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Haroon H. Dissociation and the insanity defense: A review of U.S. Federal appellate case law. J Forensic Sci 2024; 69:1782-1788. [PMID: 38876483 DOI: 10.1111/1556-4029.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Abstract
Pathological dissociation is relatively common in the United States and may be associated with violent or criminal behavior. Dissociative Disorders, especially Dissociative Identity Disorder, are considered controversial diagnoses by some in the psychiatric and legal professions. Individuals who offend during dissociative states may not be criminally responsible if they meet the legal standard for insanity, however, insanity pleas based on dissociative symptoms are rare. This review examined Federal appellate case law for potential legal barriers to the insanity defense for dissociative conditions and any restrictions imposed on related expert evidence. Few rulings directly addressed these questions but there do not appear to be any unique barriers for dissociation-related insanity pleas. Some cases provided valuable insights regarding the admission of expert evidence, effective expert testimony, and the role of defense counsel.
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Affiliation(s)
- Haseeb Haroon
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
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2
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Kratzer L, Tschöke S, Schröder J, Shevlin M, Hyland P, Eckenberger C, Heinz P, Karatzias T. Severe Dissociative Experiences beyond Detachment in a Large Clinical Sample of Inpatients with Post-Traumatic Stress Disorder: Diagnostic and Treatment Implications. Psychopathology 2024:1-9. [PMID: 39038445 DOI: 10.1159/000539740] [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: 08/22/2023] [Accepted: 02/12/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains a dissociative subtype of post-traumatic stress disorder (PTSD) characterized by depersonalization and derealization. Yet, there is evidence that dissociative symptoms in PTSD go beyond this kind of detachment dissociation and that some patients present with additional compartmentalization dissociation in the form of auditory-verbal hallucination, amnesia, and identity alteration. METHODS Hence, in this study, we examined latent profiles of childhood trauma (Childhood Trauma Questionnaire), PTSD (Impact-of-Event Scale-Revised), and pathological dissociation (Dissociative Experiences Scale-Taxon; DES-T) in a large sample of severely traumatized inpatients with PTSD (N = 1,360). RESULTS Results support a three-class solution of the latent profile analysis with a PTSD class, a dissociative subtype class, and a third class characterized by more complex and more severe dissociative symptoms. Importantly, in our inpatient sample of patients with severe PTSD, the latter class was found to be the most prevalent. Both the exploratory character of our retrospective analysis of clinical routine data and the use of the DES-T limit the generalizability of our findings, which require methodologically more rigorous replication. CONCLUSION In severe PTSD, dissociative symptoms beyond detachment are highly prevalent. Diagnostic and treatment implications are discussed.
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Affiliation(s)
- Leonhard Kratzer
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany,
| | - Stefan Tschöke
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany
- Centre for Psychiatry Südwürttemberg, Ravensburg, Germany
| | - Johanna Schröder
- Department for Psychology, Medical School Hamburg, Institute for Clinical Psychology and Psychotherapy, Hamburg, Germany
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, UK
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Peter Heinz
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
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Söderberg A, Gabrielsson S, Looi GME, Wiklund Gustin L, Bäckström J, Lindgren BM. Being Human Under Inhuman Conditions: Meanings of Living with Severe Dissociative States Involving the Experience of Being in Parts. Issues Ment Health Nurs 2024; 45:597-606. [PMID: 38640493 DOI: 10.1080/01612840.2024.2330572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Severe dissociative states involving the experience of being in parts, typically associated with diagnosis such as dissociative identity disorder and other specified dissociative disorders, continue to be a controversial and rarely studied area of research. However, because persons with severe dissociative states are at risk of being harmed instead of helped within psychiatric care, their experiences of living with such states warrant further examination, while innovative ways to include them in research remain necessary. Against that background, this study aimed to illuminate the meanings of living with severe dissociative states involving the experience of being in parts. This is a phenomenological hermeneutic study with data collected from three social media sources, one personal blog and two Instagram accounts, in February and March 2023. The results were illuminated in light of four themes; Striving to remain in the world, Balancing exposure and trust, Balancing belonging and loneliness and Owning oneselves. The interpretation of the themes suggests that living with severe dissociative states means being a human under inhuman conditions, striving for coherence and meaning in a world that is often unsupportive. This calls for a trauma-informed care to better support recovery for persons with severe dissociative states.
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Affiliation(s)
- Anja Söderberg
- Department of Health, Education and Technology, Luleå University of Technology, Lulea, Sweden
| | - Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Lulea, Sweden
| | - Git-Marie Ejneborn Looi
- Department of Health, Education and Technology, Luleå University of Technology, Lulea, Sweden
| | - Lena Wiklund Gustin
- School of Health, Care and Social Welfare, Mälardalen University, Vasteras, Sweden
- Department of Health and Care Sciences, UiT/The Arctic University of Norway, Tromsø, Norway
| | - Josefin Bäckström
- Department of Health, Education and Technology, Luleå University of Technology, Lulea, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
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Daniels JK, Timmerman ME, Spitzer C, Lampe A. Differential constellations of dissociative symptoms and their association with childhood trauma - a latent profile analysis. Eur J Psychotraumatol 2024; 15:2348345. [PMID: 38739008 PMCID: PMC11095287 DOI: 10.1080/20008066.2024.2348345] [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: 11/02/2023] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
Background: While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe.Objective: We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics.Methods: We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (Fragebogen zu Dissoziativen Symptomen-20) in a large aggregate sample (n = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics.Results: Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout.Conclusions: The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment.
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Affiliation(s)
- Judith K. Daniels
- Department of Psychology, Division of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- Psychologische Hochschule Berlin, Berlin, Germany
| | - Marieke E. Timmerman
- Department of Psychology, Psychometrics and Statistics, University of Groningen, Groningen, the Netherlands
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Astrid Lampe
- Clinic for Rehabilitation Montafon, Schruns, Austria
- Ludwig Boltzmann Institute – Rehabilitation Research, Vienna, Austria
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5
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Pierorazio NA, Robertson JL, Snyder BL, Brand BL, Schielke HJ. Helpful and meaningful aspects of a psychoeducational programme to treat complex dissociative disorders: a qualitative approach. Eur J Psychotraumatol 2024; 15:2323421. [PMID: 38516929 PMCID: PMC10962306 DOI: 10.1080/20008066.2024.2323421] [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: 09/30/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs.Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses.Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure.Conclusion: Clients and therapists in the TOP DD Network programme described the programme's components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs.
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Affiliation(s)
- Nicholas A. Pierorazio
- Department of Psychology, Towson University, Towson, MD, USA
- Psychology Department, University of Massachusetts Boston, Boston, MA, USA
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Riddle J, Schooler JW. Hierarchical consciousness: the Nested Observer Windows model. Neurosci Conscious 2024; 2024:niae010. [PMID: 38504828 PMCID: PMC10949963 DOI: 10.1093/nc/niae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
Foremost in our experience is the intuition that we possess a unified conscious experience. However, many observations run counter to this intuition: we experience paralyzing indecision when faced with two appealing behavioral choices, we simultaneously hold contradictory beliefs, and the content of our thought is often characterized by an internal debate. Here, we propose the Nested Observer Windows (NOW) Model, a framework for hierarchical consciousness wherein information processed across many spatiotemporal scales of the brain feeds into subjective experience. The model likens the mind to a hierarchy of nested mosaic tiles-where an image is composed of mosaic tiles, and each of these tiles is itself an image composed of mosaic tiles. Unitary consciousness exists at the apex of this nested hierarchy where perceptual constructs become fully integrated and complex behaviors are initiated via abstract commands. We define an observer window as a spatially and temporally constrained system within which information is integrated, e.g. in functional brain regions and neurons. Three principles from the signal analysis of electrical activity describe the nested hierarchy and generate testable predictions. First, nested observer windows disseminate information across spatiotemporal scales with cross-frequency coupling. Second, observer windows are characterized by a high degree of internal synchrony (with zero phase lag). Third, observer windows at the same spatiotemporal level share information with each other through coherence (with non-zero phase lag). The theoretical framework of the NOW Model accounts for a wide range of subjective experiences and a novel approach for integrating prominent theories of consciousness.
