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Bremner JD, Williamson D, Vaccarino V. Psychometric properties of the 23-Item Clinician Administered Dissociative States Scale (CADSS) in a psychological trauma population. J Affect Disord 2024; 364:249-258. [PMID: 39147159 PMCID: PMC11365742 DOI: 10.1016/j.jad.2024.08.050] [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: 01/30/2024] [Revised: 07/19/2024] [Accepted: 08/11/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE Dissociative symptoms are both a pathological consequence of exposure to psychological trauma as well as a side effect of N-methyl-d-aspartate (NMDA) receptor antagonist medications; therefore, accurate and valid assessment of these symptoms is important. The psychometric properties of the 23-item Clinician Administered Dissociative States Scale (CADSS) have been characterized in the ketamine and esketamine literatures. Here, we examine its performance in a sample with and without posttraumatic stress disorder (PTSD) and a history of exposure to psychological trauma. METHODS Participants with a history of psychological trauma with (N = 148) and without (N = 100) the diagnosis of PTSD and healthy participants without a psychiatric disorder or history of trauma (N = 28) were assessed with the 23-item CADSS and other psychometric and neuropsychological assessments. Analyses were performed to examine internal consistency, convergent and discriminant validity, factor structure, differential performance in populations reported to be more or less likely to report dissociative symptoms (e.g., patients with and without PTSD), and sensitivity to change resulting from exposure to trauma-related sights and sounds. RESULTS The 23-item CADSS was found to have high internal consistency (Cronbach's alpha 0.91) and a single-factor structure. CADSS total scores in trauma-exposed participants with PTSD were higher than those in trauma-exposed participants without PTSD and non-traumatized non-PTSD participants. Finally, veterans with Iraq combat-related PTSD showed a significant increase in CADSS total score after exposure to combat-related slides and sounds. CONCLUSION The 23-item CADSS, already validated as a tool to measure dissociation related to administration of NMDA receptor antagonist medication, performs in a reliable and valid manner in the assessment of dissociation in psychologically traumatized participants.
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Affiliation(s)
- J Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Atlanta VA Medical Center, Decatur, GA, United States of America.
| | - David Williamson
- Department of Psychiatry, University of South Alabama College of Medicine, United States of America; Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, United States of America
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America; Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA, United States of America
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2
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Fung HW, Yuan GF, Liu C, Lin ESS, Lam SKK, Wong JYH. Prevalence and clinical correlates of dissociative symptoms in people with complex PTSD: Is complex PTSD a dissociative disorder? Psychiatry Res 2024; 339:116076. [PMID: 38996630 DOI: 10.1016/j.psychres.2024.116076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 06/23/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024]
Abstract
The extent to which complex post-traumatic stress disorder (C-PTSD) can be conceptualized as a dissociative disorder remains an ongoing debate. This study investigated the prevalence and correlates of dissociative symptoms in people with C-PTSD. We analyzed baseline data from an international randomized controlled trial. A total of 165 intervention seekers who met the ICD-11 criteria for C-PTSD completed standardized self-report measures of trauma, C-PTSD symptoms, dissociative symptoms, depressive symptoms, and work and social impairments. In this sample, only 42.3 % of participants exhibited clinically significant dissociative symptoms. Dissociative symptoms had a unique association with depressive symptoms and work and social impairments in our participants with C-PTSD, even after controlling for trauma exposure and C-PTSD symptoms. The data does not support the theory that C-PTSD is a dissociative disorder. However, the findings highlight the importance of recognizing dissociation in people with C-PTSD.
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Affiliation(s)
- Hong Wang Fung
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong.
| | | | - Caimeng Liu
- School of Education Science, Leshan Normal University, Leshan, China
| | - Eleanor Sui Sum Lin
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Janet Yuen-Ha Wong
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong.
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3
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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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4
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Burback L, Forner C, Winkler OK, Al-Shamali HF, Ayoub Y, Paquet J, Verghese M. Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation. Psychol Res Behav Manag 2024; 17:2403-2431. [PMID: 38912158 PMCID: PMC11193433 DOI: 10.2147/prbm.s402456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Dissociation is a necessary part of our threat response system, common to all animal species, normally temporarily activated under conditions of extreme or inescapable threat. Pathological dissociation, however, continues to occur after the initial threat has passed, in response to reminders or inaccessibility of safety and security. Present across the spectrum of psychiatric diagnoses, recurrent dissociative symptoms are linked to severe trauma exposure, insecure attachment, treatment non-response, and maladaptive coping behaviors such as substance use, suicidality, and self-harm. However, empirical studies testing treatments specific to dissociative processes remain scarce. This narrative review summarizes existing studies and provides theoretical, neurobiological, and evolutionary perspectives on dissociative processes and treatments for pathological dissociation. Methods A systematic search of five databases (MEDLINE, EMBASE, APA PsycINFO, CINAHL plus, Scopus) was conducted on April 13, 2023. Peer-reviewed clinical studies with adult participants, assessing intervention effects on dissociative symptoms, were included. Results were thematically analyzed and summarized. Results Sixty-nine studies were identified, mainly focused on posttraumatic stress disorder, trauma-exposed populations, and borderline personality disorder. Psychotherapy was studied in 72.5% of studies; other interventions included medications and neurostimulation. The majority reported positive outcomes, despite the heterogeneous spectrum of interventions. However, treatment of dissociative symptoms was the primary objective in only a minority. Conclusion Pathological dissociation is a complex phenomenon involving brain and body systems designed for perceiving and responding to severe threats, requiring an individualized approach. A literature is emerging regarding potentially evidence-based treatments to help those impacted by recurrent dissociative symptoms. When contextualized within a neurobiological and evolutionary perspective, these treatments can be understood as facilitating an internal and/or relational sense of safety, resulting in symptom reduction. Further studies are needed to explore effective treatments for dissociative symptoms.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Huda F Al-Shamali
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Yahya Ayoub
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Jacquelyn Paquet
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Myah Verghese
- Department of Neuroscience, University of Alberta, Edmonton, Alberta, Canada
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Dindinger RA, Manzo LL, Manupule SE, Harp SL. Perinatal Care for Persons with Dissociative Disorders. MCN Am J Matern Child Nurs 2024:00005721-990000000-00055. [PMID: 38864882 DOI: 10.1097/nmc.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
ABSTRACT Caring for persons with mental health diagnoses can be daunting, especially when the conditions are rare, and there is little evidence to guide nursing practice. There is minimal information about caring for persons with dissociative disorders beyond the behavioral health literature, much less as in obstetric context. Women are more likely to experience dissociative disorders and post-traumatic stress disorders than men. Severe maternal morbidity is significantly more common in women with a history of stress and trauma-related conditions, highlighting the importance of providing guidance for clinicians caring for them. It is imperative that nurses caring for women who may dissociate understand the complexities of the disorders and advocate for early, interdisciplinary care. Dissociative disorders, including dissociative identity disorder, post-traumatic stress disorder with dissociation, dissociative amnesia, depersonalization-derealization disorder, other specified dissociative disorders, and the care of pregnant persons with these conditions are presented.
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Gori A, Topino E. Problematic Gambling Behavior in a Sample of Gamblers: The Role of Alexithymia, Dissociation Features, and External Locus of Control. J Gambl Stud 2024:10.1007/s10899-024-10322-6. [PMID: 38831237 DOI: 10.1007/s10899-024-10322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/05/2024]
Abstract
Gambling disorder is a severe condition that significantly compromises the lives of those affected. In light of this clinical relevance, the literature on the antecedents of this form of addiction is constant and continually evolving. Consistently with this framework, the present research aimed at investigating the role of some risk factors in gambling disorder, with a specific focus on alexithymia, dissociation, and locus of control. The research involved a sample of 290 participants (183 males and 107 females; Mage = 34.43, SD = 14.65) who practice gambling at least occasionally. They completed an online survey including the South Oaks Gambling Screen, Twenty-Items Toronto Alexithymia Scale, Dissociative Experience Scale-II, and Locus of Control of Behavior. ANOVA and a moderated-mediation model were implemented to analyse the collected data. Results showed that 19.0% of the participants were At Risk and Problem Gamblers, while 27.6% fell into the category of Problematic Gamblers. Problematic Gamblers showed significantly higher levels of alexithymia, dissociation, and external locus of control. Moreover, a significant association between alexithymia and the severity of problematic gambling behaviour was found and was significantly mediated by absorption (a dissociation feature). Furthermore, the external locus of control significantly moderated this indirect effect. The role of gender as a covariate was also investigated. Such findings may offer further insights into the field of clinical research on gambling disorder and may provide useful information for effective clinical practice.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, Firenze, 50135, Italy.
