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Rajewska-Rager A, Dmitrzak-Weglarz M, Lepczynska N, Kapelski P, Pawlak J, Skibinska M. Clinical assessment of impulsiveness and defence mechanisms in young patients with mood disorders in a two-year prospective study. Early Interv Psychiatry 2023; 17:1001-1011. [PMID: 36683289 DOI: 10.1111/eip.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/23/2022] [Accepted: 01/01/2023] [Indexed: 01/24/2023]
Abstract
AIM There have been limited prospective investigations of early clinical markers involved in mood regulation and diagnosis change in young patients. This study aimed to evaluate the changes in impulsivity and defence mechanisms in patients with major depressive disorder (MDD) and bipolar disorder (BD) with acute symptoms and remission compared to healthy controls (HC), and possible psychological predictors of diagnosis conversion. METHODS Seventy-nine young MDD or BD patients and 40 HC were enrolled in a two-year prospective study. A comprehensive clinical interview focused on clinical and psychological evaluation during follow-up visits. The severity of depressive symptoms was evaluated using the Hamilton Depression Rating Scale (HDRS-17), whilst the Young Mania Rating Scale (YMRS) was used for hypo/manic symptoms during each control visit. All patients completed the Defence Style Questionnaire (DSQ-40) and Barratt Impulsiveness Scale (BIS-11). RESULTS Patients used more immature defences, and had significantly higher total impulsivity scores than controls. BD patients had elevated motor and non-planning impulsivity compared with HC and MDD subjects. Total and non-planning impulsiveness remained elevated in euthymia in BD and MDD compared to HC. There were no statistically significant differences in total defence styles and impulsiveness scores at baseline vs. euthymia in MDD or BD patients groups. Significantly higher dissociation scores at baseline discriminated depressive patients who convert to BD in their diagnosis. CONCLUSIONS Patients with acute mood symptoms used more frequent immature defences and had significantly higher total impulsivity scores than healthy persons. A lack of differences in total defence styles and impulsiveness between patients with acute symptoms and after reaching euthymia in both MDD and BD groups indicates that they are independent of disease status. Dissociation defence mechanisms may be an early diagnostic indicator of BD.
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Affiliation(s)
- Aleksandra Rajewska-Rager
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Dmitrzak-Weglarz
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Natalia Lepczynska
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Poznań, Poland
| | - Pawel Kapelski
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Pawlak
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Skibinska
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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2
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Imperatori C, Barchielli B, Corazza O, Carbone GA, Prevete E, Montaldo S, De Rossi E, Massullo C, Tarsitani L, Ferracuti S, Pasquini M, Biondi M, Farina B, Bersani FS. The Relationship Between Childhood Trauma, Pathological Dissociation, and Behavioral Addictions in Young Adults: Findings from a Cross-Sectional Study. J Trauma Dissociation 2023; 24:348-361. [PMID: 36814178 DOI: 10.1080/15299732.2023.2181479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Interactions between childhood trauma (CT) and dissociation can contribute to psychiatric disturbances. We explored this phenomenon in relation to behavioral addictions (BAs) in a sample (n = 633) of young adults (age: 18-34 years). Self-report measures investigating CT, dissociation, and symptoms related to gambling disorder, internet gaming disorder, problematic social media use, exercise dependence and compulsive buying were used. Scales related to BAs were summarized into a single measure ("Total Behavioral Addiction Index" - TBAI) for inferential analyses. A model analyzing the direct and indirect effects of CT on TBAI through the mediation of pathological dissociation was performed, controlling for confounding factors. Measures on CT, dissociation, and TBAI were significantly associated with each other (all p < .001). The total effect of CT on TBAI was significant (B = 0.063; CI: 0.045; 0.081); pathological dissociation significantly mediated such association (B = 0.023; CI: 0.013; 0.036). Our findings support the possibility that the interaction between CT and dissociation contributes to increase disturbances related to BAs.
