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di Marco S, Gaumard M, Hage WE, Tarrada A, Fugain L, Ertan D, Hingray C. A cross-sectional survey on French psychiatrists' knowledge and perceptions of dissociative identity disorder. L'ENCEPHALE 2024:S0013-7006(24)00091-5. [PMID: 38824042 DOI: 10.1016/j.encep.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE The aim of this study was to determine French psychiatrists' level of general knowledge about dissociative identity disorder and to evaluate their perceptions of this condition. METHODS In this study, French psychiatrists were invited by e-mail to answer an online survey. The questionnaire asked about their general knowledge and perceptions of dissociative identity disorder. RESULTS We received 924 answers including 582 complete questionnaires. The survey revealed that almost two-thirds (60.8%) of psychiatrists working in France had never received any training on dissociative disorders and 62% had never managed patients suffering from dissociative identity disorder. Only 19.5% of them claimed to believe unreservedly in the existence of the diagnosis of dissociative identity disorder. The psychiatrists' confidence in diagnosing or treating dissociative identity disorder was low (mean confidence in diagnosis: 3.32 out of 10 (SD 1.89), mean confidence in treatment: 3.1 out of 10 (SD 1.68)). Fifty percent believed that dissociative identity disorder is an entity created by cinema, medias or social networks. Seventy-seven point seven percent thought that confusion with borderline personality disorder is possible, and 41.3% with schizophrenia. CONCLUSION In France, there is a lack of training and knowledge about dissociative identity disorder, as well as persistent skepticism about the validity of the diagnosis. Specific training seems essential for a better understanding of dissociative identity disorder.
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Affiliation(s)
- Sonia di Marco
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Faculté de médecine, université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - Marie Gaumard
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Faculté de médecine, université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - Wissam El Hage
- Pôle de psychiatrie et d'addictologie, CHRU de Tours, Tours, France
| | - Alexis Tarrada
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Département de neurologie, CHRU de Nancy, Nancy, France
| | - Laure Fugain
- Centre du psychotraumatisme de Lorraine-Sud (CPN), Nancy, France
| | - Deniz Ertan
- Unité de recherche, institut La-Teppe, Tain-l'Hermitage, France
| | - Coraline Hingray
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Faculté de médecine, université de Lorraine, Vandœuvre-Lès-Nancy, France; Centre du psychotraumatisme de Lorraine-Sud (CPN), Nancy, France; Département de neurologie, CHRU de Nancy, Nancy, France.
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Lam SKK, Cheung CTY, Chien WT, Ross CA, Po BSK, Lee VWP, Fung HW. Trauma, Emotional Regulation, and Coping Styles in Individuals with and without Probable Dissociative Disorders in Hong Kong. J Trauma Dissociation 2024:1-19. [PMID: 38549465 DOI: 10.1080/15299732.2024.2326511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/02/2024] [Indexed: 04/25/2024]
Abstract
Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (β = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required.
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Affiliation(s)
- Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, USA
| | | | | | - Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
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3
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Yeates S, Korner A, McLean L. A Systematic Review and Narrative Analysis of the Evidence for Individual Psychodynamically Informed Psychotherapy in the Treatment of Dissociative Identity Disorder in Adults. J Trauma Dissociation 2024; 25:248-278. [PMID: 38146918 DOI: 10.1080/15299732.2023.2293802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 09/30/2023] [Indexed: 12/27/2023]
Abstract
Dissociative Identity Disorder (DID) is a highly disabling diagnosis, characterized by the presence of two or more personality states which impacts global functioning, with a substantial risk of suicide. The International Society for the Study of Trauma and Dissociation (ISSTD) published guidelines for treating DID in 2011 that noted individual Psychodynamically Informed Psychotherapy (PDIP) was a cornerstone of treatment. This paper systematically reviews the evidence base for PDIP in the treatment of adults with DID according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirty-five articles were located and reviewed: seven prospective longitudinal publications, 13 case series and 15 case studies. Results suggested that PDIP has been widely deployed in DID to reported good effect with a range of treatment protocols and using multiple theoretical models. Despite the positive findings observed, the evidence base remains at the level of observational-descriptive design. Creative approaches in recent years have been developed, which add empirical weight to the use of PDIP as an effective treatment. The elevation to observational-analytic designs in the Evidence-Based Medicine hierarchy has yet to take place. Bearing in mind the challenges of research in PDIP, suggestions are offered for how the evidence base might develop.
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Affiliation(s)
- Steven Yeates
- Psychotherapy Educator Westmead/Cumberland Hospitals, Faculty Westmead Psychotherapy Program for Complex Traumatic Disorders, Cumberland Hospital, North Parramatta, Australia
| | - Anthony Korner
- Westmead Psychotherapy Program for Complex Traumatic Disorders, University of Sydney, North Parramatta, Australia
| | - Loyola McLean
- Cumberland Hospital, Westmead Psychotherapy Program for Complex Traumatic Disorders, Course Co-Coordinator, Brain and Mind Centre, Discipline of Psychiatry, The University of Sydney, Research Psychiatrist (HMO) Consultation-Liaison Psychiatry, RNSH, Camperdown, Australia
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4
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Brenner I, Ginzburg K, Golan A, Igawa MS, Lurie I, Reicher Y, Talmon A, Tomashev R, Padoa A. Peripartum dissociation, sense of control, postpartum posttraumatic stress disorder and emotional adjustment to motherhood in adult survivors of childhood maltreatment. Arch Womens Ment Health 2024; 27:127-136. [PMID: 37851078 DOI: 10.1007/s00737-023-01379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/07/2023] [Indexed: 10/19/2023]
Abstract
Survivors of childhood maltreatment (CM) may experience difficulties in the peripartum period and in adjustment to motherhood. In this study we examined a model wherein CM is associated with maternal self-efficacy and maternal bonding three months postpartum, through mediation of peripartum dissociation and reduced sense of control during childbirth and postpartum-posttraumatic-stress disorder (P-PTSD). Women were recruited in a maternity ward within 48 h of childbirth (T1, N = 440), and contacted three-months postpartum (T2, N = 295). Participants completed self-report questionnaires: peripartum dissociation, sense of control (T1), and CM, P-PTSD, postpartum-depression, maternal self-efficacy and bonding (T2). Obstetrical data were collected from medical files. Structural equation modeling was conducted to test the hypothesized model, controlling for mode of delivery and postpartum-depression. Reported CM included child emotional neglect (CEN; 23.5%), child emotional abuse (CEA; 16.3%), child sexual abuse (CSA; 12.9%) and child physical abuse (CPA; 7.1%). CM was positively associated with peripartum dissociation and P-PTSD (p < .001). Peripartum dissociation was positively associated with P-PTSD (p < .001). P-PTSD was negatively associated with maternal self-efficacy (p < .001) and maternal bonding (p < .001). Association between CM and maternal self-efficacy and bonding was serially mediated by peripartum dissociation and P-PTSD, but not by sense of control. Findings remained significant after controlling for mode of delivery and postpartum-depression. CM is a risk factor for adjustment to motherhood, owing to its effects on peripartum dissociation and P-PTSD. Implementation of a trauma-informed approach in obstetric care and recognition of peripartum dissociative reactions are warranted.
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Affiliation(s)
- Inbal Brenner
- Lev-Hasharon Mental Health Center, Tzur-Moshe, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Golan
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
| | - May Shir Igawa
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Lurie
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yael Reicher
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beersheba, Israel
- Ben Gurion University of the Negev, Beersheba, Israel
| | - Anat Talmon
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Roni Tomashev
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
| | - Anna Padoa
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
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Tanaka R, Ando S, Kiyono T, Minami R, Endo K, Miyashita M, Yamasaki S, Kanata S, Fujikawa S, Hiraiwa-Hasegawa M, Nishida A, Kasai K. The longitudinal relationship between dissociative symptoms and self-harm in adolescents: a population-based cohort study. Eur Child Adolesc Psychiatry 2024; 33:561-568. [PMID: 36882639 PMCID: PMC10869437 DOI: 10.1007/s00787-023-02183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
Previous studies have reported that dissociative symptoms (DIS) are associated with self-harm (SH) in adolescents. However, most of these studies were cross-sectional, which limits the understanding of their theoretical relationship. We aimed to investigate the longitudinal relationship between DIS and SH in the general adolescent population. We used data from the Tokyo Teen Cohort study (N = 3007). DIS and SH were assessed at times 1 and 2 (T1 and T2) (12 years of age and 14 years of age, respectively). DIS were assessed using the parent-report Child Behavior Checklist (CBCL), and severe dissociative symptoms (SDIS) were defined as a score above the top 10th percentile. The experience of SH within 1 year was assessed by a self-report questionnaire. The longitudinal relationship between DIS and SH was examined using regression analyses. Using logistic regression analyses, we further investigated the risk for SH at T2 due to persistent SDIS and vice versa. DIS at T1 tended to predict SH at T2 (odds ratio (OR) 1.11, 95% CI 0.99 to 1.25, p = 0.08), while SH at T1 did not predict DIS at T2 (B = - 0.03, 95% CI - 0.26 to 0.20, p = 0.81). Compared with adolescents without SDIS, those with persistent SDIS had an increased risk of SH at T2 (OR 2.61, 95% CI 1.28 to 5.33, p = 0.01). DIS tended to predict future SH, but SH did not predict future DIS. DIS may be a target to prevent SH in adolescents. Intensive attention should be given to adolescents with SDIS due to their increased risk of SH.