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, Florence, 50122, Italy.
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, Rome, 00193, Italy
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Topino E, Pallaoro N, Moyano M, Casale S, Gori A. The Mediating Role of Affect Dysregulation and Dissociation in the Relationship Between Attachment and Compulsive Online Shopping: A Path Analysis Model. CLINICAL NEUROPSYCHIATRY 2024; 21:217-224. [PMID: 38988680 PMCID: PMC11231729 DOI: 10.36131/cnfioritieditore20240307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Objective Online shopping has been described by the scientific literature both for its benefits and the potential risks when excessive usage is involved. Indeed, compulsive online shopping is commonly conceptualized as a potential behavioural addiction that substantially impacts the lives of individuals afflicted by it. In light of this, the present research aimed at exploring the association between possible risk and protective factors for compulsive online shopping, by specifically exploring the role of adult attachment, affect dysregulation, and dissociation. Method 285 participants (75% females, 25% males; Mage = 31.57, SD = 11.379) were involved in the research and completed an online survey. The collected data was analysed implementing a path analysis model. Results Results showed significant total effects in the relationship between secure/fearful attachment patterns and compulsive online shopping. Such associations were significantly mediated by the sequential effect of affect dysregulation and dissociation. Conclusions The present study provides useful information to guide tailored interventions concerning both preventive activity and clinical practice.
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Affiliation(s)
- Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy
| | - Nicole Pallaoro
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
| | - Miriam Moyano
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
| | - Silvia Casale
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
| | - Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
- Integrated Psychodynamic Psychotherapy Institute (IPPI), via Ricasoli 32, 50122 Florence, Italy
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di Marco S, Gaumard M, Hage WE, Tarrada A, Fugain L, Ertan D, Hingray C. A cross-sectional survey on French psychiatrists' knowledge and perceptions of dissociative identity disorder. L'ENCEPHALE 2024:S0013-7006(24)00091-5. [PMID: 38824042 DOI: 10.1016/j.encep.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE The aim of this study was to determine French psychiatrists' level of general knowledge about dissociative identity disorder and to evaluate their perceptions of this condition. METHODS In this study, French psychiatrists were invited by e-mail to answer an online survey. The questionnaire asked about their general knowledge and perceptions of dissociative identity disorder. RESULTS We received 924 answers including 582 complete questionnaires. The survey revealed that almost two-thirds (60.8%) of psychiatrists working in France had never received any training on dissociative disorders and 62% had never managed patients suffering from dissociative identity disorder. Only 19.5% of them claimed to believe unreservedly in the existence of the diagnosis of dissociative identity disorder. The psychiatrists' confidence in diagnosing or treating dissociative identity disorder was low (mean confidence in diagnosis: 3.32 out of 10 (SD 1.89), mean confidence in treatment: 3.1 out of 10 (SD 1.68)). Fifty percent believed that dissociative identity disorder is an entity created by cinema, medias or social networks. Seventy-seven point seven percent thought that confusion with borderline personality disorder is possible, and 41.3% with schizophrenia. CONCLUSION In France, there is a lack of training and knowledge about dissociative identity disorder, as well as persistent skepticism about the validity of the diagnosis. Specific training seems essential for a better understanding of dissociative identity disorder.
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Affiliation(s)
- Sonia di Marco
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Faculté de médecine, université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - Marie Gaumard
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Faculté de médecine, université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - Wissam El Hage
- Pôle de psychiatrie et d'addictologie, CHRU de Tours, Tours, France
| | - Alexis Tarrada
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Département de neurologie, CHRU de Nancy, Nancy, France
| | - Laure Fugain
- Centre du psychotraumatisme de Lorraine-Sud (CPN), Nancy, France
| | - Deniz Ertan
- Unité de recherche, institut La-Teppe, Tain-l'Hermitage, France
| | - Coraline Hingray
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Faculté de médecine, université de Lorraine, Vandœuvre-Lès-Nancy, France; Centre du psychotraumatisme de Lorraine-Sud (CPN), Nancy, France; Département de neurologie, CHRU de Nancy, Nancy, France.
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9
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Staniloiu A, Markowitsch HJ. Dissociative Amnesia: Remembrances Under Cover. Top Cogn Sci 2024. [PMID: 38728576 DOI: 10.1111/tops.12734] [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: 05/25/2023] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024]
Abstract
The existence or questionability of "repressed memories" can be discussed as being a matter of definition. It seems, however, far-fetched to consider all "lost" memories as caused by encoding problems, brain damage, forgetfulness, failure to disclose events, and so on. We argue that dissociative amnesia (DA) (or "psychogenic amnesia," or "functional amnesia," or, as we favor to call it, "mnestic block syndrome") is caused by psychic alterations, but ultimately they can be traced to changes in the physiology of the brain, as we are of the opinion that all memory processes-positive or negative-alter brain functions, sometimes more permanently, sometimes transiently. We have proven this idea using functional imaging techniques, in particular fluoro-deoxy-d-glucose positron emission tomography. Having investigated dozens of patients with severe and long-lasting DA conditions, we believe it to be disrespectful to many (but not to all) of the affected patients to question their disease condition, which can be proven to be not caused by feigning, malingering, or direct brain damage.
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Affiliation(s)
- Angelica Staniloiu
- Department of Physiological Psychology, University of Bielefeld
- Department of Psychology, University of Bucharest
- Psychiatry and Psychosomatics, Oberberg Clinic Hornberg
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Robinson MA, Purcell JB, Ward L, Winternitz S, Kaufman ML, Baranowski KA, Lebois LAM. Advancing Research on and Treatment of Dissociative Identity Disorder With People With Lived Experience. Am J Psychother 2024:appipsychotherapy20230024. [PMID: 38711402 DOI: 10.1176/appi.psychotherapy.20230024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Dissociative identity disorder is a posttraumatic, psychobiological syndrome that develops over time during childhood. Despite empirical evidence supporting the validity of this diagnosis and its relation to trauma, the disorder remains a misunderstood and stigmatized condition. This article highlights expert consensus guidelines and current empirical research on the treatment of dissociative identity disorder. In addition, the authors describe the Lived Experience Advisory Panel (LEAP), which was designed to leverage the expertise of individuals with dissociative identity disorder to combat stigma and improve research, clinical programming, professional education, and public outreach related to the disorder. This article also describes how LEAP members have partnered with other researchers to create new knowledge through participatory action research in order to advance equitable service provision and effect positive change.
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Affiliation(s)
- Matthew A Robinson
- Trauma Continuum, Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Robinson, Purcell, Winternitz, Kaufman, Lebois)
| | - Juliann B Purcell
- Trauma Continuum, Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Robinson, Purcell, Winternitz, Kaufman, Lebois)
| | - Laura Ward
- Trauma Continuum, Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Robinson, Purcell, Winternitz, Kaufman, Lebois)
| | - Sherry Winternitz
- Trauma Continuum, Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Robinson, Purcell, Winternitz, Kaufman, Lebois)
| | - Milissa L Kaufman
- Trauma Continuum, Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Robinson, Purcell, Winternitz, Kaufman, Lebois)
| | - Kim A Baranowski
- Trauma Continuum, Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Robinson, Purcell, Winternitz, Kaufman, Lebois)
| | - Lauren A M Lebois
- Trauma Continuum, Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Robinson, Purcell, Winternitz, Kaufman, Lebois)
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Hall H. Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. J Trauma Dissociation 2024; 25:334-348. [PMID: 36065490 DOI: 10.1080/15299732.2022.2120154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.
