Subjective sleep experiences are related to dissociation

Sleep and dream disturbances associated with dissociative experiences

Some dissociative experiences may be related, in part, to REM intrusion into waking consciousness. If so, some aspects of dream content may be associated with daytime dissociative experiences. We tested the hypothesis that some types of dream content would predict daytime dissociative symptomology. As part of a longitudinal study of the impact of dreams on everyday behavior we administered a battery of survey instruments to 219 volunteers. Assessments included the Dissociative Experiences Scale (DES), along with other measures known to be related to either REM intrusion effects or dissociative experiences. We also collected dream reports and sleep measures across a two-week period from a subgroup of the individuals in the baseline group. Of this subgroup we analyzed two different subsamples; 24 individuals with dream recall for at least half the nights in the two-week period; and 30 individuals who wore the DREEM Headband which captured measures of sleep architecture. In addition to using multiple regression analyses to quantify associations between DES and REM intrusion and dream content variables we used a split half procedure to create high vs low DES groups and then compared groups across all measures. Participants in the high DES group evidenced significantly greater nightmare distress scores, REM Behavior Disorder scores, paranormal beliefs, lucid dreams, and sleep onset times. Validated measures of dreamed first person perspective and overall dream coherence in a time series significantly predicted overall DES score accounting for 26% of the variance in dissociation. Dream phenomenology and coherence of the dreamed self significantly predicts dissociative symptomology as an individual trait. REM intrusion may be one source of dissociative experiences. Attempts to ameliorate dissociative symptoms or to treat nightmare distress should consider the stability of dream content as a viable indicator of dissociative tendencies.

Discrimination and Sleep: Differential Effects by Type and Coping Strategy

BACKGROUND

Discrimination has been posited as a contributor of sleep disparities for Latinxs. The strategy used to cope with discrimination may reduce or exacerbate its effects on sleep. This study examined whether different types of discrimination (everyday and major lifetime discrimination) were associated with sleep indices (quality, disturbances, efficiency) and whether coping strategy used moderated associations.

METHOD

Data of Latinx adults (N = 602; 51% women, 65% Dominican, Mage = 46.72 years) come from the Latino Health and Well-being Project, a community-based, cross-sectional study of Latinxs in Lawrence, MA. Multiple linear regressions were estimated separately for each sleep outcome.

RESULTS

Everyday discrimination was significantly associated with poorer sleep quality and greater disturbances; major lifetime discrimination was significantly associated with worse sleep across the three sleep indices. Coping strategy moderated associations between discrimination and sleep. Compared with Latinxs who used passive coping, those who used passive-active coping strategies had poorer sleep quality the more they experienced everyday discrimination. Latinxs who used any active coping strategy, compared with passive coping, had greater sleep disturbances the more frequently they experienced major lifetime discrimination.

CONCLUSIONS

Findings show that everyday discrimination and major lifetime discrimination are associated with different dimensions of sleep and suggest that coping with discrimination may require the use of different strategies depending on the type of discrimination experienced.

Psychobiological personality traits of children and adolescents with disorders of arousal

INTRODUCTION

Disorders of arousal (DOA) are parasomnias that emerge from incomplete arousal out of Non-Rem Sleep (NREM) and lead to a broad variety of emotional and motor behaviours. Increasing evidence supports the hypothesis that specific psychopathological traits contribute to the multifactorial origin of these phenomena. The aim of the current multicenter study was to compare the personality profile of children and adolescents with and without DOA using the Junior Temperament and Character Inventory (JTCI).

METHODS

We enrolled 36 patients with a diagnosis of DOA (mean age of 11 ± 3 years, 64% males), and 36 healthy age and gender matched control subjects (mean age of 11.2 ± 3.6, years, 67% males). Their parents completed the Paris Arousal Disorder Severity Scale (PADSS), the Sleep Disturbance Scale for Children (SDSC) and the JTCI.

RESULTS

Patients with DOA reached significantly higher levels compared to their control group in total PADSS (p < 0.0001) and in total SDSC (p < 0.0001). They also displayed higher scores in novelty seeking (p = 0.005), harm avoidance (p = 0.01), self-transcendence (p = 0.006) JTCI subscales, and lower scores on the self-directedness subscale (p = 0.004).