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Affiliation(s)
- Riki Tanaka
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Tomoki Kiyono
- Department of Psychiatry, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Rin Minami
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Kaori Endo
- Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mitsuhiro Miyashita
- Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Sho Kanata
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinya Fujikawa
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Kanagawa, Japan
| | - Atsushi Nishida
- Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
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6
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Fung HW, Hung SL, Ling HWH, Lee VWP, Lam SKK. A Preliminary Longitudinal Analysis of Symptom Management, Post-traumatic Stress, and Depressive Symptoms in Chinese Adults with Dissociative Symptoms. J Trauma Dissociation 2024; 25:129-143. [PMID: 37394873 DOI: 10.1080/15299732.2023.2231908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 06/04/2023] [Indexed: 07/04/2023]
Abstract
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.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Henry Wai-Hang Ling
- The Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong
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7
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Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
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Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
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8
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Fung HW, Geng F, Yuan D, Zhan N, Lee VWP. Childhood experiences and dissociation among high school students in China: Theoretical reexamination and clinical implications. Int J Soc Psychiatry 2023; 69:1949-1957. [PMID: 37350288 DOI: 10.1177/00207640231181528] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Dissociation remains a controversial topic in terms of its prevalence, cross-cultural validity, and relationship with childhood trauma and adversities. AIMS This study investigated the prevalence of dissociative symptoms and probable dissociative disorders among Chinese high school students and tested the trauma model of dissociation. METHODS A total of N = 1,720 high school students completed standardized measures of positive and adverse childhood experiences (PCEs and ACEs), dissociation, depression, and anxiety. RESULTS The prevalence rates of dissociative symptoms and (probable) DSM-5 dissociative disorders (DDs) were 11.2% and 6.9%, respectively. Dissociation was a reliable construct (ICC = .682 to .752, p < .001) and was moderately correlated with general psychopathology (r = .424 with depressive symptoms, r = .423 with anxiety symptoms). Participants with a probable DD reported more ACEs, fewer PCEs, and more mental health symptoms than those without a probable DD. ACEs were significantly associated with dissociative symptoms (β = .107, p < .001) even after controlling for age, depressive, and anxiety symptoms. PCEs moderated the relationship between ACEs and dissociative symptoms. CONCLUSIONS This is the first report of the prevalence of dissociative symptoms and probable DSM-5 DDs among nonclinical children. We provide cross-cultural evidence that dissociation is a reliable and valid clinical phenomenon associated with psychopathology in children across cultures. The findings partly support the trauma model of dissociation. This study contributes to the limited literature on dissociation in children. It also offers empirical data to facilitate the ongoing controversy about (childhood) trauma and dissociation. Our findings imply that dissociation is cross-culturally associated with childhood adversities, but trauma is not the only, sufficient cause. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, China
| | - Danyan Yuan
- School of Psychology, Jiangxi Normal University, China
| | - Nalan Zhan
- School of Psychology, Jiangxi Normal University, China
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9
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Fung HW, Lam SKK, Chien WT, Ng ASY, Wong ENM, Ross CA, Hung SL, Lee VWP. Dissociative symptoms among community health service users in Hong Kong: a longitudinal study of clinical course and consequences. Eur J Psychotraumatol 2023; 14:2269695. [PMID: 37902274 PMCID: PMC10763863 DOI: 10.1080/20008066.2023.2269695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
Background: Previous studies have demonstrated the high prevalence of dissociative symptoms and their association with considerable healthcare costs. However, there is a lack of studies that describe whether dissociative symptoms persist and lead to other clinical outcomes over time in the community.Objectives: This study investigated the persistence, predictors, and consequences of dissociative symptoms in the community.Methods: We analyzed longitudinal data in a sample of community health service users in Hong Kong (N = 173).Results: A relatively high proportion (63.6%) of participants with baseline dissociative symptoms continued to exhibit dissociative symptoms after approximately 9 months. Baseline non-betrayal trauma predicted subsequent dissociative symptoms (β = .141, p = .024). Participants with baseline dissociative symptoms were more likely to have received subsequent emergency mental health services (9.1% vs 0.7%, p = .005). Baseline dissociative symptoms significantly predicted subsequent post-traumatic symptoms (β = .165 to .191, p < .05) and difficulty in social and occupational participation (β = -.152 to -.182, p < .05) even after controlling for baseline scores, trauma exposure, and use of professional support. The predictive role of dissociative symptoms on subsequent disturbances in self-organization symptoms and social participation difficulty remained significant after applying the Bonferroni correction.Conclusions: This is one of the very few studies showing that dissociative symptoms are persistent to a certain degree and could predict other symptoms and subsequent impairments even in community settings. Factors that affect the trajectory of dissociative symptoms should be further investigated. Regular screening for dissociative symptoms is recommended. Considering its prevalence, persistence, and clinical and social consequences, dissociation should be given greater public health attention.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Albe Sin Ying Ng
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Braemar Hill, Hong Kong
| | - Emily Nga Man Wong
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Braemar Hill, Hong Kong
| | - Colin A. Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, TX, USA
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Vincent Wan Ping Lee
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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10
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Rowland GE, Roeckner A, Ely TD, Lebois LAM, van Rooij SJH, Bruce SE, Jovanovic T, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Gentile NT, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Merchant RC, Domeier RM, Rathlev NK, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Stevens JS, Harnett NG. Prior Sexual Trauma Exposure Impacts Posttraumatic Dysfunction and Neural Circuitry Following a Recent Traumatic Event in the AURORA Study. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:705-715. [PMID: 37881578 PMCID: PMC10593890 DOI: 10.1016/j.bpsgos.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Background Prior sexual trauma (ST) is associated with greater risk for posttraumatic stress disorder after a subsequent traumatic event; however, the underlying neurobiological mechanisms remain opaque. We investigated longitudinal posttraumatic dysfunction and amygdala functional dynamics following admission to an emergency department for new primarily nonsexual trauma in participants with and without previous ST. Methods Participants (N = 2178) were recruited following acute trauma exposure (primarily motor vehicle collision). A subset (n = 242) completed magnetic resonance imaging that included a fearful faces task and a resting-state scan 2 weeks after the trauma. We investigated associations between prior ST and several dimensions of posttraumatic symptoms over 6 months. We further assessed amygdala activation and connectivity differences between groups with or without prior ST. Results Prior ST was associated with greater posttraumatic depression (F1,1120 = 28.35, p = 1.22 × 10-7, ηp2 = 0.06), anxiety (F1,1113 = 17.43, p = 3.21 × 10-5, ηp2 = 0.05), and posttraumatic stress disorder (F1,1027 = 11.34, p = 7.85 × 10-4, ηp2 = 0.04) severity and more maladaptive beliefs about pain (F1,1113 = 8.51, p = .004, ηp2 = 0.02) but was not related to amygdala reactivity to fearful versus neutral faces (all ps > .05). A secondary analysis revealed an interaction between ST and lifetime trauma load on the left amygdala to visual cortex connectivity (peak Z value: -4.41, corrected p < .02). Conclusions Findings suggest that prior ST is associated with heightened posttraumatic dysfunction following a new trauma exposure but not increased amygdala activity. In addition, ST may interact with lifetime trauma load to alter neural circuitry in visual processing regions following acute trauma exposure. Further research should probe the relationship between trauma type and visual circuitry in the acute aftermath of trauma.
