurological' symptoms may be linked to stress-related psychopathological processes which indicate that also mild levels of stress may influence somatic feelings and may lead to various somatoform dissociative symptoms.
Collapse
Affiliation(s)
- Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress & Department of Psychiatry, First Faculty of Medicine of Charles University, Ke Karlovu 11, 128 00 Prague, Czech Republic.
| | - Petra Selesova
- Center for Neuropsychiatric Research of Traumatic Stress & Department of Psychiatry, First Faculty of Medicine of Charles University, Ke Karlovu 11, 128 00 Prague, Czech Republic
| | - Jiri Raboch
- Center for Neuropsychiatric Research of Traumatic Stress & Department of Psychiatry, First Faculty of Medicine of Charles University, Ke Karlovu 11, 128 00 Prague, Czech Republic
| | - Lubomir Kukla
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Brno, Czech Republic
| |
Collapse
|
119
|
Wabnitz P, Gast U, Catani C. Differences in trauma history and psychopathology between PTSD patients with and without co-occurring dissociative disorders. Eur J Psychotraumatol 2013; 4:21452. [PMID: 24298325 PMCID: PMC3842452 DOI: 10.3402/ejpt.v4i0.21452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The interplay between different types of potentially traumatizing events, posttraumatic symptoms, and the pathogenesis of PTSD or major dissociative disorders (DD) has been extensively studied during the last decade. However, the phenomenology and nosological classification of posttraumatic disorders is currently under debate. The current study was conducted to investigate differences between PTSD patients with and without co-occurring major DD with regard to general psychopathology, trauma history, and trauma-specific symptoms. METHODS Twenty-four inpatients were administered the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Mini-Structured Clinical Interview for DSM-IV Dissociative Disorders (MINI-SKID-D) to assess DD and PTSD. Additionally, participants completed questionnaires to assess general psychopathology and health status. RESULTS Symptom profiles and axis I comorbidity were similar in all patients. Traumatic experiences did not differ between the two groups, with both reporting high levels of childhood trauma. Only trauma-specific avoidance behavior and dissociative symptoms differed between groups. CONCLUSION Results support the view that PTSD and DD are affiliated disorders that could be classified within the same diagnostic category. Our results accord with a typological model of dissociation in which profound forms of dissociation are specific to DD and are accompanied with higher levels of trauma-specific avoidance in DD patients.
Collapse
Affiliation(s)
- Pascal Wabnitz
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | | | | |
Collapse
|
120
|
McDonald P, Bryant RA, Silove D, Creamer M, O'Donnell M, McFarlane AC. The expectancy of threat and peritraumatic dissociation. Eur J Psychotraumatol 2013; 4:21426. [PMID: 24363835 PMCID: PMC3864163 DOI: 10.3402/ejpt.v4i0.21426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/09/2013] [Accepted: 09/05/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Peritraumatic dissociation is one of the most critical acute responses to a traumatic experience, partly because it predicts subsequent posttraumatic stress disorder. Despite this, there is little understanding about the factors that influence peritraumatic dissociation. This study investigated the extent to which peritraumatic dissociation is predicted by the amount of perceived warning that participants had of the impact of the trauma. METHOD Randomized eligible admissions to four major trauma hospitals (N=243) were assessed during hospital admission with the Peritraumatic Dissociation Experiences Questionnaire (PDEQ) and the perceived warning that participants had before the trauma impact occurred. RESULTS Whereas female gender predicted both Awareness and Derealization subscale scores on the PDEQ, perceived warning also predicted scores on the Derealization subscale. CONCLUSIONS This finding suggests that the degree of anticipated threat may contribute to peritraumatic dissociation.
Collapse
Affiliation(s)
- Pamela McDonald
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
| | - Derrick Silove
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
| | - Mark Creamer
- Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Meaghan O'Donnell
- Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander C McFarlane
- Department of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
121
|
Dissociation of the Personality and EMDR Therapy in Complex Trauma-Related Disorders: Applications in the Stabilization Phase. JOURNAL OF EMDR PRACTICE AND RESEARCH 2013. [DOI: 10.1891/1933-3196.7.2.81] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As proposed in a previous article in this journal, eye movement desensitization and reprocessing (EMDR) clinicians treating clients with complex trauma-related disorders may benefit from knowing and applying the theory of structural dissociation of the personality (TSDP) and its accompanying psychology of action. TSDP postulates that dissociation of the personality is the main feature of traumatization and a wide range of trauma-related disorders from simple posttraumatic stress disorder (PTSD) to dissociative identity disorder (DID). The theory may help EMDR therapists to develop a comprehensive map for understanding the problems of clients with complex trauma-related disorders and to formulate and carry out a treatment plan. The expert consensus model in complex trauma is phase-oriented treatment in which a stabilization and preparation phase precedes the treatment of traumatic memories. This article focuses on the initial stabilization and preparatory phase, which is very important to safely and effectively use EMDR in treating complex trauma. Central themes are (a) working with maladaptive beliefs, (b) overcoming dissociative phobias, and © an extended application of resourcing.
