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Fung HW, Geng F. Childhood adversities and psychotic symptoms among high school students in China: The role of dissociation. Asian J Psychiatr 2024; 94:103964. [PMID: 38368691 DOI: 10.1016/j.ajp.2024.103964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024]
Abstract
Adverse childhood experiences (ACEs) are well-established risk factors for psychotic symptoms. This study replicated the relationship between ACEs and positive symptoms of psychosis in the Asian context and explored the moderating effect of dissociation. We analyzed data from 1439 high school students in China who completed validated measures of ACEs, positive symptoms of psychosis, and dissociative symptoms. The positive relationship between ACEs and psychotic symptoms was confirmed in our sample (r =0.244, p <0.001). Among different ACEs, childhood emotional neglect (β =0.139, p <0.001) and emotional abuse (β =0.125, p <0.001) had the strongest relationship with psychotic symptoms. Dissociative symptoms were also found to be a statistically significant moderator. We provide cross-cultural evidence for the relationship between ACEs and psychotic symptoms. Dissociative symptoms may exacerbate such effects. These results highlight the importance of child protection to prevent psychotic symptoms. Individuals with higher levels of dissociation may be at higher risk of developing psychotic symptoms when exposed to adversities. A trauma-informed approach to addressing psychotic symptoms in the community is recommended.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong.
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, China
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2
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Bi Y, Cao C, Fang R, Wang N, Liu P, Luo S, Grace E, Wang L. A latent class analysis of dissociative PTSD subtype among Chinese adolescents following the COVID-19 pandemic and lockdown. J Affect Disord 2024; 349:596-603. [PMID: 38199423 DOI: 10.1016/j.jad.2023.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The COVID-19 pandemic and related policies have amplified the vulnerability of adolescents to the development of posttraumatic stress disorder (PTSD) and dissociation symptoms. This study sought to explore the profile patterns and psychopathological characteristics of co-occurring PTSD and dissociation symptoms in Chinese adolescents. METHODS A total of 57,984 junior and senior high school students in Deyang City, China were recruited between July 13 and July 19, 2020. PTSD and dissociation symptoms, risk factors, and functional impairment variables were assessed using the Global Psychotrauma Screen for Teenagers (GPS-T) instrument. Latent class analysis (LCA) was employed to examine the phenomenology and risk factors of co-occurring PTSD and dissociation symptoms. Analysis of Variance (ANOVA) was utilized to investigate differences in COVID-19 pandemic-related exposure and functional impairment across distinct symptom profiles. RESULTS A 4-class model was selected as the optimal solution, comprising subgroups of low symptom, predominant PTSD symptom, predominant dissociation symptom, and PTSD-dissociation symptom. Class membership could be significantly predicted by other stressful experiences, social support, childhood maltreatment and psychiatric histories. The PTSD-dissociation symptom class exhibited the most severe COVID-19 pandemic-related exposure and functional impairment among all classes. LIMITATIONS The cross-sectional design, Chinese cultural background, online survey method and oversimple measurements were the limitations. CONCLUSIONS Our findings extend existing knowledge about the coexisting patterns of PTSD and dissociation symptoms in adolescents, which could assist in identifying high-risk youths. Furthermore, our findings offer recommendations for shaping public health policies and formulating effective clinical interventions for adolescents following the COVID-19 pandemic and lockdown.
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Affiliation(s)
- Yajie Bi
- Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan Province, China; School of Psychology, Guizhou Normal University, Guiyang, Guizhou Province, China; Sichuan Clinical Research Center for Neurological Disease, Deyang, Sichuan Province, China
| | - Chengqi Cao
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ruojiao Fang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Na Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ping Liu
- Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan Province, China; Sichuan Clinical Research Center for Neurological Disease, Deyang, Sichuan Province, China
| | - Shu Luo
- Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan Province, China; Sichuan Clinical Research Center for Neurological Disease, Deyang, Sichuan Province, China
| | - Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Li Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China; School of Psychology, Guizhou Normal University, Guiyang, Guizhou Province, China.