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Affiliation(s)
- Justin Riddle
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL 32304, USA
| | - Jonathan W Schooler
- Department of Psychological & Brain Sciences, University of California, Santa Barbara, Psychological & Brain Sciences, Santa Barbara, CA 93106, USA
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7
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Krüger C, Fletcher L. Schneiderian First Rank Symptoms Significantly Predict a Dissociative Disorder Diagnosis in Psychiatric In-Patients. J Trauma Dissociation 2024:1-14. [PMID: 38456363 DOI: 10.1080/15299732.2024.2326515] [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: 07/02/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
Previous empirical studies on the relationship between psychotic symptoms and dissociative disorders focused on auditory hallucinations only or employed limited statistical analyses. We investigated whether the frequency of Schneiderian first rank symptoms (FRS) predicts the presence or absence of a dissociative disorder (DD). Psychiatric in-patients (n = 116) completed measures of dissociation, FRS and general psychological distress (GPD). DD diagnoses were confirmed by multidisciplinary teams or administering the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). The FRS were recorded in the Multidimensional Inventory of Dissociation (MID) and a mean score obtained for 35 relevant items: Voices arguing, voices commenting, made feelings, made impulses, made actions, influences on body, thought withdrawal, and thought insertion. A global severity index (GSI) of GPD was obtained from the Symptom Checklist-90-Revised (SCL-90-R). Logistic regression models examined whether FRS predict diagnostic classification of patients under a DD (n = 16) or not (n = 100), controlling for GSI. The overall fit of the model was significant (p = .0002). DD was correctly classified using frequency of FRS, controlling for GSI. The latter was moderately associated with FRS (r = 0.56). FRS more than doubled the odds of a DD diagnosis (odds = 2.089; 95% CI = 1.409-3.098; correct classification rate 87.1%). The study provides convincing evidence that FRS are closely related to DDs. FRS should alert clinicians to consider DDs in differential diagnosis of psychiatric in-patients. Future research should analyze whether FRS also predict a diagnosis of schizophrenia or other psychiatric disorders.
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Affiliation(s)
- Christa Krüger
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Lizelle Fletcher
- Department of Statistics, University of Pretoria, Pretoria, South Africa
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8
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Purcell JB, Brand B, Browne HA, Chefetz RA, Shanahan M, Bair ZA, Baranowski KA, Davis V, Mangones P, Modell RL, Palermo CA, Robertson EC, Robinson MA, Ward L, Winternitz S, Kaufman ML, Lebois LAM. Treatment of dissociative identity disorder: leveraging neurobiology to optimize success. Expert Rev Neurother 2024; 24:273-289. [PMID: 38357897 PMCID: PMC10950423 DOI: 10.1080/14737175.2024.2316153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Dissociative identity disorder (DID) is a treatable mental health condition that is associated with a range of psychobiological manifestations. However, historical controversy, modern day misunderstanding, and lack of professional education have prevented accurate treatment information from reaching most clinicians and patients. These obstacles also have slowed empirical efforts to improve treatment outcomes for people with DID. Emerging neurobiological findings in DID provide essential information that can be used to improve treatment outcomes. AREAS COVERED In this narrative review, the authors discuss symptom characteristics of DID, including dissociative self-states. Current treatment approaches are described, focusing on empirically supported psychotherapeutic interventions for DID and pharmacological agents targeting dissociative symptoms in other conditions. Neurobiological correlates of DID are reviewed, including recent research aimed at identifying a neural signature of DID. EXPERT OPINION Now is the time to move beyond historical controversy and focus on improving DID treatment availability and efficacy. Neurobiological findings could optimize treatment by reducing shame, aiding assessment, providing novel interventional brain targets and guiding novel pharmacologic and psychotherapeutic interventions. The inclusion of those with lived experience in the design, planning and interpretation of research investigations is another powerful way to improve health outcomes for those with DID.
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Affiliation(s)
- Juliann B Purcell
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Bethany Brand
- Department of Psychology, Towson University, Towson, MD, USA
| | - Heidi A Browne
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | | | - Meghan Shanahan
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | - Zoe A Bair
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Kim A Baranowski
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Vona Davis
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | - Patricia Mangones
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | - Rebecca L Modell
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Cori A Palermo
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Emma C Robertson
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Smith College, Northampton, MA, USA
| | - Matthew A Robinson
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura Ward
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Sherry Winternitz
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Milissa L Kaufman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Boysen GA. Dissociative Identity Disorder: A Review of Research From 2011 to 2021. J Nerv Ment Dis 2024; 212:174-186. [PMID: 38412243 DOI: 10.1097/nmd.0000000000001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Dissociative identity disorder (DID) has historically been one of the most controversial topics in the study of psychopathology. Building on a previous review of empirical research on DID from 2000 to 2010, the present review examined DID research from 2011 to 2021. The research output included 56 case studies and 104 empirical studies. Within the empirical studies, approximately 1354 new cases of DID emerged, which resulted in an average samples of approximately 20. Reanalysis of previous samples was standard in the literature with only 40% of reported cases being new. Studies emerged from dozens of countries across the world, but the majority of cases were from Western counties, especially the United States. Diagnosis primarily relied upon validated measures, but 74% of all new cases came from six research groups. Overall, research on DID is steady but methodologically limited in ways that make generalization, especially about etiology, difficult.
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Affiliation(s)
- Guy A Boysen
- Department of Psychology, McKendree University, Lebanon, Illinois
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10
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Söderberg A, Lindgren BM, Looi GME, Bäckström J, Gabrielsson S. Psychiatric inpatient care for persons with dissociative identity disorder: a scoping review protocol. BMJ Open 2024; 14:e079207. [PMID: 38365290 PMCID: PMC10973692 DOI: 10.1136/bmjopen-2023-079207] [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: 08/25/2023] [Accepted: 02/02/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Psychiatric inpatient care (PIC) is often characterised by high pressure and thresholds for admission, brief periods of care and limited time for caring activities. Dissociative identity disorder (DID) is a contested diagnosis, and persons with DID are at risk of not receiving adequate support when cared for in PIC. Because the limited literature addressing the topic includes no overview on how persons with DID are cared for in psychiatric inpatient settings, the aim of this scoping review is to map the area of knowledge on PIC for persons experiencing DID. This scoping review will provide an overview with the possibility to elucidate gaps in the evidence base and needs for future research on PIC for persons experiencing DID. METHODS AND ANALYSIS This scoping review will follow Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Reviews and steps 1-5 described in the established method for scoping reviews: identifying research question, identifying relevant studies, study selection, charting the data and collating, summarising and reporting results. ETHICS APPROVAL Not applicable. DISSEMINATION This scoping review will be submitted for publication in an international, peer-reviewed journal.
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Affiliation(s)
- Anja Söderberg
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | | | - Git-Marie Ejneborn Looi
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Josefin Bäckström
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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11
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Escamilla I, Juan N, Peñalva C, Sánchez-Llorens M, Renau J, Benito A, Haro G. Treatment of dissociative symptoms with opioid antagonists: a systematic review. Eur J Psychotraumatol 2023; 14:2265184. [PMID: 37860852 PMCID: PMC10591526 DOI: 10.1080/20008066.2023.2265184] [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: 01/12/2023] [Accepted: 08/10/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The clinical guidelines for the treatment of dissociation focus primarily on psychotherapy. However, different psychoactive drugs are used in clinical practice. The use of opioid antagonists has been proposed as a therapeutic option based on the theory that dissociation might be a phenomenon mediated by dysregulation of the endogenous opioid system. OBJECTIVE To review and meta-analyse the available evidence on the efficacy of the opioid antagonists naltrexone, naloxone, and nalmefene as treatments for dissociative symptoms and disorders. METHOD The PRISMA guidelines were followed, and this review was registered in Prospero with reference number CRD42021280976. The search was performed in the PubMed, Scopus, Web of Science, EMBASE, PsycINFO, and PubPsych databases. RESULTS 1,798 citations were obtained. After removing duplicates and applying inclusion and exclusion criteria, we included 5 comparative studies with 9 dissociation measures that had included a total of 154 participants, of whom 134 had been treated with an opioid antagonist. The results of the meta-analysis showed a treatment effect for dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62-2.31)]. However, the studies we included were very heterogeneous [Q = 66.89 (p < .001)] and there may have been publication bias. CONCLUSIONS Although more research is needed and the results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities, opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate - large effect size in reducing these symptoms.