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Affiliation(s)
- Grace E Rowland
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Alyssa Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, Missouri
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Brown University, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- TheMany Brains Project, Belmont, Massachusetts
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, Ohio
- Ohio State University College of Nursing, Columbus, Ohio
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama
- Division of Acute Care Surgery, Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nina T Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jose L Pascual
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Traumatology, Department of Surgery, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica Harris
- Einstein Medical Center, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, Michigan
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, Ohio
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, Ohio
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - James M Elliott
- Kolling Institute, University of Sydney, St. Leonards, New South Wales, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Sydney, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karestan C Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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11
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Lanfranco RC, Martínez-Aguayo JC, Arancibia M. Assessing malingering and personality styles in dissociative identity disorder: a case study. Neurocase 2023; 29:141-150. [PMID: 38704614 DOI: 10.1080/13554794.2024.2348218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
Dissociative Identity Disorder (DID), formerly Multiple Personality Disorder, involves two or more distinct identities controlling behaviour, stemming from trauma-related dissociation. Understanding DID's cognitive, neural, and psychometric aspects remains a challenge, especially in distinguishing genuine cases from malingering. We present a case of a DID patient with nine identities, evaluated to rule out malingering. Using the Millon Index of Personality Styles, we assessed the primary and two alternate identities, revealing marked differences. High consistency scores support validity. We suggest employing personality inventories beyond symptomatology to characterise dissociative identities' consistency and adaptation styles, aiding in malingering assessments in future studies.
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Affiliation(s)
- Renzo C Lanfranco
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, University of Edinburgh, Edinburgh, UK
- Center for Research in Cognition & Neurosciences, Université libre de Bruxelles, Brussels, Belgium
| | | | - Marcelo Arancibia
- Center of Translational Studies in Stress and Mental Health (C-ESTRES), Faculty of Sciences, Universidad de Valparaíso, Valparaíso, Chile
- Department of Psychiatry, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
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12
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Eve Z, Heyes K, Parry S. Conceptualizing multiplicity spectrum experiences: A systematic review and thematic synthesis. Clin Psychol Psychother 2023. [PMID: 37699854 DOI: 10.1002/cpp.2910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/03/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Dissociative identity disorder and depersonalization-derealization have attracted research and clinical interest, facilitating greater understanding. However, little is known about the experience of multiplicity of self outside of traumagenic or illness constructs. Consequently, this systematic review explored how people identifying as having multiple selves conceptualize their experiences and identity. METHODS A comprehensive search of qualitative studies reporting lived experiences of multiplicity was conducted through PsycINFO, PubMed and Scopus (PROSPERO ID: CRD42021258555). Thirteen relevant studies were retrieved (N = 98, 16-64 years, conducted in the United Kingdom, the United States, Hungary and Poland). RESULTS Using line-by-line thematic synthesis, four analytical themes were developed: multiplicity: disorder versus experience; impact of understanding multiplicity; importance of supporting multiplicity; and continuum of experiences. DISCUSSION This review highlights heterogeneity within multiplicity-spectrum experiences, emphasizing the need for person-centred, individualized understanding, separate from mental health conceptualizations. Therefore, training in person-centred individualized care to promote self-concept clarity is needed across health, education and social care. This systematic review is the first to synthesize voices of people with lived experience across the multiplicity spectrum, demonstrating how qualitative research can contribute to advancing our understanding of this complex phenomena with the community, acknowledging reciprocal psychosocial impacts of multiplicity and providing valuable recommendations for services.
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Affiliation(s)
- Zarah Eve
- Manchester Metropolitan University, Manchester, UK
| | - Kim Heyes
- Manchester Metropolitan University, Manchester, UK
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Bachrach N, Rijkeboer MM, Arntz A, Huntjens RJC. Schema therapy for Dissociative Identity Disorder: a case report. Front Psychiatry 2023; 14:1151872. [PMID: 37151967 PMCID: PMC10160656 DOI: 10.3389/fpsyt.2023.1151872] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Treatment for Dissociative Identity Disorder (DID) often follows a practice-based psychodynamic psychotherapy approach that is conducted in three phases: symptom stabilization, trauma processing, and identity integration and rehabilitation. The percentage of patients that reach the third phase is relatively low, treatment duration is long, and the effects of this treatment on the core DID symptoms have been found to be small or absent, leaving room for improvement in the treatment of DID. Schema Therapy (ST) is an integrative psychotherapy that has been proposed as a treatment for DID. This approach is currently being investigated in several studies and has the potential to become an evidence-based treatment for DID. This case report presents an overview of the protocol adaptations for DID ST treatment. The presented case concerns a 43-year-old female patient with DID, depressive disorder (recurrent type), PTSD, cannabis use disorder, and BPD. Functioning was very low. She received 220 sessions of ST, which included direct trauma processing through Imagery Rescripting (ImRs). The patient improved in several domains: she experienced a reduction of PTSD symptoms, as well as dissociative symptoms, there were structural changes in the beliefs about the self, and loss of suicidal behaviors. After treatment she was able to stop her punitive mode, to express her feelings and needs to others, and to participate adequately in social interaction. This case report indicates that ST might be a viable treatment for DID, adding to a broader scope of treatment options for this patient group.
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Affiliation(s)
- Nathan Bachrach
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- GGZ-Oost Brabant, Department of Personality Disorders, Helmond, Netherlands
| | - Marleen M. Rijkeboer
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Rafaële J. C. Huntjens
- Department of Experimental Psychotherapy and Psychopathology, University of Groningen, Groningen, Netherlands
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14
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Dimitrova LI, Dean SL, Schlumpf YR, Vissia EM, Nijenhuis ERS, Chatzi V, Jäncke L, Veltman DJ, Chalavi S, Reinders AATS. A neurostructural biomarker of dissociative amnesia: a hippocampal study in dissociative identity disorder. Psychol Med 2023; 53:805-813. [PMID: 34165068 PMCID: PMC9975991 DOI: 10.1017/s0033291721002154] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/12/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the neural correlates of dissociative amnesia, a transdiagnostic symptom mostly present in the dissociative disorders and core characteristic of dissociative identity disorder (DID). Given the vital role of the hippocampus in memory, a prime candidate for investigation is whether total and/or subfield hippocampal volume can serve as biological markers of dissociative amnesia. METHODS A total of 75 women, 32 with DID and 43 matched healthy controls (HC), underwent structural magnetic resonance imaging (MRI). Using Freesurfer (version 6.0), volumes were extracted for bilateral global hippocampus, cornu ammonis (CA) 1-4, the granule cell molecular layer of the dentate gyrus (GC-ML-DG), fimbria, hippocampal-amygdaloid transition area (HATA), parasubiculum, presubiculum and subiculum. Analyses of covariance showed volumetric differences between DID and HC. Partial correlations exhibited relationships between the three factors of the dissociative experience scale scores (dissociative amnesia, absorption, depersonalisation/derealisation) and traumatisation measures with hippocampal global and subfield volumes. RESULTS Hippocampal volumes were found to be smaller in DID as compared with HC in bilateral global hippocampus and bilateral CA1, right CA4, right GC-ML-DG, and left presubiculum. Dissociative amnesia was the only dissociative symptom that correlated uniquely and significantly with reduced bilateral hippocampal CA1 subfield volumes. Regarding traumatisation, only emotional neglect correlated negatively with bilateral global hippocampus, bilateral CA1, CA4 and GC-ML-DG, and right CA3. CONCLUSION We propose decreased CA1 volume as a biomarker for dissociative amnesia. We also propose that traumatisation, specifically emotional neglect, is interlinked with dissociative amnesia in having a detrimental effect on hippocampal volume.
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Affiliation(s)
- Lora I. Dimitrova
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sophie L. Dean
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Yolanda R. Schlumpf
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | | | - Ellert R. S. Nijenhuis
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Vasiliki Chatzi
- Department of Biomedical Engineering, King's College London, London, UK
| | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Zurich, Switzerland
| | - Dick J. Veltman
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Antje A. T. S. Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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15
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Haltigan JD, Pringsheim TM, Rajkumar G. Social media as an incubator of personality and behavioral psychopathology: Symptom and disorder authenticity or psychosomatic social contagion? Compr Psychiatry 2023; 121:152362. [PMID: 36571927 DOI: 10.1016/j.comppsych.2022.152362] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
There has been an increasing recognition among both medical and psychological professionals, as well as the public media, of a concerning trend for child and adolescent users of audiovisual-based, algorithmic social media platforms (e.g., TikTok) to present with or claim functional psychiatric impairment that is inconsistent with or distinct from classic psychiatric nosology. In this short communication, we provide a detailed historical overview of this transdiagnostic phenomenon and suggest a conceptual model to organize thinking and research examining it. We then discuss the implications of our suggested model for accurate assessment, diagnosis, and medical-psychiatric treatment. We believe there is an urgent need for focused empirical research investigation into this concerning phenomenon that is related to the broader research and discourse examining social media influences on mental health.