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3
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Fung HW, Wong MYC, Moskowitz A, Chien WT, Hung SL, Lam SKK. Association Between Psychotic and Dissociative Symptoms: Further Investigation Using Network Analysis. J Trauma Dissociation 2024; 25:279-296. [PMID: 38124492 DOI: 10.1080/15299732.2023.2293776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/17/2023] [Indexed: 12/23/2023]
Abstract
The association and overlap between psychotic and dissociative phenomena have been increasingly recognized. Previous studies found that psychotic symptoms are closely associated with post-traumatic and dissociative symptoms and that these trauma-related phenomena may mediate the relationship between trauma and psychotic symptoms. It remained less explored which specific post-traumatic and dissociative symptom clusters are particularly associated with psychotic symptoms. This cross-sectional study used a data-driven approach (network analysis) to explore the associations among different psychotic and post-traumatic/dissociative symptom clusters in an online convenience predominantly female sample (N = 468)(59.2% had ever seen a psychiatrist). Participants completed well-established multidimensional measures that assessed different symptom clusters of psychosis, dissociation, and PTSD. In addition, multiple mediation analysis was conducted to examine which post-traumatic/dissociative symptoms could mediate the relationship between childhood and adulthood trauma and different psychotic symptoms. Our results confirmed previous findings that PTSD and dissociative symptoms are closely associated with psychotic symptoms. More importantly, both data-driven and multiple mediation analysis results indicated that identity dissociation was particularly associated with perceptual anomalies and bizarre experiences, while emotional constriction was particularly associated with negative symptoms. It is important to screen for trauma and dissociation and provide trauma-and dissociation-informed care when working with people at risk of or experiencing psychosis. Further longitudinal studies using more representative samples are needed.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Taipo, Hong Kong
| | | | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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4
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Hassan J, Taib S, Yrondi A. Structural and functional changes associated with functional/dissociative seizures: A review of the literature. Epilepsy Behav 2024; 152:109654. [PMID: 38281393 DOI: 10.1016/j.yebeh.2024.109654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The term 'functional/dissociative seizures (FDS)' refers to a paroxysmal, transient clinical manifestation that may include motor, sensory, vegetative, psychological and cognitive signs, similar to the manifestations observed in epileptic seizures. In recent years, there has been an increase of literature in the field of brain imaging research on functional neurological disorders and, more specifically, on FDS. However, most of the studies have been carried out on limited samples. We propose an update of this review work by performing a systematic review of studies performed since 2017 in the field of neuroimaging in patients with FDS. METHODS We conducted a systematic review of the literature using the PRISMA methodology and reproduced most of the methodological elements of the latest systematic literature review. RESULTS Our work over the last five years has identified 14 articles. It is still difficult to isolate a distinct structure or network specifically involved in the mechanism of FDS. However, certain structures are recurrently involved in imaging studies, notably the amygdala, the orbitofrontal cortex, and the anterior cingulate cortex. CONCLUSION The contribution of neuroimaging may allow a more precise explanation of the disorder for patients, avoiding the stigma frequently associated with this diagnosis. as with other 'conversion' phenomena which have traditionally been considered only as 'medically unexplained'. In the longer term and beyond a better understanding of the physiopathology of the disorder, the challenge of this neuroimaging work would be to identify specific imaging biomarkers for a diagnosis of FDS.
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Affiliation(s)
- Johann Hassan
- Service de Psychiatrie et de Psychologie Médicale (Department of Psychiatry and Medical Psychology), Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Simon Taib
- Service de Psychiatrie, Psychothérapie et Art thérapie CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale (Department of Psychiatry and Medical Psychology), Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France.
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5
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Alpay EH, Aydın A. Effects of peritraumatic reactions on post-traumatic stress among Kahramanmaras earthquake survivors. Nord J Psychiatry 2024; 78:153-161. [PMID: 38165775 DOI: 10.1080/08039488.2023.2291548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/01/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE Peritraumatic reactions play a crucial role in the development of mental health problems, including depression and post-traumatic stress disorder. Therefore, this study sought to examine the influence of the peritraumatic reactions, including peritraumatic dissociation, peritraumatic distress, mental defeat, and tonic immobility, on post-traumatic stress disorder and major depressive disorder in earthquake survivors. MATERIALS AND METHODS A total of 261 adult participants aged between 18 and 65 (Mage=29.20, SD = 28.06, 162 were female, and 99 were male) who were exposed to the Kahramanmaras earthquake in February 2023 were recruited in the study. Data were collected between April 10 and 18 2023, two months after the earthquake. Participants completed questionnaires, including The International Trauma Questionnaire, The International Depression Questionnaire, The Mental Defeat Questionnaire, The Tonic Immobility Scale, and The Peritraumatic Dissociative Experiences Questionnaire. RESULTS Two-step multiple linear regression analyses indicated all peritraumatic reactions predicted both post-traumatic stress disorder and depression. Dominance analysis results showed that the contribution of peritraumatic dissociation in predicting PTSD and depression was higher among other peritraumatic reactions. CONCLUSION The findings of the study revealed a robust association between peritraumatic reactions and both depression and PTSD, shedding light on the underlying processes in the development of trauma-related disorders. Early assessment of peritraumatic reactions may be useful in identifying individuals at risk of developing PTSD and depression.
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Affiliation(s)
- Emre H Alpay
- Department of Psychology, Mersin University, Mersin, Türkiye
| | - Arzu Aydın
- Department of Psychology, Mersin University, Mersin, Türkiye
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6
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Bregman-Hai N, Soffer-Dudek N. Posttraumatic symptoms and poor sleep are independent pathways to agency disruptions and dissociation: A longitudinal study with objective sleep assessment. J Psychopathol Clin Sci 2024; 133:192-207. [PMID: 38108801 DOI: 10.1037/abn0000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Dissociation and diminished sense of agency are experiential distortions of disintegration in the perception of self and action. Although one is often implied in the other, they are seldom studied together. Assessing their relationship and shared influences may allow for a more comprehensive and nuanced understanding of dissociative experiences. We aimed to examine their temporal (concurrent or directional) co-occurrence, and to elucidate their etiology, focusing on posttraumatic symptoms (PTS), poor sleep, and their hypothesized joint effect. N = 113 adults oversampled for the existence of trauma exposure history reported PTS and then, for a week, wore an actigraphic sleep monitor, reported subjective sleep quality each morning, and reported state dissociation (depersonalization, derealization, and absorption) and sense of agency four times each day. Data were analyzed using multilevel linear modeling. Higher state dissociation correlated with diminished state sense of agency, but only contemporaneously, not directionally. Both hypothesized etiological factors, namely, PTS (especially complex) and poor sleep (objective and subjective) predicted state dissociation and diminished state sense of agency, but psychological distress seemed to overshadow these main effects. However, robust interactive effects suggested that poor sleep predicted dissociation and disruptions in the sense of agency only among individuals with low PTS. These findings suggest that PTS and poor sleep quality are separate paths to dissociation and impaired sense of agency. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Noa Bregman-Hai
