Frontal lobe dysfunctions, dissociation, and trauma self-reports in forensic psychiatric patients

Cognitive Health and Differential Cortical Functioning in Dissociative Trance: An Explorative Study About Mediumship

Aim

To evaluate the cognitive functioning of subjects practicing trance mediumship in Brazil.

Method

The study was based on the measurement of cognitive functions of 19 spirits mediums through neuropsychological tests such as the Brief Cognitive Screening Battery (BCSB), the Verbal Fluency Test (FAS), the digit span test, the cube test, the five digit test (FDT) and an evaluation of mental health through scales such as the Beck Depression Inventory (BDI), the Self-Report Questionnaire (SRQ), and the Trauma History Questionnaire (THQ). The sample included the participation of spirit mediums divided into two groups. The more experienced group (MEG) with 11 subjects had more than 10 years of mediumistic practice, while the other less experienced group (LEG) with 8 subjects had 1–5 years of experience. The inclusion criteria were psychophonic mediums (who have the ability to communication when deceased beings communicate directly via speaking) with regular trance practices for at least one year. The data collected were analyzed using the SPSS statistical package.

Results

Regarding performance on the BCSB and digit span test, all subjects reached scores at the median or higher in comparison to standardized scores of Brazilians. Scores of 90% on the cube test and 42% on the FAS were reached in comparison to median or higher values, versus the median of standardized scores among Brazilians. On the FDT, we found statistical significance (p = 0.038) in the choice stage, with higher performance of subjects whose initial age of trance recognition occurred before 21 years old. On the BDI scale, no participant met the criteria for major depression. The SRQ showed an incidence of common mental disorders in 21% of the sample, which was more prevalent in the LEG (p = 0.008).

Conclusion

The cognitive functioning of subjects who practice trance mediumship in Brazil is associated with cognitive health. Executive dysfunction may be a tendency in LEG. However, an incidence of common mental disorders in the LEG was observed. Executive processing was higher in the subgroup with early practices of recognizing the phenomenon.

Dissociation and Dissociative Disorders Reconsidered: Beyond Sociocognitive and Trauma Models Toward a Transtheoretical Framework

For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identify empirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Differential executive functioning in the topology of Spirit possession or dissociative disorders: an explorative cultural study

BACKGROUND

In Oman, anecdotal and impressionistic observation have helped parse and categorize various manifestations of spirit possession into two broad and distinct categories: intermittent dissociative phenomenon and transitory dissociative phenomenon. The primary aim of the present study was to compare the performance of participants on neuropsychological tests among different grades of possession. Other correlates were also sought.

METHODS

Assessment criteria for the two groups included measures examining executive functioning: controlled oral word association test Verbal Fluency, Wisconsin Card Sorting Test (Perseverative error and the number of categories achieved), Trail Making Test and the Tower of London Test (number of correctly solved problems). Sociodemographic variables and the history of trauma were also sought.

RESULT

Among 84 participants, one third of them presented the intermittent possession type and two thirds, the transitory possession type. Their mean age was 34.17 ± 11.82 and 56% of them were female. Nearly 35% of them endorsed a history of a traumatic experience. Both the multivariate models showed statistical significance (F (5, 78) = 5.57, p < 0.001, R² = 0.22), F (5, 78) = 11.38, p < 0.001, R² = 0.39) with an independent predictor of intermittent dissociative phenomenon (β = - 3.408, p < 0.001), (β = 63.88, p < 0.001) for Verbal Fluency and Trail Making Test, respectively. The history of the traumatic event was also statistically significant with the results of the Trail Making Test (β = - 26.01, p < 0.041. Furthermore, the subtype of Pathogenic Possession turned out to be an independent predictor across all models: Wisconsin Card Sorting Test perseverative error, Wisconsin card sorting test categories achieved and the number of problems solved in the Tower of London Test (OR = 3.70, 95% C.I. 2.97-4.61; p < 0.001), (OR = 0.57, 95% C.I.0.39-0.84; p = 0.004) and (OR = 0.80, 95% C.I. 0.65-0.99; p < 0.037) respectively.