CONCLUSION

Our pediatric sample with DOA exhibited specific psychobiological personality traits compared to age and gender matched subjects without DOA. These results shed light on new possible etiopathogenetic mechanisms, as TCI traits have been linked to specific genetic variants and brain circuits, like the reward system. Prospective studies are required to assess the effect of targeted psychological/psychiatric treatment on DOA symptomatology.

The Maternal Disintegrative Responses Scale (MDRS): Development and initial validation

OBJECTIVE

This study aimed to design and examine the validity of the Maternal Disintegrative Responses Scale (MDRS) to assess intrusive thoughts and dissociative experiences in the postpartum period.

METHOD

A convenience sample of 455 mothers whose babies were up to 12 months old completed the MDRS and a series of questionnaires assessing postnatal depression (Edinburgh Postnatal Depression Scale [EPDS]), childbirth-related post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and general symptoms of dissociation.

RESULTS

The final scale consists of eight items tapping two dimensions, intrusive thoughts and dissociative experiences, and displays good psychometric properties. Both factors were found to be related to EPDS, PTSD OCD, and general symptoms of dissociation. Primiparous women scored higher than multiparous women on both dimensions, and mothers of infants up to 3 months old scored higher on dissociative experiences than those whose infants were aged 4-12 months.

CONCLUSIONS

The MDRS can contribute to the theoretical and practical conceptualization and assessment of these phenomena.

Dissociation in relation to other mental health conditions: An exploration using network analysis

Dissociative experiences, traditionally studied in relation to trauma and PTSD, may be important phenomena across many different psychological conditions, including as a contributory causal factor for psychotic experiences. In this study, the aim was to explore, using network approaches, how dissociative experiences taking the form of a Felt Sense of Anomaly (FSA) relate to both common mental health conditions and psychotic experiences. 6941 individuals from the general population completed online assessments of FSA-dissociation, post-traumatic stress symptoms (PTSS), anxiety, depression, insomnia, worry, distress tolerance, hallucinations, grandiosity, paranoia, and cognitive disorganization. An undirected partial correlation network analysis was used to explore the network structure, then Bayesian inference with Directed Acyclic Graphs (DAGs) was used to identify potential directions of relationships between dissociation and mental health symptoms. Dissociation was found to be highly connected in both network models. Both networks found direct relationships between dissociation and hallucinations, grandiosity, paranoia, cognitive disorganization, anxiety, depression, and PTSS. In the DAGs analysis, the direction of influence between dissociation and hallucinations, PTSS, anxiety and depression was unclear, however it was found to be probable that dissociation influences paranoia (97.66% of sampled DAGs found the direction dissociation to paranoia, versus 2.34% finding the reverse direction), cognitive disorganization (99.74% vs. 0.26%), and grandiosity (93.49% vs. 6.51%). Further, dissociation was found to be a probable influence of insomnia and distress tolerance via indirect pathways. In summary, dissociation is connected to many mental health disorders, and may influence a number of presentations, particularly psychotic experiences. The importance of dissociation in mental health may therefore currently be under-recognised.

Anomalous experiences are more prevalent among highly suggestible individuals who are also highly dissociative

Introduction: Predictive coding models propose that high hypnotic suggestibility confers a predisposition to hallucinate due to an elevated propensity to weight perceptual beliefs (priors) over sensory evidence. Multiple lines of research corroborate this prediction and demonstrate a link between hypnotic suggestibility and proneness to anomalous perceptual states. However, such effects might be moderated by dissociative tendencies, which seem to account for heterogeneity in high hypnotic suggestibility. We tested the prediction that the prevalence of anomalous experiences would be greater among highly suggestible individuals who are also highly dissociative.Methods: We compared high and low dissociative highly suggestible participants and low suggestible controls on multiple psychometric measures of anomalous experiences.Results: High dissociative highly suggestible participants reliably reported greater anomalous experiences than low dissociative highly suggestible participants and low suggestible controls, who did not significantly differ from each other.Conclusions: These results suggest a greater predisposition to experience anomalous perceptual states among high dissociative highly suggestible individuals.

The prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies

This meta-analysis of 31,905 college students includes 12 studies diagnosing Dissociative Disorders (DD) and 92 studies measuring dissociation with the Dissociative Experiences Scale (DES). Prevalence rates were used to separately test the plausibility of the Trauma Model (TM) and the Fantasy Model (FM) of dissociation. Results show 11.4% of students sampled meet criteria for DD, which is consistent with the prevalence of experiencing multiple (types of) trauma during childhood (12%), but is not consistent with the very low prevalence expected from the role of fantasy-proneness proposed in the FM. DES scores varied significantly across the 16 countries and were not higher in North America, but in countries that were comparatively unsafe. The least well-known DD was the most common, which is inconsistent with the FM which holds that the diagnosed person is enacting a familiar social role. There was no evidence that DES scores had decreased over recent decades, which does not support FM assertions that DD were a fad of the 1990s. Three of the five hypotheses tested provided clear support for the TM and a fourth hypothesis provided partial support for the TM. None of the five hypotheses tested supported the FM. The finding that DD were slightly more common in college populations than the general population did not support predictions of either model. The theoretical perspective of the authors moderated DES scores, although this is unlikely due to experimenter bias as studies led by FM theorists had significantly higher DES scores than those led by TM theorists.

The effects of individual biological rhythm differences on sleep quality, daytime sleepiness, and dissociative experiences

Individuals who differ markedly by sleep chronotype, i.e., morning-type or evening-type also differ on a number of psychological, behavioral, and biological variables. Among several other psychological functions, dissociation may also lead to disruption and alteration of consciousness, which may facilitate dream-like experiences. Our study was aimed at an inquiry into the effects of individual biological rhythm differences on sleep quality and daytime sleepiness in conjunction with dissociative experiences. Participants were 372 undergraduate college students, completed a package of psychological instruments, including the Morningness-Eveningness Questionnaire, Dissociative Experiences Scale, Insomnia Severity Index, and Epworth Sleepiness Scale. Using logistic regression models, direct relations of pathological dissociation with sleepiness, sleep quality and circadian preferences were investigated. Poor sleep quality and sleepiness significantly contributed to the variance of dissociative symptomatology. Although there was no substantial linear association between circadian preferences and pathological dissociation, having evening-type preferences of sleep was indirectly associated with higher dissociation mediated by poor sleep quality. Poor sleep quality and daytime sleepiness seems to be significant antecedents of pathological dissociation. Sleep chronotype preferences underlie this relational pattern that chronobiological characteristics seem to influence indirectly on dissociative tendency via sleep quality.

Arousal in Nocturnal Consciousness: How Dream- and Sleep-Experiences May Inform Us of Poor Sleep Quality, Stress, and Psychopathology

The term "sleep experiences," coined by Watson (2001), denotes an array of unusual nocturnal consciousness phenomena; for example, nightmares, vivid or recurrent dreams, hypnagogic hallucinations, dreams of falling or flying, confusional arousals, and lucid dreams. Excluding the latter, these experiences reflect a single factor of atypical oneiric cognitions ("general sleep experiences"). The current study is an opinionated mini-review on the associations of this factor-measured with the Iowa sleep experiences survey (ISES, Watson, 2001)-with psychopathological symptoms and stress. Findings support a strong relation between psychological distress and general sleep experiences. It is suggested that that they should be viewed as a sleep disturbance; they seem to represent involuntary intrusions of wakefulness into sleep, resulting in aroused sleep. These intrusions may stem from excessively thin boundaries between consciousness states (e.g., "transliminality"), or, conversely, they may follow an attempt at disconnecting mental elements (e.g., dissociation), which paradoxically results in a "rebound effect." The extent to which unusual dreaming is experienced as intrusive, rather than controlled, may explain why general sleep experiences are related to psychopathology, whereas lucid dreams are related to psychological resilience. In conclusion, the exploration of the interplay between psychopathology and sleep should be expanded from focusing almost exclusively on quantitative aspects (e.g., sleep efficiency, latency) to including qualitative conscious experiences which may reflect poor sleep quality. Taking into account nocturnal consciousness-including unusual dreaming and permeable sleep-wake boundaries-may unveil rich information on night-time emotional states and broaden our definition of poor sleep quality.