- Department of Psychology, Ben-Gurion University of the Negev
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Danböck SK, Liedlgruber M, Franke LK, Miedl SF, Hettegger SE, Weber RC, Wilhelm FH. Acute dissociation as part of the defense cascade: Associations with behavioral, autonomic, and experiential threat responses in posttraumatic stress disorder. J Psychopathol Clin Sci 2024; 133:76-89. [PMID: 38059936 DOI: 10.1037/abn0000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Dissociative symptoms, such as depersonalization and derealization, are experienced by about half of individuals with posttraumatic stress disorder (PTSD). Theoretical models propose that acute dissociation is accompanied by specific behavioral, physiological, and experiential alterations and contributes to unfavorable PTSD symptom course. Yet, empirical evidence is scarce. Here, we explored associations between dissociative and behavioral, physiological, and experiential threat responses as well as effects of dissociative responding on PTSD symptom course. Individuals with PTSD (N = 71) participated in a preregistered script-driven imagery study including exposure to standardized, detail-enriched trauma, and neutral scripts. Stabilometry, eye-tracking, facial electromyography, autonomic psychophysiology, and self-report data were collected. Moreover, PTSD symptoms were assessed before and 3 months after testing. Analyses did not link acute dissociation to bodily and facial immobility or staring in response to trauma scripts. However, dissociation displayed an inverted U-shaped relationship with heart rate and was linked to higher nonspecific skin conductance fluctuation and higher high-frequency heart rate variability in response to trauma scripts. Moreover, acute dissociation was linked to higher self-reported negative affect responses to trauma scripts and displayed a U-shaped relationship with unfavorable PTSD symptom course. While results did not confirm hypothesized behavioral markers of dissociation, they do support defense-cascade model assumptions of an inverted U-shaped relationship between dissociation and psychophysiological arousal resulting from a progression of parasympathetic versus sympathetic dominance with increasing dissociation. On an experiential level, results did not confirm posttraumatic dissociation-induced emotional numbing, questioning theoretical notions. The observed nonlinear associations may help explain the heterogeneity of prior findings and might inform an updated conceptualization of posttraumatic dissociation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sarah K Danböck
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg
| | - Michael Liedlgruber
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg
| | - Laila K Franke
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg
| | - Stephan F Miedl
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg
| | - Sabrina E Hettegger
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg
| | | | - Frank H Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg
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Strachan LP, Paulik G, Preece DA, McEvoy PM. Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation. Psychol Psychother 2023; 96:934-951. [PMID: 37493351 DOI: 10.1111/papt.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area. AIMS This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model. MATERIALS The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire. METHODS We used path analysis in a non-clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation. RESULTS Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14-.61) and indirect pathways (βs = .01-.08) were significant (ps < .001). DISCUSSION Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation. CONCLUSION Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.
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Affiliation(s)
- Laura P Strachan
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
- Perth Voices Clinic, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David A Preece
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Longman J, Rahman K, Matthews V, Bennett-Levy J. Research Letter: Flooding, displacement, peritraumatic experience and disaster-related PTSD in northern New South Wales - The critical need for quality data to plan mental health support. Aust N Z J Psychiatry 2023; 57:1580-1582. [PMID: 37791723 PMCID: PMC10666513 DOI: 10.1177/00048674231203901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Jo Longman
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - Kazi Rahman
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - James Bennett-Levy
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Fung HW, Chau AKC, Hung SL, Lam SKK, Chien WT, Lee VWP. Persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms: a one-year follow-up study. Eur J Psychotraumatol 2023; 14:2263314. [PMID: 37818716 PMCID: PMC10569344 DOI: 10.1080/20008066.2023.2263314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/04/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms. OBJECTIVE This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms. METHODS We analyzed longitudinal data from an international sample of people self-reporting depressive emotions (N = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31). RESULTS More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally (r = .286 to .528, p < .001) and longitudinally (r = .181 to .462, p < .001) correlated with depressive symptoms. A sense of current threat (β = .146, p < .05) and negative self-concept (β = .173, p < .05) at baseline significantly predicted depressive symptoms after one year. CONCLUSIONS These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
| | - Anson Kai Chun Chau
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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13
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Vancappel A, Raysseguier C, Révellière C, Penverne T, Fernandes R, El-Hage W. Inhibition, Attentional Control and Binding Abilities in Relation to Dissociative Symptoms Among PTSD Patients. J Trauma Dissociation 2023; 24:609-623. [PMID: 36992662 DOI: 10.1080/15299732.2023.2195397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/03/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION The relationship between dissociation and cognitive abilities remains controversial. Empirical studies have reported positive, negative and non-existent associations between dissociation and cognition. These inconsistent results may be due to the fact that the studies focused mainly on trait dissociation, while dissociation is not stable but transient. After validating the French version of the Clinician Administered Dissociative States Scale (CADSS), the aim of the present study was to evaluate the relationship between state dissociation and cognitive abilities. METHOD We recruited 83 patients suffering from post-traumatic stress disorder (PTSD) and assessed them twice. At T1, they performed a neutral Stroop task and a neutral binding task. At T2 (one to three weeks later), after a script-driven dissociative induction, they performed an emotional Stroop task and an emotional binding task. Between the two sessions, they completed questionnaires at home evaluating PTSD severity, trait dissociation and cognitive difficulties. State dissociation was assessed at T1 and T2 using the Clinician-Administered Dissociative States Scale (CADSS). RESULTS We found good psychometric properties of the French version of the CADSS. After inducing dissociation, significantly lower attentional performance was found among patients with than without dissociative reactions. We found a significant positive correlation between state dissociation and increased attention and memory difficulties after induction. CONCLUSION The French version of the CADSS is a reliable and valid tool to assess state dissociation, which is correlated with attentional difficulties. Attentional training is recommended to help patients control dissociative symptoms.