CONCLUSIONS

This study suggests that typology of spirit possession found in Oman tends to differ on indices of executive function. Those with 'diagnosis' of intermittent possession showed impairment in many indices of executive functioning. Despite its wide prevalence, spirit possession has not been examined in terms of its neuropsychological functioning. We believe that this study will be instrumental in laying the groundwork for a more robust methodology.

Aging With Mental Disorders in the Criminal Justice System: A Content Analysis of the Empirical Literature

To fill a current gap in the literature on aging, mental health, and the criminal justice system, a content analysis of international peer-reviewed research studies was conducted. A comprehensive literature search was conducted to identify English language research studies published in 2018-19. Forty-four articles were located using keyword search terms, such as aging, mental health, and criminal justice. The methods and major findings were analyzed using deductive and inductive approaches. It was found that the majority of the research studies were conducted in the United States and England. The results of the inductive analyses revealed major themes related to mental health detection and access to services, comorbid conditions, and the relationship of age, mental health, criminal behavior, and the social determinants of mental health. Findings from this review have significant implications for advancing epidemiological research, practice, and policy, especially as it relates to the influence of the social determinants of health of aging on life course mental health and criminal justice involvement. Research findings about the correlates and consequences of the social determinants of health, especially as it relates to aging, mental health, and criminal justice involvement, can be used to inform prevention and intervention efforts that target the social determinants of life course health and criminal justice involvement. It also provides a comprehensive assessment of the m methods used in prior studies to help improve future studies in this important area of investigation.

Dissociative Experiences and Psychopathology Among Inmates in Italian and Portuguese Prisons

The association between dissociation and psychopathological symptoms is well established, yet studies with inmates are lacking. If higher rates of dissociation and psychiatric symptoms are reported in inmate samples, it is not clear whether they represent two separate, albeit related, characteristics. We examined the association between dissociation and psychopathological symptoms among 320 Italian subjects (122 inmates and 198 community participants) and a Portuguese inmate sample ( n = 67). Then, we tested whether dissociation and psychopathology levels were higher among inmates. Both hypotheses were supported, confirming the relevance of dissociative, paranoid, and psychotic symptoms among inmates, as well as their interrelations. Notably, the group difference in dissociation remained significant after partialing out the variance associated with other psychopathological symptoms. Conversely, only the difference in paranoid symptoms remained-marginally-significant when controlling for the influence of dissociation. This finding suggests that dissociation may have unique relevance for the psychological functioning of inmates.

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.

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.

Is the dissociative adult suggestible? A test of the trauma and fantasy models of dissociation

Psychologists have long assumed a connection between traumatic experience and psychological dissociation. This hypothesis is referred to as the trauma model of dissociation. In the past decade, a series of papers have been published that question this traditional causal link, proposing an alternative fantasy model of dissociation. In the present research, the relationship among dissociation, suggestibility, and fantasy proneness was examined. Suggestibility was measured through the Gudjonsson Scale of Interrogative Suggestibility (GSS) as well as an autobiographically based version of this measure based on the events of September 11, 2001. Consistent with prior research and with the trauma model, dissociation correlated positively with trauma severity (r = .32, p < .01) and fantasy proneness (r = .60, p < .01). Inconsistent with the fantasy model, dissociation did not correlate with the neutral form of the GSS and correlated negatively (r = -.24, p < .05) with the trauma-focused form of this suggestibility measure. Although some participants did become quite emotional during the procedure, the risk/benefit ratio was perceived by almost all participants to be positive, with more reactive individuals evaluating the procedure more positively. The results consistently support the trauma model of dissociation and fail to support the fantasy model of dissociation.

Behavioral and molecular genetics of dissociation: the role of the serotonin transporter gene promoter polymorphism (5-HTTLPR)

We evaluated the role of the serotonin transporter gene promoter polymorphism (5-HTTLPR) in the etiology of dissociation. Adult twin pairs (N = 184 pairs; mean age 33.0 years, SD = 10.8) completed measures for dissociation and trauma. The DNA samples were genotyped for 5-HTTLPR adjusted for rs25531 alleles. Behavioral genetic analyses showed that genetic factors explained 45% of the variance in dissociative symptoms, while 55% of the variance was explained by unique environment and measurement error. Participants with the SS genotype of 5-HTTLPR reported more dissociative symptoms compared to participants with the other genotypes (p = .02), and they showed more pathological dissociative symptoms than the other participants (p = .04) when they reported more depressive symptoms and when they had experienced trauma.