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Affiliation(s)
- John D Haltigan
- Department of Psychiatry, University of Toronto, Canada; Child & Youth Psychiatry, the Centre for Addiction and Mental Health, Canada.
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Program Lead, Tourette and Pediatric Movement Disorders, Canada
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16
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Fung HW, Wong ENM, Lam SKK, Chien WT, Hung SL, Ross CA. The prevalence of dissociative symptoms and disorders: Findings from a sample of community health service users in Hong Kong. Asian J Psychiatr 2023; 80:103351. [PMID: 36495727 DOI: 10.1016/j.ajp.2022.103351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/07/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong.
| | - Emily Nga Man Wong
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong Kong
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, United States
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17
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Fung HW, Chan C, Chien WT, Chong YY, Ross CA. The Acceptability and Potential Benefits of a Web-Based Psychoeducation Program for People with Pathological Dissociation: A Pilot Evaluation Study. J Trauma Dissociation 2023; 24:95-110. [PMID: 36050905 DOI: 10.1080/15299732.2022.2119457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pathological dissociation is a common trauma-related condition and is associated with considerable health and social care needs. People with pathological dissociation typically require psychosocial interventions, but there are many challenges in providing such interventions for this vulnerable population. An important question that remains unexplored is whether web-based interventions are acceptable and beneficial for people with pathological dissociation. This paper reports the findings of a pilot evaluation study of a web-based psychoeducation program for people with pathological dissociation. A total of 80 participants were included. The preliminary findings revealed that: most participants were satisfied with the web-based program (e.g., most participants agreed that the program helped them understand [94.1%] and manage [66.7%] their mental health conditions and remain hopeful for recovery [78.4%]); and participants had improvements in symptom management (large effect; partial eta squared = .143) and self-esteem (medium-to-large effect; partial eta squared = .111) after the program. However, no improvements in clinical symptoms were observed on measures of post-traumatic or dissociative symptoms. The dropout rate at posttest was 36.3%. This is one of the first studies that evaluated web-based interventions for people with pathological dissociation. Although the web-based program is well-accepted by the participants and might be associated with some potential benefits, the limitations of this pilot study should be acknowledged. Implications are discussed in terms of the directions for future developments of the program and the needs for further evaluation.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Chitat Chan
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Shatin, China
| | - Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Shatin, China
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, USA
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18
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Campbell MC, Smakowski A, Rojas-Aguiluz M, Goldstein LH, Cardeña E, Nicholson TR, Reinders AATS, Pick S. Dissociation and its biological and clinical associations in functional neurological disorder: systematic review and meta-analysis. BJPsych Open 2022; 9:e2. [PMID: 36451595 PMCID: PMC9798224 DOI: 10.1192/bjo.2022.597] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Studies have reported elevated rates of dissociative symptoms and comorbid dissociative disorders in functional neurological disorder (FND); however, a comprehensive review is lacking. AIMS To systematically review the severity of dissociative symptoms and prevalence of comorbid dissociative disorders in FND and summarise their biological and clinical associations. METHOD We searched Embase, PsycInfo and MEDLINE up to June 2021, combining terms for FND and dissociation. Studies were eligible if reporting dissociative symptom scores or rates of comorbid dissociative disorder in FND samples. Risk of bias was appraised using modified Newcastle-Ottawa criteria. The findings were synthesised qualitatively and dissociative symptom scores were included in a meta-analysis (PROSPERO CRD42020173263). RESULTS Seventy-five studies were eligible (FND n = 3940; control n = 3073), most commonly prospective case-control studies (k = 54). Dissociative disorders were frequently comorbid in FND. Psychoform dissociation was elevated in FND compared with healthy (g = 0.90, 95% CI 0.66-1.14, I2 = 70%) and neurological controls (g = 0.56, 95% CI 0.19-0.92, I2 = 67%). Greater psychoform dissociation was observed in FND samples with seizure symptoms versus healthy controls (g = 0.94, 95% CI 0.65-1.22, I2 = 42%) and FND samples with motor symptoms (g = 0.40, 95% CI -0.18 to 1.00, I2 = 54%). Somatoform dissociation was elevated in FND versus healthy controls (g = 1.80, 95% CI 1.25-2.34, I2 = 75%). Dissociation in FND was associated with more severe functional symptoms, worse quality of life and brain alterations. CONCLUSIONS Our findings highlight the potential clinical utility of assessing patients with FND for dissociative symptomatology. However, fewer studies investigated FND samples with motor symptoms and heterogeneity between studies and risk of bias were high. Rigorous investigation of the prevalence, features and mechanistic relevance of dissociation in FND is needed.
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Affiliation(s)
- Malcolm C Campbell
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and Central and North West London NHS Foundation Trust, London, UK
| | - Abigail Smakowski
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maya Rojas-Aguiluz
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Etzel Cardeña
- Center for Research on Consciousness and Anomalous Psychology (CERCAP), Department of Psychology, Lund University, Lund, Sweden
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Susannah Pick
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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19
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Fung HW, Ross CA, Lam SKK, Hung SL. Recent research on the interventions for people with dissociation. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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20
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Salter M, Hall H. Reducing Shame, Promoting Dignity: A Model for the Primary Prevention of Complex Post-Traumatic Stress Disorder. TRAUMA, VIOLENCE & ABUSE 2022; 23:906-919. [PMID: 33345743 DOI: 10.1177/1524838020979667] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Complex post-traumatic stress disorder (CPTSD) refers to the complex psychological and psychosocial sequelae caused by prolonged interpersonal abuse. Contemporary approaches to CPTSD are dominated by individualized psychological interventions that are long term and costly. However, accumulating evidence indicates that CPTSD is a high prevalence mental illness implicated in significant social problems, with a pattern of lateral and intergenerational transmission that impacts on already disadvantaged communities. Consequently, there have been calls for a public health model for the prevention of CPSTD; however, there has been a lack of clarity as to what this should entail. This article argues that empirical and conceptual shifts framing CPTSD as a shame disorder offers new preventative opportunities. The article presents a series of interconnected literature reviews including a review of available prevalence data on CPTSD, the public health implications of CPTSD, the role of shame and humiliation in CPTSD, and current scholarship on dignity in public policy and professional practice. Drawing on these reviews, this article develops a social ecological model of primary prevention to CPTSD with a focus on the reduction of shame and the promotion of dignity at the relational, community, institutional, and macrolevel. A broad overview of this model is provided with examples of preventative programs and interventions. While the epidemiology of CPTSD is still emerging, this article argues that this model provides the conceptual foundations necessary for the coordination of preventative interventions necessary to reduce to the risk and prevalence of CPSTD.
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Affiliation(s)
- Michael Salter
- School of Social Sciences, University of New South Wales, Sydney, Australia
| | - Heather Hall
- International Society for the Study of Trauma and Dissociation, Arlington, VA, USA
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21
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Wieder L, Brown RJ, Thompson T, Terhune DB. Hypnotic suggestibility in dissociative and related disorders: A meta-analysis. Neurosci Biobehav Rev 2022; 139:104751. [PMID: 35760389 DOI: 10.1016/j.neubiorev.2022.104751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/04/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
Elevated responsiveness to verbal suggestions is hypothesized to represent a predisposing factor for dissociative disorders (DDs) and related conditions. However, the magnitude of this effect has not been estimated in these populations nor has the potential moderating influence of methodological limitations on effect size variability across studies. This study assessed whether patients with DDs, trauma- and stressor-related disorders (TSDs), and functional neurological disorder (FND) display elevated hypnotic suggestibility. A systematic literature search identified 20 datasets. A random-effects meta-analysis revealed that patients displayed greater hypnotic suggestibility than controls, Hedges's g=0.92 [0.66, 1.18]. This effect was observed in all subgroups but was most pronounced in the DDs. Although there was some evidence for publication bias, a bias-corrected estimate of the group effect remained significant, g=0.57 [0.30, 0.85]. Moderation analyses did not yield evidence for a link between effect sizes and methodological limitations. These results demonstrate that DDs and related conditions are characterized by elevated hypnotic suggestibility and have implications for the mechanisms, risk factors, and treatment of dissociative psychopathology.
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Affiliation(s)
- Lillian Wieder
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Richard J Brown
- School of Health Sciences, University of Manchester, Manchester, UK; Psychotherapy Services, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Sciences Centre, UK
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, UK
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, London, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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23
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Bækkelund H, Ulvenes P, Boon-Langelaan S, Arnevik EA. Group treatment for complex dissociative disorders: a randomized clinical trial. BMC Psychiatry 2022; 22:338. [PMID: 35578194 PMCID: PMC9112598 DOI: 10.1186/s12888-022-03970-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment. METHODS Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group-treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties. RESULTS Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period. CONCLUSION In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning. TRIAL REGISTRATION Clinical Trials ( NCT02450617 ).