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Affiliation(s)
- Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Benedetta Barchielli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Ornella Corazza
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, Hatfield, UK
| | - Giuseppe Alessio Carbone
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Elisabeth Prevete
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Simone Montaldo
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Elena De Rossi
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Chiara Massullo
- Experimental Psychology Laboratory, Department of Education, Roma Tre University, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Benedetto Farina
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Lee SH, Kang NR, Moon DS. Dissociative Identity Disorder in an Adolescent With Nine Alternate Personality Traits: A Case Study. Soa Chongsonyon Chongsin Uihak 2022; 33:73-81. [PMID: 35832863 PMCID: PMC9242847 DOI: 10.5765/jkacap.220005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Since dissociative identity disorder (DID) has symptoms similar to schizophrenia, such as auditory hallucinations and delusional thoughts of being controlled, there are difficulties in its differential diagnosis. A 16-year-old adolescent male patient who was previously diagnosed with schizophrenia from a different hospital was admitted to our inpatient psychiatric unit for the evaluation of auditory hallucinations and suicide attempts. Through psychiatric evaluations, it was determined that the patient suffered from identity alternation, dissociation, and amnesia. As for the diagnostic evaluations, the following measures were implemented: a psychiatric interview regarding the diagnostic criteria, mental status examination, laboratory tests, brain imaging studies, electroencephalography, and full psychological test for adolescents, and the self-reported measure of the Adolescent Dissociative Experiences Scale. The patient was diagnosed with DID, and the following treatments were administered: pharmacotherapy, ego state therapy, psychoeducation regarding emotions, trauma-focused psychotherapy including stabilization, and family therapy. Following treatment, in the internal dimensions, the patient was able to recognize the nine alternate identities in charge of his emotions, which established a basis for the potential integration of identities. In the external dimensions, he showed improvements in the aspects of family conflicts and issue of school refusal. This is the first reported case of DID in an adolescent in Korea; it emphasizes the consideration of DID in the differential diagnosis of other mental illnesses such as schizophrenia, bipolar disorder, and posttraumatic stress disorder and expands the treatment opportunities for DID by sharing the procedures of ego state therapy.
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Affiliation(s)
- Sang-Hun Lee
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
| | - Na Ri Kang
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
- Department of Psychiatry, Jeju National University College of Medicine, Jeju, Korea
| | - Duk-Soo Moon
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
- Department of Psychiatry, Jeju National University College of Medicine, Jeju, Korea
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4
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REL-1017 (Esmethadone) May Rapidly Reduce Dissociative Symptoms in Adults With Major Depressive Disorder Unresponsive to Standard Antidepressants: A Report of 2 Cases. J Clin Psychopharmacol 2022; 42:503-506. [PMID: 35943402 PMCID: PMC9426728 DOI: 10.1097/jcp.0000000000001583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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5
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Rajkumar RP. Dissociative Symptoms and Disorders in Patients With Bipolar Disorders: A Scoping Review. Front Psychiatry 2022; 13:925983. [PMID: 35722564 PMCID: PMC9199377 DOI: 10.3389/fpsyt.2022.925983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 12/03/2022] Open
Abstract
Dissociative disorders are an important group of trauma-related disorders associated with significant disability. The co-occurrence of dissociative disorders (DD) and symptoms (DS) in bipolar disorder has been relatively understudied, but there is some evidence that this comorbidity may have significant mechanistic and clinical implications. This paper presents the results of a scoping review of the frequency and correlates of DS and DD in bipolar disorder. Based on the available evidence, DS/DD are more common in bipolar disorder than in healthy controls or in unipolar depression, are related to childhood trauma, and are associated with psychotic symptoms, suicide attempts, and a poorer response to treatment in patients with bipolar disorder. The implications of these findings, and possible mechanistic pathways underlying them, are discussed based on the current literature. Clinicians should be aware of the frequent occurrence of significant DS or DD when treating patients with bipolar disorder. A tentative future research agenda for this field, based on clinical, risk factor-related and neurobiological considerations, is outlined.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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6