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Affiliation(s)
- Irene Escamilla
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
| | - Nerea Juan
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
| | - Celeste Peñalva
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
| | | | - Jorge Renau
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
| | - Ana Benito
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Torrent Mental Health Unit, Hospital General Universitario Valencia, Valencia, Spain
| | - Gonzalo Haro
- TXP Research Group. Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Dual Disorder Program, Consorcio Hospitalario Provincial Castellón, Castellón de la Plana, Spain
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Bongard J, Levin M. There's Plenty of Room Right Here: Biological Systems as Evolved, Overloaded, Multi-Scale Machines. Biomimetics (Basel) 2023; 8:110. [PMID: 36975340 PMCID: PMC10046700 DOI: 10.3390/biomimetics8010110] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
The applicability of computational models to the biological world is an active topic of debate. We argue that a useful path forward results from abandoning hard boundaries between categories and adopting an observer-dependent, pragmatic view. Such a view dissolves the contingent dichotomies driven by human cognitive biases (e.g., a tendency to oversimplify) and prior technological limitations in favor of a more continuous view, necessitated by the study of evolution, developmental biology, and intelligent machines. Form and function are tightly entwined in nature, and in some cases, in robotics as well. Thus, efforts to re-shape living systems for biomedical or bioengineering purposes require prediction and control of their function at multiple scales. This is challenging for many reasons, one of which is that living systems perform multiple functions in the same place at the same time. We refer to this as "polycomputing"-the ability of the same substrate to simultaneously compute different things, and make those computational results available to different observers. This ability is an important way in which living things are a kind of computer, but not the familiar, linear, deterministic kind; rather, living things are computers in the broad sense of their computational materials, as reported in the rapidly growing physical computing literature. We argue that an observer-centered framework for the computations performed by evolved and designed systems will improve the understanding of mesoscale events, as it has already done at quantum and relativistic scales. To develop our understanding of how life performs polycomputing, and how it can be convinced to alter one or more of those functions, we can first create technologies that polycompute and learn how to alter their functions. Here, we review examples of biological and technological polycomputing, and develop the idea that the overloading of different functions on the same hardware is an important design principle that helps to understand and build both evolved and designed systems. Learning to hack existing polycomputing substrates, as well as to evolve and design new ones, will have massive impacts on regenerative medicine, robotics, and computer engineering.
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Affiliation(s)
- Joshua Bongard
- Department of Computer Science, University of Vermont, Burlington, VT 05405, USA
| | - Michael Levin
- Allen Discovery Center at Tufts University, 200 Boston Ave., Suite 4600, Medford, MA 02155, USA
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13
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Dissoziation: ein transdiagnostisches Phänomen. DIE PSYCHOTHERAPIE 2023. [PMCID: PMC9982778 DOI: 10.1007/s00278-022-00641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Der Begriff der Dissoziation wurde in frühen Anfängen der Neurosenlehre verwendet, hat sich seither gewandelt und ist Ausgangspunkt vieler Kontroversen. Unter Dissoziation wird i. Allg. die Abspaltung sonst integrierter Gedächtnis‑, Bewusstseins‑, Identitäts- und Wahrnehmungsfunktionen (eigene Person und Umwelt) verstanden. Dissoziation ist ein klinisches Kriterium von Belastungsstörungen und der emotional instabilen Persönlichkeitsstörung; dissoziative Symptome haben sind ebenfalls als Phänomene bei anderen Erkrankungen hochrelevant. Differenzialdiagnostisch ist Schizophrenie bedeutsam. Die Unterscheidung zwischen Dissoziation von Detachment- und Kompartmentalisationstyp sowie die Berücksichtigung möglicher Traumatatypen können die Entwicklung von Krankheitsmodellen unterstützen. Die Behandlung basiert auf akkurater Diagnostik, einschließlich Biografie und Beziehungen. Komplexe Dissoziationslagen erfordern eine komplexe Therapie, weil neben der psychischen Integration weitere psychosoziale Bedarfe zu bedienen sind.
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Sauer KS, Wendler-Bödicker C, Boos A, Niemeyer H, Palmer S, Rojas R, Hoyer J, Hitzler M. Treatment of Comorbid Disorders, Syndromes, and Symptoms of Posttraumatic Stress Disorder Related to Childhood Maltreatment with STAIR-NT. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2023. [DOI: 10.1026/1616-3443/a000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract. Background: Early interpersonal traumatic events, such as childhood maltreatment, increase the risk of developing complex posttraumatic stress symptoms. The biphasic treatment program STAIR-NT (Skills Training for Affective and Interpersonal Regulation with Narrative Therapy), developed specifically for this patient group, combines interventions to improve emotion regulation and interpersonal skills with narrative therapy. Objective: Many affected patients with PTSD after childhood maltreatment also suffer from various comorbid mental disorders and symptoms that can affect and impede the course and outcome of treatment with STAIR-NT. Method: Based on experience from a current treatment study, we provide recommendations for integrating treatment of comorbid mental symptoms into STAIR-NT. Results / Conclusion: Training affective and interpersonal regulation skills in the first treatment phase offers various interventions to efficiently adapt transdiagnostic mechanisms such as emotion dysregulation. In cases of severe comorbid mental disorders or symptoms, adding disorder-specific interventions to STAIR-NT may be indicated.
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Affiliation(s)
- Karoline Sophie Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Germany
| | | | - Anne Boos
- Psychotherapy Practice in Großhartau, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sebastian Palmer
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Gießen, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
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15
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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: 13] [Impact Index Per Article: 13.0] [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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16
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Marais L, Bezuidenhout M, Krüger C. How do Patients Diagnosed with Dissociative Identity Disorder Experience Conflict? A Qualitative Study. J Trauma Dissociation 2023; 24:125-140. [PMID: 36062716 DOI: 10.1080/15299732.2022.2119630] [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] [Indexed: 12/27/2022]
Abstract
The role and nature of conflict in the development and manifestation of dissociative identity disorder (DID) remains underexplored beyond theoretical deduction. In this qualitative instrumental case study, we explored the subjective experience and nature of conflict in a group of adult psychiatric patients diagnosed with DID. We purposively selected typed transcriptions of 28 previously recorded in-depth individual interviews with 15 patients, their audio recordings and associated field notes. The data were thematically analyzed and constant comparison was applied. Two main themes emerged from the transcriptions, namely, participants' experiences of having one or more incompatible and conflicting worldviews about their DID, and the type and nature of conflict that arises between dissociative identities, i.e., conflict of information in awareness, conflicting actions or behaviors, conflicting emotions, conflicting goals, conflicting values, and a battle of wills. Patients with DID have contextually and culturally variable comprehension of the origin of their DID. Conflict between dissociative identities was pervasive, multifaceted, and exacerbated by a lack of awareness between identities. The study provides insight into the complexities of conflict between dissociative identities, as well as highlights the role of inter-identity awareness in conflict.
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Affiliation(s)
- Lizanda Marais
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
| | | | - Christa Krüger
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
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17
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Childhood trauma in patients with Dissociative Identity Disorder: A systematic Review of Data from 1990 to 2022. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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18
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Kearney BE, Lanius RA. The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Front Neurosci 2022; 16:1015749. [PMID: 36478879 PMCID: PMC9720153 DOI: 10.3389/fnins.2022.1015749] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/14/2022] [Indexed: 08/16/2023] Open
Abstract
Although the manifestation of trauma in the body is a phenomenon well-endorsed by clinicians and traumatized individuals, the neurobiological underpinnings of this manifestation remain unclear. The notion of somatic sensory processing, which encompasses vestibular and somatosensory processing and relates to the sensory systems concerned with how the physical body exists in and relates to physical space, is introduced as a major contributor to overall regulatory, social-emotional, and self-referential functioning. From a phylogenetically and ontogenetically informed perspective, trauma-related symptomology is conceptualized to be grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities. Lastly, we introduce a novel hierarchical model bridging somatic sensory processes with limbic and neocortical mechanisms regulating an individual's emotional experience and sense of a relational, agentive self. This model provides a working framework for the neurobiologically informed assessment and treatment of trauma-related conditions from a somatic sensory processing perspective.
