The relationship between characteristics of sexual abuse and dissociative experiences

The impact of sexual abuse on psychopathology of patients with psychogenic nonepileptic seizures

OBJECTIVES

In the present study, we evaluated if the presence of sexual abuse in the clinical history of patients with psychogenic non-epileptic seizures (PNES) is associated with a different psychopathological profile.

MATERIALS AND METHODS

In a consecutive population of 63 PNES patients, we compared two demographically and clinically matched groups of patients with (no. 15) and without (no. 48) a history of sexual abuse using a comprehensive psychopathological assessment (Beck Depression Inventory, Hamilton Anxiety Rating Scale, Dissociative Experience Scale, Somatoform Dissociation Questionnaire, and Toronto Alexithymia Scale).

RESULTS

We found that the group of patients reporting sexual abuse is characterized by higher scores on Dissociative Experience Scale (p = 0.003) and Beck Depression Inventory (p = 0.001) with respect to the other group. No significant statistical differences in Hamilton Anxiety Rating Scale (p = 0.103), Toronto Alexithymia Scale (p = 0.137), and Somatoform Dissociation Questionnaire (p = 0.486) were captured. Moreover, we found that the negative effect on dissociate symptoms was also hampered by the increasing of seizure frequency.

CONCLUSIONS

This study reinforces the importance of traumatic screening in the clinical spectrum of PNES in order to implement and improve specific therapeutic strategies.

A Systematic Review of Dissociation in Female Sex Workers

We analyze the empirical evidence for the association between the occurrence of dissociation and acting as a female sex worker (FSW). The ten screened databases included original research papers looking at the association between various abusive relationships and dissociation. From the initial 5942 records, we screened 554 full-text articles from which eleven studies met the inclusion criteria. Dissociation was mainly described as a strategy to cope with work related experiences, persisting from an early age in cases affected by childhood sexual abuse (CSA). Only one study investigated the occurrence of dissociative disorders. The other studies showed that the FSW population frequently exhibits dissociative symptoms. Most study participants were street FSW characterized by high rates of revictimization, a history of childhood sexual abuse, and of trauma-related and substance use disorders. Due to the selectivity of the study samples, conclusions cannot be generalized. Our findings disclose an important research gap. Further research on mental health among FSW should cover all fields of the sex industry in order to understand the roots of sex work (SW) and its sequelae. This could help develop and implement targeted interventions.

How do men with severe sexual and physical childhood traumatization experience trauma-stabilizing group treatment? A qualitative study

Background: Exposure to potentially traumatizing events, defined as events involving actual or threatened death or serious injury, is associated with an elevated risk of developing enduring physical, psychological and social problems. Complex post-traumatic stress disorder (PTSD) is a disorder that can occur after prolonged and repeated trauma. At least 30% of the sexually abused population is male, but in spite of this fact, treatment research focusing on male victims is virtually non-existent in comparison to research on female victims. Objective: Trauma-stabilizing group treatment is an increasingly used treatment method for patients with complex PTSD. The aim of the present study was to explore how men participating in a gender-specific trauma-stabilizing intervention experience this treatment approach. Methods: Five men who participated in a trauma-stabilizing group treatment were interviewed with a semi-structured qualitative interview. The data were analysed using interpretative phenomenological analysis. Results: The analysis revealed five main themes. The themes highlight the experiences of the participants and describe positive and negative experiences: (1) Group atmosphere, comprising safety, community, emotional openness, anxiety and pressure; (2) Learning, categorized into knowledge and self-understanding; (3) Motivation, which describes both inner and outer motivation; (4) Structure, comprising structure of the meetings, group size and duration of the meetings; and (5) Gender, defined as the experiences of being in an all-male group with female group leaders. Conclusions: There seem to be a lot of advantages to inviting men to attend gender-specific groups for trauma-stabilizing treatment. The men emphasized the support they received and that participating in a mixed-gender group would have been more difficult. In the future, it may be important to arrange all-male stabilization groups with more focus on male-specific topics.