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Affiliation(s)
- Harald Bækkelund
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway. .,Section for Implementation and Treatment Research, Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
| | - Pål Ulvenes
- grid.5510.10000 0004 1936 8921Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Espen Ajo Arnevik
- grid.55325.340000 0004 0389 8485Section for clinical addiction research, Oslo University Hospital, Oslo, Norway
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Das S, Goyal N, Sayeed N. Efficacy of dialectical behavior therapy-A in adolescents with dissociative disorder in India: An open-label trial. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Sommer JL, Blaney C, Mota N, Bilevicius E, Beatie B, Kilborn K, Chang U, Sareen J, El-Gabalawy R. Dissociation as a Transdiagnostic Indicator of Self-Injurious Behavior and Suicide Attempts: A Focus on Posttraumatic Stress Disorder and Borderline Personality Disorder. J Trauma Stress 2021; 34:1149-1158. [PMID: 34426995 DOI: 10.1002/jts.22726] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022]
Abstract
Dissociative symptoms and suicidality are transdiagnostic features of posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The primary objective of this study was to examine associations between dissociation (i.e., depersonalization and derealization) and suicidality (i.e., self-harm and suicide attempts) among individuals with PTSD and BPD. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule for DSM-5 was used to assess lifetime PTSD and BPD. Estimated rates of self-harm among individuals who endorsed dissociation were 15.5%-26.2% for those with PTSD and 13.7%-23.5% for those with BPD, and estimates of suicide attempts among individuals who endorsed dissociation were 34.5%-38.1% for those with PTSD and 28.3%-33.1% for those with BPD. Multiple logistic regressions were conducted to examine the associations between dissociation (derealization, depersonalization, and both) and both self-harm and suicide attempts among respondents with PTSD and BPD. The results indicated that dissociation was associated with self-harm and suicide attempts, especially among individuals with BPD, aORs = 1.39-2.66; however, this association may be driven in part by a third variable, such as other symptoms of PTSD or BPD (e.g., mood disturbance, PTSD or BPD symptom severity). These results may inform risk assessments and targeted interventions for vulnerable individuals with PTSD, BPD, or both aimed at mitigating the risk of self-harm and suicide.
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Affiliation(s)
- Jordana L Sommer
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Caitlin Blaney
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elena Bilevicius
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brooke Beatie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kayla Kilborn
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Unice Chang
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Boulet C, Lopez-Castroman J, Mouchabac S, Olié E, Courtet P, Thouvenot E, Abbar M, Conejero I. Stress response in dissociation and conversion disorders: A systematic review. Neurosci Biobehav Rev 2021; 132:957-967. [PMID: 34740754 DOI: 10.1016/j.neubiorev.2021.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 12/28/2022]
Abstract
Dissociative disorders (DD) and conversion disorders (CD) are frequent in general and psychiatric populations. Some evidence suggest that the hypothalamic-pituitary axis (HPA) and autonomic nervous system (ANS) are dysregulated in both disorders. We carried out a systematic review of the literature to summarize the existing knowledge on the stress response, via HPA and/or ANS, in patients with DD, CD, or dissociative symptoms. We systematically searched Medline and Web of Science using the Medical Subject Headings related to stress axis, CD, DD, and dissociative symptoms following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results suggest that in participants without psychiatric history, high cortisol secretion is related to high dissociation scores. Conversely the stress system might be blunted in patients with post-traumatic stress disorder who develop dissociative symptoms. Stress response changes seem to be associated with the emergence and persistence of dissociative and conversion disorders. Hence, monitoring the stress response and examining closely the history of stress exposure in DD and CD should be encouraged in future larger studies.
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Affiliation(s)
- Charlotte Boulet
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Stéphane Mouchabac
- Saint-Antoine Hospital Center APHP, Department of Psychiatry, iCRIN Psychiatry (Infrastructure of Clinical Research in Neurosciences-Psychiatry), Brain and Spine Institute (ICM), Sorbonne University, INSERM, CNRS, 75013, Paris, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Mocrane Abbar
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France
| | - Ismael Conejero
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; Centre de Biochimie Structurale, University of Montpellier, Montpellier, France.
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27
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Emran A, Sharma V, Singh R, Jha M, Iqbal N. Lived Experiences of Women with Dissociative Disorder: An Interpretative Phenomenological Analysis. Indian J Psychol Med 2021; 43:492-499. [PMID: 35210677 PMCID: PMC8826197 DOI: 10.1177/02537176211044801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the Indian setting, several studies have documented that dissociative disorders (DDs) are more common in females, and the most commonly elicited stressors are interpersonal. However, much of the research up to now has been quantitative. There is a notable paucity of qualitative studies exploring the subjective experiences of women with DD. Therefore, the present study sought to explore and gain an in-depth understanding of the lived experiences of women diagnosed with DD. METHODS Five women were recruited who were seeking psychological treatment for dissociative symptoms at a tertiary care neuropsychiatric institute in North India. In-depth interviews were conducted with each, and the transcripts were analyzed using the analytic method of interpretative phenomenological analysis. RESULTS Three superordinate themes that emerged were: patients' illness perspectives, the salience of relationships, and dealing with relationship conflicts. CONCLUSIONS Our findings highlight the role of culture in influencing the participants' illness perspectives. Women with DD tend to define their self in relational terms and, thus, inhibit the expression of one's needs and opinions, to avoid conflict and to maintain harmony in relationships.
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Affiliation(s)
- Ashti Emran
- Dept. of Psychology, Jamia Millia Islamia, New Delhi, India
| | - Vibha Sharma
- Dept. of Clinical Psychology, Institute of Human Behavior and Allied Sciences, IHBAS, Delhi, India
| | - Ravinder Singh
- Dept. of Medical Anthropology, Institute of Human Behavior and Allied Sciences, IHBAS, Delhi, India
| | - Manisha Jha
- Dept. of Clinical Psychology, Institute of Human Behavior and Allied Sciences, IHBAS, Delhi, India
| | - Naved Iqbal
- Dept. of Psychology, Jamia Millia Islamia, New Delhi, India
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28
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Mayer G, Fuhrmann M. A German online survey of people who have experienced sleep paralysis. J Sleep Res 2021; 31:e13509. [PMID: 34676599 DOI: 10.1111/jsr.13509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/29/2021] [Accepted: 10/09/2021] [Indexed: 11/28/2022]
Abstract
We present some key findings from an online survey on isolated sleep paralysis. The aim of our study was to get a differentiated picture of the correlation between the frequency of sleep paralysis and several phenomena (symptoms, experiences) as well as factors correlated with these phenomena. We also investigated the role of gender in relation to the experience of sleep paralysis. We used a selected sample of subjects who had had at least one sleep paralysis experience, with a total of 380 subjects. On average, the participants experienced 10-20 sleep paralysis episodes. We found high and expected positive correlations between the frequency of sleep paralysis experiences and the amount of phenomena, emotions, and perceived shapes and forms experienced during sleep paralysis. An increased frequency of sleep paralysis also appears to lead to habituation and de-dramatization in some affected individuals. Interestingly, significant correlations are missing where one would have suspected them based on the previous hypotheses. Neither self-perceived general stress nor poor sleep hygiene appeared to influence the frequency of sleep paralysis. We found highly significant gender differences in some items. Women reported more experienced phenomena and emotions overall, had more frequent sleep paralysis experiences of the intruder and incubus type, and were significantly more likely to perceive concrete forms such as human figures or people they know. They were also more likely than men to report experiencing fearful emotions, especially the fear of going crazy. Most of these findings were based on exploratory questions; they require replication for validation.
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Affiliation(s)
- Gerhard Mayer
- Institut für Grenzgebiete der Psychologie und Psychohygiene, Freiburg im Breisgau, Germany
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29
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Childhood traumatization and dissociative experiences among maladaptive and normal daydreamers in a Hungarian sample. CURRENT PSYCHOLOGY 2021; 42:9509-9525. [PMID: 34483632 PMCID: PMC8403514 DOI: 10.1007/s12144-021-02223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 12/13/2022]
Abstract
The aim of the study was to identify some potential etiological segments of maladaptive daydreaming, especially the relationships between maladaptive daydreaming, childhood traumatization, and dissociative propensity. The questionnaire package included the Hungarian version of the Maladaptive Daydreaming Scale, the Traumatic Antecedents Questionnaire, as well as the Dissociation Questionnaire. 717 participants were recruited online, 106 of whom were problematic daydreamers. The results revealed that certain types of childhood trauma occurred significantly more frequently in the group of maladaptive daydreamers. Furthermore, maladaptive daydreamers possessed a significantly higher level of dissociative propensity compared to normal daydreamers. The estimated SEM models showed that dissociative experiences - more precisely Identity confusion and fragmentation and Lack of control – mediated the relationship between certain childhood traumatic experiences and maladaptive daydreaming. The results suggest that we should consider childhood traumatization and increased dissociative propensity as potentially significant factors in the etiology of maladaptive daydreaming.