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12
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Fung HW, Cheung CTY. The bidirectional relationship between depression and dissociation: A longitudinal investigation. Asian J Psychiatr 2024; 94:103940. [PMID: 38367483 DOI: 10.1016/j.ajp.2024.103940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/24/2023] [Accepted: 01/31/2024] [Indexed: 02/19/2024]
Abstract
Depression is a major public health concern. Recent studies suggest that dissociative symptoms are associated with depressive symptoms, and the concept of "dissociative depression" has been proposed. Yet, only cross-sectional evidence is available in the literature. This study examined the bidirectional relationship between dissociative and depressive symptoms through the use of screening tools in a sample of Chinese young adults (N = 340) over four months. Baseline dissociative symptoms predicted depressive symptoms at follow-up (β = .262, p < .001), but not the other way around (β = .065, p = .121). Among different dissociative symptom clusters, identity dissociation was the only significant predictor of subsequent depressive symptoms (β = .177, p < .001). Furthermore, identity dissociation symptoms partially mediated the relationship between childhood trauma and subsequent depressive symptoms. This preliminary study is the first to test the bidirectional relationship between dissociative and depressive symptoms. The results highlight the importance of taking dissociative symptoms into account when preventing and treating depressive symptoms, especially among childhood trauma survivors.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong.
| | - Cherry Tin Yan Cheung
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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13
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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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Rimmington D, Roberts R, Sawyer A, Sved-Williams A. Dissociation in mothers with borderline personality disorder: a possible mechanism for transmission of intergenerational trauma? A scoping review. Borderline Personal Disord Emot Dysregul 2024; 11:7. [PMID: 38462614 PMCID: PMC10926641 DOI: 10.1186/s40479-024-00250-7] [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: 09/09/2023] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Dissociation is a feature of Borderline Personality Disorder (BPD), but rarely a focus for research, particularly in the perinatal literature. BPD partly has its aetiology in childhood and is characterised by emotional changes and difficulty with self-coherence that impacts on the processes of caregiving. METHODS A scoping review was conducted to synthesise current perspectives on the effect of dissociation in caregivers with BPD, particularly regarding the impact of caregiver dissociation on the interactional quality of relationship within parent-child dyads. Studies were included if they explicitly mentioned dissociation in the target population, or if dissociation was implied. A thematic analysis was conducted. RESULTS 20 studies were included; 10 experimental or quasi-experimental; 2 presenting case material; and 8 non-systematic review articles. 4 studies used the Dissociative Experiences Scale (DES) to measure dissociation, while 2 studies included a 'dissociative behaviour' subscale as part of an observational measure. The remaining studies did not measure dissociation but referenced directly or indirectly a concept of dissociation. CONCLUSIONS Findings suggested there was some evidence that dissociation plays a unique role in BPD caregivers' interactions with their offspring, however any findings should be interpreted with caution as the concept has been poorly operationalised and defined.
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Affiliation(s)
- David Rimmington
- School of Psychology, The University of Adelaide, North Terrace, Adelaide, SA, Australia.
| | - Rachel Roberts
- School of Psychology, The University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Alyssa Sawyer
- School of Psychology, The University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Anne Sved-Williams
- School of Psychology, The University of Adelaide, North Terrace, Adelaide, SA, Australia
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, SA, Australia
- Australian National University, ACT, Canberra, SA, Australia
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15
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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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16
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Brewerton TD, Perlman MM, Gavidia I, Suro G. The treatment of dissociative identity disorder in an eating disorder residential treatment setting. Int J Eat Disord 2024; 57:450-457. [PMID: 38041242 DOI: 10.1002/eat.24106] [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: 09/23/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co-occurrence generally is associated with greater morbidity, self-harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder. METHOD We report our experience with a case series of 18 patients with DSM-5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state-trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma-focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence-based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t-tests. RESULTS Following integrated, trauma-focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes. DISCUSSION These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma-focused ED program at higher levels of care. PUBLIC SIGNIFICANCE EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma-focused ED program.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- LLC, Mt. Pleasant, South Carolina, USA
- Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA
- Department of Psychiatry and Behavioral Health, Florida International University College of Medicine, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
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17
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Kieran K, Morse B, Margolis A. Dissociative Identity Disorder in Schools Part II. NASN Sch Nurse 2024:1942602X231223940. [PMID: 38268128 DOI: 10.1177/1942602x231223940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Dissociation is a well-established outcome of early life trauma, but school nurses may not be aware of resources and recommendations available to support students who experience it. If dissociation or behaviors consistent with dissociation are present, trauma-informed care (TIC) principles can guide individualized care of the student. Part I of this two-part article provided a pertinent background on dissociation, dissociative identity disorder (DID), the effects of social media, and TIC. Part II offers specific recommendations for implementing these principles in school nursing practice and follows the student vignette through the school year. Due to their holistic approach to care and long-standing leadership in providing TIC, nurses can significantly affect health, safety, and access to learning for students expressing dissociative experiences at school.
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Affiliation(s)
| | - Brenna Morse
- Associate Professor MGH Institute of Health Professions Boston, MA
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18
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Kieran K, Morse B, Margolis A. Dissociative Identity Disorder in Schools Part I. NASN Sch Nurse 2024:1942602X231223938. [PMID: 38246892 DOI: 10.1177/1942602x231223938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Dissociation is a normal life adaptation that can become pronounced and disruptive in the setting of repeated or extreme exposure to trauma. Children and adolescents may experience dissociation due to a trauma or stressor-related disorder, anxiety, or depressive disorders. Children and adolescents also may mimic behavior they see online as a way of expressing internally painful and intolerable experiences. Myth and misinformation surround the diagnosis of dissociative identity disorder (DID), formerly multiple personality disorder. The purpose of this article is to provide school nurses with evidence-based information on DID and resources for practice regarding how to provide a secure, consistent approach to students who are being traumatized, misunderstood, or excluded at home or at school. Part 1 of this two-part series describes DID foundations and DID in school-aged children, reviews controversy spurred by social media representation, and presents the Trauma-Informed Care (TIC) model. TIC offers useful perspectives regardless of a student's presentation or diagnostic status. Part 2 will discuss recommendations for managing dissociative presentations using a team-based approach, focusing on the school nurse's roles and responsibilities.
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Affiliation(s)
- Kathryn Kieran
- Instructor MGH Institute of Health Professions, Boston, MA
| | - Brenna Morse
- Associate Professor, MGH Institute of Health Profession
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19
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Longkumer I, Patil R, Sinha N, Sahu N. Social Stigmatization and Late Treatment of Dissociative Disorder: A Case Report on Trance and Possession Disorder. Cureus 2023; 15:e50198. [PMID: 38192943 PMCID: PMC10772312 DOI: 10.7759/cureus.50198] [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: 10/19/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
Dissociative disorders have been present in our society since time immemorial, with culture, society, and spiritual beliefs playing a major part. It went through many changes from its name and what it constituted. Diagnosis can be made based on the International Classification of Diseases (ICD) 10, Diagnostic and Statistical Manual of Mental Disorders (DSM) 5, and now the current International Classification of Diseases (ICD) 11 criteria. One of its constituents is trance and possession disorder which is one of the main obstacles faced by psychiatrists in Indian society. Through this case, we can assume that there are many factors involved that lead to delays in diagnosing and managing a case of dissociative disorder, most importantly the social and cultural factors. Even now cultural-socio-spiritual beliefs add to the challenge of dissociative disorders. This case reveals that individuals first consult a general physician before visiting a psychiatrist; so, the need for consultation liaison psychiatry (CLP) and its role today in diagnosis and further management is emphasized. There still exists a need for awareness to be made regarding the mind-body relationship and psychosocial support to both patients and their relatives keeping in mind their beliefs.
