Using Online Methods to Develop and Examine the Hong Kong Chinese Translation of the Dissociative Experiences Scale

A Preliminary Longitudinal Analysis of Symptom Management, Post-traumatic Stress, and Depressive Symptoms in Chinese Adults with Dissociative Symptoms

People with dissociative symptoms are generally poly-symptomatic and require high levels of healthcare resources. Post-traumatic stress disorder (PTSD) and depressive symptoms are two major disabling comorbid symptoms in people with dissociative symptoms. While the sense of control over symptoms may be associated with PTSD and dissociative symptoms, the interplay among these factors over time remains unexplored. This study examined the predictors of PTSD and depressive symptoms in people with dissociative symptoms. Longitudinal data from 61 participants with dissociative symptoms were analyzed. Participants completed self-report measures of dissociative, depressive, and PTSD symptoms and the sense of control over symptoms two times (T1 & T2) with an interval of over one month. PTSD and depressive symptoms were not transient or time-specific, but they persisted over time in our sample. Hierarchical multiple regression analyses revealed that, after controlling for age, treatment usage and baseline symptom severity, T1 symptom management scores (β = -.264, p = .006) negatively predicted T2 PTSD symptoms, while T1 PTSD symptoms (β = .268, p = .017) positively predicted T2 depressive symptoms. T1 depressive symptoms (β = -.087, p = .339) did not predict T2 PTSD symptoms. The findings highlight the importance of improving symptom management skills and treating comorbid PTSD symptoms when working with people with dissociative symptoms.

Substance abuse among mothers in Taiwan: Investigating its prevalence and testing the trauma model

Substance abuse is a serious problem in our society. In particular, household or parental substance abuse could lead to adverse childhood experiences for the affected children. However, little is known about the prevalence of substance abuse among parents, especially in Asian societies. Moreover, although the trauma model of addiction has significant implications for the prevention and treatment of substance abuse, most evidence comes from Western samples. To address these knowledge gaps, we examined the prevalence of substance abuse in a sample of mothers in Taiwan and tested the trauma model of substance abuse. A total of 867 Taiwanese mothers completed standardized self-report assessments in 2023. The screening results indicated that the 12-month prevalence of drug abuse and alcohol abuse was 12.3% and 7.3%, respectively; 15.5% had either or both drug and alcohol abuse. Most types of trauma exposure were associated with drug abuse severity, while interpersonal stress and dissociative symptoms were associated with alcohol abuse severity, even after controlling for a variety of demographic and health variables as well as general psychopathology (i.e., depressive symptoms). The relatively high prevalence of substance abuse among Taiwanese mothers in our sample is concerning, particularly when compared to the rates reported in other Asian samples. We also provide preliminary cross-cultural evidence supporting the self-medication theory and the trauma model of substance abuse in the Asian context. We discuss the potential importance of addressing trauma and stress to prevent substance abuse and call for follow-up studies.

Sleep Quality, Sleep-Related Experiences, and Dissociation in Adult Survivors of Childhood Trauma

OBJECTIVES

Exposure to traumatic stress in childhood increases the risk of sleep disturbances. Preliminary evidence suggests that the relationship between childhood trauma and sleep may depend on trauma chronicity. Additionally, little is known about the relationship between sleep and dissociation, a common symptom in post-traumatic stress disorder. This study examined sleep quality, sleep-related experiences, and dissociation in survivors of childhood trauma with different trauma chronicity.

METHOD

Nine-hundred-and-fourteen community-dwelling adults completed an online survey. They were divided into three groups: no childhood trauma, short-term childhood trauma, and chronic childhood trauma.

RESULTS

We found that survivors of chronic childhood trauma had poorer sleep quality than survivors of short-term childhood trauma and individuals without a history of childhood trauma, controlling for age, number of trauma types experienced, psychological distress, and PTSD symptoms. The relationship between dissociation and sleep quality was moderated by trauma chronicity such that dissociation was associated with better sleep quality only in the chronic trauma group. Dissociation was positively associated with sleep-related experiences regardless of trauma exposure and trauma chronicity.

CONCLUSION

Our findings highlighted the differential impact of acute and chronic traumatic stress on sleep, and suggested that the relationship between dissociation and sleep could depend on trauma chronicity.