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Panisch LS, Currin-McCulloch J, Covington E. Dissociation among individuals receiving cancer care: a scoping review. J Psychosoc Oncol 2021; 40:541-560. [PMID: 34190678 DOI: 10.1080/07347332.2021.1930324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PROBLEM IDENTIFICATION Dissociation is a common presentation of trauma, distinguishable from classic post-traumatic stress disorder (PTSD) symptoms. While pre-cancer and cancer-related traumatic experiences are prevalent among cancer-affected individuals, the specific impact of traumatic dissociation is unclear. LITERATURE SEARCH This scoping review includes a search of English articles published between 1980 and 2019 referencing dissociation in the context of cancer-affected adults. DATA EVALUATION/SYNTHESIS Articles assessed how dissociation was addressed in relation to pre-cancer and cancer-related trauma exposure and treatment. Out of 1,265 articles, 71 met inclusion criteria, and 15 underwent a full review. Two studies addressed dissociation related to pre-cancer trauma, nine in regard to cancer-related trauma only, and four in relation to both trauma types. No studies included experimental designs or described interventions. CONCLUSIONS Despite high rates of trauma exposure among cancer-affected adults, limited studies specifically address the impact of dissociation. Further inquiry on this topic is needed, especially on treatment implications.
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Affiliation(s)
- Lisa S Panisch
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, USA
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31
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Pietkiewicz IJ, Bańbura-Nowak A, Tomalski R, Boon S. Revisiting False-Positive and Imitated Dissociative Identity Disorder. Front Psychol 2021; 12:637929. [PMID: 34025510 PMCID: PMC8134744 DOI: 10.3389/fpsyg.2021.637929] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/14/2021] [Indexed: 11/25/2022] Open
Abstract
ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to distinguish ‘genuine’ DID from imitated or false-positive cases. This study explores meaning which patients with false-positive or imitated DID attributed to their diagnosis. 85 people who reported elevated levels of dissociative symptoms in SDQ-20 participated in clinical assessment using the Trauma and Dissociation Symptoms Interview, followed by a psychiatric interview. The recordings of six women, whose earlier DID diagnosis was disconfirmed, were transcribed and subjected to interpretative phenomenological analysis. Five main themes were identified: (1) endorsement and identification with the diagnosis. (2) The notion of dissociative parts justifies identity confusion and conflicting ego-states. (3) Gaining knowledge about DID affects the clinical presentation. (4) Fragmented personality becomes an important discussion topic with others. (5) Ruling out DID leads to disappointment or anger. To avoid misdiagnoses, clinicians should receive more systematic training in the assessment of dissociative disorders, enabling them to better understand subtle differences in the quality of symptoms and how dissociative and non-dissociative patients report them. This would lead to a better understanding of how patients with and without a dissociative disorder report core dissociative symptoms. Some guidelines for a differential diagnosis are provided.
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Affiliation(s)
- Igor Jacob Pietkiewicz
- Research Centre for Trauma & Dissociation, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | - Anna Bańbura-Nowak
- Research Centre for Trauma & Dissociation, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | - Radosław Tomalski
- Research Centre for Trauma & Dissociation, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | - Suzette Boon
- Research Centre for Trauma & Dissociation, SWPS University of Social Sciences and Humanities, Katowice, Poland
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32
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"This Is Not the Original Timeline": A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State. Case Rep Psychiatry 2021; 2021:6619579. [PMID: 34007506 PMCID: PMC8110420 DOI: 10.1155/2021/6619579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022] Open
Abstract
Dissociation is a disconnection between a person's thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.
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Fung HW, Chan C, Ross CA, Wang EKS. Clinical Features of a Chinese Sample with Self-Reported Symptoms of Pathological Dissociation. J Trauma Dissociation 2021; 22:378-393. [PMID: 33427126 DOI: 10.1080/15299732.2020.1869651] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Hong Wang Fung
- The Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chitat Chan
- The Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, USA
| | - Edward K S Wang
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kaspersen K, Hol G, Jepsen EKK. Negative affective responses to positive events and stimuli in patients with complex dissociative disorders: a mixed-methods pilot study. Eur J Psychotraumatol 2021; 12:1976954. [PMID: 34721820 PMCID: PMC8555534 DOI: 10.1080/20008198.2021.1976954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Research suggests that individuals exposed to (childhood) trauma are not only unable to experience pleasure, known as hedonic deficit (HD), but also experience 'negative affective responses to positive events', known as negative affective interference (NAI). The clinical relevance and prognostic features of NAI have increasingly been recognized. To date, no studies have focused on NAI in patients with complex dissociative disorders (CDDs) who were abused early in life. OBJECTIVE In this pilot study, we quantitatively and qualitatively investigated how NAI is related to trauma-related symptoms and how this phenomenon can be understood in a selected group of adult CDD patients. METHOD CDD patients (N = 25) referred to an inpatient dissociation-focused treatment programme completed the Hedonic Deficit & Interference Scale (HDIS), and measures of trauma-related symptoms and interpersonal functioning, as well as a qualitative questionnaire addressing possible inner conflicts and phobias with respect to the experience of positive events. A convergent mixed-methods design was used to obtain different but complementary data on NAI to gain a more complete understanding of the phenomenon. RESULTS The quantitative analyses showed a significant relationship between NAI and trauma-related symptoms and interpersonal functioning. NAI seems to be more strongly associated with these symptoms than HD. The qualitative analysis revealed three themes - fear, shame, and aggressive 'parts' - preventing positive emotions, which provided a possible interpretation of the quantitative results. The integrated findings were discussed in light of theories of structural dissociation of the personality and attachment. CONCLUSIONS These findings indicate that NAI is related to a spectrum of trauma-related symptoms and interpersonal functioning in patients with a CDD to a larger degree than HD and that different dissociative identities are involved. Studies of the relationship between changes in HDIS (particularly the NAI subscale) and changes in trauma-related symptoms and interpersonal functioning following treatment are warranted.
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Affiliation(s)
- Kaja Kaspersen
- Department for Trauma Treatment, Modum Bad Clinical Center, Vikersund, Norway
| | - Gorm Hol
- Independent scholar, Oslo, Norway
| | - Ellen K K Jepsen
- Department for Trauma Treatment, Modum Bad Clinical Center, Vikersund, Norway.,Research Institute, Modum Bad, Vikersund, Norway
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From Bones to Brain: 50 Years of Star Trek and Changes in the Stigmatization of Psychological Disorders. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-018-9868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Abstract
The Star Trek franchise currently includes five spin-off series and 13 motion pictures. Star Trek’s central theme is the utopian future of mankind, but the series does not disregard issues that were socially relevant for its time of production. Therefore, Star Trek has functioned as a representation of history throughout its 50-year lifespan. This paper conducts a comparative analysis of fictional representations of psychological disorders and corresponding treatments to retrace the cultural changes in the portrayal and treatment of psychological disorders from the 1960s to the turn of the millennium. Video material produced between 1966 and 1999 was analysed with a focus on psychological disorders and coded according to the ICD-10. The results of the quantitative analysis indicate that the different Star Trek series demonstrate similar patterns of percentage distributions for psychological disorders. The qualitative analysis shows that psychological disorders were portrayed and treated in an increasingly realistic fashion. Changes in society’s attitude towards psychological disorders can be comprehensively illustrated through Star Trek episodes produced through 1999. Psychological phenomena are increasingly destigmatized, and the necessity of treatment has not been disregarded.
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Gold SN, Quiñones M. Applicability of hypnosis to the treatment of Complex PTSD and dissociation. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2020; 63:78-94. [PMID: 33118880 DOI: 10.1080/00029157.2020.1789546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In considering the applicability of hypnosis to treating Complex PTSD (C-PTSD) we examine the relationship between trauma, hypnosis, and dissociation, the latter being a common response to traumatization that is particularly salient in C-PTSD. We then provide an overview of the nature of C-PTSD, which research is beginning to demonstrate is considerably more prevalent than the more circumscribed PTSD syndrome depicted in the DSM. Building on this foundation, we discuss the reasons why hypnotically structured treatment is particularly well suited for C-PTSD, explaining how each of the major aspects of this syndrome can be addressed within a hypnotic framework.
