Social anxiety and dissociation among male patients with alcohol dependency

The consequences of childhood maltreatment on dual-diagnosis psychiatric conditions and clinical outcomes in substance use disorders: A systematic review and meta-analysis

BACKGROUND

Evidence suggests that the phenotypic expression of substance use disorders (SUD) may be influenced by exposure to childhood maltreatment (CM).

OBJECTIVE

To assess how CM could impact severity (relapse, treatment dropout, withdrawal), age of substance use onset, psychiatric dual diagnosis (depression, anxiety, PTSD, distress), and self-harm behavior/suicide attempts in adults with SUD, we performed a systematic review and meta-analyses.

METHODS

We searched PubMed, Web of Science, PsycINFO, and Embase to identify articles examining the association of maltreatment (physical, sexual, or emotional abuse or neglect) before age 18 years with clinical features and course of illness SUD. Multilevel random effects models were performed. Heterogeneity was quantified using the I2 statistic. Subgroup/meta-regression analyses were employed to investigate sources of heterogeneity. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale.

RESULTS

Forty-five studies were included. CM was associated with all tested outcomes, such as anxiety (OR = 1.52; 95 % CI = 1.39, 1.65), depression (OR = 1.57; 95 % CI = 1.40, 1.77), PTSD (OR = 1.67; 95 % CI = 1.40, 1.99), psychological distress (OR = 1.49; 95 % CI = 1.24, 1.78), self-harm behavior and suicidal attempts (OR = 1.70; 95 % CI = 1.47, 1.96), SUD severity (OR = 1.15; 95 % CI = 1.04, 1.26), and younger age of onset use (OR = 0.76; 95 % CI = 0.69, 0.84). However, comparisons between outcomes revealed that the association was stronger for dual diagnosis symptoms/conditions than for measures of SUD severity itself. Meta-analyses for some outcomes had large statistical heterogeneity, though these were partly addressed through additional analyses. Gender, mean age of participants, polysubstance use pattern, substance of preference, and CM subtype were found to be moderators of these associations.

CONCLUSIONS

The consequences of CM on individuals with SUD are more closely linked to co-occurring psychiatric manifestations than to the severity of common clinical indicators (relapse, treatment dropout, withdrawal), and this finding has important implications.

FUNDING

None.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42021245936).

Childhood Trauma and Dissociation Correlates in Alcohol Use Disorder: A Cross-Sectional Study in a Sample of 587 French Subjects Hospitalized in a Rehabilitation Center

This study aimed to determine whether dissociative symptoms and childhood trauma (CT) may help identify a specific subgroup of patients among those hospitalized for alcohol use disorder (AUD). We assessed 587 patients hospitalized for an AUD in a French addiction rehabilitation center (cross-sectional study) regarding dissociative symptoms (DES-taxon), childhood trauma (CTQ), depression (BDI), anxiety (STAI-state and STAI-trait), posttraumatic stress disorder (PTSD; PCL-5), and AUD symptoms (AUDIT). We ran a hierarchical cluster analysis and compared the clusters in terms of dissociation and CT, as well as AUD, depressive, anxiety, and PTSD symptoms. We identified three clusters of patients: (1) patients with low AUD severity and low dissociation (LALD); (2) patients with high AUD severity and low dissociation (HALD); (3) patients with high AUD severity and high dissociation (HAHD). Patients from the HAHD group had significantly higher dissociation and more severe depression, anxiety, and PTSD symptoms than those with LALD and HALD. They also reported more emotional and sexual abuse than those with LALD. Among patients with an AUD, those with high dissociation may constitute an independent subgroup that exhibits a higher prevalence for CT and higher AUD severity, as well as higher depression, anxiety, and PTSD symptoms. Patients with more severe AUD and associated psychiatric symptoms should be systematically screened for dissociation and provided with tailor-based treatments.

Parasomnias in patients with addictions-a systematic review

Parasomnias are involuntary behaviors or subjective experiences during sleep. Our objective was to review existing information on the presence of parasomnias in patients with addictions or during treatment for addictions. Information about parasomnias related to rapid-eye-movement (REM) and non-REM sleep in patients with addictions, while using substances or in abstinence, was reviewed. A systematic search of published articles reporting parasomnias as a consequence of drug use or abuse was conducted in the PubMed and SciELO databases. The search for the studies was performed in three phases: (1) by title, (2) by abstract, and (3) by complete text. The search was performed independently by two researchers, who then compared their results from each screening phase. Seventeen articles were found. The consumption of alcohol was reported in association with arousal disorders, such as sexsomnia and sleep-related eating disorder; and REM sleep behavior disorder was reported during alcohol withdrawal. Cocaine abuse was associated with REM sleep behavior disorder with drug consumption dream content. Overall, we found that several types of parasomnias were very frequent in patients with addictions. To avoid accidents in bedroom, legal problems, and improve evolution and prognosis; must be mandatory to include security measures related to sleep period; avoid pharmacological therapy described as potential trigger factor; improve sleep hygiene; and give pharmacological and behavioral treatments for patients with these comorbid sleep disorders.