Collapse
|
122
|
Gordon N. The dissociative bond. J Trauma Dissociation 2013; 14:11-24. [PMID: 23282044 DOI: 10.1080/15299732.2012.694595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Dissociation leaves a psychic void and a lingering sense of psychic absence. How do 2 people bond while they are both suffering from dissociation? The author explores the notion of a dissociative bond that occurs in the aftermath of trauma--a bond that holds at its core an understanding and shared detachment from the self. Such a bond is confined to unspoken terms that are established in the relational unconscious. The author proposes understanding the dissociative bond as a transitional space that may not lead to full integration of dissociated knowledge yet offers some healing. This is exemplified by R. Prince's (2009) clinical case study. A relational perspective is adopted, focusing on the intersubjective aspects of a dyadic relationship. In the dissociative bond, recognition of the need to experience mutual dissociation can accommodate a psychic state that yearns for relationship when the psyche cannot fully confront past wounds. Such a bond speaks to the need to reestablish a sense of human relatedness and connection when both parties in the relationship suffer from disconnection. This bond is bound to a silence that becomes both a means of protection against the horror of traumatic memory and a way to convey unspoken gestures toward the other.
Collapse
Affiliation(s)
- Nirit Gordon
- Trauma and Violence Transdisciplinary Studies, New York University, New York, NY, USA.
| |
Collapse
|
123
|
Affiliation(s)
- Julian D. Ford
- a Department of Psychiatry , University of Connecticut School of Medicine , Farmington , Connecticut , USA
| |
Collapse
|
124
|
Reinders AATS, Reinders AATS, Willemsen ATM, Vos HPJ, den Boer JA, Nijenhuis ERS. Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One 2012; 7:e39279. [PMID: 22768068 PMCID: PMC3387157 DOI: 10.1371/journal.pone.0039279] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/16/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Dissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion. METHODOLOGY/PRINCIPAL FINDINGS DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation. CONCLUSIONS/SIGNIFICANCE The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin.
Collapse
Affiliation(s)
- A A T S Reinders
- King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, United Kingdom.
| | | | | | | | | | | |
Collapse
|
125
|
Perona-Garcelán S, Carrascoso-López F, García-Montes JM, Ductor-Recuerda MJ, López Jiménez AM, Vallina-Fernández O, Pérez-Álvarez M, Gómez-Gómez MT. Dissociative experiences as mediators between childhood trauma and auditory hallucinations. J Trauma Stress 2012; 25:323-9. [PMID: 22589015 DOI: 10.1002/jts.21693] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of this work was to study the relationship between reported traumatic experiences in childhood and positive psychotic symptoms. We hypothesized that dissociative experiences were potential mediators between childhood trauma and hallucinations, but not delusions. The sample comprised 71 patients diagnosed with psychoses. They were assessed with the Dissociative Experiences Scale (DES-II; Carlson & Putnam, 1993), a questionnaire on trauma (TQ; Davidson, Hughes, & Blazer, 1990), and the Positive and Negative Syndrome Scale (PANSS; Kay, Opler, & Lindenmayer, 1988) delusions and hallucinations items. The results showed that childhood trauma was positively associated with the dissociation scale scores (r = .40) and also the hallucination (r = .36) and delusions scale scores (r = .32). Furthermore, it was demonstrated that the dissociation variable was a potential mediator between childhood trauma and hallucinations, but not between childhood trauma and delusions. Of the 3 DES-II factors, only depersonalization showed a mediating relationship between childhood trauma and hallucinations. The main conclusion is that the impact of childhood trauma on hallucinations may not simply be direct, but mediated by dissociative experiences, especially depersonalization. Clinical implications are also briefly discussed.
Collapse
Affiliation(s)
- Salvador Perona-Garcelán
- Virgen del Rocío Mental Health Rehabilitation Unit, Andalusian Health Services, Seville, Andalusia, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
126
|
|