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Affiliation(s)
- Imyarila Longkumer
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ragini Patil
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nayan Sinha
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Namita Sahu
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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20
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Fung HW, Geng F, Yuan D, Zhan N, Lee VWP. Childhood experiences and dissociation among high school students in China: Theoretical reexamination and clinical implications. Int J Soc Psychiatry 2023; 69:1949-1957. [PMID: 37350288 DOI: 10.1177/00207640231181528] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Dissociation remains a controversial topic in terms of its prevalence, cross-cultural validity, and relationship with childhood trauma and adversities. AIMS This study investigated the prevalence of dissociative symptoms and probable dissociative disorders among Chinese high school students and tested the trauma model of dissociation. METHODS A total of N = 1,720 high school students completed standardized measures of positive and adverse childhood experiences (PCEs and ACEs), dissociation, depression, and anxiety. RESULTS The prevalence rates of dissociative symptoms and (probable) DSM-5 dissociative disorders (DDs) were 11.2% and 6.9%, respectively. Dissociation was a reliable construct (ICC = .682 to .752, p < .001) and was moderately correlated with general psychopathology (r = .424 with depressive symptoms, r = .423 with anxiety symptoms). Participants with a probable DD reported more ACEs, fewer PCEs, and more mental health symptoms than those without a probable DD. ACEs were significantly associated with dissociative symptoms (β = .107, p < .001) even after controlling for age, depressive, and anxiety symptoms. PCEs moderated the relationship between ACEs and dissociative symptoms. CONCLUSIONS This is the first report of the prevalence of dissociative symptoms and probable DSM-5 DDs among nonclinical children. We provide cross-cultural evidence that dissociation is a reliable and valid clinical phenomenon associated with psychopathology in children across cultures. The findings partly support the trauma model of dissociation. This study contributes to the limited literature on dissociation in children. It also offers empirical data to facilitate the ongoing controversy about (childhood) trauma and dissociation. Our findings imply that dissociation is cross-culturally associated with childhood adversities, but trauma is not the only, sufficient cause. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, China
| | - Danyan Yuan
- School of Psychology, Jiangxi Normal University, China
| | - Nalan Zhan
- School of Psychology, Jiangxi Normal University, China
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21
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Saxena M, Tote S, Sapkale B. Multiple Personality Disorder or Dissociative Identity Disorder: Etiology, Diagnosis, and Management. Cureus 2023; 15:e49057. [PMID: 38116333 PMCID: PMC10730093 DOI: 10.7759/cureus.49057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
Dissociative identity disorder (DID), commonly known as multiple personality disorder (MPD), is a contentious mental health condition that typically arises as a result of traumatic events to help people avoid unpleasant memories. To completely comprehend the complexity and nuance of DID, this study investigates its symptomatology, diagnostic criteria, therapeutic modalities, and historical controversies. Patients with DID frequently have two or more distinct personality identities, each with its memories, characteristics, and attributes. Ten personality disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), but DID, formerly known as MPD, is not one of those personality disorders. Nevertheless, myths and misunderstandings cloud our knowledge of the disease, and some critics attribute the condition's emergence to therapy rather than trauma. This study emphasizes the possibilities for recovery and fulfilling life for persons affected by DID by attempting to provide a comprehensive understanding of DID, debunk myths and misconceptions, and throw light on effective therapy methods. It accomplishes this by carefully examining the body of literature and existing studies. The DID study used a systematic strategy to obtain a thorough grasp of the causes, diagnosis, symptoms, and therapies of the disorder. It employed precise keywords and Boolean operators across four databases, prioritized current peer-reviewed English-language publications, and enforced strict exclusion standards. While admitting potential biases and limits in the databases used, the research intended to maintain methodological transparency and robustness, helping to provide an accurate and up-to-date picture of DID.
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Affiliation(s)
- Mudit Saxena
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Tote
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhagyesh Sapkale
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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22
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Fung HW, Lam SKK, Chien WT, Ng ASY, Wong ENM, Ross CA, Hung SL, Lee VWP. Dissociative symptoms among community health service users in Hong Kong: a longitudinal study of clinical course and consequences. Eur J Psychotraumatol 2023; 14:2269695. [PMID: 37902274 PMCID: PMC10763863 DOI: 10.1080/20008066.2023.2269695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
Background: Previous studies have demonstrated the high prevalence of dissociative symptoms and their association with considerable healthcare costs. However, there is a lack of studies that describe whether dissociative symptoms persist and lead to other clinical outcomes over time in the community.Objectives: This study investigated the persistence, predictors, and consequences of dissociative symptoms in the community.Methods: We analyzed longitudinal data in a sample of community health service users in Hong Kong (N = 173).Results: A relatively high proportion (63.6%) of participants with baseline dissociative symptoms continued to exhibit dissociative symptoms after approximately 9 months. Baseline non-betrayal trauma predicted subsequent dissociative symptoms (β = .141, p = .024). Participants with baseline dissociative symptoms were more likely to have received subsequent emergency mental health services (9.1% vs 0.7%, p = .005). Baseline dissociative symptoms significantly predicted subsequent post-traumatic symptoms (β = .165 to .191, p < .05) and difficulty in social and occupational participation (β = -.152 to -.182, p < .05) even after controlling for baseline scores, trauma exposure, and use of professional support. The predictive role of dissociative symptoms on subsequent disturbances in self-organization symptoms and social participation difficulty remained significant after applying the Bonferroni correction.Conclusions: This is one of the very few studies showing that dissociative symptoms are persistent to a certain degree and could predict other symptoms and subsequent impairments even in community settings. Factors that affect the trajectory of dissociative symptoms should be further investigated. Regular screening for dissociative symptoms is recommended. Considering its prevalence, persistence, and clinical and social consequences, dissociation should be given greater public health attention.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Albe Sin Ying Ng
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Braemar Hill, Hong Kong
| | - Emily Nga Man Wong
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Braemar Hill, Hong Kong
| | - Colin A. Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, TX, USA
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Vincent Wan Ping Lee
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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23
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İçin ZN, Koşe Ç, Şar V. Turkish Adaptation of Dissociative Subtype of Post Traumatic Stress Disorder Scale. J Trauma Dissociation 2023; 24:624-639. [PMID: 36994469 DOI: 10.1080/15299732.2023.2195396] [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: 01/20/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023]
Abstract
After the changes in DSM-5, dissociative subtype was added to post-traumatic stress disorder. That caused a necessity for a scale to measure the mentioned change. A scale named Dissociative Subtype of Post-Traumatic Stress Disorder (DSPS) was developed to measure this subtype and help the diagnosis. The purpose of this study is to adapt the Dissociative Subtype of Post-Traumatic Stress Disorder to Turkish and examine its reliability and validity. The Dissociative Subtype of PTSD (DSPS) was translated into Turkish. DSPS, Turkish forms of The Posttraumatic Diagnostic Scale and Dissociative Experiences Scale were sent to participants via Google Forms and data from 279 people aged 18-45 were analyzed. Reliability tests and factor analysis were conducted. Factor analysis showed that scale has good model fit scores and items were loaded to the factors the same as the original study. Scales internal consistency was examined, and a good score was obtained (α=.84). Fit index values of confirmatory factor analysis were found as χ2/df = 2.51, GFI=.90, RMSEA=.07, RMR=.02. As a result of the high reliability scores and sufficient model fit scores, this scale is considered as a dependable measure to evaluate the dissociative subtype of PTSD.