Sexual Contact in Childhood, Revictimization, and Lifetime Sexual and Psychological Outcomes

Using data from the 2010 to 2011 wave of the National Social Life, Health, and Aging Project-a nationally representative probability sample of older U.S. adults-this study queried distinctive linkages of mild and of severe childhood sexual contact with lifetime sexual and psychological outcomes among women and men aged 60-99 years (N = 3283). In addition, we examined stratification of these associations by sexual revictimization (forced sex and/or harassment). Among women, sequelae of childhood contact seemed consistently negative for the mild rather than severe variant-but only in the co-presence of revictimization-a pattern that may have remained obscured in previous analysis of event effects. Men's results suggested lifelong eroticizing but not psychological effects of this early experience-with the co-presence of revictimization potentially enhancing rather than lowering their mental health. Overall, findings appeared to reflect gendered patterns of risk-with mild childhood contact potentially channeling women but not men into revictimization and finally to elevated sexuality and poor mental health in late life. Early sexual experiences should thus be conceptualized not as singular events, but as part of a lifelong career with regularities and rhythms that may influence their pathogenic potential.

Dissociative fugue symptoms in a 28-year-old male Nigerian medical student: a case report

Introduction

Dissociative fugue is a psychiatric disorder characterized by amnesia coupled with sudden unexpected travel away from the individual’s usual surroundings and denial of all memory of his or her whereabouts during the period of wandering. Dissociative fugue is a rare disorder that is infrequently reported. Before now, no case of it had been reported in a medical student.

Case presentation

This article focuses on the report of a case of dissociative fugue symptoms in a 28-year-old male Nigerian medical student.

Conclusion

The observation in this case report brings to the fore that dissociative fugue is often related to stressful life events and can comorbid with a depressive disorder.

Dissociative and psychotic experiences of adolescents admitted to a psychiatric inpatient unit

A positive correlation between the incidences of dissociative and psychotic experiences has been consistently reported in a variety of adult populations. The present study was a preliminary investigation of the association between dissociative and psychotic experiences in adolescents requiring inpatient mental health care. No previous research has investigated this relationship in an adolescent cohort. Adolescents currently under inpatient care (n = 18) completed questionnaires assessing their experience of dissociative and psychotic phenomena. In line with previous research, a significant positive correlation was found between dissociative and psychotic experiences that remained highly significant once similarities between measures were taken into account. Recognizing the relationship between psychotic and dissociative experiences may be important in developing appropriate and effective treatment for young people experiencing mental health difficulties. Although the study is cross-sectional in nature and has a small sample, the results offer further evidence of the robust relationship between dissociative and psychotic experiences.

Dissociative experiences during sexual behavior among a sample of adults living with HIV infection and a history of childhood sexual abuse

Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of dissociative experiences during sexual behavior. Predictor variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses of posttraumatic stress disorder (PTSD) and dissociative disorders, rape by an intimate partner, duration of CSA, number of perpetrators of CSA, and current sexual satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, dissociative disorders, rape by an intimate partner, duration of CSA, and number of perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA.

Teaching Chinese psychiatrists to make reliable dissociative disorder diagnoses

The aim of the study was to assess the outcome of an educational effort by two North American experts in dissociative disorders to teach Chinese psychiatrists to make reliable dissociative disorder diagnoses. In the final phase of the educational effort, 569 patients at Shanghai Mental Health Center completed the Chinese version of the Dissociative Experiences Scale (DES). Patients were then randomly selected in different proportions according to their DES scores: 96 selected patients were then assessed with the Dissociative Disorders Interview Schedule (DDIS) and clinical diagnostic interviews based on DSM-IV criteria. According to the clinical diagnostic interviews, 28 (4.9%) patients were diagnosed as having dissociative disorders. Agreement between the American experts and Chinese psychiatrists for presence or absence of a dissociative disorder was 0.75 using Cohen's kappa. Dissociative disorders can be diagnosed in China with good inter-rater reliability. The authors describe the steps taken to achieve this outcome.

The relationship between childhood abuse and dissociation. Is it influenced by catechol-O-methyltransferase (COMT) activity?