Is teacher violence a form of betrayal trauma? Relationship with mental health problems among young adults

BACKGROUND

Childhood trauma is one of the most preventable risk factors for mental health problems. Considering the substantial amount of time that young people spend in school during their early years, it is important to understand the potential impacts of teachers' behaviors on students' mental health.

OBJECTIVES

This study examined the relationship between exposure to teacher violence and mental health problems.

PARTICIPANTS AND SETTING

An international sample of young adults aged 18 to 24 (N = 283).

METHODS

Participants completed self-report measures of childhood trauma, exposure to teacher violence, depressive symptoms, post-traumatic stress, and alcohol misuse.

RESULTS

Exposure to teacher violence could be reliably and validly measured using the Teacher Violence Scale (TVS). Current mental health problems - including depressive symptoms, post-traumatic stress, and alcohol misuse - were associated with exposure to teacher violence during high school years, but not with childhood non-betrayal trauma.

CONCLUSIONS

Our findings expand the application of the betrayal trauma theory to school settings and point to the importance of preventing and managing teacher violence. It is important to provide more support and training to teachers and enhance monitoring measures in schools. More research on the prevalence and correlates of exposure to teacher violence is needed. We also provided first evidence supporting the reliability and validity of the English version of the TVS to facilitate future research.

Psychometric evaluation of the Hong Kong Chinese version of the Dissociative Experiences Measure, Oxford (HKC-DEMO)

The Dissociative Experiences Measure, Oxford (DEMO) is a recently developed measure that reflects the current conceptualization of dissociation. However, psychometric investigations of the DEMO are still limited. The current study examined the factor structure and psychometric properties of the Hong Kong Chinese version of the DEMO (HKC-DEMO). Online survey data on 914 community-dwelling adults in Hong Kong was extracted from a primary preregistered study on sleep and dissociation. Confirmatory factor analyses revealed that a five-factor structure, identified as "unreality," "numbness and disconnectedness," "memory blanks," "zoned out," and "vivid internal world," fit the data adequately. The five-factor structure fit significantly better than a four-factor structure, which combined "zoned out" and "vivid internal world" as a single factor of "absorption." Furthermore, the HKC-DEMO demonstrated excellent reliability, and satisfactory convergent, and divergent validity. The current study was the first to translate the DEMO to other language and showed that the HKC-DEMO is reliable and valid for use in Hong Kong Chinese adults. Further validation of the HKC-DEMO with a clinical sample and samples with a wider age range would enhance the generalizability of the HKC-DEMO.

A Cross-Cultural Investigation of the Association between Betrayal Trauma and Dissociative Features

Betrayal trauma theory proposes that betrayal and non-betrayal traumas are different in terms of their nature and impacts. The theory predicts that dissociation is more strongly related to betrayal than to non-betrayal trauma, however there is a lack of cross-cultural evaluation of the theory. One competing theory is the socio-cognitive model, which proposes that dissociative amnesia (DA) and identity dissociation (ID) are the results of social influence and are not trauma-related conditions. This study aimed to test the hypotheses based on betrayal trauma theory and investigated the relationship between trauma, dissociation and other mental health problems in two culturally different convenience samples of people seeking web-based educational interventions for dissociation (N = 83 English speakers and N = 82 Chinese speakers). Compared with childhood non-betrayal trauma, childhood betrayal trauma had a statistically stronger relationship with dissociation and borderline personality disorder (BPD) symptoms in both samples. DA and ID symptoms were cross-culturally associated with childhood betrayal trauma after controlling for other variables (including sample membership, age, depression levels, medication treatment and non-betrayal trauma). Participants with DA/ID symptoms reported significantly more trauma-related symptoms in both samples. The findings supported the cross-cultural application of the betrayal trauma theory for dissociative features and BPD symptoms. Implications for research and practice (e.g., child protection, assessment for survivors of childhood betrayal trauma) are highlighted.