Cognitive processes in dissociation: comment on Giesbrecht et al. (2008)

In their recent review "Cognitive Processes in Dissociation: An Analysis of Core Theoretical Assumptions," published in Psychological Bulletin, Giesbrecht, Lynn, Lilienfeld, and Merckelbach have challenged the widely accepted trauma theory of dissociation, which holds that dissociative symptoms are caused by traumatic stress. In doing so, the authors have outlined a series of links between various constructs--such as fantasy proneness, cognitive failures, absorption, suggestibility, altered information-processing, dissociation, and amnesia--claiming that these linkages lead to the false conclusion that trauma causes dissociation. A review of the literature, however, shows that these are not necessarily related constructs. Careful examination of their arguments reveals no basis for the conclusion that there is no association between trauma and dissociation. The current comment offers a critical review and rebuttal of Giesbrecht et al.'s argument that there is no relationship between trauma and dissociation.

Pathological dissociation and neuropsychological functioning in borderline personality disorder

OBJECTIVE

Transient, stress-related severe dissociative symptoms or paranoid ideation is one of the criteria defining the borderline personality disorder (BPD). Examinations of the neuropsychological correlates of BPD reveal various findings. The purpose of this study was to investigate the association between dissociation and neuropsychological functioning in patients with BPD.

METHOD

The performance on an extensive neuropsychological battery of patients with BPD with (n=10) and without (n=20) pathological dissociation was compared with that of healthy controls (n=30).

RESULTS

Patients with pathological dissociation were found to have reduced functioning on every neuropsychological domain when compared with healthy controls. Patients without pathological dissociation were found to have reduced executive functioning, but no other differences were found.

CONCLUSION

Pathological dissociation is a clinical variable that differentiates patients with BPD with regard to cognitive functioning.

Positive and useful auditory vocal hallucinations: prevalence, characteristics, attributions, and implications for treatment

OBJECTIVE

Auditory hallucinations that are viewed by patients as positive and useful may be barriers to treatment-seeking. The aim was to assess prevalence, impact, and course of, and attributions to, these voices in psychotic and non-psychotic patients.

METHOD

One hundred thirty-one patients of a Voices Clinic and 65 members of the Dutch Resonance Foundation were assessed with the Positive and Useful Voices Inquiry. Data were analyzed using Pearson's chi-square, one-way anova, and Crohnbach's alpha statistics.

RESULTS

First voices are most often reported as negative. Positive voices occur more among non-psychotic subjects, but the specific characteristics and diagnosis are not significantly associated. Lifetime prevalence of positive and useful voices ranged between 40% and 60%, with varied prevalence rates over time. Positive voices are experienced by subjects as direct addresses in the third person. Perceived control of voices is significantly associated with the wish to preserve them. Attribution of protective power to positive voices has the strongest association with positive experience.

CONCLUSION

Many patients express a desire to preserve these voices. Voice characteristics do not allow for validly discriminating psychotic from non-psychotic disorders.

Factor structure and correlates of the dissociative experiences scale in a large offender sample

The authors examined the psychometric properties, factor structure, and construct validity of the Dissociative Experiences Scale (DES) in a large offender sample (N = 1,515). Although the DES is widely used with community and clinical samples, minimal work has examined offender samples. Participants were administered self-report and interview measures, and a subsample was followed longitudinally to determine criminal and violent recidivism. The DES exhibited good psychometric properties, but an identified three-factor structure was of questionable replicability. Moreover, the DES factors displayed no evidence of differential correlates. DES total scores were correlated with trauma-related variables even after controlling for negative affectivity. Total scores were related to measures of antisocial behavior and aggression but did not predict recidivism. These findings support the reliability and construct validity of the DES in offenders but raise questions regarding the clinical utility of the DES factor scores above and beyond that of the total score.