Dissociation is a failure of perceptual, memorial and emotional integration that is associated with a variety of psychiatric disorders. Dissociative processes are usually attributed to the sequelae of childhood trauma although there are data to suggest that genetic influences are also important. Bipolar disorder (BD), a condition with a strong genetic basis, has also been associated with early psychological trauma. Since childhood trauma is a risk factor for both BD and dissociation, we tested for potential gene-childhood abuse interactions on dissociation in a pilot sample of BD probands and their affected and unaffected relatives (n=178). Dissociation was measured with the Dissociative Experiences Scale (DES II) and childhood maltreatment with the Childhood Trauma Questionnaire (CTQ). The BD and recurrent unipolar depression (MDE-R) groups showed higher levels of self-reported abuse and dissociation than their unaffected relatives. The low-activity Met allele of the Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene was associated with lower levels of self-reported dissociation. Further, the functional catechol-O-methyltransferase (COMT) Val158Met polymorphism interacted significantly with total CTQ abuse scores to impact perceived dissociation. The Val/Val genotype was associated with increasing levels of dissociation in participants exposed to higher levels of childhood trauma. The opposite was observed in people with Met/Met genotypes who displayed decreased dissociation with increasing self-reported childhood trauma. The current findings support the involvement of the COMT Val158Met polymorphism in mediating the relationship between trauma and psychopathology.

Role of distinct PTSD symptoms in intimate partner reabuse: a prospective study

This prospective study examines the impact of four posttraumatic stress disorder (PTSD) symptom clusters (hyperarousal, reexperiencing, numbing, and avoidance) on reabuse over 1 year among women exposed to intimate partner violence (IPV). The covariates include severity of IPV, a history of childhood violence, and characteristics of the abusive relationship. Although both hyperarousal and numbing symptoms were higher at baseline among women subsequently reabused, only numbing symptoms increased the odds of reabuse after controlling for the covariates. Greater IPV severity and shorter relationship duration also increased the risk of reabuse. Results indicate that specific symptoms of PTSD, especially numbing, need to be addressed to increase the safety of women seeking services for IPV.

An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse

This study compared the effectiveness of cognitive processing therapy for sexual abuse survivors (CPT-SA) with that of the minimal attention (MA) given to a wait-listed control group. Seventy-one women were randomly assigned to 1 of the 2 groups. Participants were assessed at pretreatment and 3 times during posttreatment: immediately after treatment and at 3-month and 1-year follow-up, using the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (D. Blake et al., 1995), the Beck Depression Inventory (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the Structured Clinical Interview for the DSM-IV (R. L. Spitzer, J. B. W. Williams, & M. Gibbon, 1995; M. B. First et al., 1995), the Dissociative Experiences Scale-II (E. M. Bernstein & F. W. Putnam, 1986), and the Modified PTSD Symptom Scale (S. A. Falsetti, H. S. Resnick, P. A. Resick, & D. G. Kilpatrick, 1993). Analyses suggested that CPT-SA is more effective for reducing trauma-related symptoms than is MA, and the results were maintained for at least 1 year.

Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology

This study examined whether peritraumatic dissociation serves as a proxy risk factor for experiential avoidance in its relationship with posttraumatic stress disorder (PTSD) symptomatology. One hundred eighty-five trauma survivors completed measures that assessed for peritraumatic dissociation, experiential avoidance, and PTSD symptom severity. The results indicated that peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptomatology at baseline. However, after initial levels of PTSD symptomatology were taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later. These results indicate that peritraumatic dissociation is not a proxy risk factor for experiential avoidance and contributes to the growing body of literature indicating that experiential avoidance is an important factor related to the psychological symptoms experienced by trauma survivors.