The Role of Childhood Maltreatment in The Relationship Between Social Anxiety and Dissociation: A Novel Link

Children that have been maltreated may experience manifold negative effects later in life. Two such sequelae are social anxiety and dissociation. Recent studies have noted their frequent co-occurrence, but no hypothesis has yet been offered explaining how they interact. College undergraduates (N = 198) completed the Child Trauma Questionnaire, Liebowitz Social Anxiety Scale, and Cambridge Depersonalization Scale. Social anxiety significantly predicted severity of dissociation, and self-reported childhood maltreatment (CM) significantly predicted both social anxiety and dissociation. Notably, emotional abuse was the only significant subtype of CM to predict social anxiety. Furthermore, CM moderated the relationship between social anxiety and dissociation, such that the presence of CM strengthened the predictive effect of social anxiety on dissociation. This study was the first to implicate CM as a mechanism in the social anxiety-dissociation relationship. This study was also the first to note a social anxiety-dissociation link in a non-clinical sample, thus demonstrating the existence of this relationship along a continuum of severity - not solely for those with extreme disturbances.

Is there a complex relation between social anxiety disorder, childhood traumatic experiences and dissociation?

BACKGROUND

A possible relationship has been suggested between social anxiety and dissociation. Traumatic experiences, especially childhood abuse, play an important role in the aetiology of dissociation.

AIM

This study assesses childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with social anxiety disorder (SAD).

METHOD

The 94 psychotropic drug-naive patients participating in the study had to meet DSM-IV criteria for SAD. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the Dissociation Questionnaire (DIS-Q), the Liebowitz Social Anxiety Scale (LSAS), and the Childhood Trauma Questionnaire (CTQ). Patients were divided into two groups using the DIS-Q, and the two groups were compared.

RESULTS

The evaluation found evidence of at least one dissociative disorder in 31.91% of participating patients. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Average scores on LSAS and fear and avoidance sub-scale averages were significantly higher among the high DIS-Q group (p < .05). In a logistic regression taking average LSAS scores as the dependent variable, the five independent variables DIS-Q, CTQ-53 total score, emotional abuse, sexual abuse, and emotional neglect were associated with average LSAS scores among patients with SAD (p < .05).

CONCLUSIONS

It is concluded that, on detecting SAD symptoms during hospitalization, the clinician should not neglect underlying dissociative processes and traumatic experiences among these patients.

Sociodemographic Factors and Comorbidities Associated with Remission from Alcohol Dependence: Results from a Nationwide General Population Survey in Korea

OBJECTIVE

The lifetime prevalence of alcohol dependence in South Korea remains higher than other countries. The aim of our study is to identify factors associated with remission from alcohol dependence.

METHODS

Data from the Korean Epidemiological Catchment Area-Replication (KECA-R) study were used in our study. The Korean version of the Composite International Diagnostic Interview 2.1 (K-CIDI 2.1) was administered. Remission was defined as having no symptom of alcohol dependence for 12 months or longer at the time of the interview. Demographic and clinical variables putatively associated with remission from alcohol dependence were examined by t-test, chi-square-test and logistic regression analysis.

RESULTS

The lifetime prevalence rate of alcohol dependence was 7.0%. Among them, 3.2% of the subjects were diagnosed with active alcohol dependence in the previous 12 months, and 3.8% were found to be in remission. Subjects in 35- to 44-year-old group, not living with partner group, and lower level of educational attainment group were more likely to be in the active alcohol dependence state. Of the comorbid mental disorders, dysthymia, anxiety disorder, nicotine use, and nicotine dependence were more common among the actively alcohol-dependent subjects.

CONCLUSION

There is considerable level of recovery from alcohol dependence. Attention to factors associated with remission from alcohol dependence may be important in designing more effective treatment and prevention programs in this high-risk population.

The severity of Internet addiction risk and its relationship with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students

The aim of this study was to investigate the relationship of Internet addiction (IA) risk with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. A total of 271 Turkish university students participated in this study. The students were assessed through the Internet Addiction Scale (IAS), the Borderline Personality Inventory (BPI), the Dissociative Experiences Scale (DES), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The rates of students were 19.9% (n=54) in the high IA risk group, 38.7% (n=105) in the mild IA risk group and 41.3% (n=112) in the group without IA risk. Correlation analyses revealed that the severity of IA risk was related with BPI, DES, emotional abuse, CTQ-28, depression and anxiety scores. Univariate covariance analysis (ANCOVA) indicated that the severity of borderline personality features, emotional abuse, depression and anxiety symptoms were the predictors of IAS score, while gender had no effect on IAS score. Among childhood trauma types, emotional abuse seems to be the main predictor of IA risk severity. Borderline personality features predicted the severity of IA risk together with emotional abuse, depression and anxiety symptoms among Turkish university students.

Social anxiety disorder in genuine halitosis patients

Background

There is a possibility that genuine halitosis patients' anxiety do not recover after oral malodor treatment due to their social anxiety disorder. The objective of this study was to investigate the influence of social anxiety disorder on the level of anxiety in genuine halitosis patients before and after treatment for oral malodor.