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Affiliation(s)
- Zühre Neslihan İçin
- Institute of Forensic Sciences and Legal Medicine, Department of Social Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Çiğdem Koşe
- Department of Psychology, Topkapı University, Istanbul, Turkey
| | - Vedat Şar
- Department of Psychiatry, Koc University, Istanbul, Turkey
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24
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Eve Z, Heyes K, Parry S. Conceptualizing multiplicity spectrum experiences: A systematic review and thematic synthesis. Clin Psychol Psychother 2023. [PMID: 37699854 DOI: 10.1002/cpp.2910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/03/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Dissociative identity disorder and depersonalization-derealization have attracted research and clinical interest, facilitating greater understanding. However, little is known about the experience of multiplicity of self outside of traumagenic or illness constructs. Consequently, this systematic review explored how people identifying as having multiple selves conceptualize their experiences and identity. METHODS A comprehensive search of qualitative studies reporting lived experiences of multiplicity was conducted through PsycINFO, PubMed and Scopus (PROSPERO ID: CRD42021258555). Thirteen relevant studies were retrieved (N = 98, 16-64 years, conducted in the United Kingdom, the United States, Hungary and Poland). RESULTS Using line-by-line thematic synthesis, four analytical themes were developed: multiplicity: disorder versus experience; impact of understanding multiplicity; importance of supporting multiplicity; and continuum of experiences. DISCUSSION This review highlights heterogeneity within multiplicity-spectrum experiences, emphasizing the need for person-centred, individualized understanding, separate from mental health conceptualizations. Therefore, training in person-centred individualized care to promote self-concept clarity is needed across health, education and social care. This systematic review is the first to synthesize voices of people with lived experience across the multiplicity spectrum, demonstrating how qualitative research can contribute to advancing our understanding of this complex phenomena with the community, acknowledging reciprocal psychosocial impacts of multiplicity and providing valuable recommendations for services.
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Affiliation(s)
- Zarah Eve
- Manchester Metropolitan University, Manchester, UK
| | - Kim Heyes
- Manchester Metropolitan University, Manchester, UK
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25
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Almaazmi BM, Aldweik AN, Mukhtar MA. Dissociative Amnesia: A Mist Over Psychosis. Cureus 2023; 15:e44619. [PMID: 37799250 PMCID: PMC10547924 DOI: 10.7759/cureus.44619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
This case report highlights the unique presentation of dissociative amnesia masking an underlying brief psychotic disorder, triggered by a very intense psycho-social stressor. Learning points from this report center around the importance of considering psychotic as well as affective disorders alongside a presentation of dissociative amnesia, and not only the expected anxious, post-traumatic or personality-oriented states. Our patient, a 37-year-old gentleman, was brought to our emergency department via police referral. He had gaps in his autobiographical memory that, upon receiving a regular dose of benzodiazepines, unraveled bizarre, uncooperative, and agitated behavior as well as marked fluctuations in his daily mental state examinations. Biological management through antipsychotic monotherapy, psychological management through insight-oriented therapy as well as psychological support, and social management revolving around the alleviation of surrounding stressors enabled his safe recovery.
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26
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Poli A, Cappellini F, Sala J, Miccoli M. The integrative process promoted by EMDR in dissociative disorders: neurobiological mechanisms, psychometric tools, and intervention efficacy on the psychological impact of the COVID-19 pandemic. Front Psychol 2023; 14:1164527. [PMID: 37727746 PMCID: PMC10505816 DOI: 10.3389/fpsyg.2023.1164527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
Dissociative disorders (DDs) are characterized by a discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, bodily representation, motor control, and action. The life-threatening coronavirus disease 2019 (COVID-19) pandemic has been identified as a potentially traumatic event and may produce a wide range of mental health problems, such as depression, anxiety disorders, sleep disorders, and DD, stemming from pandemic-related events, such as sickness, isolation, losing loved ones, and fear for one's life. In our conceptual analysis, we introduce the contribution of the structural dissociation of personality (SDP) theory and polyvagal theory to the conceptualization of the COVID-19 pandemic-triggered DD and the importance of assessing perceived safety in DD through neurophysiologically informed psychometric tools. In addition, we analyzed the contribution of eye movement desensitization and reprocessing (EMDR) to the treatment of the COVID-19 pandemic-triggered DD and suggest possible neurobiological mechanisms of action of the EMDR. In particular, we propose that, through slow eye movements, the EMDR may promote an initial non-rapid-eye-movement sleep stage 1-like activity, a subsequent access to a slow-wave sleep activity, and an oxytocinergic neurotransmission that, in turn, may foster the functional coupling between paraventricular nucleus and both sympathetic and parasympathetic cardioinhibitory nuclei. Neurophysiologically informed psychometric tools for safety evaluation in DDs are discussed. Furthermore, clinical and public health implications are considered, combining the EMDR, SDP theory, and polyvagal conceptualizations in light of the potential dissociative symptomatology triggered by the COVID-19 pandemic.
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27
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Scott CL, Salem AM, Tindell WW, Neely HK, Blum AW. The forensic assessment of dissociation: Distinguishing real from the unreal. BEHAVIORAL SCIENCES & THE LAW 2023; 41:397-414. [PMID: 37010094 DOI: 10.1002/bsl.2622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/26/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
Because a wide range of disorders incorporate dissociative symptoms, evaluators should be familiar with evidence-based approaches to evaluating dissociation claims in the clinical and forensic context. This article provides specific guidelines for practitioners when conducting a forensic assessment of individuals who report dissociative symptoms. We review the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition disorders that include dissociation as a symptom, highlight how to distinguish genuine versus atypical symptoms of dissociative identity disorder, and summarize strengths and weaknesses of structured assessments in the evaluation of dissociative claims.
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Affiliation(s)
- Charles L Scott
- Division of Psychiatry and the Law, University of California Davis Medical Center, University of California, Sacramento, California, USA
| | - Amanie M Salem
- Division of Psychiatry and the Law, University of California Davis Medical Center, University of California, Sacramento, California, USA
| | - William W Tindell
- Division of Psychiatry and the Law, University of California Davis Medical Center, University of California, Sacramento, California, USA
| | - Hunter K Neely
- Division of Psychiatry and the Law, University of California Davis Medical Center, University of California, Sacramento, California, USA
| | - Austin W Blum
- Division of Psychiatry and the Law, University of California Davis Medical Center, University of California, Sacramento, California, USA
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Tarchi L, Crescenzo P, Talamonti K. Prevalence and predictors of mental distress among Italian Red Cross auxiliary corps: A cross-sectional evaluation after deployment in anti-COVID-19 operations. MILITARY PSYCHOLOGY 2023; 35:394-407. [PMID: 37615558 PMCID: PMC10453978 DOI: 10.1080/08995605.2022.2069983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/20/2022] [Indexed: 12/23/2022]
Abstract
The aim of the present study is to describe the prevalence and individual predictors of mental distress (anxiety, depression, and burnout) in a sample of volunteers engaged in emergency services. A total of 823 volunteers enrolled in the Red Cross auxiliary corps were surveyed between 28 June 2021 and 28 August 2021 (299 men and 524 women). After deployment in anti-COVID-19 operations, participants completed the Patient Health Questionnaire, Generalized Anxiety Disorder Questionnaire, Maslach Burnout Inventory, and Big Five Inventory through an online platform. A moderately severe risk of depression was found in 1.70% of the sample. A severe risk for anxiety disorders was found in 1.82%. A high risk for emotional exhaustion was found in 3.40%, depersonalization in 12.88%, and low personal accomplishment in 7.53%. Women showed a higher risk of both depression and anxiety in comparison to males. Personality factors were significant predictors for all dimensions. In contrast to the current literature, openness was found to be a predisposing personality factor in developing burnout dimensions. The relevance of the current findings for the development of effective screening tools before the deployment of reserve forces during medical crises is discussed.