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Affiliation(s)
- Breanne E. Kearney
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ruth A. Lanius
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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19
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Stubley J. Working with Trauma and Dissociation in the
NHS. BRITISH JOURNAL OF PSYCHOTHERAPY 2022. [DOI: 10.1111/bjp.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Pan X, Palermo CA, Kaplan CS, Harnett NG, Winternitz SR, Kaufman ML, Lebois LAM. Anxiety sensitivity predicts depression severity in individuals with dissociative identity disorder. J Psychiatr Res 2022; 155:263-268. [PMID: 36126396 PMCID: PMC9588735 DOI: 10.1016/j.jpsychires.2022.09.003] [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: 05/02/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Anxiety sensitivity involves the fear of anxiety-related symptoms and can exacerbate both major depressive disorder and posttraumatic stress disorder (PTSD) symptoms. However, it is unclear if anxiety sensitivity plays a similar role in dissociative identity disorder (DID) where symptoms of depression and PTSD commonly co-occur. We examined the association between anxiety sensitivity, depression, PTSD and dissociative symptoms in DID, hypothesizing a positive association between all symptoms and anxiety sensitivity. METHOD Participants were 21 treatment-seeking adult females with histories of childhood trauma, current PTSD, and DID. Participants completed the Anxiety Sensitivity Index (ASI), Beck Depression Inventory-II, Childhood Trauma Questionnaire, Multidimensional Inventory of Dissociation, and PTSD Checklist for DSM-5. The ASI included subscales that assessed anxiety sensitivity in cognitive, physical, and social domains. RESULTS Participants reported high levels of anxiety sensitivity. A multiple regression analysis demonstrated that the ASI cognitive subscale was the strongest predictor of depressive symptoms. No direct associations were identified between anxiety sensitivity and PTSD or dissociative symptoms. We conducted a mediation analysis to test an indirect relationship between cognitive anxiety sensitivity and dissociative symptoms, and found a significant indirect effect through depressive symptoms. CONCLUSIONS Our results suggest that cognitive anxiety sensitivity or the fear of cognitive dyscontrol is linked with symptom severity in DID. These findings emphasize the need to assess for and utilize interventions that target anxiety sensitivity, which may in turn alleviate symptoms of depression and dissociation in DID.
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Affiliation(s)
- Xi Pan
- McLean Hospital, Belmont, MA, USA
| | | | | | - Nathaniel G Harnett
- McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sherry R Winternitz
- McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Milissa L Kaufman
- McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauren A M Lebois
- McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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21
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Schlesselmann AJ, Huntjens RJC, Renard SB, McNally RJ, Albers CJ, De Vries VE, Pijnenborg GHM. A Network Approach to Trauma, Dissociative Symptoms, and Psychosis Symptoms in Schizophrenia Spectrum Disorders. Schizophr Bull 2022; 49:559-568. [PMID: 36124634 PMCID: PMC10154708 DOI: 10.1093/schbul/sbac122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Dissociative experiences commonly occur in schizophrenia spectrum disorders (SSD). Yet little is known about how dissociative experiences in SSD are related to SSD symptoms. Accordingly, we investigated the relations between dissociative experiences and SSD symptoms, focusing on symptoms bridging these 2 symptom clusters as well as their relation to reported trauma history. STUDY DESIGN Network analyses were conducted on the responses of 248 individuals with an SSD who enrolled from multiple mental health centers in The Netherlands. Dissociative experiences were assessed via the Dissociative Experience Scale, SSD symptoms using the Positive and Negative Syndrome Scale, and trauma history through the Trauma History Questionnaire. STUDY RESULTS The results indicated that dissociative symptoms in SSD are mostly independent of other symptoms, but that emotional distress bridges between the dissociative and SSD symptom clusters. Furthermore, results revealed associations between positive and negative SSD symptoms and trauma through emotional distress, whereas dissociative symptoms remained relatively isolated. CONCLUSION Because SSD symptoms and dissociative experiences clustered relatively independent from each other, our findings promote the idea of tailored treatment approaches for individuals with an SSD with frequent dissociative experiences, specifically targeting these symptoms.
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Affiliation(s)
- Ante J Schlesselmann
- Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Rafaele J C Huntjens
- Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Selwyn B Renard
- Department of Forensic Psychiatry, GGZ Friesland, Leeuwarden, The Netherlands
| | | | - Casper J Albers
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Vera E De Vries
- Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.,Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands
| | - G H Marieke Pijnenborg
- Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.,Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands
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22
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Lee SH, Kang NR, Moon DS. Dissociative Identity Disorder in an Adolescent With Nine Alternate Personality Traits: A Case Study. Soa Chongsonyon Chongsin Uihak 2022; 33:73-81. [PMID: 35832863 PMCID: PMC9242847 DOI: 10.5765/jkacap.220005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Since dissociative identity disorder (DID) has symptoms similar to schizophrenia, such as auditory hallucinations and delusional thoughts of being controlled, there are difficulties in its differential diagnosis. A 16-year-old adolescent male patient who was previously diagnosed with schizophrenia from a different hospital was admitted to our inpatient psychiatric unit for the evaluation of auditory hallucinations and suicide attempts. Through psychiatric evaluations, it was determined that the patient suffered from identity alternation, dissociation, and amnesia. As for the diagnostic evaluations, the following measures were implemented: a psychiatric interview regarding the diagnostic criteria, mental status examination, laboratory tests, brain imaging studies, electroencephalography, and full psychological test for adolescents, and the self-reported measure of the Adolescent Dissociative Experiences Scale. The patient was diagnosed with DID, and the following treatments were administered: pharmacotherapy, ego state therapy, psychoeducation regarding emotions, trauma-focused psychotherapy including stabilization, and family therapy. Following treatment, in the internal dimensions, the patient was able to recognize the nine alternate identities in charge of his emotions, which established a basis for the potential integration of identities. In the external dimensions, he showed improvements in the aspects of family conflicts and issue of school refusal. This is the first reported case of DID in an adolescent in Korea; it emphasizes the consideration of DID in the differential diagnosis of other mental illnesses such as schizophrenia, bipolar disorder, and posttraumatic stress disorder and expands the treatment opportunities for DID by sharing the procedures of ego state therapy.
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Affiliation(s)
- Sang-Hun Lee
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
| | - Na Ri Kang
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
- Department of Psychiatry, Jeju National University College of Medicine, Jeju, Korea
| | - Duk-Soo Moon
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
- Department of Psychiatry, Jeju National University College of Medicine, Jeju, Korea
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23
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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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24
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Krause-Utz A. Dissociation, trauma, and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:14. [PMID: 35440020 PMCID: PMC9020027 DOI: 10.1186/s40479-022-00184-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Dissociation is a complex phenomenon, which occurs in various clinical conditions, including dissociative disorders, (complex) post-traumatic stress disorder (CPTSD, PTSD), and borderline personality disorder (BPD). Traumatic stress is considered an important risk factor, while the etiology of dissociation is still debated. Next to traumatic experiences, temperamental and neurobiological vulnerabilities seem to contribute to the development of dissociation. Stress-related dissociation is a prevalent symptom of BPD, which may interfere with psychosocial functioning and treatment outcome. More research in the field is strongly needed to improve the understanding and management of this complex phenomenon. This article collection brings together research on dissociation and trauma, with a special focus on BPD or sub-clinical expressions of BPD. In this editorial, recent conceptualizations of dissociation and relevant previous research are introduced in order to provide a framework for this novel research.
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Affiliation(s)
- Annegret Krause-Utz
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands. .,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
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25
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Levin M. Technological Approach to Mind Everywhere: An Experimentally-Grounded Framework for Understanding Diverse Bodies and Minds. Front Syst Neurosci 2022; 16:768201. [PMID: 35401131 PMCID: PMC8988303 DOI: 10.3389/fnsys.2022.768201] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/24/2022] [Indexed: 12/11/2022] Open
Abstract
Synthetic biology and bioengineering provide the opportunity to create novel embodied cognitive systems (otherwise known as minds) in a very wide variety of chimeric architectures combining evolved and designed material and software. These advances are disrupting familiar concepts in the philosophy of mind, and require new ways of thinking about and comparing truly diverse intelligences, whose composition and origin are not like any of the available natural model species. In this Perspective, I introduce TAME-Technological Approach to Mind Everywhere-a framework for understanding and manipulating cognition in unconventional substrates. TAME formalizes a non-binary (continuous), empirically-based approach to strongly embodied agency. TAME provides a natural way to think about animal sentience as an instance of collective intelligence of cell groups, arising from dynamics that manifest in similar ways in numerous other substrates. When applied to regenerating/developmental systems, TAME suggests a perspective on morphogenesis as an example of basal cognition. The deep symmetry between problem-solving in anatomical, physiological, transcriptional, and 3D (traditional behavioral) spaces drives specific hypotheses by which cognitive capacities can increase during evolution. An important medium exploited by evolution for joining active subunits into greater agents is developmental bioelectricity, implemented by pre-neural use of ion channels and gap junctions to scale up cell-level feedback loops into anatomical homeostasis. This architecture of multi-scale competency of biological systems has important implications for plasticity of bodies and minds, greatly potentiating evolvability. Considering classical and recent data from the perspectives of computational science, evolutionary biology, and basal cognition, reveals a rich research program with many implications for cognitive science, evolutionary biology, regenerative medicine, and artificial intelligence.