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Affiliation(s)
- A Vancappel
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
- Département de Psychologie, EE 1901 QualiPsy, Qualité de vie et santé psychologique, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - C Raysseguier
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
| | - C Révellière
- Département de Psychologie, EE 1901 QualiPsy, Qualité de vie et santé psychologique, Tours, France
| | - T Penverne
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
| | - R Fernandes
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
| | - W El-Hage
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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14
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Dorahy MJ, Yogeeswaran K, Middleton W. Dissociation-Induced Shame in Those with a Dissociative Disorder: Assessing the Impact of Relationship context using Vignettes. J Trauma Dissociation 2023; 24:674-691. [PMID: 36994492 DOI: 10.1080/15299732.2023.2195402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
Some evidence in non-clinical groups suggests that the relationship context in which dissociation is experienced might moderate its association with shame. The current study used vignettes detailing either dissociative symptoms or the expression of sadness occurring in three different relationship contexts: with a friend, an acquaintance, or when alone. Ratings of emotional (e.g. shame, anxiety) and behavioral (e.g. leave, talk) reactions were made on single-item measures, and shame feelings were further assessed with the State Shame Scale. Participants were in treatment for either dissociative identity disorder (n = 31) or other specified dissociative disorder (n = 3; N = 34). Feelings of shame were elevated in the acquaintance condition compared to when with a close friend or alone regardless of whether dissociation or sadness was experienced. In the acquaintance context, participants exposed to dissociation or sadness reported feeling annoyed at themselves, having a greater desire to leave, and a lesser desire to talk compared to when these experiences happened with a close friend or alone. Results suggest those with a dissociative disorder appraise themselves as more vulnerable to shame if experiencing dissociation or sadness when with an acquaintance, potentially because the risk of not being understood and rejected is heightened.
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Affiliation(s)
- Martin J Dorahy
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- The Cannan Institute, Belmont Private Hospital, Brisbane, Australia
| | - Kumar Yogeeswaran
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Warwick Middleton
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- The Cannan Institute, Belmont Private Hospital, Brisbane, Australia
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15
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Li A, Wang S, Paetzold RL, Rholes WS, Liu X. Childhood Trauma and Its Link to Adult Dissociation: The Role of Mentalizing and Disorganized Attachment in a Chinese Adult Sample. J Trauma Dissociation 2023; 24:559-574. [PMID: 36975105 DOI: 10.1080/15299732.2023.2195395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/03/2023] [Indexed: 03/29/2023]
Abstract
Based on previous findings in a U.S. sample, the present study validated the relationship between childhood trauma and dissociation, as well as the mediating role of disorganized attachment and the moderating role of mentalizing (i.e. self-concept clarity and reflective functioning) in a group of 569 Chinese adults (i.e. a community sample). Results demonstrated a mediating role for disorganized attachment relationships in linking childhood maltreatment and dissociative symptoms. Moreover, self-concept clarity moderated this mediating relationship. An interesting finding that differs from the U.S. sample is that reflective functioning did not play a moderating role between insecure attachment and dissociation in Chinese adults. Chinese culture places greater emphasis on collectivism, altruism, and other-oriented, and thus the protective effect of the reflective function may not be as effective as in an individualistic culture. This study provides evidence for a better understanding of the relationship between childhood trauma, attachment, dissociation, and the moderating role of mentalizing in an Eastern culture, and it opens the door to further research examining whether more Western (such as the U.S.) and Eastern (particularly Chinese) relationships are similar in both social and clinical psychology.
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Affiliation(s)
- Angyang Li
- School of Teacher Education, Nanjing University of Information Science & Technology, Nanjing, P.R.China
| | - Shuo Wang
- Faculty of Education, Beijing Normal University, Beijing, China
| | - Ramona L Paetzold
- Department of Management, Mays Business School, Texas A & M University, College Station, Texas, USA
| | - W Steven Rholes
- Department of Psychological and Brain Sciences, Texas A & M University, College Station, Texas, USA
| | - Xiangping Liu
- Faculty of Psychology, Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, Beijing, P.R.China
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16
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Lathan EC, Sheikh IS, Guelfo A, Choucair KC, Fulton T, Julian J, Mekawi Y, Currier JM, Powers A, Fani N. Moral injury appraisals and dissociation: Associations in a sample of trauma-exposed community members. J Trauma Dissociation 2023; 24:692-711. [PMID: 37387238 PMCID: PMC10771817 DOI: 10.1080/15299732.2023.2231010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/22/2023] [Indexed: 07/01/2023]
Abstract
Appraisal of trauma is a critical factor in the development of impairing post-traumatic stress symptoms, such as dissociation. Individuals may appraise trauma as morally injurious (i.e., moral injury exposure [MIE]) and experience subsequent moral distress related to this exposure (i.e., moral injury distress [MID]). To date, however, investigation into the relations between moral injury appraisals and dissociation has been limited, particularly within community populations. This study investigated MIE and MID in relation to six facets of dissociation (disengagement, depersonalization, derealization, memory disturbances, emotional constriction, identity dissociation) in a sample of trauma-exposed community members (n = 177, 58.2% Black, 89.3% female) recruited from a public hospital and/or community advertisements. Participants completed measures assessing trauma exposure, MIE, MID, dissociation, and posttraumatic stress disorder (PTSD) symptoms. Partial correlation analyses revealed that after controlling for PTSD symptoms, MIE was correlated with disengagement, r = .23, p ≤ .025, and depersonalization, r = .25, p ≤ .001, and MID was correlated with depersonalization, r = .19, p ≤ .025. Sex moderated each association, with stronger associations observed for female participants. Findings suggest that moral injury appraisals are linked to more severe dissociative symptoms among female civilians, and as such, may need to be specifically targeted in empirically supported treatments.