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Affiliation(s)
- Livio Tarchi
- Psychological Activities Unit (NAP), Italian Red Cross Voluntary Military Corps, Ministry of Defense, Rome, Italy
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Pietro Crescenzo
- Psychological Activities Unit (NAP), Italian Red Cross Voluntary Military Corps, Ministry of Defense, Rome, Italy
| | - Kristian Talamonti
- Psychological Activities Unit (NAP), Italian Red Cross Voluntary Military Corps, Ministry of Defense, Rome, Italy
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Khan F, Joshi A, Devkota HP, Subramaniyan V, Kumarasamy V, Arora J. Dietary glucosinolates derived isothiocyanates: chemical properties, metabolism and their potential in prevention of Alzheimer's disease. Front Pharmacol 2023; 14:1214881. [PMID: 37554984 PMCID: PMC10404612 DOI: 10.3389/fphar.2023.1214881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
Alzheimer's disease (AD) is the most prevalent form of dementia affecting millions of people worldwide. It is a progressive, irreversible, and incurable neurodegenerative disorder that disrupts the synaptic communication between millions of neurons, resulting in neuronal death and functional loss due to the abnormal accumulation of two naturally occurring proteins, amyloid β (Aβ) and tau. According to the 2018 World Alzheimer's Report, there is no single case of an Alzheimer's survivor; even 1 in 3 people die from Alzheimer's disease, and it is a growing epidemic across the globe fruits and vegetables rich in glucosinolates (GLCs), the precursors of isothiocyanates (ITCs), have long been known for their pharmacological properties and recently attracted increased interest for the possible prevention and treatment of neurodegenerative diseases. Epidemiological evidence from systematic research findings and clinical trials suggests that nutritional and functional dietary isothiocyanates interfere with the molecular cascades of Alzheimer's disease pathogenesis and prevent neurons from functional loss. The aim of this review is to explore the role of glucosinolates derived isothiocyanates in various molecular mechanisms involved in the progression of Alzheimer's disease and their potential in the prevention and treatment of Alzheimer's disease. It also covers the chemical diversity of isothiocyanates and their detailed mechanisms of action as reported by various in vitro and in vivo studies. Further clinical studies are necessary to evaluate their pharmacokinetic parameters and effectiveness in humans.
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Affiliation(s)
- Farhana Khan
- Laboratory of Bio-Molecular Technology, Department of Botany, Mohanlal Sukhadia University, Udaipur, Rajasthan, India
| | - Abhishek Joshi
- Laboratory of Bio-Molecular Technology, Department of Botany, Mohanlal Sukhadia University, Udaipur, Rajasthan, India
| | - Hari Prasad Devkota
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Vetriselvan Subramaniyan
- Department of Pharmacology, Center for Transdisciplinary Research, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Vinoth Kumarasamy
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jaya Arora
- Laboratory of Bio-Molecular Technology, Department of Botany, Mohanlal Sukhadia University, Udaipur, Rajasthan, India
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Jukić M, Malenica L, Đuričić V, Talapko J, Lukinac J, Jukić M, Škrlec I. Long-Term Consequences of War Captivity in Military Veterans. Healthcare (Basel) 2023; 11:1993. [PMID: 37510434 PMCID: PMC10379024 DOI: 10.3390/healthcare11141993] [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: 05/16/2023] [Revised: 07/02/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Numerous studies on the health and functioning of veterans and former prisoners of war have shown that the experience of war captivity is one of the most difficult human experiences. Captivity is often characterized by extremely difficult and inhumane conditions, as well as exposure to various forms of both psychological and physical abuse. Such traumatic experiences can lead to serious psychological consequences that can last for years, even decades after release from captivity. The aim of this paper is to present a brief overview of research that points to the specifics of wartime captivity and the long-term psychological consequences in veterans of former camp detainees, as well as the consequences suffered by their families and factors that, apart from the intensity of the trauma, contribute to the emergence and persistence of psychological disorders. From the presented research, it can be concluded that former prisoners of the camp represent an extremely vulnerable group of the social community and require long-term appropriate treatment, while the needs of veterans' families should not be neglected, with the necessity of including spouses and children in psychological and psychosocial treatments.
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Affiliation(s)
- Melita Jukić
- Department of Psychiatry, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Luka Malenica
- Department of Psychiatry, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vanja Đuričić
- Department of Psychiatry, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jasmina Lukinac
- Faculty of Food Technology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marko Jukić
- Faculty of Food Technology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Anselmetti C, Fourneret P, Gauld C. [Dissociative identity disorder in adolescents: From self-diagnosis to transient illness]. Med Sci (Paris) 2023; 39:377-379. [PMID: 37094271 DOI: 10.1051/medsci/2023042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
The category of dissociative identity disorder (DID) has puzzled medical science and fascinated popular culture for almost 200 years. Its occurrence in young people raises at least two new questions addressed by science studies and embedded philosophy: self-diagnosis (related to cyberchondria and mass media-induced illness) and transient disease (related to looping effect and identity claim specific to adolescence). In an attempt to refine the sociocognitive model, we analyze the impact of these notions in understanding the local ecological niche in which contemporary adolescent DID occurs.
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Affiliation(s)
- Clara Anselmetti
- Service psychopathologie du développement de l'enfant et de l'adolescent, Hospices civils de Lyon F-69000 Lyon, France
| | - Pierre Fourneret
- Service psychopathologie du développement de l'enfant et de l'adolescent, Hospices civils de Lyon F-69000 Lyon, France - Institut des sciences cognitives Marc Jeannerod, UMR 5229 CNRS & université Claude Bernard Lyon 1, F-69000 Lyon, France
| | - Christophe Gauld
- Service psychopathologie du développement de l'enfant et de l'adolescent, Hospices civils de Lyon F-69000 Lyon, France - Institut des sciences cognitives Marc Jeannerod, UMR 5229 CNRS & université Claude Bernard Lyon 1, F-69000 Lyon, France
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Graumann L, Heekerens JB, Duesenberg M, Metz S, Spitzer C, Otte C, Roepke S, Wingenfeld K. Association between baseline dissociation levels and stress-induced state dissociation in patients with posttraumatic-stress disorder, borderline personality disorder, and major depressive disorder. Borderline Personal Disord Emot Dysregul 2023; 10:11. [PMID: 36997956 PMCID: PMC10064785 DOI: 10.1186/s40479-023-00215-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/15/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Dissociative symptoms are highly prevalent in patients with trauma-related disorders such as borderline personality disorder (BPD) and posttraumatic-stress disorder (PTSD), and also occur in patients with depressive disorders. Acute dissociative states are theorized to be stress-related, and some individuals experience recurring patterns of dissociation. The relationship between the intensity of dissociative episodes (trait-like dissociation) and acute dissociative states, however, is incompletely understood. In the present study, we investigated how levels of baseline (trait-like) dissociation relate to changes in dissociative states during a laboratory stress induction. METHODS Our female sample comprised 65 patients with BPD and/or PTSD, 84 patients with major depressive disorder (MDD) and 44 non-clinical controls (NCC). Baseline dissociation was assessed at the start of the study using the Dissociation Tension Scale past week version (DSS-7). All participants underwent the Trier Social Stress Test (TSST) and a placebo version (P-TSST). Before and after the TSST or P-TSST, state dissociation was assessed using the Dissociation Tension Scale acute (DSS-4). We used structural equation models to estimate changes in state dissociation items (somatoform dissociation, derealization, depersonalization, analgesia), and to test whether these changes relate to levels of baseline dissociation. RESULTS We found significant increases in all state dissociation items in response to the TSST in patients with BPD and/or PTSD and patients with MDD, but not in NCCs. Increases in somatoform dissociation and derealization during the TSST were significantly related to higher levels of baseline dissociation in patients with BPD and/or PTSD, but not in patients with MDD or NCCs. Results indicate no significant changes in state dissociation during the P-TSST. CONCLUSION Our results replicate earlier findings that patients with BPD and/or PTSD report higher levels of stress-related state dissociation than NCC and extend them to patients with MDD. In addition, our findings indicate that baseline levels of dissociation relate to stress-induced changes in state dissociation among patients with BPD and PTSD, but not patients with MDD. In clinical applications, measures of baseline dissociation could be used to facilitate the prediction and treatment of stress-related dissociative states in patients with BPD and/or PTSD.
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Affiliation(s)
- Livia Graumann
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Johannes Bodo Heekerens
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Moritz Duesenberg
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Sophie Metz
- Department of Medical Psychology, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Christian Otte
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Katja Wingenfeld
- Department of Psychiatry and Neuroscience, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt- Universitaet Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.