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Tzikos A, Arvaniti A, Kalamara E, Vorvolakos T, Kafalis G, Samakouri M, Livaditis M. Validating Dissociative Experience Scale (DES) in a Greek sample. J Trauma Dissociation 2021; 22:522-539. [PMID: 33427597 DOI: 10.1080/15299732.2020.1869648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to validate the Greek version of the Dissociative Experience Scale (DES). A sample of 340 psychiatric outpatients and controls was selected. Part of the sample went through a retest procedure after a two-week period. Due to the absence of equivalent tests, the Multiscale Dissociation Inventory (MDI), the Structured Clinical Interview for DSM-IV-Dissociative Disorders Revised (SCID-D-R), and the Zung Self-Rating Anxiety Scale were used. Explanatory factor analysis was performed, resulting in a 28-item scale; the analysis revealed four factors, explaining 61% of total variation: Depersonalization, Amnesia, Absorption, and Miscellaneous. Cronbach's alpha coefficient for the DES was 0.95. Intraclass correlation coefficient (ICC) of the total score between the first and second interview was 0.84. Concurrent and convergent validity, as assessed by correlations with clinical assessment used as a "gold standard," (0.77), MDI (0.96), and Zung scale (0.75) were satisfactory to excellent. The total score on the DES was significantly higher in the clinical sample than in the controls (17.8 ± 16.2 vs. 5.8 ± 7.2, p < .001), indicating high discriminant validity. After the ROC analysis was run, the best compromise between sensitivity/specificity was achieved at the value of 20. The Greek version of the DES is a reliable and valid tool suitable to assess dissociation in clinical and healthy populations.
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Affiliation(s)
- Anthimos Tzikos
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
| | - Aikaterini Arvaniti
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
| | | | - Theofanis Vorvolakos
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
| | - Georgios Kafalis
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Maria Samakouri
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
| | - Miltos Livaditis
- Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
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Bergouignan L, Nyberg L, Ehrsson HH. Out-of-body memory encoding causes third-person perspective at recall. JOURNAL OF COGNITIVE PSYCHOLOGY 2021. [DOI: 10.1080/20445911.2021.1958823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Lars Nyberg
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - H. Henrik Ehrsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Steardo L, Carbone EA, Ventura E, de Filippis R, Luciano M, Segura-Garcia C, De Fazio P. Dissociative Symptoms in Bipolar Disorder: Impact on Clinical Course and Treatment Response. Front Psychiatry 2021; 12:732843. [PMID: 34759848 PMCID: PMC8572831 DOI: 10.3389/fpsyt.2021.732843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Dissociative symptoms are under recognized and scarcely studied by clinicians and researchers in patients with bipolar disorder (BD). We examined the relationship between dissociative symptoms and the psychotic features in patients with BD and assessed clinical and socio-demographic characteristics more frequently associated with dissociative symptoms and treatment response. Methods: Participants were 100 adult outpatients with BD. They were screened with semi-structured interview to collect socio-demographic and clinical characteristics; the Dissociative Experiences Scale-II (DES-II) and the ALDA scale were used to assess dissociative psychopathologies and response to treatment with mood stabilizers, respectively. Results: DES score (mean 31.7 ± 21.7) correlated with clinical variables, BD features, and course of illness. Psychotic symptoms, mixed features, and previous suicide attempts significantly predicted DES score [F (3, 47) = 39.880, p < 0.001, R 2 corrected = 0.713]. Dissociative symptoms were inversely correlated with poor response to treatment (r = -0.593; p < 0.001). Limitations: Cross-sectional design with a small sample and backward clinical assessment of psychotic symptoms. Conclusions: Dissociative phenomena are closely related to the presence of psychotic symptoms, mixed features, and previous suicide attempts in BD, especially in BD-I. Given the close association between dissociative and psychotic symptoms, this association could represent a diagnostic indicator of BD-I that may guide the clinician to plan the most appropriate treatment.