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Affiliation(s)
- Michael Levin
- Allen Discovery Center at Tufts University, Medford, MA, United States
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Cambridge, MA, United States
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26
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Chefetz RA. The Quest to Understand and Resolve Persistent Dissociative Processes: A Discussion of Levy and Shalgi, “Imagination and Fantasy: The Dialectic Nature of the Encounter with Trauma and Dissociation”. PSYCHOANALYTIC DIALOGUES 2022. [DOI: 10.1080/10481885.2021.2013686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Richard A. Chefetz
- Private Practice, Institute of Contemporary Psychotherapy and Psychoanalysis, Washington, District of Columbia, USA
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27
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Nester MS, Schielke HJ, Brand BL, Loewenstein RJ. Dissociative Identity Disorder: Diagnostic Accuracy and DSM-5 Criteria Change Implications. J Trauma Dissociation 2021; 23:1-13. [PMID: 34661505 DOI: 10.1080/15299732.2021.1989123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) revised the diagnostic criteria for dissociative identity disorder (DID) to more accurately reflect the symptom profile of DID patients. No study has examined how this change affects clinical diagnosis of DID. The present study examined clinician reports of patient symptoms in relation to DSM-IV-TR and DSM-5 DID diagnostic criteria. Data were analyzed from 169 clinicians who participated in the Treatment of Patients with Dissociative Disorders Network Study with a patient they assigned a DID diagnosis. Clinicians evaluated their patients with respect to DSM-IV-TR and DSM-5 DID diagnostic criteria. Researchers determined a clinician-assigned DID diagnosis as "accurate" when the patient's reported dissociative symptoms matched DSM-IV-TR and/or DSM-5 criteria for DID. Most of the clinicians (95.27%) accurately diagnosed DID. Of those accurately diagnosed, 83.85% of patients met DSM-IV-TR and DSM-5 DID criteria, 9.94% only met DSM-IV-TR DID criteria, and 6.21% only met DSM-5 DID criteria. Further examination of responses suggested that possible idiomatic responses to the negative wording of the DSM-5 exclusionary criteria might have accounted for the DSM-IV-TR appearing to fit for a greater number of cases in this study. Changes in the DSM criteria for DID did not substantially change the frequency or accuracy of assigned DID diagnoses, but the removal of the requirement in DSM-5 that self-states regularly take control of an individual's behavior slightly increased the number of individuals meeting criteria for DID.
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Affiliation(s)
- M Shae Nester
- Department of Psychology, Towson University, Towson, Maryland, USA
| | - Hugo J Schielke
- Traumatic Stress Injury & Concurrent Program, Homewood Health Centre, Guelph, Ontario, Canada
| | - Bethany L Brand
- Department of Psychology, Towson University, Towson, Maryland, USA
| | - Richard J Loewenstein
- Department of Psychiatry, University of Maryland School of Medicine, and Private Practice, Baltimore, Marylad, USA
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28
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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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Krause-Utz A, Frost R, Chatzaki E, Winter D, Schmahl C, Elzinga BM. Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment. Curr Psychiatry Rep 2021; 23:37. [PMID: 33909198 PMCID: PMC8081699 DOI: 10.1007/s11920-021-01246-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD. RECENT FINDINGS Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands.
| | - Rachel Frost
- Department of Psychology, King's College London, Institute of Psychiatry Psychology & Neuroscience, London, UK
| | - Elianne Chatzaki
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Dorina Winter
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bernet M Elzinga
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
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Abstract
SUMMARYDissociation is a common and often overlooked symptom in traumatised children. Although there is a lack of a scientific consensus as to the nature of dissociation and very limited research about dissociative identity disorder (DID) in children, the authors have seen children given this diagnosis recently referred to their clinic and are concerned about this practice and the parenting approaches that have ensued. The diagnosis of DID in children may be rare or of doubtful validity, but repeated traumatic experiences of an interpersonal nature can have a profound effect on a child's identity, memory and self-organisation. Furthermore, abuse and neglect can increase the risk of dissociative symptoms. This brief article considers dissociation in post-traumatic stress disorder, then outlines developmental factors hypothesised to be associated with dissociation in childhood and early adulthood. It warns that clinicians should keep an open mind about how dissociation may manifest transdiagnostically, and concludes with recommendations for further research.
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Blunden N, Billie. ‘And we are a human being’: Coproduced reflections on person‐centred psychotherapy in plural and dissociative identity. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2021. [DOI: 10.1002/ppi.1578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicola Blunden
- Director of Studies, Person‐Centered Experiential and Pluralistic Counselling Metanoia Institute London UK
| | - Billie
- University of South Wales Pontypridd UK
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Marsh RJ, Dorahy MJ, Butler C, Middleton W, de Jong PJ, Kemp S, Huntjens R. Inter-identity amnesia for neutral episodic self-referential and autobiographical memory in Dissociative Identity Disorder: An assessment of recall and recognition. PLoS One 2021; 16:e0245849. [PMID: 33577556 PMCID: PMC7880432 DOI: 10.1371/journal.pone.0245849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/09/2021] [Indexed: 11/18/2022] Open
Abstract
Amnesia is a core diagnostic criterion for Dissociative Identity Disorder (DID), however previous research has indicated memory transfer. As DID has been conceptualised as being a disorder of distinct identities, in this experiment, behavioral tasks were used to assess the nature of amnesia for episodic 1) self-referential and 2) autobiographical memories across identities. Nineteen DID participants, 16 DID simulators, 21 partial information, and 20 full information comparison participants from the general population were recruited. In the first study, participants were presented with two vignettes (DID and simulator participants received one in each of two identities) and asked to imagine themselves in the situations outlined. The second study used a similar methodology but with tasks assessing autobiographical experience. Subjectively, all DID participants reported amnesia for events that occurred in the other identity. On free recall and recognition tasks they presented a memory profile of amnesia similar to simulators instructed to feign amnesia and partial information comparisons. Yet, on tests of recognition, DID participants recognized significantly more of the event that occurred in another identity than simulator and partial information comparisons. As such, results indicate that the DID performance profile was not accounted for by true or feigned amnesia, lending support to the idea that reported amnesia may be more of a perceived than actual memory impairment.
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Affiliation(s)
- Rosemary J. Marsh
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
| | - Martin J. Dorahy
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
- The Cannan Institute, Belmont Private Hospital, Brisbane, Australia
- * E-mail:
| | - Chandele Butler
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
| | - Warwick Middleton
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
- The Cannan Institute, Belmont Private Hospital, Brisbane, Australia
| | - Peter J. de Jong
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
| | - Simon Kemp
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
| | - Rafaele Huntjens
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
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Merker JB, Hill SB, Wolff J, Winternitz SR, Ressler KJ, Kaufman ML, Lebois LAM. Posttraumatic cognitions predict distorted body perceptions in women with dissociative identity disorder. J Psychiatr Res 2021; 134:166-172. [PMID: 33388699 PMCID: PMC7870557 DOI: 10.1016/j.jpsychires.2020.12.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/13/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dissociative identity disorder (DID) is a psychobiological syndrome associated with a history of exposure to childhood abuse and neglect. The consequences of these traumatic events often include a profound impact on the way individuals inhabit and experience their bodies. Despite this, there is a paucity of empirical research on the subject. The aim of this study was to systematically document the occurrence of distorted body perceptions in DID and examine childhood maltreatment, posttraumatic stress disorder (PTSD) symptom severity, and posttraumatic cognitions as predictors of distorted body perceptions in DID. METHODS Participants were adult women with histories of childhood abuse and neglect and a current DID diagnosis receiving treatment at a psychiatric care facility. Data were obtained through a battery of self-report measures, including the Body Uneasiness Test, Childhood Trauma Questionnaire, PTSD Checklist for DMS-5, and Posttraumatic Cognitions Inventory. RESULTS A series of unpaired t-tests documented elevated levels of weight phobia, body image concerns, body avoidance, compulsive self-monitoring, and depersonalization in DID compared to published non-clinical data on the Body Uneasiness Test. A series of multiple regression models including measures of childhood trauma, PTSD symptoms, and posttraumatic cognitions demonstrated that over and above childhood trauma and PTSD symptom severity, posttraumatic cognitions significantly predicted distorted body perceptions. CONCLUSIONS In a treatment-seeking sample of women with DID, distorted body perceptions were elevated. Furthermore, posttraumatic cognitive distortions significantly predicted distorted body perceptions when controlling for childhood maltreatment and PTSD symptom severity. This suggests that distorted cognitions are a key target for therapeutic intervention.