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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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Doychak K, Raghavan C. Trauma-Coerced Attachment: Developing DSM-5’s Dissociative Disorder “Identity Disturbance due to Prolonged and Intense Coercive Persuasion”. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2023. [DOI: 10.1016/j.ejtd.2023.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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Gori A, Topino E, Cacioppo M, Craparo G, Schimmenti A, Caretti V. An addictive disorders severity model: a chained mediation analysis using structural equation modeling. J Addict Dis 2023; 41:98-109. [PMID: 35616192 DOI: 10.1080/10550887.2022.2074762] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The clinical relevance of the degree of severity in addiction disorders supports the need to investigate the variables underlying this aspect of the phenomenon. OBJECTIVE This study aimed to explore the relationships between factors that may influence the severity of addiction disorder, with a particular focus on temperamental disinhibition, emotion dysregulation, interpersonal vulnerability, and their interactions. METHODS A clinical sample of 502 (77% males and 22% females) was involved. All participants received a DSM-5 clinical diagnosis of "Substance-Related and Addictive Disorders" and were recruited from the Italian National Health System. The collected data were analyzed by implementing a chained mediation model using structural equation modeling. RESULTS The statistical appropriateness of the hypothesized latent 4- factors model was confirmed. Specifically, temperamental disinhibition (composed of impulsiveness, compulsiveness, and obsessiveness), emotion dysregulation (composed of affect dysregulation, alexithymia, and dissociation), interpersonal vulnerability (composed of traumatic experiences, preoccupied, avoidant and unresolved attachment), and Addictive Disorders Severity (composed by substance use severity, alcohol use severity, gambling severity, and Internet use severity) were the four factors which have been identified. Furthermore, a total chained mediation model emerged, where emotion dysregulation and interpersonal vulnerability mediated the relationship between temperamental disinhibition and Addictive Disorders Severity. CONCLUSIONS Our findings offer a better understanding of the variables associated with addictive disorder severity, providing important indications for therapeutic interventions.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Florence, Italy.,Integrated Psychodynamic Psychotherapy Institute (IPPI), Florence, Italy
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Rome, Italy
| | - Marco Cacioppo
- Department of Human Sciences, LUMSA University of Rome, Rome, Italy
| | - Giuseppe Craparo
- Faculty of Human and Social Sciences, UKE-Kore University of Enna, Enna, Italy
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE-Kore University of Enna, Enna, Italy
| | - Vincenzo Caretti
- Department of Human Sciences, LUMSA University of Rome, Rome, Italy
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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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Fung HW, Ross CA, Lam SKK, Hung SL. Recent research on the interventions for people with dissociation. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Simeon D, Putnam F. Pathological Dissociation in The National Comorbidity Survey Replication (NCS-R): Prevalence, Morbidity, Comorbidity, and Childhood Maltreatment. J Trauma Dissociation 2022; 23:490-503. [PMID: 35422203 DOI: 10.1080/15299732.2022.2064580] [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: 10/18/2022]
Abstract
Our aim was to examine U.S. national prevalence of pathological dissociation (PD) likely indicative of dissociative disorder, and associated morbidity, comorbidity, and childhood maltreatment. PD was assessed in 6,644 participants in the National Comorbidity Survey Replication, a nationally representative adult survey. Seven of the eight pathological dissociation taxon items were inquired about over the past month and scored on a 4-point scale. A conservative PD cutoff score was applied, with 100% specificity against healthy individuals and 84% sensitivity for Depersonalization Disorder which lies at the less severe end of the dissociative disorder spectrum; it yielded a national PD prevalence of 4.1%. The PD group had diminished physical and mental health, marked comorbidity with most major psychiatric disorders, and high likelihood of psychiatric hospitalization. Over half of PD members had attempted suicide, significantly more than individuals with lifetime major depression. Childhood maltreatment was quantified for physical abuse, witnessing domestic violence, physical neglect, emotional abuse, and emotional neglect. Total childhood trauma significantly positively predicted PD severity, as well as severity of all three pathological dissociative experiences (amnesia, depersonalization / derealization, identity alteration). Furthermore, each childhood trauma category significantly predicted PD severity uniquely and additively. Childhood maltreatment in the PD group was significantly greater than in lifetime major depression, except for similar emotional neglect, and was comparable to lifetime PTSD. The study reinforces the validity of prior PD findings across clinical and community samples, and highlights the need for increased attention toward diagnosing and treating these quite common and highly morbid disorders and their traumatic antecedents.
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Affiliation(s)
- Daphne Simeon
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
| | - Frank Putnam
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
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Al-Shamali HF, Winkler O, Talarico F, Greenshaw AJ, Forner C, Zhang Y, Vermetten E, Burback L. A systematic scoping review of dissociation in borderline personality disorder and implications for research and clinical practice: Exploring the fog. Aust N Z J Psychiatry 2022; 56:1252-1264. [PMID: 35152771 PMCID: PMC9511244 DOI: 10.1177/00048674221077029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more severe trauma exposure, emotional dysregulation and worse treatment outcomes in Posttraumatic Stress Disorder and Dissociative Disorders, with implications for BPD. OBJECTIVE A systematic scoping review was conducted to assess the extent of current literature regarding the impact of dissociation on BPD and to identify knowledge gaps. METHODS Four electronic databases (MEDLINE, APA PsycINFO, EMBASE, CINAHL Plus) were searched, and English peer-reviewed studies with adults with BPD were included, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension for scoping reviews (PRISMA-ScR) 2018 guidelines. RESULTS Most of the 70 included studies were observational (98%) with first authors from Germany (59%). Overall, dissociation was associated with increased BPD symptom severity, self-harm and reduced psychotherapy treatment response; findings regarding suicide risk were mixed. Dissociation was associated with working memory and cognitive deficits, decreased pain perception, altered body ownership, no substance abuse or the abuse of sedative substances, increased fantasy proneness, personality fragmentation, fearful attachment, dream anxiety, perceived stress and altered stress responses, increased cumulative body mass index, decreased water consumption, several neurological correlates and changes in gene expression. CONCLUSION BPD with significant dissociative symptoms may constitute a more severe and at-risk subgroup of BPD patients. However, there are significant research gaps and methodological issues in the area, including the possibility of unrecognized Dissociative Disorders in BPD study populations confounding results. Further studies are needed to better understand the impact of dissociation on BPD course and treatment, and to clarify the most appropriate assessment tools for clinical practice. In addition, interventional studies are needed to develop dissociation-specific BPD treatments to determine whether targeting dissociation in BPD can improve treatment outcomes.
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Affiliation(s)
- Huda F Al-Shamali
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Fernanda Talarico
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | | | - Yanbo Zhang
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada,Lisa Burback, Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R7, Canada.
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Prevalence and correlates of dissociative symptoms among people with depression. J Psychiatr Res 2022; 154:132-138. [PMID: 35933857 DOI: 10.1016/j.jpsychires.2022.07.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND To improve the outcomes of depression treatment, personalized treatments that take individual needs into account are recommended. Recent research suggests that a subgroup of depressed people who suffer from co-occurring dissociation may be more likely to have encountered traumatic or stressful experiences and they may also have more psychosocial intervention needs. METHODS This study examined the prevalence and correlates of dissociative symptoms in an online convenience sample of people (N = 410) from 18 different countries/regions who reported clinically significant levels of depressive symptoms (indicated by Patient Health Questionnaire-9 score ≥10). RESULTS Over 60% of participants exhibited clinically significant levels of dissociative symptoms (indicated by a Multiscale Dissociation Inventory total score >66). Compared with those with low levels of dissociative symptoms, participants with high levels of dissociative symptoms reported more traumas, interpersonal stress, depression and trauma-related symptoms. Emotional constriction in particular had a weak but significant negative correlation with the level of perceived medication benefits. LIMITATIONS The use of an online convenience sample could limit the generalizability of our findings. Our cross-sectional data could not demonstrate causal relationships between the study variables. CONCLUSIONS The findings highlight a need for complex health interventions for depressed people with co-occurring dissociative symptoms, focusing not only on depressive symptoms but also addressing trauma and dissociation-related symptoms.