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Affiliation(s)
- Emma C. Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | - Alfonsina Guelfo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Khaled C. Choucair
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Travis Fulton
- Molecular and Systems Pharmacology PhD Program, Emory University
| | - Jacob Julian
- Department of Psychology, Georgia State University
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville
| | | | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
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17
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Pozuelo Moyano B, Duquenne C, Favrat B, Francois-Xavier B, Kokkinakis I, Tzartzas K. Clinical impact and misdiagnosis of functional ophthalmological symptoms: a case report. J Med Case Rep 2023; 17:340. [PMID: 37563729 PMCID: PMC10416532 DOI: 10.1186/s13256-023-04063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/02/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND There is a high prevalence of somatoform disorders and medically unexplained symptoms. When it comes to deciding whether a patient is able to work, it is essential to differentiate a somatoform disorder from a factitious disorder. The case presented demonstrates the impact on disability benefits and the subsequent psychosocial repercussions of misdiagnosing between a factitious disorder and a somatoform disorder. CASE PRESENTATION A 42-year-old Caucasian woman worked as a 100% fiduciary accountant until the age of 32 when she was placed on medical leave due to persistent trigeminal neuralgia. Afterward, she developed total blindness, not explained by a physiological process, accompanied by distress in a crucial emotional context. We evaluated the patient for a revision of a disability income after a diagnosis of factitious disorder with severe consequences such as disability income suspension and family conflict. Our psychiatric examination concluded the diagnoses of pain disorders related to psychological factors and a dissociative neurological symptom disorder with visual disturbance. CONCLUSIONS Blindness not explained by a physiological process may accompany trauma and psychological distress. Differentiating this pathology from factitious disorder or simulation is essential from an insurance medicine point of view, but also for its treatment.
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Affiliation(s)
- Beatriz Pozuelo Moyano
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011 Lausanne, Switzerland
| | - Catherine Duquenne
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011 Lausanne, Switzerland
| | - Bernard Favrat
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011 Lausanne, Switzerland
| | | | - Ioannis Kokkinakis
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011 Lausanne, Switzerland
| | - Konstantinos Tzartzas
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011 Lausanne, Switzerland
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18
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Kouri N, D'Andrea W, Brown AD, Siegle GJ. Shame-induced dissociation: An experimental study of experiential avoidance. Psychol Trauma 2023; 15:547-556. [PMID: 36701538 DOI: 10.1037/tra0001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The study experimentally investigated shame-induced dissociation, and to what extent that process was associated with exposure to childhood maltreatment. METHOD Using a shame-related script-driven imagery paradigm and mirror-viewing task, 50 female participants from the community recalled two shame-related and two neutral autobiographical memories, after which they listened to recordings of themselves retelling the narratives looking in a mirror or at a black curtain (i.e., mirror-viewing task). RESULTS Shame-related memories compared to neutral memories resulted in higher rates of dissociation. The relationship between shame and dissociation was significantly moderated by experiential avoidance or avoidance of unwanted cognitive and affective reactions. In contrast to previous research, looking in the mirror and childhood maltreatment severity did not predict dissociative responses. CONCLUSIONS The strong relationship between shame and dissociation suggests the importance of monitoring patients' affect and behavior when revisiting shame-related memories, to not reinforce dissociative reactions and inadvertently foster treatment resistance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Nicole Kouri
- Department of Psychology, New School for Social Research
| | - Wendy D'Andrea
- Department of Psychology, New School for Social Research
| | - Adam D Brown
- Department of Psychology, New School for Social Research
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine
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19
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Killeen TK, Brewerton TD. Women with PTSD and Substance Use Disorders in a Research Treatment Study: A Comparison of those with and without the Dissociative Subtype of PTSD. J Trauma Dissociation 2023; 24:229-240. [PMID: 36266949 PMCID: PMC9905299 DOI: 10.1080/15299732.2022.2136327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/14/2022] [Accepted: 08/12/2022] [Indexed: 02/07/2023]
Abstract
Significant differences in clinical features have been reported in women with substance use disorders (SUDs) between those with the dissociative subtype of posttraumatic stress disorder (D-PTSD) compared to those without, namely more severe trauma histories, PTSD symptoms, and general psychopathology. This presentation reports on a group of 88 women with PTSD and SUD taking part in a research treatment study. All women were assessed using the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and were categorized into those with (n = 23, 26%) and without (n = 65, 74%) D-PTSD. Assessments for SUDs were via the Multi-International Neuropsychiatric Inventory, Seventh Version (MINI-7). Compared to those without D-PTSD, those with D-PTSD had significantly higher CAPS-5 scores (50.5 ± 9.9 v. 39.6 ± 8.8), greater number of PTSD symptoms (16.4 ± 2.6 v. 14.2 ± 2.4), more alcohol use disorder (AUD) (65.2% v. 30.8%), and more non-cocaine stimulant use disorder (34.8% v. 12.3%). No significant differences were found for other SUDs. These women with SUDs and D-PTSD have higher degrees of PTSD severity as well as unique clinical presentations. Future research is needed to explore the significance of these findings for clinical assessment and treatment.