Methods

The subjects were 262 genuine halitosis patients who visited the Fresh Breath Clinic from March, 2008 to October, 2009. The subjects who had score 2 or higher by the organoleptic test were diagnosed as genuine halitosis patients. Gas chromatography (GC) was conducted before and after oral malodor treatment for the oral malodor measurement. Based on their risk of social anxiety disorder, subjects were divided into low- and high-risk groups using the Liebowitz Social Anxiety Scale (LSAS). The questions related to oral malodor and the clinical oral examination were both conducted before oral malodor treatment. The level of anxiety before and after oral malodor treatment was evaluated using the Visual Analogue Scale of Anxiety (VAAS).

Results

More than 20% of subjects had a score of 60 or more on the LSAS (high LSAS group). The mean age and the percentage of females were significantly higher in the high LSAS group compared to the low LSAS group. The high LSAS group was more likely to have problems associated with oral malodor and to adopt measures against oral malodor compared to the low LSAS group. The mean concentrations of H₂S and CH₃SH by GC significantly decreased after the oral malodor treatment in both LSAS groups. VAAS scores also significantly decreased after treatment in both LSAS groups. The logistic regression analysis indicated that the high LSAS group had a 2.28 times higher risk of having a post-VAAS score of 50 or more compared to the low LSAS group.

Conclusions

This study revealed that genuine halitosis patients with a strong trait of social anxiety disorder have difficulty overcoming their anxiety about oral malodor. Oral malodor treatment of genuine halitosis patients requires not only regular oral malodor treatment but also attention to social anxiety disorder.

Lifetime PTSD and quality of life among alcohol-dependent men: impact of childhood emotional abuse and dissociation

The aim of this study was to investigate the impact of lifetime posttraumatic stress disorder (PTSD), dissociation and a history of childhood trauma on quality of life (QoL) among men with alcohol dependency. A consecutive series of alcohol-dependent men (N=156) admitted to an inpatient treatment unit were screened using the Michigan Alcoholism Screening Test, the Clinician Administered PTSD Scale, the Dissociative Experiences Scale, and the Childhood Trauma Questionnaire. QoL was assessed using the Medical Outcomes Study Short-Form 36-item health survey. Fifty (32.1%) patients had lifetime diagnosis of PTSD. Besides problems related to severity of alcohol use, the lifetime PTSD group was impaired on several physical and mental components of QoL. While the lifetime PTSD group and remaining patients did not differ on reports of childhood trauma and dissociation, in lifetime PTSD group, dissociative patients had higher scores of childhood emotional abuse than those of the non-dissociative patients. In multivariate covariance analysis, both dissociation and lifetime PTSD predicted impairment in physical functioning, general health, vitality, and mental health components of QoL. Among alcohol-dependent men with lifetime PTSD, a history of childhood emotional abuse contributes to impairment of QoL through its relationship with dissociation.

The Attentional Resource Allocation Scale (ARAS): psychometric properties of a composite measure for dissociation and absorption

BACKGROUND

Differences in attentional processes have been linked to the development and maintenance of psychopathology. Shifts in such processes have been described by the constructs Dissociation and Absorption. Dissociation occurs when external and/or internal stimuli are excluded from consciousness due to discrepant, rather than unitary, manifestations of cognitive awareness [Erdelyi MH. 1994: Int J Clin Exp Hypnosis 42:379-390]. In contrast, absorption can be conceptualized by a focus on limited stimuli, to the exclusion of other stimuli, because of unifying, rather than discrepant, manifestations of cognitive awareness. The Dissociative Experiences Scale [DES; Bernstein EM, Putnam FW. 1986: J Nerv Ment Dis 174:727-735] and Tellegen Absorption Scale [TAS; Tellegen A, Atkinson G. 1974: J Abnorm Psychol 83:268-277] are common measures of each construct; however, no factor analyses are available for the TAS and despite accepted overlap, no one has assessed the DES and TAS items simultaneously. Previous research suggests the constructs and factor structures need clarification, possibly including more parsimonious item inclusion [Lyons LC, Crawford HJ. 1997: Person Individ Diff 23:1071-1084]. The purpose of this study was to evaluate the factor structure of the DES and TAS and create a psychometrically stable measure of Dissociation and Absorption.

METHODS

This study included data from an undergraduate (n=841; 76% women) and a community sample (n=233; 86% women) who each completed the DES and TAS.

RESULTS

Exploratory factor analyses [Osborne JW (ed). 2008: Best Practices in Quantitative Methods. Los Angeles: Sage Publications Inc.] with all DES and TAS items suggested a 15-item 3-factor solution (i.e., imaginative involvement, dissociative amnesia, attentional dissociation). Confirmatory factor analyses resulted in excellent fit indices for the same solution.

CONCLUSIONS

The items and factors were conceptualized in line with precedent research as the Attentional Resource Allocation Scale (ARAS). Comprehensive results, implications, and future research directions are discussed.