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Badura Brack AS, Marklin M, Embury CM, Picci G, Frenzel M, Klanecky Earl A, Stephen J, Wang YP, Calhoun V, Wilson TW. Neurostructural brain imaging study of trait dissociation in healthy children. BJPsych Open 2022; 8:e172. [PMID: 36148845 PMCID: PMC9534905 DOI: 10.1192/bjo.2022.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Trait dissociation has not been examined from a structural human brain mapping perspective in healthy adults or children. Non-pathological dissociation shares some features with daydreaming and mind-wandering, but also involves subtle disruptions in affect and autobiographical memory. AIMS To identify neurostructural biomarkers of trait dissociation in healthy children. METHOD Typically developing 9- to 15-year-olds (n = 180) without psychological or behavioural disorders were enrolled in the Developmental Chronnecto-Genomics (DevCoG) study of healthy brain development and completed psychological assessments of trauma exposure and dissociation, along with a structural T1-weighted magnetic resonance imaging. We conducted univariate ANCOVA generalised linear models for each region of the default mode network examining the effects of trait dissociation, including scanner site, age, gender and trauma as covariates and correcting for multiple comparison. RESULTS We found that the precuneus was significantly larger in children with higher levels of trait dissociation but this was not related to trauma exposure. The inferior parietal volume was smaller in children with higher levels of trauma but was not related to dissociation. No other regions of interest, including frontal and limbic structures, were significantly related to trait dissociation even before multiple comparison correction. CONCLUSIONS Trait dissociation reflects subtle cognitive disruptions worthy of study in healthy people and warrants study as a potential risk factor for psychopathology. This neurostructural study of trait dissociation in healthy children identified the precuneus as an essential brain region to consider in future dissociation research.
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Affiliation(s)
- Amy S Badura Brack
- Department of Psychological Science, Creighton University, Omaha, Nebraska, USA
| | - Marika Marklin
- Department of Psychological Science, Creighton University, Omaha, Nebraska, USA
| | - Christine M Embury
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, Nebraska, USA; and Department of Psychology, University of Nebraska - Omaha, Nebraska, USA
| | - Giorgia Picci
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Michaela Frenzel
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, Nebraska, USA; and Department of Psychology, University of Nebraska - Omaha, Nebraska, USA
| | | | - Julia Stephen
- The Mind Research Network, Albuquerque, New Mexico, USA
| | - Yu-Ping Wang
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, USA
| | - Vince Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, Georgia, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, Nebraska, USA; and Department of Psychology, University of Nebraska - Omaha, Nebraska, USA
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42
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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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Parry S, Eve Z, Myers G. Exploring the Utility and Personal Relevance of Co-Produced Multiplicity Resources with Young People. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:427-439. [PMID: 35600531 PMCID: PMC9120276 DOI: 10.1007/s40653-021-00377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 06/15/2023]
Abstract
Multiplicity, the experience of more than one self in the body, is an under-researched area of young people's mental health. The aim of this study was to explore the perspectives of experts-by-experience within a community sample regarding two specific resources: a co-produced self-help guide about multiplicity for adolescents, and a set of guidelines for supporting someone who identifies as 'multiple'. 34 participants (Mage= 22.06, 2.26 SD; 15F, 1M, 18NBG) completed an online survey consisting of open-ended and Likert scale questions to assess the language, utility, transferability and therapeutic impact of the materials. Descriptive statistics and a Foucauldian-informed Narrative Analysis were employed to analyse responses, producing a summary of utility and two narrative chapters. The emergent chapters, 'Breaking the Stigma' and 'Recognising the Many', highlight the need for greater understanding and awareness of multiplicity, with psychoeducation materials viewed as helpful. Inclusive language can reduce stigma and normalise multiplicity as a response to trauma. With greater understanding, practitioners and researchers can collaborate with young people through trauma wise care, providing multiplicity sensitive language and support. Overall, the term 'parts' was viewed as problematic by the participants as it could imply the plural system is not coexisting as a whole. Additionally, opinions varied as to how much diagnostic language could and should be used to describe multiplicity; linguistically and conceptually. Importantly, compassion was seen as particularly essential for younger selves within the system; older in their years and presence, but often more vulnerable within the societies in which the system resides.
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Affiliation(s)
- Sarah Parry
- Department of Psychology, Manchester Metropolitan University, Brooks Building, Manchester, M15 6GX UK
| | - Zarah Eve
- Department of Psychology, Manchester Metropolitan University, Brooks Building, Manchester, M15 6GX UK
| | - Gemma Myers
- Department of Psychology, Manchester Metropolitan University, Brooks Building, Manchester, M15 6GX UK
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Bækkelund H, Ulvenes P, Boon-Langelaan S, Arnevik EA. Group treatment for complex dissociative disorders: a randomized clinical trial. BMC Psychiatry 2022; 22:338. [PMID: 35578194 PMCID: PMC9112598 DOI: 10.1186/s12888-022-03970-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment. METHODS Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group-treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties. RESULTS Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period. CONCLUSION In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning. TRIAL REGISTRATION Clinical Trials ( NCT02450617 ).
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Affiliation(s)
- Harald Bækkelund
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway. .,Section for Implementation and Treatment Research, Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
| | - Pål Ulvenes
- grid.5510.10000 0004 1936 8921Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Espen Ajo Arnevik
- grid.55325.340000 0004 0389 8485Section for clinical addiction research, Oslo University Hospital, Oslo, Norway
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The Molecular Genetics of Dissociative Symptomatology: A Transdiagnostic Literature Review. Genes (Basel) 2022; 13:genes13050843. [PMID: 35627228 PMCID: PMC9141026 DOI: 10.3390/genes13050843] [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: 04/23/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.
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Bahari K. Dissociative Trance Disorder Among Adolescents. Issues Ment Health Nurs 2022; 43:482-484. [PMID: 34641755 DOI: 10.1080/01612840.2021.1980639] [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: 10/20/2022]
Affiliation(s)
- Kissa Bahari
- Department of Nursing, Politeknik Kesehatan Kemenkes Malang, Malang City, Indonesia
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Lindfors KUM, Therman S, Lindgren M, Kekkonen V, Tolmunen T. Factor Structure, Measurement Invariance, and Abbreviated Versions of The Adolescent Dissociative Experiences Scale (A-DES). J Trauma Dissociation 2022; 23:1-16. [PMID: 35467493 DOI: 10.1080/15299732.2022.2064575] [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: 01/20/2021] [Accepted: 10/05/2021] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to examine the factor structure of the Adolescent Dissociative Experiences Scale (A-DES) questionnaire with item response theory (IRT) methods, including an assessment of measurement invariance with differential item functioning (DIF) analysis. Three abbreviated versions of the A-DES (with 20, 10, and 5 items) were constructed based on the IRT and DIF statistics. The respondents in this population-based study (N = 4,072) were 12- to 19-year-old Finnish junior and senior high school students. A one-factor model of the A-DES was best supported, and the original theoretical four-factor model showed poor fit. The A-DES turned out to have high measurement invariance with respect to age, gender, transgender tendencies, having multiple friends, the use of illegal substances, and experience of being bullied. Compared to the full 30-item A-DES, abbreviated versions of the questionnaire retained acceptable information value and empirical reliability in the clinically relevant range of symptomatology. Further psychometric studies are needed especially with regards to clinical use.
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Affiliation(s)
| | - Sebastian Therman
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Maija Lindgren
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Virve Kekkonen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio University Hospital, Finland
| | - Tommi Tolmunen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio University Hospital, Finland
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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: 0] [Impact Index Per Article: 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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Lynn SJ, Polizzi C, Merckelbach H, Chiu CD, Maxwell R, van Heugten D, Lilienfeld SO. Dissociation and Dissociative Disorders Reconsidered: Beyond Sociocognitive and Trauma Models Toward a Transtheoretical Framework. Annu Rev Clin Psychol 2022; 18:259-289. [PMID: 35226824 DOI: 10.1146/annurev-clinpsy-081219-102424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identify empirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Steven Jay Lynn
- Psychology Department, Binghamton University, Binghamton, New York, USA;
| | - Craig Polizzi
- Psychology Department, Binghamton University, Binghamton, New York, USA;
| | - Harald Merckelbach
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Chui-De Chiu
- Department of Psychology, Chinese University of Hong Kong, Hong Kong, China
| | - Reed Maxwell
- Department of Psychiatry, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dalena van Heugten
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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