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Affiliation(s)
| | - Sarah B. Hill
- McLean Hospital, Belmont, MA, USA,Department of Psychology, Northern Illinois University
| | - Jonathan Wolff
- McLean Hospital, Belmont, MA, USA,Lynch School of Education and Development, Boston College
| | - Sherry R. Winternitz
- McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kerry J. Ressler
- McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Milissa L. Kaufman
- McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauren A. M. Lebois
- McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Roydeva MI, Reinders AATS. Biomarkers of Pathological Dissociation: A Systematic Review. Neurosci Biobehav Rev 2020; 123:120-202. [PMID: 33271160 DOI: 10.1016/j.neubiorev.2020.11.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/20/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a transdiagnostic manner to recommend the most promising research and treatment pathways in support of the precision medicine framework. A total of 205 unique studies that met inclusion criteria were included. Studies were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. The dorsomedial and dorsolateral prefrontal cortex, bilateral superior frontal regions, (anterior) cingulate, posterior association areas and basal ganglia are identified as neurofunctional biomarkers of pathological dissociation and decreased hippocampal, basal ganglia and thalamic volumes as neurostructural biomarkers. Increased oxytocin and prolactin and decreased tumor necrosis factor alpha (TNF-α) are identified as psychobiological markers. Psychophysiological biomarkers, including blood pressure, heart rate and skin conductance, were inconclusive. For the genetic biomarker category studies related to dissociation were limited and no clear directionality of effect was found to warrant identification of a genetic biomarker. Recommendations for future research pathways and possible clinical applicability are provided.
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Affiliation(s)
- Monika I Roydeva
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
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Ganslev CA, Storebø OJ, Callesen HE, Ruddy R, Søgaard U. Psychosocial interventions for conversion and dissociative disorders in adults. Cochrane Database Syst Rev 2020; 7:CD005331. [PMID: 32681745 PMCID: PMC7388313 DOI: 10.1002/14651858.cd005331.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms or changes in awareness or identity. However, symptoms and clinical signs cannot be explained by a neurological disease or other medical condition. Instead, a psychological stressor or trauma is often present. The symptoms are real and can cause significant distress or problems with functioning in everyday life for the people experiencing them. OBJECTIVES To assess the beneficial and harmful effects of psychosocial interventions of conversion and dissociative disorders in adults. SEARCH METHODS We conducted database searches between 16 July and 16 August 2019. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and eight other databases, together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: We included all randomised controlled trials that compared psychosocial interventions for conversion and dissociative disorders with standard care, wait list or other interventions (pharmaceutical, somatic or psychosocial). DATA COLLECTION AND ANALYSIS: We selected, quality assessed and extracted data from the identified studies. Two review authors independently performed all tasks. We used standard Cochrane methodology. For continuous data, we calculated mean differences (MD) and standardised mean differences (SMD) with 95% confidence interval (CI). For dichotomous outcomes, we calculated risk ratio (RR) with 95% CI. We assessed and downgraded the evidence according to the GRADE system for risk of bias, imprecision, indirectness, inconsistency and publication bias. MAIN RESULTS We included 17 studies (16 with parallel-group designs and one with a cross-over design), with 894 participants aged 18 to 80 years (female:male ratio 3:1). The data were separated into 12 comparisons based on the different interventions and comparators. Studies were pooled into the same comparison when identical interventions and comparisons were evaluated. The certainty of the evidence was downgraded as a consequence of potential risk of bias, as many of the studies had unclear or inadequate allocation concealment. Further downgrading was performed due to imprecision, few participants and inconsistency. There were 12 comparisons for the primary outcome of reduction in physical signs. Inpatient paradoxical intention therapy compared with outpatient diazepam: inpatient paradoxical intention therapy did not reduce conversive symptoms compared with outpatient diazepam at the end of treatment (RR 1.44, 95% CI 0.91 to 2.28; 1 study, 30 participants; P = 0.12; very low-quality evidence). Inpatient treatment programme plus hypnosis compared with inpatient treatment programme: inpatient treatment programme plus hypnosis did not reduce severity of impairment compared with inpatient treatment programme at the end of treatment (MD -0.49 (negative value better), 95% CI -1.28 to 0.30; 1 study, 45 participants; P = 0.23; very low-quality evidence). Outpatient hypnosis compared with wait list: outpatient hypnosis might reduce severity of impairment compared with wait list at the end of treatment (MD 2.10 (higher value better), 95% CI 1.34 to 2.86; 1 study, 49 participants; P < 0.00001; low-quality evidence). Behavioural therapy plus routine clinical care compared with routine clinical care: behavioural therapy plus routine clinical care might reduce the number of weekly seizures compared with routine clinical care alone at the end of treatment (MD -21.40 (negative value better), 95% CI -27.88 to -14.92; 1 study, 18 participants; P < 0.00001; very low-quality evidence). Cognitive behavioural therapy (CBT) compared with standard medical care: CBT did not reduce monthly seizure frequency compared to standard medical care at end of treatment (RR 1.56, 95% CI 0.39 to 6.19; 1 study, 16 participants; P = 0.53; very low-quality evidence). CBT did not reduce physical signs compared to standard medical care at the end of treatment (MD -4.75 (negative value better), 95% CI -18.73 to 9.23; 1 study, 61 participants; P = 0.51; low-quality evidence). CBT did not reduce seizure freedom compared to standard medical care at end of treatment (RR 2.33, 95% CI 0.30 to 17.88; 1 trial, 16 participants; P = 0.41; very low-quality evidence). Psychoeducational follow-up programmes compared with treatment as usual (TAU): no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy inpatient programme compared with wait list: no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy outpatient intervention compared with TAU: no study measured reduction in physical signs at end of treatment. Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) compared with standard care: brief psychotherapeutic interventions did not reduce conversion symptoms compared to standard care at end of treatment (RR 0.12, 95% CI 0.01 to 2.00; 1 study, 19 participants; P = 0.14; very low-quality evidence). CBT plus adjunctive physical activity (APA) compared with CBT alone: CBT plus APA did not reduce overall physical impacts compared to CBT alone at end of treatment (MD 5.60 (negative value better), 95% CI -15.48 to 26.68; 1 study, 21 participants; P = 0.60; very low-quality evidence). Hypnosis compared to diazepam: hypnosis did not reduce symptoms compared to diazepam at end of treatment (RR 0.69, 95% CI 0.39 to 1.24; 1 study, 40 participants; P = 0.22; very low-quality evidence). Outpatient motivational interviewing (MI) and mindfulness-based psychotherapy compared with psychotherapy alone: psychotherapy preceded by MI might decrease seizure frequency compared with psychotherapy alone at end of treatment (MD 41.40 (negative value better), 95% CI 4.92 to 77.88; 1 study, 54 participants; P = 0.03; very low-quality evidence). The effect on the secondary outcomes was reported in 16/17 studies. None of the studies reported results on adverse effects. In the studies reporting on level of functioning and quality of life at end of treatment the effects ranged from small to no effect. AUTHORS' CONCLUSIONS The results of the meta-analysis and reporting of single studies suggest there is lack of evidence regarding the effects of any psychosocial intervention on conversion and dissociative disorders in adults. It is not possible to draw any conclusions about potential benefits or harms from the included studies.
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Affiliation(s)
- Christina A Ganslev
- Clinic of Liaison Psychiatry, Region Zealand, Denmark
- Psychiatric Research Unit, Psychiatry of Region Zealand, Slagelse, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatry of Region Zealand, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | - Ulf Søgaard
- Clinic of Liaison Psychiatry, Region Zealand, Denmark
- Psychiatric Research Unit, Psychiatry of Region Zealand, Slagelse, Denmark
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Loewenstein RJ. Firebug! Dissociative Identity Disorder? Malingering? Or …? An Intensive Case Study of an Arsonist. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractCourts struggle with questions of how to assess competency to stand trial (CTS) and not guilty by reason of insanity (NGRI) in dissociative identity disorder (DID). Concerns about CTS include dissociative amnesia and unpredictable switching behaviors that could cause inconsistent information transfer across self states, with the defendant unable to access important legal information about his/her defense and to collaborate with his/her attorney; DID defendants could not conform their conduct to the law or know right from wrong due to dissociative amnesia, the seemingly independent actions of self states, and the disruption of reality testing by switching. The author presents the case of a woman charged with both a witnessed and an unwitnessed burglary and arson, the latter at the home of her former therapist. The author was the fourth forensic evaluator in the case. Disagreements included whether the defendant met diagnostic criteria for DID or was malingering, and whether she was CTS and/or NGRI. In clinical work with DID, “the whole human being” is held responsible for all behavior, despite reported amnesia or lack of subjective agency. The Discrete Behavioral States (DBS) model of DID avoids reification of the DID self states and their conflation as separate “people.” This model supports evaluating the defendant at the level of specific self states, the self-state system, and that of the whole human being. The author concluded that the defendant met diagnostic criteria for DID and also was malingering its severity. She was competent to stand trial and legally sane.