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Affiliation(s)
- Luca Steardo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elvira Anna Carbone
- Psychiatric Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Enrica Ventura
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Renato de Filippis
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Cristina Segura-Garcia
- Psychiatric Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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9
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Vellante F, Ferri F, Baroni G, Croce P, Migliorati D, Pettoruso M, De Berardis D, Martinotti G, Zappasodi F, Giannantonio MD. Euthymic bipolar disorder patients and EEG microstates: a neural signature of their abnormal self experience? J Affect Disord 2020; 272:326-334. [PMID: 32553374 DOI: 10.1016/j.jad.2020.03.175] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/27/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A growing number of neuroimaging studies have revealed spatial abnormalities of resting-state functional brain network activity in bipolar disorder (BD). Conversely, abnormalities of resting state temporal dynamics have been scarcely investigated so far. The aim of this study was to characterize the EEG microstates activity in BD patients with a history of manic predominant polarity. Patients were euthymic and pharmacologically stabilized. METHODS Nineteen BD patients (mean age 34.4 ± 11.0, 7 female) and 19 healthy controls (HC; mean age 38.2 ± 9.9, 7 female) were recruited. The psychometric evaluation included the Hamilton Depression Scale (HAMD), the Young Mania Rating Scale (YMRS), the Dissociative Experience Scale (DES), and the State-Trait Anxiety Inventory (STAI). Two runs of 2 minutes of EEG activity by a 128-channel system were acquired at rest and analyzed through microstate analysis. RESULTS We found a reduced presence of microstate B in BD patients compared to HC, since BD patients have a tendency to transit from the microstate B to the microstates C and D significantly more than HC. Furthermore, microstate B features were correlated with DES, state STAI and trait STAI scores. CONCLUSION The reduced presence of microstate B might be associated with episodic autobiographic memory deficit, exaggerated self-focusing and states of dissociations characteristic of BD. Strong correlations of microstate B metrics and dynamics with symptoms of dissociation and anxiety across the two groups supported this interpretation.
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Affiliation(s)
- Federica Vellante
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy.
| | - Francesca Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Gaia Baroni
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Pierpaolo Croce
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Daniele Migliorati
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Mauro Pettoruso
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Domenico De Berardis
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy; Hospital "Giuseppe Mazzini", Teramo, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Filippo Zappasodi
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy; Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti-Pescara, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy; Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti-Pescara, Italy
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Keefe KM, Hetzel-Riggin MD, Sunami N. The Mediating Roles of Hostility and Dissociation in the Relationship Between Sexual Assault and Suicidal Thinking in College Students. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:1635-1653. [PMID: 29294684 DOI: 10.1177/0886260517698282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sexual assault and suicide are two serious public health concerns. Research has documented the relationship between sexual assault and suicidal thinking and attempts; however, limited research explores the more multifaceted relationships between posttraumatic stress reactions and suicidal ideation in college students through unsuccessful modulation of emotion. The authors hypothesized a mediation model where the relationship between sexual assault and suicidal ideation is mediated by dissociation and hostility. In total, 1,677 undergraduate students were administered modified versions of the Traumatic Life Events Questionnaire (TLEQ), Symptom Checklist-90-Revised (SCL-90-R), and Peritraumatic Dissociative Experiences Questionnaire (PDEQ). The results revealed both significant partial but equal mediators of hostility and dissociation. However, a portion of the direct effect between sexual assault and suicidal ideation remained unaccounted for by indirect effects. The current model supports previous work on dialectical behavior therapy that says either side of the dialectic between extreme expression and suppression of hostility increases the likelihood of suicidal thinking after sexual assault. With sexual assault survivors, practitioners should use strategies that emphasize both anger expression and healthy avoidance as a way to modulate emotion to potentially reduce suicidal thoughts. Future research should focus on different gender models, additional possible mediators such as alcohol use and guilt, and different forms of sexual assault. Limitations of the correlational, cross-sectional methodology are discussed.