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Affiliation(s)
- Therese K. Killeen
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - Timothy D. Brewerton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
- Timothy D. Brewerton, MD, LLC, Mt. Pleasant, SC 29464
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20
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Nakamura A, Tanaka K. A boy with dissociative symptoms who benefited from biopsychosocial assessment. Pediatr Int 2023; 65:e15502. [PMID: 36790052 DOI: 10.1111/ped.15502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/06/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Akio Nakamura
- Department of Child and Adolescent Liaison, Division of Mental Health Care, National Center for Child Health and Development, Tokyo, Japan
- Faculty of Medicine, Department of Pediatrics, Juntendo University, Tokyo, Japan
| | - Kyoko Tanaka
- Department of Child and Adolescent Liaison, Division of Mental Health Care, National Center for Child Health and Development, Tokyo, Japan
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21
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Fung HW, Chien WT, Chan C, Ross CA. A Cross-Cultural Investigation of the Association between Betrayal Trauma and Dissociative Features. J Interpers Violence 2023; 38:NP1630-NP1653. [PMID: 35467456 DOI: 10.1177/08862605221090568] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Betrayal trauma theory proposes that betrayal and non-betrayal traumas are different in terms of their nature and impacts. The theory predicts that dissociation is more strongly related to betrayal than to non-betrayal trauma, however there is a lack of cross-cultural evaluation of the theory. One competing theory is the socio-cognitive model, which proposes that dissociative amnesia (DA) and identity dissociation (ID) are the results of social influence and are not trauma-related conditions. This study aimed to test the hypotheses based on betrayal trauma theory and investigated the relationship between trauma, dissociation and other mental health problems in two culturally different convenience samples of people seeking web-based educational interventions for dissociation (N = 83 English speakers and N = 82 Chinese speakers). Compared with childhood non-betrayal trauma, childhood betrayal trauma had a statistically stronger relationship with dissociation and borderline personality disorder (BPD) symptoms in both samples. DA and ID symptoms were cross-culturally associated with childhood betrayal trauma after controlling for other variables (including sample membership, age, depression levels, medication treatment and non-betrayal trauma). Participants with DA/ID symptoms reported significantly more trauma-related symptoms in both samples. The findings supported the cross-cultural application of the betrayal trauma theory for dissociative features and BPD symptoms. Implications for research and practice (e.g., child protection, assessment for survivors of childhood betrayal trauma) are highlighted.
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Affiliation(s)
- Hong Wang Fung
- The Department of Applied Social Sciences, 177361The Hong Kong Polytechnic University, Hong Kong
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Chitat Chan
- The Department of Applied Social Sciences, 177361The Hong Kong Polytechnic University, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, United States
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22
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Ross CA. The False Memory Debate A Reply to Otgaar. J Child Sex Abus 2023; 32:127-129. [PMID: 36658774 DOI: 10.1080/10538712.2023.2166887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
The author replies to a critique of his paper about false memories in an effort to clarify issues on which there is disagreement. A key point made is that the validity of dissociation as a phenomenon, that is, as reported symptoms, does not depend on theories about the mechanisms of dissociation. There are no proven mechanisms for any mental health symptoms or DSM-5 diagnoses including anxiety, depression, psychosis and substance use disorders.
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Affiliation(s)
- Colin A Ross
- Institute for Psychological Trauma, Richardson, TX, USA
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23
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Fung HW, Černis E, Shum MHY. Self-stigma predicts post-traumatic and depressive symptoms in traumatized individuals seeking interventions for dissociative symptoms: a preliminary investigation. Eur J Psychotraumatol 2023; 14:2251778. [PMID: 37682581 PMCID: PMC10494730 DOI: 10.1080/20008066.2023.2251778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Background: Previous studies showed that self-stigma is associated with poor clinical outcomes in people with serious mental illness, and is associated with post-traumatic stress disorder (PTSD). However, less is known about self-stigma in people with dissociative symptoms, which are often related to psychological trauma. This study examined whether baseline self-stigma would be associated with dissociative, PTSD and depressive symptoms at post-intervention, after controlling for treatment usage and baseline symptom severity, in a sample of traumatized Chinese adults undertaking a psychoeducation intervention for dissociative symptoms.Methods: We conducted a secondary analysis of data from a 60-day web-based psychoeducation programme. A total of 58 participants who provided data before and after the intervention were included for analysis. Hierarchical regression analyses were conducted.Results: In this highly traumatized, dissociative, and symptomatic help-seeking sample, baseline self-stigma was associated with PTSD (β = .203, p = .032) and depressive (β = .264, p = .025) symptoms at post-intervention, even after controlling for baseline symptom severity, age, location, number of sessions attended in the web-based psychoeducation programme, and use of psychological treatments for PTSD/dissociative symptoms. However, self-stigma was not associated with dissociative symptoms (p = .108).Conclusions: This is the first study showing that self-stigma is a significant predictor of comorbid symptoms (i.e. PTSD and depressive symptoms) in people seeking interventions for dissociative symptoms. The findings that post-traumatic and dissociative symptoms have different relationships to self-stigma also highlight the possibility dissociation might be an independent psychological construct closely associated with trauma, but not merely a PTSD symptom, although further studies are necessary. The preliminary findings call for more efforts to understand, prevent, and address self-stigma in people with trauma-related mental health issues such as dissociative symptoms.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Emma Černis