Self-stigma predicts post-traumatic and depressive symptoms in traumatized individuals seeking interventions for dissociative symptoms: a preliminary investigation

Background: Previous studies showed that self-stigma is associated with poor clinical outcomes in people with serious mental illness, and is associated with post-traumatic stress disorder (PTSD). However, less is known about self-stigma in people with dissociative symptoms, which are often related to psychological trauma. This study examined whether baseline self-stigma would be associated with dissociative, PTSD and depressive symptoms at post-intervention, after controlling for treatment usage and baseline symptom severity, in a sample of traumatized Chinese adults undertaking a psychoeducation intervention for dissociative symptoms.Methods: We conducted a secondary analysis of data from a 60-day web-based psychoeducation programme. A total of 58 participants who provided data before and after the intervention were included for analysis. Hierarchical regression analyses were conducted.Results: In this highly traumatized, dissociative, and symptomatic help-seeking sample, baseline self-stigma was associated with PTSD (β = .203, p = .032) and depressive (β = .264, p = .025) symptoms at post-intervention, even after controlling for baseline symptom severity, age, location, number of sessions attended in the web-based psychoeducation programme, and use of psychological treatments for PTSD/dissociative symptoms. However, self-stigma was not associated with dissociative symptoms (p = .108).Conclusions: This is the first study showing that self-stigma is a significant predictor of comorbid symptoms (i.e. PTSD and depressive symptoms) in people seeking interventions for dissociative symptoms. The findings that post-traumatic and dissociative symptoms have different relationships to self-stigma also highlight the possibility dissociation might be an independent psychological construct closely associated with trauma, but not merely a PTSD symptom, although further studies are necessary. The preliminary findings call for more efforts to understand, prevent, and address self-stigma in people with trauma-related mental health issues such as dissociative symptoms.

Clinical Features of a Chinese Sample with Self-Reported Symptoms of Pathological Dissociation

People with pathological dissociation should receive proper clinical attention and timely support. Recent studies have shown that pathological dissociation is common in the Chinese context. However, little is known about the clinical features of Chinese people with pathological dissociation. This paper reports the first data regarding trauma histories, mental health symptoms, clinical diagnoses, service usages, stigma and psychosocial needs in a convenience sample of Chinese people who screened positive for pathological dissociation on a self-report measure (N = 72). This sample was characterized by a history of trauma and high levels of trauma-related symptoms and depression. Medication treatments were the most common interventions for them; many participants did not receive psychotherapy. We found no clinical differences between participants who had and had not received psychotherapy for post-traumatic/dissociative symptoms. This implies that many participants did not have the chance of receiving specific psychotherapy even though their trauma histories and clinical symptoms were as severe as those who were receiving specific psychotherapy. Stigma and unmet psychosocial needs were common in this sample and should receive more attention in the field. Implications for research and practice are highlighted. More dissociation-informed services are required for Chinese-speaking populations.

Characteristics and outcomes of children with dissociative (conversion) disorders in western China: a retrospective study

BACKGROUND

Dissociative (conversion) disorder in children is a complex biopsychosocial disorder with high rates of medical and psychiatric comorbidities. We sought to identify the characteristics and outcomes of children with dissociative (conversion) disorders in western China.

METHODS

We conducted a retrospective cohort study of 66 children admitted with dissociative (conversion) disorders from January 2017 to July 2019, and analyzed their clinical characteristics, socio-cultural environmental variables, and personality and psychiatric/psychological characteristics. Binary logistic regression was used to analyze the variables associated with clinical efficacy.

RESULTS

Of these 66 patients, 38 (57.6%) were male and 28 (42.4%) were female, 46 (69.7%) had an antecedent stressor, 30 (45.5%) were left-behind adolescents, and 16 (24.2%) were from single-parent families. In addition, 30 patients (45.5%) were not close to their parents, 38 patients (59.4%) had an introverted personality, and 34 (53.1%) had unstable emotions. Thirteen families (19.7%) were uncooperative with the treatment. Patients who had cormorbid anxiety or depression exhibited significantly lower cognitive ability (P < 0.01). Logistic regression found that better treatment outcomes were positively associated with having a close relationship with parents, parental cooperation with treatment, and having a father with a lower level of education (i.e., less than junior college or higher).

CONCLUSIONS

The characteristics and outcomes of children with dissociative (conversion) disorders are related to socio-cultural environmental variables and psychiatric/psychological factors. Timely recognition and effective treatment of dissociative (conversion) disorders are important.