Sexual revictimization: a review of the empirical literature

This article reviews the literature on sexual revictimization, covering approximately 90 empirical studies and includes a discussion of prevalence, risk factors, and correlates of sexual revictimization. Research suggests that two of three individuals who are sexually victimized will be revictimized. The occurrence of childhood sexual abuse and its severity are the best documented and researched predictors of sexual revictimization. Multiple traumas, especially childhood physical abuse, and recency of sexual victimization are also associated with higher risk. There is preliminary evidence that membership in some ethnic groups or coming from a dysfunctional family places an individual at a greater risk. Revictimization is associated with higher distress and certain psychiatric disorders. People who were revictimized show difficulty in interpersonal relationships, coping, self-representations, and affect regulation and exhibit greater self-blame and shame. Existing research on prevention efforts and treatment is discussed. More longitudinal studies on sexual revictimization are needed.

Perceived Uncontrollability and Unpredictability, Self-Regulation, and Sexual Revictimization

This article reviews the descriptive literature on sexual revictimization and the evidence for the theoretical models that have been formulated to explain this phenomenon. Also, a speculative account of sexual revictimization is presented. The proposed model emphasizes individuals’ attempts to influence or control the quality, frequency, intensity, or duration of fear and arousal associated with a history of uncontrollable and unpredictable childhood sexual abuse through the use of antecedent or response-focused emotion regulation processes. The various forms of emotion regulation may produce symptoms or behaviors that may signal vulnerability to sexual predators, result in impairment of the ability to properly process danger cues, and impede successful defensive behavior. Implications of the proposed model and future directions are discussed.

Family risk factors and prevalence of dissociative symptoms among homeless and runaway youth

OBJECTIVE

To examine family risk factors associated with dissociative symptoms among homeless and runaway youth.

METHOD

Three hundred and twenty-eight homeless and runaway youth were interviewed using a systematic sampling strategy in metropolitan Seattle. Homeless young people were interviewed on the streets and in shelters by outreach workers in youth service agencies.

RESULTS

The current study revealed widespread prevalence of dissociative symptoms among these young people. Multivariate analyses revealed that sexual abuse, physical abuse, and family mental health problems were all positively associated with dissociative symptoms. No gender differences were found for any of the models.

CONCLUSIONS

Dissociative behavior is widespread among these youth and may pose a serious mental health concern. Some young people experience numerous stressors, and with few resources and little support available, many may invoke maladaptive strategies such as dissociative behavior to handle such situations, which may in turn be detrimental to their mental health. Unless youth are provided with programs and intervention, the cycle of abuse that they have experienced at home is likely to continue on the street.

Revictimization and self-harm in females who experienced childhood sexual abuse: results from a prospective study

Lifetime trauma histories were ascertained for females with confirmed histories of childhood sexual abuse and comparison females participating in a longitudinal, prospective study. Abused participants reported twice as many subsequent rapes or sexual assaults (p = .07), 1.6 times as many physical affronts including domestic violence (p = .01), almost four times as many incidences of self-inflicted harm (p = .002), and more than 20% more subsequent, significant lifetime traumas (p = .04) than did comparison participants. Sexual revictimization was positively correlated with posttraumatic stress disorder symptoms (PTSD), peritraumatic dissociation, and sexual preoccupation. Physical revictimization was positively correlated with PTSD symptoms, pathological dissociation, and sexually permissive attitudes. Self-harm was positively correlated with both peritraumatic and pathological dissociation. Competing theoretical explanations for revictimization and self-harm are discussed and evaluated.

Dissociative experiences of women child abuse survivors: a selective constructivist review

A selective literature review of dissociation in women abuse survivors was under-taken from a feminist, constructivist perspective. Dissociation has been conceptualized many ways historically. Current understandings of dissociative phenomena are diverse, as reflected in the research and treatment literature. Dissociation has been linked to physical and psychological problems, including major mental illnesses, pelvic pain, somatization disorders, and eating disorders. There has been a preoccupation with rare but fascinating extremes of dissociation, such as multiple personality disorder, with less emphasis on more frequently seen types of dissociation, such as depersonalization and derealization. Views of dissociation as it occurs in women child abuse survivors affect their autonomy and perceived credibility and determine treatment trajectories. Questions remain as to what aspects and types of dissociation are "pathological." There is evidence that dissociation may be a commonplace human experience in the general population. Implications for theory, research, and practice are included.

Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems

OBJECTIVE

To examine the associations of childhood traumatic experiences and childhood neglect with dissociative experiences and posttraumatic stress disorder (PTSD) in a population of female borderline personality disorder (BPD) patients with and without substance abuse.

METHOD

The sample included 64 female patients with BPD. Childhood traumatic experiences and childhood neglect were measured using the Structured Trauma Interview, dissociative experiences with the Dissociative Experiences Scale, and PTSD with the Structured Clinical Interview for DSM-IV.

RESULTS

In general, dissociation scores were higher among those with a history of childhood trauma and neglect, in particular among those who reported both sexual and physical abuse before age 16, more than one perpetrator and severe maternal dysfunction. The prevalence of PTSD was clearly associated with the severity of childhood sexual abuse (CSA) in terms of the occurrence of penetration during CSA, intrafamilial CSA, a duration of CSA longer than 1 year and more than one perpetrator. Comorbid substance abuse problems modified the observed associations such that the associations mentioned above were also present or even more pronounced among those without substance abuse, whereas no associations were found in those with substance abuse.

CONCLUSIONS

The results suggest a moderately strong association between childhood trauma and neglect with dissociation and PTSD. However, trauma-dissociation and trauma-PTSD links were only observed among BPD patients without addictive problems. The findings are largely consistent with the literature. Potential explanations for the lack of a trauma-dissociation and trauma-PTSD link in the addicted subgroup are discussed.

[Current understanding about intergenerational transmission of child sexual abuse]

OBJECTIVE

The aim of this article is to review what is currently understood about intergenerational transmission of child sexual abuse (CSA).

METHOD

CSA transmission is discussed first from the point of view of men CSA survivors who become sexually abusive, and then from the perspective of mothers who survived CSA whose children have been sexually abused. Mechanisms that may help us understand how CSA is transmitted from one generation to another are described. More specifically, focus is given to those mechanisms that might differentiate CSA survivors who break the cycle of abuse from those who perpetuate it.

RESULTS

In light of the research reviewed, it seems that the transmission of CSA is far from inevitable, since one-third of sexually abusive men and half of sexually abused children's mothers mentioned having been sexually abused in their childhood. Because of the retrospective method used in many studies, causal links could not be established. However, some mechanisms have been proposed in order to better understand the phenomenon of CSA. Severity of abuse, attachment relationships with parental figures, as well as dissociative symptoms that follow the abuse were identified. Dissociative symptomatology appeared to be a determining factor in understanding the cycle of CSA.

CONCLUSIONS

More studies on CSA transmission are needed to understand the mechanisms that are involved in that cycle, as well as to develop effective strategies to treat and prevent CSA.

Prevalence of dissociative experiences in a community sample: relationship to gender, ethnicity, and substance use

This study examined the relationship between gender, ethnicity, substance use, and dissociation in a community sample of adults. Telephone interviews were conducted using, among others, measures of dissociation (Dissociative Experiences Scale-Taxon [DES-T]) and alcohol use (Alcohol Use Disorders Identification Test [AUDIT]) to screen a representative sample of 1007 adults in Memphis, Tennessee. Six percent of respondents endorsed four or more lifetime dissociative symptoms, whereas approximately one third of respondents endorsed at least one symptom. Only 2% were identified as having pathological dissociation on the DES-T. DES-T scores were significantly associated with gender (male), ethnicity (African-American), and harmful alcohol use. Dissociative symptoms appear to be relatively common in the population, but only a small proportion of individuals suffer from significant levels of dissociation. Further assessment of the link between demographic factors and the severity and expression of dissociative phenomena in nonclinical samples is warranted.

Factors predicting PTSD, depression, and dissociative severity in female treatment-seeking childhood sexual abuse survivors

OBJECTIVE

Two main questions were asked: (1) what abuse characteristics relate to PTSD, depressive, and dissociative severity in adult survivors of child sexual abuse (CSA); and (2) what abuse characteristics influence the severity of dissociation during CSA.

METHOD

89 female CSA survivors' current symptoms of PTSD, depression, and dissociation were assessed with standardized measures. Additionally, abuse characteristics (e.g., age of onset, peritraumatic dissociation) were assessed with a structured interview.