- School of Psychology, University of Birmingham, Birmingham, UK
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24
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Lebois LAM, Kumar P, Palermo CA, Lambros AM, O'Connor L, Wolff JD, Baker JT, Gruber SA, Lewis-Schroeder N, Ressler KJ, Robinson MA, Winternitz S, Nickerson LD, Kaufman ML. Deconstructing dissociation: a triple network model of trauma-related dissociation and its subtypes. Neuropsychopharmacology 2022; 47:2261-2270. [PMID: 36202907 PMCID: PMC9630268 DOI: 10.1038/s41386-022-01468-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022]
Abstract
Trauma-related pathological dissociation is characterized by disruptions in one's sense of self, perceptual, and affective experience. Dissociation and its trauma-related antecedents disproportionately impact women. However, despite the gender-related prevalence and high individual and societal costs, dissociation remains widely underappreciated in clinical practice. Moreover, dissociation lacks a synthesized neurobiological model across its subtypes. Leveraging the Triple Network Model of psychopathology, we sought to parse heterogeneity in dissociative experience by examining functional connectivity of three core neurocognitive networks as related to: (1) the dimensional dissociation subtypes of depersonalization/derealization and partially-dissociated intrusions; and, (2) the diagnostic category of dissociative identity disorder (DID). Participants were 91 women with and without: a history of childhood trauma, current posttraumatic stress disorder (PTSD), and varied levels of dissociation. Participants provided clinical data about dissociation, PTSD symptoms, childhood maltreatment history, and completed a resting-state functional magnetic resonance imaging scan. We used a novel statistical approach to assess both overlapping and unique contributions of dissociation subtypes. Covarying for age, childhood maltreatment and PTSD severity, we found dissociation was linked to hyperconnectivity within central executive (CEN), default (DN), and salience networks (SN), and decreased connectivity of CEN and SN with other areas. Moreover, we isolated unique connectivity markers associated with depersonalization/derealization in CEN and DN, to partially-dissociated intrusions in CEN, and to DID in CEN. This suggests dissociation subtypes have robust functional connectivity signatures that may serve as targets for PTSD/DID treatment engagement. Our findings underscore dissociation assessment as crucial in clinical care, in particular, to reduce gender-related health disparities.
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Affiliation(s)
- Lauren A M Lebois
- McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Poornima Kumar
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Ashley M Lambros
- McLean Hospital, Belmont, MA, USA
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, Belmont, MA, USA
| | | | - Jonathan D Wolff
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, MA, USA
| | - Justin T Baker
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Staci A Gruber
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, Belmont, MA, USA
| | | | - Kerry J Ressler
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Matthew A Robinson
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sherry Winternitz
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lisa D Nickerson
- 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
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25
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Masuda R, Oe M, Kakuma T, Uchimura N. Development of a Subclinical Dissociation Scale by Comparing Healthy Controls with Patients. Kurume Med J 2022; 67:65-75. [PMID: 36288960 DOI: 10.2739/kurumemedj.ms6723002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We developed a Subclinical Dissociation Scale by comparing healthy controls with patients with post-traumatic stress disorder (PTSD) or dissociative disorder. The Dissociative Experiences Scale, Subclinical Dissociation Scale, and General Health Questionnaire were completed by 441 healthy Japanese adolescents (mean age, 19.9 years) and 23 psychiatric inpatients (mean age, 28.8 years) diagnosed with PTSD or dissociative disorder. The initial Subclinical Dissociation Scale included 52 items grouped into five factors: F1, absentmindedness (14 items); F2, immersion or preoccupation (15 items); F3, temporary amnesia (10 items); F4, feelings of unreality (eight items); and F5, feelings of alienation (five items). Factor and correlation analyses revealed the validity and reliability of the Subclinical Dissociation Scale. The final version of the scale that comprised three factors (F1, F2, and F4) and 37 items underwent logistic regression and receiver operating characteristic (ROC) curve analyses to compare healthy controls with patients with PTSD or dissociative disorder. The ROC curve analysis using the Youden Index indicated a cut-off score of 18 for the borderline or abnormal range, which was calculated using the following formula: "(F1) + (F4) - (F2)." This study provides evidence of the partial test-retest reliability and con current validity of the Subclinical Dissociation Scale.
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Affiliation(s)
- Ryota Masuda
- Department of Psychology, School of Human Sciences, Sugiyama Jogakuen University
| | - Misari Oe
- Department of Neuropsychiatry, Kurume University School of Medicine
| | | | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine
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Ross CA, Ridgway J, Neighbors Q, Myron T. Reversal of Amnesia for Trauma in a Sample of Psychiatric Inpatients with Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified. J Child Sex Abus 2022; 31:550-561. [PMID: 35437119 DOI: 10.1080/10538712.2022.2067096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/27/2022] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
The authors interviewed 118 highly dissociative inpatients in a Trauma Program with the Dissociative Disorders Interview Schedule, the Dissociative Experiences Scale and the Adverse Childhood Experiences questionnaire; of the 118 participants 42 met DSM-5 criteria for dissociative identity disorder and 52 for other specified dissociative disorder. The average score on the Dissociative Experiences Scale in the sample of 118 participants was 44.7. The authors also conducted semi-structured interviews inquiring about the circumstances and triggers for reversal of amnesia for childhood trauma in the participants. Only a small minority of the reversal of amnesia took place in therapy sessions, and 24 different triggers for remembering were described. Childhood sexual abuse was by far the most common type of trauma for which amnesia was reversed. The findings are inconsistent with the view that amnesia for childhood sexual abuse is reversed primarily during psychotherapy.