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Affiliation(s)
| | | | - Naoyuki Sunami
- Western Illinois University, Macomb, USA
- University of Delaware, Newark, USA
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11
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Tuineag M, Therman S, Lindgren M, Rouanet M, Nahon S, Bertrand L, Saury S, Renaud S, Beaulieu S, Linnaranta O. Dissociative symptoms as measured by the Cambridge Depersonalization Scale in patients with a bipolar disorder. J Affect Disord 2020; 263:187-192. [PMID: 31818776 DOI: 10.1016/j.jad.2019.11.137] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/25/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Cambridge Depersonalization Scale (CDS) characterizes the quality, frequency, and duration of dissociative symptoms. While the psychometric properties of the CDS have been evaluated in primary dissociative disorder, this has been insufficiently addressed among other psychiatric patient groups such as patients with a bipolar disorder (BD). METHODS Outpatients with variable mood (n = 73) responded to a survey that assessed dissociative symptoms and other characteristics. We used factor analysis and McDonald's omega to evaluate psychometric properties of the CDS, and correlations with other characteristics. RESULTS Previously suggested multifactorial models of the CDS were not supported, but the single-dimensional model fit both dichotomized (p = 0.31, CFI = 0.99, RMSEA = 0.02, ECV 70%) and trichotomized CDS responses (p = 0.06, CFI = 0.96, RMSEA = 0.04, ECV 47%). The CDS showed high internal consistency (ω = 0.96). CDS factor scores correlated with symptom severity on the Quick Inventory for Depressive Symptoms (QIDS-SR-16) (ρ = 0.59), the Social Phobia Inventory (ρ = 0.52), the American Association of Psychiatry Severity measure for Panic Disorders (ρ = 0.46), the Childhood Trauma Questionnaire (ρ = 0.44), and the Trauma Screening Questionnaire (ρ = 0.53). Two abbreviated versions of the CDS, retaining the best 14 or 7 items were proposed. LIMITATIONS The sample size remained moderate. CONCLUSIONS The CDS is a psychometrically sound, unidimensional measure with clinical impact to detect and characterize dissociative symptoms in BD patients. Establishing the reliability and validity of the abbreviated scales for screening necessitates further study.
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Affiliation(s)
- Maria Tuineag
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Mood disorders Psychopharmacology Unit, University of Toronto, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
| | - Sebastian Therman
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Maija Lindgren
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Manon Rouanet
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sara Nahon
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Lia Bertrand
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sybille Saury
- Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Suzanne Renaud
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
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12
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Fung HW, Chan C. A preliminary study of the clinical differences between dissociative and nondissociative depression in Hong Kong: implications for mental health practice. SOCIAL WORK IN HEALTH CARE 2019; 58:564-578. [PMID: 30958123 DOI: 10.1080/00981389.2019.1597006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 02/12/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
Depression is a serious public health issue, but not all patients with depression respond well to pharmaceutical treatments. Some scholars suggested that dissociation could be a marker indicating the types of patients with depression that may benefit more from psychosocial interventions than from pharmaceutical treatments. This study explored the possibility to differentiate dissociative depression and nondissociative depression in a clinical sample (N = 68) in the Chinese context, and discusses the potential implications for treatment considerations. Compared with the nondissociative group, the dissociative group reported higher occurrences of psychosocial etiological risk factors (e.g., childhood physical abuse, lack of help from family) and psychosocial-related symptoms (e.g., unstable relations, fear of abandonment, trauma-related flashbacks, somatization symptoms). Our initial findings revealed that patients with dissociative depression appeared to have distinct clinical features and might require more psychosocial interventions. Implications for health care research and practice are discussed.