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Lebois LAM, Palermo CA, Scheuer LS, Lebois EP, Winternitz SR, Germine L, Kaufman ML. Higher integration scores are associated with facial emotion perception differences in dissociative identity disorder. J Psychiatr Res 2020; 123:164-170. [PMID: 32070885 PMCID: PMC7057292 DOI: 10.1016/j.jpsychires.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recovery from dissociative identity disorder (DID) is associated with the process of integration, which includes an increasing sense of self-cohesion and ownership over one's own emotions. Emotion perception is a construction based on interplay between stored knowledge (past experience), and incoming sensory inputs, suggesting changes in emotion perception might occur at different levels of integration - but this remains unexplored. Therefore, we examined the association between integration, psychiatric symptoms, and facial emotion perception. We hypothesized higher integration would be associated with fewer psychiatric symptoms, and differences in the perception of emotions. METHODS Participants were 82 respondents to a cross-sectional web-based study. All participants met self-report cutoff scores for posttraumatic stress disorder (PTSD) and DID using the PTSD Checklist for DSM-5 and Multiscale Dissociation Inventory, respectively. Participants completed a psychometrically-matched test of facial emotion perception for anger, fear, and happiness called the Belmont Emotion Sensitivity Test. Participants also completed the Beck Depression Inventory II, Childhood Trauma Questionnaire, and Integration Measure, a validated measure of self-cohesion. RESULTS Higher integration scores were associated with lower depression, PTSD, and autobiographical memory disturbance scores. Repeated-measures ANCOVA confirmed integration significantly interacted with emotion category on the facial emotion perception task. Specifically, higher integration scores were associated with greater accuracy to fearful and angry faces. CONCLUSIONS While acknowledging the limitations of a cross-sectional design, our results suggest that the process of integration is associated with fewer psychiatric symptoms, and more accurate facial emotion perception. This supports treatment guidelines regarding integration as a therapeutic goal for DID.
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Affiliation(s)
- Lauren A M Lebois
- McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | | | | | - Evan P Lebois
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA, 02142, USA
| | - Sherry R Winternitz
- McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Laura Germine
- McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Milissa L Kaufman
- McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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Shinn AK, Wolff JD, Hwang M, Lebois LAM, Robinson MA, Winternitz SR, Öngür D, Ressler KJ, Kaufman ML. Assessing Voice Hearing in Trauma Spectrum Disorders: A Comparison of Two Measures and a Review of the Literature. Front Psychiatry 2020; 10:1011. [PMID: 32153431 PMCID: PMC7050446 DOI: 10.3389/fpsyt.2019.01011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
Voice hearing (VH) can occur in trauma spectrum disorders (TSD) such as posttraumatic stress disorder (PTSD) and dissociative disorders. However, previous estimates of VH among individuals with TSD vary widely. In this study, we sought to better characterize the rate and phenomenology of VH in a sample of 70 women with TSD related to childhood abuse who were receiving care in a specialized trauma program. We compared the rate of VH within our sample using two different measures: 1) the auditory hallucination (AH) item in the Structured Clinical Interview for DSM-IV-TR (SCID), and 2) the thirteen questions involving VH in the Multidimensional Inventory of Dissociation (MID), a self-report questionnaire that comprehensively assesses pathological dissociation. We found that 45.7% of our sample met threshold for SCID AH, while 91.4% met criteria for MID VH. Receiver operating characteristics (ROC) analyses showed that while SCID AH and MID VH items have greater than chance agreement, the strength of agreement is only moderate, suggesting that SCID and MID VH items measure related but not identical constructs. Thirty-two patients met criteria for both SCID AH and at least one MID VH item ("unequivocal VH"), 32 for at least one MID VH item but not SCID AH ("ambiguous VH"), and 6 met criteria for neither ("unequivocal non-VH"). Relative to the ambiguous VH group, the unequivocal VH group had higher dissociation scores for child voices, and higher mean frequencies for child voices and Schneiderian voices. Our findings suggest that VH in women with TSD related to childhood abuse is common, but that the rate of VH depends on how the question is asked. We review prior studies examining AH and/or VH in TSD, focusing on the measures used to ascertain these experiences, and conclude that our two estimates are consistent with previous studies that used comparable instruments and patient samples. Our results add to growing evidence that VH-an experience typically considered psychotic or psychotic-like-is not equivalent to having a psychotic disorder. Instruments that assess VH apart from psychotic disorders and that capture their multidimensional nature may improve identification of VH, especially among patients with non-psychotic disorders.
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Affiliation(s)
- Ann K. Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jonathan D. Wolff
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
| | - Melissa Hwang
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | - Lauren A. M. Lebois
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
- Neurobiology of Fear Laboratory, McLean Hospital, Belmont, MA, United States
| | - Mathew A. Robinson
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
| | - Sherry R. Winternitz
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Neurobiology of Fear Laboratory, McLean Hospital, Belmont, MA, United States
| | - Milissa L. Kaufman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
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Smith GP, Hartelius G. Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention. MILITARY PSYCHOLOGY 2020; 32:135-148. [PMID: 38536266 PMCID: PMC10013259 DOI: 10.1080/08995605.2019.1654292] [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: 11/06/2018] [Accepted: 08/07/2019] [Indexed: 10/25/2022]
Abstract
A novel understanding and therapeutic approach to the treatment of PTSD-related flashback triggers are described. Triggered responses are conceptualized as the result of latent dissociative structures of neural organization and psychodynamic functioning activated by current events. The dissociative structure - here described as a dissociated ego state (DES) - reflects a fracturing of executive functioning resulting in a delimited aspect of self that is not under cognitive control or subject to cognitive inhibition by the self of daily experience, and is the psychological construct behind intrusive PTSD symptoms. Use of a mindful attentional state permits regulated access to the DES (therapeutic engagement without risk of emotional dysregulation) so that dissociated cognitive resources can be recovered and the dissociated structure deactivated. This may relieve maladaptive responses and behaviors associated with the DES in a profound and durable way, without the need for exposure to or recovery of traumatic memories. Based on this understanding, a 9-step intervention is introduced with a case example of a Vietnam veteran suffering PTSD symptoms for 49 years with significant gains maintained at 21 months follow up. These findings demonstrate rapid and durable resolution of chronic PTSD symptoms through a mindfulness-based approach that focused on deactivation of dissociated ego states, in contrast to targeting trauma memories. If proven efficacious, this novel approach may result in reduced treatment costs and improved outcomes for veterans suffering with PTSD.
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Affiliation(s)
- Genine P. Smith
- Department of Integral and Transpersonal Psychology, California Institute of Integral Studies, San Francisco, California, USA
| | - Glenn Hartelius
- Department of Integral and Transpersonal Psychology, California Institute of Integral Studies, San Francisco, California, USA
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Kate MA, Hopwood T, Jamieson G. The prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies. J Trauma Dissociation 2020; 21:16-61. [PMID: 31461395 DOI: 10.1080/15299732.2019.1647915] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This meta-analysis of 31,905 college students includes 12 studies diagnosing Dissociative Disorders (DD) and 92 studies measuring dissociation with the Dissociative Experiences Scale (DES). Prevalence rates were used to separately test the plausibility of the Trauma Model (TM) and the Fantasy Model (FM) of dissociation. Results show 11.4% of students sampled meet criteria for DD, which is consistent with the prevalence of experiencing multiple (types of) trauma during childhood (12%), but is not consistent with the very low prevalence expected from the role of fantasy-proneness proposed in the FM. DES scores varied significantly across the 16 countries and were not higher in North America, but in countries that were comparatively unsafe. The least well-known DD was the most common, which is inconsistent with the FM which holds that the diagnosed person is enacting a familiar social role. There was no evidence that DES scores had decreased over recent decades, which does not support FM assertions that DD were a fad of the 1990s. Three of the five hypotheses tested provided clear support for the TM and a fourth hypothesis provided partial support for the TM. None of the five hypotheses tested supported the FM. The finding that DD were slightly more common in college populations than the general population did not support predictions of either model. The theoretical perspective of the authors moderated DES scores, although this is unlikely due to experimenter bias as studies led by FM theorists had significantly higher DES scores than those led by TM theorists.