A Preliminary Investigation of Depression in People with Pathological Dissociation

Depression is a common and challenging comorbid condition in people with pathological dissociation. To our knowledge, this preliminary study is the first study that has looked at the clinical correlates of depression in a sample of people with pathological dissociation (N = 72). We found that severe depression is common in this sample and that depression is associated with dissociative symptoms, post-traumatic stress disorder (PTSD) symptoms, borderline personality disorder symptoms and clinical recovery; the level of depression is also associated with both childhood and adulthood betrayal trauma but not with childhood and adulthood trauma with less betrayal. PTSD symptoms are the most significant correlates of the level of depression in this sample. Some clinical implications are discussed. Our initial findings imply that it may be important to manage depression by preventing adulthood betrayal trauma and stabilizing PTSD and dissociative symptoms when working with service users with pathological dissociation. Further studies are needed.

A Web-based Psychoeducation Program for People with Pathological Dissociation: Development and Pilot Testing

PURPOSE

Although people with pathological dissociation (PD) can benefit from specific interventions, there are challenges in providing suitable interventions for them in the field (e.g., high cost, lack of specialized services, stigma). Many people with PD cannot receive dissociation-focused services in their current service locations. It is important to develop easily-accessible interventions that can support people with PD, especially for those who cannot access dissociation-specific treatment. The authors developed a web-based psychoeducation program to support people with PD, and examined its feasibility and acceptability.

METHOD

A single-group pretest-posttest pilot study was conducted.

RESULTS

Findings showed that most of the intended psychosocial outcomes were achieved as planned, which initially proved the feasibility and acceptability of the program.

DISCUSSION

This is one of the first studies that report the use of web-based interventions to support people with PD, especially those who are in the early stages of recovery. The findings suggest that information and communication technology can contribute to different aspects of clinical practice, including recruitment, engagement, assessment and interventions. Further discussion and research are required.

Validity of A Web-based Measure of Borderline Personality Disorder: A Preliminary Study

PURPOSE

Early identification of borderline personality disorder (BPD) is important as timely interventions are beneficial and cost-effective. Unrecognized BPD not only results in suffering for individuals and their families, but also leads to considerable social costs. Although web-based measures have the potential to facilitate screening assessment of BPD for research and clinical purposes, little is known about whether the results of web-based measures of BPD are valid. This preliminary study aims to examine the validity of a web-based measure of BPD.

METHOD

We analyzed data from five independent samples (N = 828 in total).

RESULTS

The web-based BPD measure had a consistent relationship with relevant variables, including trauma exposure, mental well-being, depression, post-traumatic stress, dissociation and psychotic features across samples. It was also strongly correlated with another BPD measure. The web-based BPD measure could discriminate between participants with and without BPD and the discrimination performance was excellent (area under the curve =.853).

DISCUSSION

The initial findings suggest that the web-based BPD measure used in the present study is valid and may be helpful for research and screening purposes, although it should be followed up with a more comprehensive assessment in clinical settings. Implications are discussed. Given the limitations in this study, further studies are needed.

Using the Post-traumatic Stress Disorder (PTSD) Checklist for DSM-5 to Screen for PTSD in the Chinese Context: A Pilot Study in a Psychiatric Sample

Purpose: Post-traumatic stress disorder (PTSD) is a common mental health problem but it is often unrecognized in health care and social service settings. Reliable and valid measures are important for practitioners to screen for PTSD in the Chinese context. This study developed and pilot tested a Chinese version of the PTSD Checklist for DSM-5 (PCL-5). Methods: The reliability and validity of the Chinese version of the PCL-5 were evaluated in a sample of N = 56 adult psychiatric patients in Taiwan. Online methods were used to facilitate the research process. Results: The Chinese version of the PCL-5 is internally consistent and is associated with trauma exposure and other mental health constructs. Participants with clinically diagnosed DSM-5 PTSD scored significantly higher on the PCL-5 than those without PTSD. The PCL-5 also had an acceptable discrimination performance in this sample. Discussion: Although the initial findings suggest that the PCL-5 is reliable and valid in this pilot study, caution should be taken when interpreting the results. The Chinese version of the PCL-5 may be a promising screening tool, but further psychometric evaluation is necessary.

A preliminary study of the clinical differences between dissociative and nondissociative depression in Hong Kong: implications for mental health practice

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.