RESULTS

Correlational analyses indicated that peritraumatic dissociation was most strongly related to all three types of symptom severity. Additional posthoc correlational analyses revealed that women who experienced penile penetration, believed someone/thing else would be killed, and/or were injured as a result of the abuse exhibited more severe peritraumatic dissociation. Regression analyses indicated that peritraumatic dissociation was the only variable to significantly predict symptom severity across symptom type or disorder. Furthermore, different abuse characteristics predicted adult symptom severity and peritraumatic dissociation.

CONCLUSIONS

The relation between peritraumatic dissociation and adult symptomatology was most intriguing and has two main clinical implications: (1) teaching engagement strategies to some CSA survivors in hopes of containing dissociative symptoms immediately following the abuse and (2) the inclusion of exposure-based interventions in the treatment of some adult CSA survivors where indicated.

Trauma and dissociation in delinquent adolescents

OBJECTIVES

To assess history of trauma and dissociation in a group of juvenile delinquents and to assess how adolescents would respond to a structured interview for dissociative symptoms.

METHOD

Sixty-four adolescents in juvenile probation hall participated in 2 investigational sessions in 1996-1997. For session 1 they answered the Childhood Trauma Questionnaire (CTQ), the Response Evaluation Measure for Youth-71 (REMY-71), and the Weinberger Adjustment Inventory. For session 2 they were given the Childhood Trauma Interview (CTI) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D).

RESULTS

In this sample 28.3% met criteria for a dissociative disorder and 96.8% endorsed a history of traumatic events. There were significant positive correlations between CTI and CTQ trauma scores and SCID-D and REMY-71 dissociative symptoms. All dissociative symptoms were endorsed, but depersonalization was the most common experience. There was a lack of congruence between the different methods of assessing dissociation.

CONCLUSIONS

This study provides support for an early link between history of trauma and dissociation. Adolescents were able to answer questions from a structured interview assessing dissociation.

Dissociative symptomatology and traumatogenic factors in adolescent psychiatric patients

This study describes the relation of different types of childhood trauma to the degree of dissociative experiences. Subjects were 198 consecutively admitted adolescent psychiatric patients, 11 to 19 years old (89 inpatients and 109 outpatients). All patients completed the Adolescent Dissociative Experiences Scale. A Checklist of Traumatic Childhood Events was filled out by clinicians. The results showed an increase in the degree of dissociative experiences in patients with a history of sexual abuse, physical abuse, neglect, and stressful life events. With the exception of life events, a moderate form of traumatic experience had the same effect on dissociative experiences as severe forms. The strongest effect was found for emotional neglect, which seems to be an important pathogenic risk factor. The results suggest that therapists and researchers should be aware that even less severe forms of abuse and neglect may have a significant impact on the development of dissociative psychopathology in adolescents.

Dissociation, psychopathology, and abusive experiences in a nonclinical Latino university student group

A variety of clinical and experimental data suggest that many individuals who report abusive and traumatic experiences also report a wide array of dissociative and other psychopathological symptoms. In this study, 198 Puerto Rican undergraduate students participated in a study to examine the possible relationship between different types of traumatic experiences and the self-report of dissociative experiences, depressive symptoms, and general psychopathology. Another aspect of this study was the examination of the psychometric properties of the Dissociative Experiences Scale (DES) in a Latino sample. Results supported the hypothesis that those individuals who reported frequent and severe traumatic experiences were also the most likely to experience psychological malaise and scored higher on the DES. Of interest was the finding that the psychometric characteristics of the DES are consistent with those reported in the United States and other countries. The authors conclude that individuals with a marked history of trauma and abuse are more likely to use dissociative defenses as a coping response.

Psychological defense styles in women who report childhood sexual abuse: a controlled community study

OBJECTIVE

The psychological defense styles of women who reported childhood sexual abuse were assessed and compared to those of women without childhood sexual abuse.

METHOD

Subjects in a random community sample (N = 354) of New Zealand women were interviewed and completed two relevant questionnaires, the Defense Style Questionnaire and the Dissociative Experiences Scale.