Tracking Potentiating States of Dissociation: An Intensive Clinical Case Study of Sleep, Daydreaming, Mood, and Depersonalization/Derealization

This study examined in real time the role of sleep and daydreaming as potentiating states for subsequent dissociation in depersonalization/derealization disorder (DDD). Research and theory suggests that dissociation may be exacerbated and maintained by a labile sleep-wake cycle in which "dream-like" mentation intrudes into waking life and fuels dissociative symptoms. We explore and extend this idea by examining the state of daydreaming in dissociation. Daydreaming is a state of consciousness between dreaming and waking cognition that involves stimulus-independent and task-unrelated mentation. We report the results of a unique intensive N = 1 study with an individual meeting diagnostic criteria for DDD. Using experience-sampling methodology, the participant rated (six times daily for 40 days) current daydreaming, mood, and dissociative symptoms. At the start of each day sleep quality and duration was also rated. Daydreaming was reported on 45% of occasions and significantly predicted greater dissociation, in particular when daydreams were repetitive and negative (but not fanciful) in content. These relationships were mediated by feelings of depression and anxiety. Sleep quality but not duration was a negative predictor of daily dissociation and also negatively predicted depression but not anxiety. Findings offer initial evidence that the occurrence and content of daydreams may act as potentiating states for heightened, in the moment, dissociation. The treatment implications of targeting sleep and daydreaming for dissociative disorders are discussed.

Increased Reward-Related Behaviors during Sleep and Wakefulness in Sleepwalking and Idiopathic Nightmares

BACKGROUND

We previously suggested that abnormal sleep behaviors, i.e., as found in parasomnias, may often be the expression of increased activity of the reward system during sleep. Because nightmares and sleepwalking predominate during REM and NREM sleep respectively, we tested here whether exploratory excitability, a waking personality trait reflecting high activity within the mesolimbic dopaminergic (ML-DA) system, may be associated with specific changes in REM and NREM sleep patterns in these two sleep disorders.

METHODS

Twenty-four unmedicated patients with parasomnia (12 with chronic sleepwalking and 12 with idiopathic nightmares) and no psychiatric comorbidities were studied. Each patient spent one night of sleep monitored by polysomnography. The Temperament and Character Inventory (TCI) was administered to all patients and healthy controls from the Geneva population (n = 293).

RESULTS

Sleepwalkers were more anxious than patients with idiopathic nightmares (Spielberger Trait anxiety/STAI-T), but the patient groups did not differ on any personality dimension as estimated by the TCI. Compared to controls, parasomnia patients (sleepwalkers together with patients with idiopathic nightmares) scored higher on the Novelty Seeking (NS) TCI scale and in particular on the exploratory excitability/curiosity (NS1) subscale, and lower on the Self-directedness (SD) TCI scale, suggesting a general increase in reward sensitivity and impulsivity. Furthermore, parasomnia patients tended to worry about social separation persistently, as indicated by greater anticipatory worry (HA1) and dependence on social attachment (RD3). Moreover, exploratory excitability (NS1) correlated positively with the severity of parasomnia (i.e., the frequency of self-reported occurrences of nightmares and sleepwalking), and with time spent in REM sleep in patients with nightmares.

CONCLUSIONS

These results suggest that patients with parasomnia might share common waking personality traits associated to reward-related brain functions. They also provide further support to the notion that reward-seeking networks are active during human sleep.

Sleep loss increases dissociation and affects memory for emotional stimuli

BACKGROUND AND OBJECTIVES

Because of their dreamlike character, authors have speculated about the role that the sleep-wake cycle plays in dissociative symptoms. We investigated whether sleep loss fuels dissociative symptoms and undermines cognitive efficiency, particularly memory functioning.