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Mohajerin B, Lynn SJ, Bakhtiyari M, Dolatshah B. Evaluating the Unified Protocol in the Treatment of Dissociative Identify Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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38
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Fung HW, Chan C, Ross CA. A Web-based Psychoeducation Program for People with Pathological Dissociation: Development and Pilot Testing. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:427-442. [PMID: 32410503 DOI: 10.1080/26408066.2020.1760990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Hong Wang Fung
- The Department of Applied Social Sciences, The Hong Kong Polytechnic University , Hung Hom, Hong Kong
| | - Chitat Chan
- The Department of Applied Social Sciences, The Hong Kong Polytechnic University , Hung Hom, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma , Richardson, Texas, USA
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Vine V, Victor SE, Mohr H, Byrd AL, Stepp SD. Adolescent suicide risk and experiences of dissociation in daily life. Psychiatry Res 2020; 287:112870. [PMID: 32171125 PMCID: PMC7983062 DOI: 10.1016/j.psychres.2020.112870] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Abstract
Dissociation is associated with risk for suicide in adults, but this link is not well studied in adolescents, in spite of their marked suicide risk. This study assessed adolescents' dissociative experiences in daily life and evaluated the association between dissociative experiences and suicide risk, including the independence of this relationship from related affective and clinical states and demographic characteristics. Clinically referred early adolescents (N = 162; aged 11-13) were assessed via multi-informant clinical interview, questionnaires, and 4-day ecological momentary assessment protocol. Adolescents were classified as being at elevated suicide risk using multi-informant, multi-method reports of suicide risk behavior and/or at elevated proximal risk using the 4-day EMA only. Suicide risk was associated with daily dissociative experiences, and this relationship was independent of daily negative and positive affect and co-occurring borderline personality symptoms. Gender differences emerged, such that the relationship between daily dissociative experiences and suicide risk was only significant in adolescent girls. Overall, findings suggest dissociation may be independently relevant to adolescent suicide risk, above and beyond effects of psychopathology and affective disturbance, and especially in girls. Daily dissociative experiences may help understand and detect suicide risk among early adolescents and warrant further research.
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Affiliation(s)
- Vera Vine
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
| | - Sarah E Victor
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Harmony Mohr
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Amy L Byrd
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
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van Heugten-van der Kloet D, Lynn SJ. Dreams and Dissociation-Commonalities as a Basis for Future Research and Clinical Innovations. Front Psychol 2020; 11:745. [PMID: 32390913 PMCID: PMC7189023 DOI: 10.3389/fpsyg.2020.00745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Dalena van Heugten-van der Kloet
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Steven Jay Lynn
- Psychology Department, Binghamton University (SUNY), Binghamton, NY, United States
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Fung H, Ling HH, Ross C, Tse JL, Liu RK. Dissociative, Schneiderian and borderline personality symptoms in a non-clinical sample in Hong Kong: A preliminary report. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dimitrova L, Fernando V, Vissia EM, Nijenhuis ERS, Draijer N, Reinders AATS. Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: a replication and extension study. Eur J Psychotraumatol 2020; 11:1705599. [PMID: 32082509 PMCID: PMC7006753 DOI: 10.1080/20008198.2019.1705599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/14/2019] [Accepted: 11/13/2019] [Indexed: 10/26/2022] Open
Abstract
Background: Two aetiology models for dissociative identity disorder (DID) have been proposed, namely a childhood Trauma Model and an iatrogenic or Fantasy model. A recent study indicated that sleep disturbances underlie dissociative symptomatology. Objective: Our current study aims to test whether this finding can be replicated in an independent sample and to investigate if this finding still holds after correcting for childhood and adult traumatization. An experimental working memory task is included to investigate how sleep disturbance, traumatization, dissociation, and fantasy proneness impact cognitive functioning. Methods: Three groups of participants were included - individuals with DID, individuals with post-traumatic stress disorder (PTSD), and matched healthy controls. Sleep disturbances were measured and compared between the groups along with measures of childhood and adult traumatization, psychoform and somatoform [psychological and somatic] dissociative symptoms, and fantasy proneness. Cognitive capacity was assessed using a working memory task. Results: When controlled for traumatic experiences, sleep disturbances did not predict dissociative symptoms. When controlled for sleep disturbance and fantasy proneness, childhood traumatization did predict dissociative symptoms. Psychoform dissociative symptoms correlated with traumatic experiences more than with fantasy proneness. Working memory performance was similar among the participating groups. Propensity to fantasy did not discriminate individuals with DID and PTSD, and was a weak predictor of dissociative symptoms. Conclusion: Whereas DID and PTSD are associated with sleep disturbances, these features do not statistically predict dissociative symptoms in these disorders when traumatic experiences are taken into account. Fantasy proneness is not excessive in DID and PTSD. Hence, we found no evidence that sleep disturbances, propensity to fantasy and abnormal working memory capacity explain dissociative symptoms in DID and PTSD. In sum, the relationship between sleep and dissociative symptoms disappeared when potentially traumatizing events were controlled for.
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Affiliation(s)
- Lora Dimitrova
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.,Department of Psychiatry, Amsterdam UMC, location VUMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Vinuri Fernando
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.,Department of Psychiatry, Amsterdam UMC, location VUMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Eline M Vissia
- Heelzorg, Centre for Psychotrauma, Zwolle, The Netherlands
| | - Ellert R S Nijenhuis
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Nel Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Reinders AATS, Marquand AF, Schlumpf YR, Chalavi S, Vissia EM, Nijenhuis ERS, Dazzan P, Jäncke L, Veltman DJ. Aiding the diagnosis of dissociative identity disorder: pattern recognition study of brain biomarkers. Br J Psychiatry 2019; 215:536-544. [PMID: 30523772 DOI: 10.1192/bjp.2018.255] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND A diagnosis of dissociative identity disorder (DID) is controversial and prone to under- and misdiagnosis. From the moment of seeking treatment for symptoms to the time of an accurate diagnosis of DID individuals received an average of four prior other diagnoses and spent 7 years, with reports of up to 12 years, in mental health services. AIM To investigate whether data-driven pattern recognition methodologies applied to structural brain images can provide biomarkers to aid DID diagnosis. METHOD Structural brain images of 75 participants were included: 32 female individuals with DID and 43 matched healthy controls. Individuals with DID were recruited from psychiatry and psychotherapy out-patient clinics. Probabilistic pattern classifiers were trained to discriminate cohorts based on measures of brain morphology. RESULTS The pattern classifiers were able to accurately discriminate between individuals with DID and healthy controls with high sensitivity (72%) and specificity (74%) on the basis of brain structure. These findings provide evidence for a biological basis for distinguishing between DID-affected and healthy individuals. CONCLUSIONS We propose a pattern of neuroimaging biomarkers that could be used to inform the identification of individuals with DID from healthy controls at the individual level. This is important and clinically relevant because the DID diagnosis is controversial and individuals with DID are often misdiagnosed. Ultimately, the application of pattern recognition methodologies could prevent unnecessary suffering of individuals with DID because of an earlier accurate diagnosis, which will facilitate faster and targeted interventions. DECLARATION OF INTEREST The authors declare no competing financial interests.