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Affiliation(s)
- Mary-Anne Kate
- Department of Psychology, University of New England, Armidale, Australia
| | - Tanya Hopwood
- Department of Psychology, University of New England, Armidale, Australia
| | - Graham Jamieson
- Department of Psychology, University of New England, Armidale, Australia
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Abstract
In the field of trauma and dissociation, culture has a significant influence on the clinical presentation of patients. A growing body of literature addresses the relationship between culture and dissociation. Studies of this relationship though, evoke the important, but at the same time extremely sensitive issue of cross-cultural comparisons. In this editorial, I provide a limited overview of various ways in which cultural influences have been addressed in the field of trauma and dissociation. Most studies have examined the occurrence of dissociative disorders in clinical populations in different cultures and countries. Some have focused on normative dissociation as a response to traumatic events in non-clinical samples from different cultures. This editorial also explores the concepts of double consciousness and black consciousness, which have emerged from the fields of social psychology and black psychology; and how these concepts influence our thinking about non-clinical dissociation. Culture-related challenges in the field of trauma and dissociation create opportunities for training in cultural competence for therapists. Qualitative research methods might be best suited to future research on the relationship between culture, trauma and dissociation. The chances of reaching a thorough and deep understanding of the influence of culture on trauma and dissociation might be best if the entire spectrum of dissociation is studied - from normal to pathological dissociation, and in its different manifestations from universal to those unique to certain cultural groups.
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Affiliation(s)
- Christa Krüger
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
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Tschoeke S, Steinert T, Bichescu-Burian D. Causal connection between dissociation and ongoing interpersonal violence: A systematic review. Neurosci Biobehav Rev 2019; 107:424-437. [PMID: 31562923 DOI: 10.1016/j.neubiorev.2019.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify evidence for dissociation as a cause of ongoing interpersonal violence. METHOD A systematic review of the literature retrieved from ten databases. RESULTS Fifteen studies yielded from our search strategy have been included in the review; eleven of these were longitudinal and four were experimental. The evidence indicates that pathological dissociation may contribute towards enduring interpersonal violence. Thus, dissociation may account for instances of repeated victimisation. There are similar indications concerning offenders, but study designs in this area allow one to draw fewer causal conclusions. There is some evidence that dissociation decreases information processing from the limbic system, which may be one underlying neurofunctional mechanism of persistent violence. CONCLUSION There is growing evidence for dissociation as a cause of interpersonal violence. However, the available evidence is still limited, and our review rather reveals an important research gap. Future longitudinal and experimental studies aimed at clarifying the role of dissociation in the context of violence should take into account the theoretical and empirical complexity around the concept of dissociation.
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Affiliation(s)
- Stefan Tschoeke
- Center for Psychiatry Südwürttemberg, Ulm University, Ravensburg- Weissenau, Germany.
| | - Tilman Steinert
- Center for Psychiatry Südwürttemberg, Ulm University, Ravensburg- Weissenau, Germany.
| | - Dana Bichescu-Burian
- Center for Psychiatry Südwürttemberg, Ulm University, Ravensburg- Weissenau, Germany.
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43
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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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Abstract
SUMMARYDissociative identity disorder (DID) is as real as any other psychiatric disorder but has been over-diagnosed by gullible clinicians, especially in forensic settings. Its classification has been poor, but the new ICD-11 classification, especially of partial DID, should help research and practice.DECLARATION OF INTERESTNone.
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Hielscher E, Whitford TJ, Scott JG, Zopf R. When the body is the target—Representations of one’s own body and bodily sensations in self-harm: A systematic review. Neurosci Biobehav Rev 2019; 101:85-112. [DOI: 10.1016/j.neubiorev.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/14/2018] [Accepted: 03/11/2019] [Indexed: 02/03/2023]
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Faria MDA, Prado EBDA, Souza WCD, Martins VF, Ferreira VM. A utilização do Método de Rorschach no diagnóstico diferencial da Esquizofrenia e Transtorno Dissociativo de Identidade. PSICOLOGIA: TEORIA E PESQUISA 2019. [DOI: 10.1590/0102.3772e3521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
RESUMO O objetivo deste artigo foi investigar a prevalência do Transtorno Dissociativo de Identidade (TDI) em dez pacientes diagnosticados com esquizofrenia com característica paranóide, com base no Método de Rorschach. Foram registrados indicadores ou sintomas psicológicos que caracterizaram o diagnóstico diferencial desses pacientes, analisadas diferenças clínicas específicas e verificado o enquadramento dos dados obtidos, com a aplicação da Técnica de Rorschach. Para fins de diagnóstico diferencial, observou-se que dois pacientes apresentaram sintomas diferenciais aos da esquizofrenia, sendo que um deles apresentou sintomas dissociativos, não sendo confirmada a prevalência do TDI entre os esquizofrênicos. No caso da esquizofrenia e do TDI, devido às características similares que apresentam, avaliações multidisciplinares são indicadas para se fazer o diagnóstico diferencial entre eles.
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Psychiatric Impact of Organized and Ritual Child Sexual Abuse: Cross-Sectional Findings from Individuals Who Report Being Victimized. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112417. [PMID: 30384461 PMCID: PMC6266763 DOI: 10.3390/ijerph15112417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022]
Abstract
Organized and ritual child sexual abuse (ORA) is often rooted in the child’s own family. Empirical evidence on possible associations between ORA and trauma-related symptoms in those who report this kind of extreme and prolonged violence is rare. The aim of our study was to explore socio-demographic and clinical characteristics of the individuals reporting ORA experiences, and to investigate protective as well as promotive factors in the link between ORA and trauma-related symptom severity. Within the framework of a project of the Independent Inquiry into Child Sexual Abuse in Germany, we recruited 165 adults who identified themselves as ORA victims via abuse- and trauma-specific networks and mailing lists, and they completed an anonymous online survey. We used variance analyses to examine correlations between several variables in the ORA context and PTSD symptoms (PCL-5) as well as somatoform dissociation (SDQ-5). Results revealed a high psychic strain combined with an adverse health care situation in individuals who report experiences with ORA. Ideological strategies used by perpetrators as well as Dissociative Identity Disorders experienced by those affected are associated with more severe symptoms (η2p = 0.11; η2p = 0.15), while an exit out of the ORA structures is associated with milder symptoms (η2p = 0.11). Efforts are needed to improve health care services for individuals who experience severe and complex psychiatric disorders due to ORA in their childhood.
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Vang ML, Shevlin M, Karatzias T, Fyvie C, Hyland P. Dissociation fully mediates the relationship between childhood sexual and emotional abuse and DSM-5 PTSD in a sample of treatment-seeking adults. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2018. [DOI: 10.1016/j.ejtd.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Sagan O. Art-Making and its Interface With Dissociative Identity Disorder: No Words That Didn’t fit. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2018. [DOI: 10.1080/15401383.2018.1499062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Olivia Sagan
- Queen Margaret University, Edinburgh, Scotland, United Kingdom
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50
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Abstract
This article describes the conclusions of an investigation done with 120 Spanish patients: the finding of a new psychopathological profile within a subgroup of patients suffering from schizophrenia. The patients were evaluated through different questionnaires about sociodemographic data, traumatic events, the severity index (both clinical and psychopathological), self-esteem and consciousness of the illness. From the scores obtained on a scale of dissociative experiences, they were classified into two groups: high dissociative symptomatology or HD, and low dissociative symptomatology or LD. The HD group contained 44 patients (36.7% of the total population). The groups LD and HD show meaningful differences with respect to dissociative symptomatology levels, general psychopathology and level of traumatic events suffered. The percentage of patients with low self-esteem was higher in group HD than in group LD (M=25.52 front 28.76 of group LD; t (118)=2.94, p=.00). In addition, the group HD was more conscious of having a mental disorder, of the beneficial effects of medication and of the social consequences of their illness: F (1)=10.929, p=.001; ƞ2pt=0.083; 1-β=0.907. The results show the existence of a subgroup of schizophrenic patients with higher levels of dissociation and trauma that were related with higher levels of symptomatology, lower self-esteem and higher consciousness of the illness, building a population of higher severity in which it would make sense to implement coadjutant treatments specifically oriented to these variables and, in addition, opening a therapeutic possibility for the patients with refractory schizophrenia.
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