METHODS

Fifty-six healthy undergraduate students were randomly assigned to an experimental group (n = 28) and a control group (n = 28). The experimental group was deprived of sleep for 36 h in a sleep laboratory; the control group had a regular night of sleep. Sleepiness, mood, and dissociative symptoms were assessed 6 times in the experimental group (control group: 4 times). Several cognitive tasks were administered.

RESULTS

Sleep deprivation led to an increase in dissociative symptoms, which was mediated by levels of general distress. Feelings of sleepiness preceded an increase of dissociative symptoms and deterioration of mood. Finally, sleep loss also undermined memory of emotional material, especially in highly dissociative individuals.

LIMITATIONS

Limitations included moderate reliability of the mood scale, limited generalizability due to student sample, and a relatively short period of intensive sleep deprivation rather than lengthy but intermittent sleep loss, representative of a clinical population.

CONCLUSIONS

We found that sleep deprivation had significant effects on dissociation, sleepiness, and mood. Specifically, sleepiness and dissociation increased during the night, while mood deteriorated. Our findings stress the importance of sleep deficiencies in the development of dissociative symptoms. They support the view that sleep disruptions fuel distress, but also degrade memory and attentional control. It is against this background that dissociative symptoms may arise.

Night-time experiences and daytime dissociation: a path analysis modeling study

Dissociative symptoms may be the by-products of a labile sleep-wake cycle (Koffel and Watson, 2009a). This may help to explain why dissociation overlaps with fantasy proneness and cognitive failures. Using path analysis, we tested to what extent data gathered in a nonclinical, predominantly female sample (N=139) supported two conceptual models. The first model assumes that unusual sleep experiences increase fantasy proneness and cognitive failures, which in turn encourage trait dissociation and reports of trauma. The second model assumes that trauma leads to dissociative experiences both directly and through its influence on sleep. In this cross-sectional design, the data were reasonably well described by both models. Importantly, in both models, unusual sleep experiences serve as antecedents of trait dissociation. Our analysis underlines the importance of unusual sleep experiences and may inspire treatment intervention focusing on sleep normalization.

Dissociative symptoms and sleep parameters--an all-night polysomnography study in patients with insomnia

BACKGROUND

Dissociative disorders encompass a range of symptoms varying from severe absent-mindedness and memory problems to confusion about one's own identity. Recent studies suggest that these symptoms may be the by-products of a labile sleep-wake cycle.

METHODS

In the current study, we explored this issue in patients suffering from insomnia (N=46). We investigated whether these patients have raised levels of dissociative symptoms and whether these are related to objective sleep parameters. Patients stayed for at least one night in a specialized sleep clinic, while sleep EEG data were obtained. In addition, they completed self-report measures on dissociative symptoms, psychological problems, and sleep characteristics.

RESULTS

Dissociative symptom levels were elevated in patients suffering from insomnia, and were correlated with unusual sleep experiences and poor sleep quality. Longer REM sleep periods and less time spent awake during the night were predictive of dissociation.

CONCLUSIONS

This is the first study to show that insomnia patients have raised dissociative symptom levels and that their dissociative symptoms are related to objective EEG parameters. These findings are important because they may inspire sleep-related treatment methods for dissociative disorders.

Fragmented Sleep, Fragmented Mind

In psychopathology, dissociation typically refers to a disturbance in the normal integration of thoughts, feelings, and experiences into consciousness and memory. In this article, we review the literature on how sleep disturbances relate to dissociative symptoms and memory failure. We contend that this body of research offers a fresh perspective on dissociation. Specifically, we argue that dissociative symptoms are associated with a labile sleep–wake cycle, in which dreamlike mentation invades the waking state, produces memory failures, and fuels dissociative experiences. The research domain of sleep and dissociation can accommodate the dominant idea in the clinical literature that trauma is the distal cause of dissociation, and it holds substantial promise to inspire new treatments for dissociative symptoms (e.g., interventions that focus on normalization of the sleep-wake cycle). We conclude with worthwhile paths for further investigations and suggest that the sleep–dissociation approach may help reconcile competing interpretations of dissociative symptoms.