RESULTS

Women reporting childhood sexual abuse showed more immature defense styles, and those who experienced the most severe childhood sexual abuse showed the most immature styles. Dissociation, however, as measured on the Dissociative Experiences Scale, was not linked to childhood sexual abuse.

CONCLUSIONS

Reporting childhood sexual abuse was associated with more immature coping styles, although not dissociation, in this community sample of women. Coping styles are likely to be a major mechanism through which childhood sexual abuse increases rates of later psychological problems.

Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients

OBJECTIVE

Research on the etiology of dissociation in adults has focused primarily on childhood sexual abuse. The role of co-occurring childhood stressors and of more chronic adverse conditions such as neglect is less clear. This study examined the level of dissociation in relation to childhood trauma (sexual/physical abuse, witnessing interparental violence), early separation from a parent, and perceived parental dysfunction.

METHOD

One hundred sixty inpatients consecutively admitted to a general psychiatric hospital were administered the Dissociative Experiences Scale and the Structured Trauma Interview.

RESULTS

The mean Dissociative Experiences Scale score was 17.4; 18.0% of the patients scored beyond 30. Early separation was reported by 26.4% of the patients; 30.1% had witnessed interparental violence; 23.6% reported physical abuse; 34.6% reported sexual abuse; 11.7% reported rape before age 16; and 42.1% reported sexual and/or physical abuse. The level of dissociation was primarily related to reported overwhelming childhood experiences (sexual and physical abuse). When sexual abuse was severe (involving penetration, several perpetrators, lasting more than 1 year), dissociative symptoms were even more prominent. Highest dissociation levels were found in patients reporting cumulative sexual trauma (intrafamilial and extrafamilial) or both sexual and physical abuse. In particular, maternal dysfunction was related to the level of dissociation. With control for gender and age, stepwise multiple regression analysis indicated that the severity of dissociative symptoms was best predicted by reported sexual abuse, physical abuse, and maternal dysfunction.

CONCLUSIONS

These findings indicate that dissociation, although trauma-related, is neglect-related as well. This implies the importance of object relations and attachment in the diagnosis and treatment of patients with dissociative disorders.

A model to explain the relationship between sexual abuse and HIV risk among women

This paper presents a model developed to advance the understanding of the relationship between sexual abuse and HIV risk among women. It is proposed that the relationship is mediated by many of the long-term sequelae of sexual abuse. The process of mediation is believed to occur through various causal pathways propelled by specific underlying mechanisms that increase the likelihood of HIV risk. The following causal pathways are proposed: (1) initiation of and/or increasing reliance on drug use as a method of coping with the sexual abuse experience, (2) problems with sexual adjustment related to sex risk taking, and (3) psychopathology (e.g. depression) which increases the likelihood of an individual participating in HIV risk behaviours. These hypothesized pathways are based on the characteristics and behaviours of individuals with histories of sexual abuse and do not take into account the influence of the individual's social environment. Increasingly, evidence suggests that understanding the social context of HIV risk is crucial to the development of preventive interventions. Therefore, a final pathway is explored which suggests that specific social network characteristics (e.g. network membership type, social support, and social isolation) influence HIV risk exposure opportunities among women with sexual abuse histories.

Dissociative detachment relates to psychotic symptoms and personality decompensation

Previous studies have addressed the prominence of psychotic symptoms in conjunction with multiple personality disorder (now dissociative identity disorder). The present study examines the relation between psychotic symptoms and a more pervasive form of dissociative disturbance, namely dissociative detachment. Two hundred sixty-six women in inpatient treatment for severe trauma-related disorders completed the Dissociative Experiences Scale (DES), and 102 of these patients also completed the Millon Clinical Multiaxial Inventory (MCMI-III). A factor analysis of the DES yielded two dimensions of dissociative detachment: detachment from one's own actions and detachment from the self and the environment. Each of these DES dimensions relates strongly to the thought disorder and schizotypal personality disorder scales of the MCMI-III. We propose that severe dissociative detachment, by virtue of loosening the moorings in inner and outer reality, is conducive to psychotic symptoms and personality decompensation.