Neuropsychological characteristics of highly dissociative healthy individuals

OBJECTIVE

Dissociative disorders are characterized by disturbances in several neuropsychological domains, especially attention, memory, and consciousness. As a tendency to dissociate can also be observed in healthy individuals, and may be a risk factor for the development of dissociative disorders and posttraumatic stress disorder (PTSD), we were interested in the neuropsychological characteristics of these participants.

METHOD

We examined attention, memory, and executive control functions in 17 high and 17 low dissociators without any psychiatric or neurological disorder and without prior experiences of trauma.

RESULTS

High dissociators showed relative performance deficiencies in tasks of memory for associative, context-dependent verbal material, visuospatial working memory, and executive control functions in terms of a heightened perseveration tendency and false positive errors.

CONCLUSION

These cognitive deficits are consistent with models of dissociative disorders and dissociation in PTSD assuming a hippocampal and prefrontal dysfunction as a core factor. Mild cognitive impairments in otherwise healthy high dissociators may constitute a risk factor for the development of later PTSD or dissociative disorders.

Cognitive functioning in depersonalization disorder

Depersonalization disorder (DPD) is a dissociative disorder characterized by a subjective sense of unreality and detachment, and has been associated with deficits in perception and short-term memory. In this study, 21 DPD and 17 healthy comparison participants free of psychiatric disorders were administered a comprehensive neuropsychologic battery. The groups did not differ in full-scale, verbal, and performance IQ (Wechsler Adult Intelligence Scale), in working memory (Paced Auditory Serial Addition Test), or in selective attention (Digit Span with Distracters). The DPD group performed significantly worse on immediate visual and verbal recall (Wechsler Memory Scale, Revised), but not on delayed recall. Dissociation severity was significantly correlated with processing slowness and distractibility. We conclude that DPD is associated with cognitive disruptions in early perceptual and attentional processes.

The relationship between executive functioning and dissociation

Although dissociation by definition affects cognition, few studies have used neuropsychological measures to examine dissociative phenomena. This study compared 33 high and 32 low dissociators based on the Dissociative Experiences Scale, on self-report and neuropsychological measures of executive function, including the Dysexecutive Questionnaire, Iowa Gambling Task, Operation Span task, and Wisconsin Card Sorting Test-64. High dissociators endorsed significantly more executive difficulties than did low dissociators, but these difficulties were not related to their performance on neuropsychological measures. Results suggest that dissociative individuals' perceptions of executive impairments may be divorced from objective deficits, revealing an important process underlying the clinical manifestations of dissociation.

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.

Profiles of DES performance in inmate and student samples

Despite the finding of a recent review of the literature (Moskowitz, 2004) that at least 25% of offenders demonstrated pathological levels of dissociation, very little empirical research has been conducted that examines dissociation in samples of prison inmates. This study examined the profiles of dissociative experiences reported in a sample of 42 prison inmates, when compared to 119 students on the Dissociative Experiences Scale. Profile analysis indicated that overall DES performances differed significantly for the two samples. Using Hotelling's criterion, DES items were found to deviate significantly from flatness, and using Wilks's criterion, the profiles also found to differ significantly from parallelism (p < .01). Specific items contributing to these differences were examined. It is hypothesized that some of these items may be reflective of past criminal activities rather than dissociation. As DES-taxon item content reflects less susceptibility to alternative interpretations, it is recommended that both researchers and clinicians consider using the DES-taxon, rather than DES total scores when examining dissociation in forensic samples.

Dissociation in undergraduate students: disruptions in executive functioning

The concept of dissociation refers to disruptions in attentional control. Attentional control is an executive function. Few studies have addressed the link between dissociation and executive functioning. Our study investigated this relationship in a sample of undergraduate students (N = 185) who completed the Dissociative Experiences Scale and the Random Number Generation Task. We found that minor disruptions in executive functioning were related to a subclass of dissociative experiences, notably dissociative amnesia and the Dissociative Experiences Scale Taxon. However, the two other subscales of the Dissociative Experiences Scale, measuring depersonalization and absorption, were unrelated to executive functioning. Our findings suggest that a failure to inhibit previous responses might contribute to the pathological memory manifestations of dissociation.