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Affiliation(s)
- Hong Wang Fung
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hung Hom , Hong Kong
| | - Chitat Chan
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hung Hom , Hong Kong
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Rafiq S, Campodonico C, Varese F. The relationship between childhood adversities and dissociation in severe mental illness: a meta-analytic review. Acta Psychiatr Scand 2018; 138:509-525. [PMID: 30338524 DOI: 10.1111/acps.12969] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Several studies have observed that dissociative experiences are frequently reported by individuals with severe mental illness (SMI), especially amongst patients that report a history of adverse/traumatic life experiences. This review examined the magnitude and consistency of the relationship between childhood adversity (sexual abuse, physical abuse, emotional abuse, neglect, bullying, natural disasters and mass violence) and dissociation across three SMI diagnostic groups: schizophrenia, bipolar disorder and personality disorders. METHOD A database search (EMBASE, PubMed and PsycINFO) identified 30 eligible empirical studies, comprising of 2199 clinical participants. Effect sizes representing the relationship between exposure to childhood adversity and dissociation were examined and integrated using a random-effects meta-analysis. RESULTS The results indicated that exposure to childhood trauma was associated with heightened dissociation across SMIs. Positive significant associations were also found between specific childhood adversities and dissociation, with aggregated effect sizes in the small-to-moderate range. CONCLUSION These findings support calls for the routine assessment of traumatic experiences in clients with SMIs presenting with dissociative symptoms and the provision of adequate therapeutic support (e.g. trauma-focused therapies) to manage and resolve these difficulties.
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Affiliation(s)
- S Rafiq
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - C Campodonico
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - F Varese
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Childhood maltreatment is associated with attachment insecurities, dissociation and alexithymia in bipolar disorder. Psychiatry Res 2018; 260:391-399. [PMID: 29253803 DOI: 10.1016/j.psychres.2017.12.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/10/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022]
Abstract
Child maltreatment is a public health issue that is a well-established risk factor for many psychological conditions, including bipolar disorder. The current study is one of the first to investigate associations among child maltreatment, dissociative symptomatology, alexithymia, anxiety, depression, and attachment insecurities. 40 patients with bipolar disorder-I and 40 healthy subjects matched for age, gender, and education participated in the study. The Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), Childhood Trauma Questionnaire (CTQ-28), Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scale (DASS-21), and Experiences in Close Relationships-Revised (ECR-R) were completed by participants. In comparison to control participants, patients with bipolar disorder-I reported significantly more frequent abusive experiences in childhood, higher levels of attachment insecurities, more severe pathological and somatoform dissociation, as well as higher scores on measures of alexithymia, anxiety, depression and psychological stress. Reports of psychopathology among first-degree relatives (OR = 102.169, 95%IC = 4.596-2271.255; P < 0.01) and childhood emotional trauma (OR = 1.032; 95%CI = 0.782-1.363, P = 0.05) significantly contributed to bipolar disorder-I diagnosis. In contrast, absorption was negatively associated with bipolar illness (OR = 0.852; 95% CI = 0.747-0.973, P < 0.05). Our results showed significant associations between childhood trauma exposure and risk of bipolar disorder. Moreover, the results demonstrate that emotional abuse exposure predicts bipolar illness.
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Abstract
Borderline personality disorder (BPD) is a prevalent and severe mental disorder with affect dysregulation, impulsivity, and interpersonal dysfunction as its core features. Up to now, six studies have been performed to investigate the role of oxytocin in the pathogenesis of BPD. While a beneficial effect of oxytocin on threat processing and stress responsiveness was found, other studies using an oxytocin challenge design presented with rather heterogeneous results. Future studies have to include a sufficiently large sample of patients, control for gender, and focus on mechanisms known to be related to aversive early life experiences.
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Affiliation(s)
- Katja Bertsch
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.