Mindfulness and dream quality: the inverse relationship between mindfulness and negative dream affect

The aim of the study was to examine the relationship of mindfulness to the emotional quality of dreaming. In our questionnaire-based study, comprising the data of 587 undergraduate students we examined the association between trait anxiety, perceived stress, trait mindfulness, negative dream affect and dream anxiety. Our results indicate that mindfulness is inversely related to disturbed dreaming and predicts less severe dream disturbances after controlling for trait anxiety. Moreover, the results of the applied hierarchical regression analysis suggest that mindfulness is associated with reduced dream anxiety by moderating the extent of waking anxiety. Our findings extend previous research relating mindfulness, emotional regulation and sleep quality to the domain of dream research. We suggest that mindfulness is a possible protective factor against dream disturbances.

Unusual sleep experiences, dissociation, and schizotypy: Evidence for a common domain

This paper reviews studies that have examined associations between unusual sleep experiences (including nightmares, vivid dreaming, narcolepsy symptoms, and complex nighttime behaviors) and dissociation and schizotypy. Using correlational studies and structural analyses, evidence is provided that unusual sleep experiences, dissociation, and schizotypy belong to a common domain. It is demonstrated that unusual sleep experiences show specificity to dissociation and schizotypy compared to other daytime symptoms (e.g., anxiety, depression, substance use) and other sleep disturbances (e.g., insomnia, lassitude/fatigue). The paper also outlines the methodological limitations of the existing evidence and makes suggestions for future research. Finally, three models for the overlap of daytime and nighttime symptoms are reviewed, including biological abnormalities, trauma, and personality traits. Although further research is needed, it is suggested that daytime and nighttime symptoms result from problems with sleep-wake state boundaries, which may be precipitated by stress or trauma. In addition, association between daytime and nighttime symptoms can be attributed to the higher order personality trait of Oddity.

Dissociation, memory commission errors, and heightened autonomic reactivity

If dissociative symptoms are manifestations of a psychological defense mechanism, one would expect people who have such symptoms to react with lower levels of physiological arousal and with memory omissions to emotionally provocative material. The current study tested this assumption in a sample of undergraduates. Sixty-two undergraduate students viewed a highly emotional video fragment. Pearson's product-moment correlations were calculated between dissociation (as indexed by the Dissociative Experiences Scale, DES) and all dependent measures. High dissociators exhibited elevated skin conductance responses (SCRs) to the fragment. Memory for the video fragment was then tested. While omission errors were unrelated to dissociation, high dissociators exhibited a tendency to produce commission errors. This could not be explained by a reduced working memory capacity. However, fantasy proneness was found related to high dissociators' commission errors. Thus, it seems that a pattern of heightened emotional reactivity and commission errors is typical for people with elevated dissociation scores. This pattern is difficult to reconcile with the defensive function ascribed to dissociation.

Dissociation, resting EEG, and subjective sleep experiences in undergraduates

In this study, we explored whether individual differences in dissociation are related to certain resting electroencephalographic (EEG) parameters. Baseline EEG with eyes open and closed was recorded in an undergraduate sample (N = 67). Cortical power in the alpha range was inversely related to dissociative symptoms as measured by the Dissociative Experiences Scale, while both delta and theta power where positively related to dissociation. However, sleep experiences, as indexed with the Iowa Sleep Experiences Survey, were unrelated to resting EEG characteristics. We propose that suppression in the alpha band and raised levels of theta activity, which are typical for high dissociators, might help to explain why dissociative symptoms are accompanied by attentional and memory deficits.

�ber die kausale Beziehung zwischen Dissoziation und Trauma

This article discusses the accepted view that trauma causes dissociation. We critically evaluate studies that explored this relationship and discuss their shortcomings. In addition, individual differences related to dissociative experiences are discussed. In doing so, we focus on their potential to create pseudo-correlations between dissociative symptoms and self-reports of childhood trauma. After concluding that the causal link between trauma and dissociation is far from self-evident or empirically substantiated, we suggest some avenues for further research.