Dissociative experiences and dissociative disorders in acute psychiatric inpatients

The study attempted to determine the extent of dissociative experiences and the prevalence of dissociative disorders (DDs) in a series of acute psychiatric inpatients and to correlate these experiences and disorders with some sociodemographic, clinical, and historical variables. A total of 207 consecutively admitted psychiatric inpatients qualified for the study. All were examined with the Dissociative Experiences Scale (DES), Structured Clinical Interview for DSM-III-R Personality Questionnaire (SCID-II PQ), Parental Bonding Instrument (PBI), and Frankfurter Self-Concept Scales (FS). Patients who scored greater than 20 on the DES were examined with the Dissociative Disorders interview Schedule (DDIS). Altogether, 20% of patients scored greater than 20 on the DES. In 5% of the patients, a DD was diagnosed. Significant positive correlations were found between DES scores and SCID-II PQ items' frequency with regard to all personality disorder types, especially borderline, antisocial, schizotypal, and dependent. Less pronounced correlations were found between DES and PBI scores, and between DES score and age. Clinical axis I diagnoses did not have any pronounced influence on the DES score. In contrast, patients with greater proneness to dissociation scored lower on most FS scales. There was a tendency for patients with DDs to report childhood abuse more frequently and they complained significantly more of somatic symptoms. Dissociative experiences seem to be as frequent in Swiss as in North American inpatients, whereas DDs (and childhood abuse) were encountered less frequently in Swiss inpatients. A correlation seems to exist between dissociation and somatization.

Childhood abuse, adult assault, and dissociation

Recent studies have suggested an association between childhood physical and sexual abuse and adult dissociative experiences. The purpose of this study was to determine the relationship of both childhood and adult-onset abuse and their characteristics for adult dissociative symptoms. One hundred forty-four psychiatric outpatients completed self-report questionnaires on measures of dissociation (Dissociative Experience Scale [DES]) and histories of both past and current sexual and physical abuse (Traumatic Events Questionnaire [TEQ]). Of 114 subjects (30 men and 84 women) who completed both forms, 35% and 43% reported childhood physical and sexual abuse, respectively. Dissociative symptoms were significantly related to ethnicity and multiple episodes or combined types of abuse in childhood and adulthood. In terms of the characteristics of childhood abuse, numerous episodes of physical abuse (P = .01) and father-perpetrated sexual abuse (P = .02) were significantly related to the degree of dissociation. These findings emphasize the role of repeated childhood trauma and the combination of both childhood and adult traumatic experiences in the development of dissociative phenomena.

The validation of the Trauma Symptom Checklist-40 (TSC-40) in a sample of inpatients

This study examined the construct validity of the Trauma Symptom Checklist-40 (TSC-40; Elliot & Briere, 1992) in a sample of 130 female psychiatric inpatients. Consistent with other findings, the TSC-40 displayed criterion-related validity in relation to childhood sexual abuse. Survivors of sexual abuse obtained significantly higher scores than those without such a history on the overall TSC-40 and on each of the six subscales, except the Depression subscale. Convergent validity of three subscales was demonstrated, and divergent validity on the total TSC-40 and each of its subscales was established. Further, among a range of abuse-effects measures, the Sexual Abuse Trauma Index (SATI) subscale was the most powerful predictor of sexual abuse. The SATI and Dissociation subscales were the subscales most sensitive to the specific features of the sexual abuse.

The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse, and self-mutilation

The overall purpose of the present study was to further our understanding of the mechanisms of self-mutilative behavior in a sample of female inpatients. The study found that self-mutilators (n = 103) displayed a greater degree of dissociative symptoms and alexithymia and a greater number of self-injurious behaviors, as well as higher rates of childhood sexual abuse, than nonmutilators (n = 45). In addition, the study found that among these variables, the number of self-injurious behaviors had the strongest relationship to self-mutilation. However, both dissociative symptoms and alexithymia were independently associated with self-mutilative behavior. Implications of our findings for clinicians and researchers are discussed.