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Dualibe AL, Osório FL. Bipolar Disorder and Early Emotional Trauma: A Critical Literature Review on Indicators of Prevalence Rates and Clinical Outcomes. Harv Rev Psychiatry 2017; 25:198-208. [PMID: 28759479 DOI: 10.1097/hrp.0000000000000154] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate the prevalence of early emotional trauma in patients with bipolar disorder (BD)• Assess the impact of these traumas on patients and on their development of BD OBJECTIVES: We performed a systematic literature review to (1) evaluate the prevalence of early emotional trauma (EET) in patients with bipolar disorder (BD) and the impact of these traumas on the development of the disorder, and (2) integrate the findings of our review with those previously reported by Fisher and Hosang, Daruy-Filho and colleagues, and Maniglio. METHODS The literature search was performed on PubMed, SciELO, and PsycINFO databases using the keywords bipolar disorder, early trauma, physical abuse, emotional abuse, sexual abuse, maltreatment, adversity, and neglect. RESULTS Twenty-eight articles were selected and analyzed. Taken together, the articles described a high prevalence of EET in BD, consisting mainly of emotional neglect/abuse (approximately 40%), particularly when compared to healthy subjects. The review also identified substantial evidence regarding an association between the presence of EET, early disease onset, rapid cycling, comorbidity with anxiety/stress disorders, and cannabis use. CONCLUSION The integration of the current findings with the identified studies reveals that (1) the methodological limitations noted by Daruy-Filho and colleagues have been largely resolved in more recent studies and (2) the presence of EET in patients with BD is associated with worse clinical outcomes, particularly early disease onset, presence of clinical or psychiatric comorbidities, suicide, and presence of psychotic episodes/symptoms. The review shows that patients with BD experience more traumatic situations than controls and that emotional trauma is the most frequent type of trauma in this group.
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Affiliation(s)
- Aline Limiéri Dualibe
- From the Department of Neurosciences and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo State, Brazil; Brazilian National Institute of Science and Translational Technology in Medicine, Brazil (Dr. Osório)
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McKinnon MC, Boyd JE, Frewen PA, Lanius UF, Jetly R, Richardson JD, Lanius RA. A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions. Neuropsychologia 2016; 90:210-34. [DOI: 10.1016/j.neuropsychologia.2016.07.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/16/2016] [Accepted: 07/16/2016] [Indexed: 01/01/2023]
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Cakir S, Tasdelen Durak R, Ozyildirim I, Ince E, Sar V. Childhood trauma and treatment outcome in bipolar disorder. J Trauma Dissociation 2016; 17:397-409. [PMID: 26683845 DOI: 10.1080/15299732.2015.1132489] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The aim of the present study was to investigate the potential influence of childhood trauma on clinical presentation, psychiatric comorbidity, and long-term treatment outcome of bipolar disorder. A total of 135 consecutive patients with bipolar disorder type I were recruited from an ongoing prospective follow-up project. The Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM-IV Axis I Disorders were administered to all participants. Response to long-term treatment was determined from the records of life charts of the prospective follow-up project. There were no significant differences in childhood trauma scores between groups with good and poor responses to long-term lithium treatment. Poor responders to long-term anticonvulsant treatment, however, had elevated emotional and physical abuse scores. Lifetime diagnosis of posttraumatic stress disorder (PTSD) was associated with poor response to lithium treatment and antidepressant use but not with response to treatment with anticonvulsants. Total childhood trauma scores were related to the total number of lifetime comorbid psychiatric disorders, antidepressant use, and the presence of psychotic features. There were significant correlations between all types of childhood abuse and the total number of lifetime comorbid psychiatric diagnoses. Whereas physical neglect was related to the mean severity of the mood episodes and psychotic features, emotional neglect was related to suicide attempts. A history of childhood trauma or PTSD may be a poor prognostic factor in the long-term treatment of bipolar disorder. Whereas abusive experiences in childhood seem to lead to nosological fragmentation (comorbidity), childhood neglect tends to contribute to the severity of the mood episodes.
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Affiliation(s)
- Sibel Cakir
- a Psychiatry Department , Istanbul University , Istanbul , Turkey
| | | | - Ilker Ozyildirim
- a Psychiatry Department , Istanbul University , Istanbul , Turkey
| | - Ezgi Ince
- a Psychiatry Department , Istanbul University , Istanbul , Turkey
| | - Vedat Sar
- b Department of Psychiatry , Koc University School of Medicine (KUSOM) , Istanbul , Turkey
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