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Affiliation(s)
- Antje A T S Reinders
- Senior Research Associate with Lecturer status, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Neuroscience, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Andre F Marquand
- Assistant Professor, Donders Institute for Brain Cognition and Behaviour, Radboud University, The Netherlands and Honorary Lecturer, Department of Clinical Neuroscience, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Yolanda R Schlumpf
- Postdoctoral Assistant, Division of Neuropsychology, Department of Psychology, University of Zurich and Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Switzerland
| | - Sima Chalavi
- Postdoctoral Researcher, Department of Neuroscience, University Medical Center Groningen, University of Groningen, The Netherlands and Research Center for Movement Control and Neuroplasticity, Department of Movement Sciences, Katholieke Universiteit Leuven, Belgium
| | - Eline M Vissia
- Mental Healthcare Psychologist, Department of Neuroscience, University Medical Center Groningen, University of Groningen and Top Referent Trauma Centrum, GGz Centraal, The Netherlands
| | - Ellert R S Nijenhuis
- Psychologist/Psychotherapist, Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Switzerland
| | - Paola Dazzan
- Professor of Neurobiology of Psychosis, Vice Dean International, Honorary Consultant Psychiatrist, Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Lutz Jäncke
- Professor of Neuropsychology, Scientific Director, Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy and Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Switzerland
| | - Dick J Veltman
- Professor of Neuroimaging in Psychiatry, Department of Psychiatry, VU University Medical Center, The Netherlands
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Firoozabadi A, Golshani S, Razeghian L, Rahimi S, Sepehry AA, Farnia V, Tatari F, Hookari S, Alikhani M. Dissociative Experiences In Iranian Depressed Patients. J Trauma Dissociation 2019; 20:445-456. [PMID: 30945624 DOI: 10.1080/15299732.2019.1597804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the present study, 229 major depressive disorder (MDD) patients (57.6% female; 42.4% male) were selected by convenience sampling and examined for rate of dissociative experiences. Research tools were Dissociative Experiences Scale (DES) and demographic questionnaire. Group difference examinations were performed for gender, settlement region (place of residence), and chief complaints using standard t-test, analysis of variance, and Chi-square tests as appropriate. Ordinal regression was implemented for model building. The average age of the sample was 36.78 ± 10.73. Of which, 150 (65.5%) lived in the urban and 79 (34.5%) in the rural areas. The chief complaint of the 146 patients (63.8%) was psychiatric symptoms specific to MDD, and the remaining 83 patients (36.2%) had physical symptoms. The average DES score was 10.59 ± 13.59; and a significant mean DES score differences (P < 0.01) between patients' referred to physician for physical versus psychological complaints (physical: 23.61 ± 14.39; psychological: 3.19 ± 4.5) and geographic settlements (rural: 19.58 ± 15.13; urban: 5.86 ± 9.86) were observed. This study highlights the presence of subtype within MDD patients with significant dissociative tendencies. Given the relationship between trauma history and dissociation, this subgroup could be considered as probable cases with childhood history of abuse, lending to use dissociation as a defense mechanism. Given the evidence for promising results of trauma-focused psychotherapy in treating such patients, paying proper attention to childhood history of depression especially with somatization may minimize pain and suffering of these individuals overtime.
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Affiliation(s)
- Ali Firoozabadi
- a Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, Hafez Hospital , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Senobar Golshani
- b Substance abuse prevention research center , Kermanshah University of Medical Sciences , Kermanshah , Iran
| | - Lila Razeghian
- c Department of Psychiatry , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Somayeh Rahimi
- c Department of Psychiatry , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Amir Ali Sepehry
- d Faculty of Medicine, Division of Neurology , UBC , Vancouver , Canada
| | - Vahid Farnia
- b Substance abuse prevention research center , Kermanshah University of Medical Sciences , Kermanshah , Iran
| | - Faezeh Tatari
- b Substance abuse prevention research center , Kermanshah University of Medical Sciences , Kermanshah , Iran
| | - Sara Hookari
- b Substance abuse prevention research center , Kermanshah University of Medical Sciences , Kermanshah , Iran
| | - Mostafa Alikhani
- b Substance abuse prevention research center , Kermanshah University of Medical Sciences , Kermanshah , Iran
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Fung HW, Ross CA, Yu CKC, Lau EKL. Adverse childhood experiences and dissociation among Hong Kong mental health service users. J Trauma Dissociation 2019; 20:457-470. [PMID: 30945625 DOI: 10.1080/15299732.2019.1597808] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adverse childhood experiences (ACEs) have become a major concern in the mental health field. The literature suggests that ACEs could be associated with various mental health problems. Yet, ACEs require further investigation in Chinese cultures, especially in Hong Kong. Both the frequency of ACEs and their relationships with dissociation remain unknown in clinical settings in Hong Kong. In this study, we administered the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ) and the 10-item Adverse Childhood Experiences (ACEs) Questionnaire to 202 community mental health service users in Hong Kong. The frequency of ACEs and dissociation is reported and the trauma model of dissociation can be observed in this sample. Consistent with the Western literature, we found that ACEs are associated with mental health problems and that participants with childhood abuse and/or neglect report a significantly higher level of dissociation. While this study is preliminary, we suggest that ACEs and dissociation should receive more attention in the Chinese mental health field. Implications for practice are highlighted. Further studies are warranted.
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Affiliation(s)
- Hong Wang Fung
- a The Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hung Hom , Hong Kong
| | - Colin A Ross
- b The Colin A. Ross Institute for Psychological Trauma , Richardson , TX , United States
| | - Calvin Kai-Ching Yu
- c Department of Counselling & Psychology , Hong Kong Shue Yan University , Hong Kong North Point , Hong Kong
| | - Edison Ka-Lok Lau
- d Research & Development Division , The Society of Rehabilitation and Crime Prevention , Hong Kong , Hong Kong
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Raghavan SS. Cultural Considerations in the Assessment of Survivors of Torture. J Immigr Minor Health 2019; 21:586-595. [DOI: 10.1007/s10903-018-0787-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Controversy about dissociation and the dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence support a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and that DD are artefactual conditions produced by iatrogenesis and/or socio-cultural factors. Almost no research or clinical data support this view. DD are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior. Prospective treatment outcome studies of severely ill DD patients show significant improvement in symptoms including suicidal/self-destructive behaviors, with reductions in treatment cost. A major public health effort is needed to raise awareness about dissociation/DD, including educational efforts in all mental health training programs and increased funding for research.
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Affiliation(s)
- Richard J Loewenstein
- The Trauma Disorders Program, Sheppard Pratt Health System, Maryland, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Huntjens RJC, Rijkeboer MM, Arntz A. Schema therapy for Dissociative Identity Disorder (DID): rationale and study protocol. Eur J Psychotraumatol 2019; 10:1571377. [PMID: 30815233 PMCID: PMC6383624 DOI: 10.1080/20008198.2019.1571377] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/23/2018] [Accepted: 01/06/2019] [Indexed: 12/24/2022] Open
Abstract
Background: A category of disorders frequently associated with a history of trauma are the dissociative disorders, of which Dissociative Identity Disorder (DID) is the most severe and chronic form. DID is associated with high levels of impairment, treatment utilization, and treatment costs, yet systematic research into treatment effects is scarce. Practice-based clinical guidelines advise a phase-based approach which is lengthy and has rather high reported dropout rates. Therefore, in the current proposal the efficacy of an alternative treatment for DID (i.e. schema therapy) is tested. Objective: The aim of this study is to critically test the effectiveness of schema therapy for DID patients, for whom at present no evidence-based treatment is available. Method: In light of the low prevalence of DID, and the proposed treatment length of three years, a case series experimental approach is used (non-concurrent multiple baseline design). Ten outpatients are included, who are diagnosed with DID by an independent rater using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), which is double-checked by another independent expert. Primary outcomes are a (bi)weekly assessed state measure of dissociative symptoms, a pre-, post- and follow-up measure of the presence of the DID diagnosis, and drop-out rate. Secondary outcomes include various measures of trait dissociative symptoms, comorbid symptomatology, and global symptomatic distress. Trial registration: Netherlands Trial Register (NTR): NTR4496.
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Affiliation(s)
- Rafaële J. C. Huntjens
- Department of Experimental Psychotherapy and Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Marleen M. Rijkeboer
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Brand BL, Schielke HJ, Putnam KT, Putnam FW, Loewenstein RJ, Myrick A, Jepsen EKK, Langeland W, Steele K, Classen CC, Lanius RA. An Online Educational Program for Individuals With Dissociative Disorders and Their Clinicians: 1-Year and 2-Year Follow-Up. J Trauma Stress 2019; 32:156-166. [PMID: 30698858 PMCID: PMC6590319 DOI: 10.1002/jts.22370] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 01/10/2023]
Abstract
Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self-injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web-based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web-based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample |d|s = 0.44-0.90, as well as reduced NSSI. The improvements in NSSI among the most self-injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation |d|s = 0.54-1.04 vs. |d|s = 0.24-0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.
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Affiliation(s)
| | | | - Karen T. Putnam
- The Department of PsychiatryUniversity of North Carolina School of Medicine at Chapel HillChapel HillNorth CarolinaUSA
| | - Frank W. Putnam
- The Department of PsychiatryUniversity of North Carolina School of Medicine at Chapel HillChapel HillNorth CarolinaUSA
| | - Richard J. Loewenstein
- Sheppard Pratt Health System and University of Maryland School of MedicineBaltimoreMarylandUSA
| | - Amie Myrick
- Family and Children's ServicesBel AirMaryland
| | | | | | | | - Catherine C. Classen
- University of California San Francisco and Zuckerberg San Francisco General HospitalSan FranciscoCaliforniaUSA
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