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Visser E, Den Oudsten BL, Lodder P, Gosens T, De Vries J. Psychological risk factors that characterize acute stress disorder and trajectories of posttraumatic stress disorder after injury: a study using latent class analysis. Eur J Psychotraumatol 2022; 13:2006502. [PMID: 35087642 PMCID: PMC8788340 DOI: 10.1080/20008198.2021.2006502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 10/13/2021] [Accepted: 11/07/2021] [Indexed: 11/04/2022] Open
Abstract
Background The course and different characteristics of acute and posttraumatic stress disorder (ASD, PTSD) in trauma populations are unclear. Objective The aims were to identify longitudinal trajectories of PTSD, to establish a risk profile for ASD and PTSD based on patients' sociodemographic, clinical, and psychological characteristics, and to study the effect of ASD and dissociation on PTSD during 12 months after trauma. Method Patients completed questionnaires after inclusion and at 3, 6, 9, and 12 months afterwards. Trajectories were identified using repeated measures latent class analysis (RMLCA). The risk profile was based on a ranking of importance of each characteristic using Cohen's d effect sizes and odds ratios. The impact of ASD and dissociation on PTSD was examined using logistic regression analyses. Results Altogether, 267 patients were included. The mean age was 54.0 (SD = 16.1) and 62% were men. The prevalence rate of ASD was approximately 21.7% at baseline, and 36.1% of trauma patients exhibited PTSD at 12 months after injury. Five trajectories were identified: (1) no PTSD symptoms, (2) mild, (3) moderate, (4) subclinical, and (5) severe PTSD symptoms. These trajectories seemed to remain stable over time. Compared with patients in other trajectories, patients with ASD and (subclinical) PTSD were younger and scored higher on anxiety, depressive symptoms, neuroticism, and trait anxiety. Regarding dissociation symptoms, inability to recall memories about the event was significantly more present than an altered sense of reality, (105 (40.7%) versus 56 (21.7%), p = .031), although that symptom had the strongest likelihood for PTSD. Patients with dissociation were significantly at risk for PTSD than patients without dissociation (OR = 4.82; 95%CI: 1.91-12.25). Conclusions Psychological factors characterized ASD and trajectories of PTSD during 12 months post-trauma. Healthcare providers who are aware of these findings could early identify patients at risk for ASD and PTSD and refer them for patient-centred interventions.
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Affiliation(s)
- Eva Visser
- Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
- Department of Medical Psychology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | | | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopaedics, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Jolanda De Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Macarenco MM, Opariuc-Dan C, Nedelcea C. Childhood trauma, dissociation, alexithymia, and anger in people with autoimmune diseases: A mediation model. Child Abuse Negl 2021; 122:105322. [PMID: 34508924 DOI: 10.1016/j.chiabu.2021.105322] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/23/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite research linking dissociation, alexithymia, and anger with childhood trauma and ADs, the investigation addressing the relationships between the potential mediators has not yet been established within the literature. OBJECTIVE The present study examined the relationship between childhood trauma and autoimmune disorders, using a multiple mediation model that included dissociation, alexithymia, and anger as hypothesized mediators. PARTICIPANTS AND SETTING 306 autoimmune patients and 292 self-declared healthy controls were included in the study. They completed self-report questionnaires regarding childhood abuse, alexithymia, dissociation, and anger. METHODS Multiple mediation analysis was conducted to investigate the study's proposed model. RESULTS The results of the Structural Equation Model (SEM) suggest an indirect relationship between childhood trauma and autoimmune disorders, mediated by dissociation [z = 4.57, p < .01, β = 0.19, 90% CI (0.08-0.10)], alexithymia [z = 10.74, p < .01, β = 0.43, 90% CI (0.08-0.10)], but not by anger [z = 1.58, p = .11, 90% CI (0.08-0.10)]. CONCLUSIONS These findings are in line with previous studies that show associations between childhood trauma, dissociation, alexithymia, and ADs. They indicate that mental health professionals and medical doctors should assess childhood trauma in autoimmune patients. They also should consider the possible maintaining role of dissociation and alexithymia in the treatment of autoimmune diseases.
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Schroter FA, Günther BA, Jansen P. The effects of subliminal or supraliminal sadness induction on the sense of body ownership and the role of dissociative symptoms. Sci Rep 2021; 11:22274. [PMID: 34782628 PMCID: PMC8592987 DOI: 10.1038/s41598-021-01039-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022] Open
Abstract
Previous research has shown that emotions can alter our sense of ownership. Whether this relationship is modulated by differences in emotion experience and awareness, however, remains unclear. We investigated this by comparing the susceptibility to the rubber hand illusion (RHI) between participants who were either exposed to a low-arousing emotion induction (sadness) or placed in a neutral control group. Several factors that might influence this relationship were considered: dissociative symptoms were included to observe if a sadness induction led to a higher RHI score in participants scoring high in dissociation, as a result of detached emotion experience. Whether the level of awareness of the emotion mattered was also tested, as subliminal processing was shown to require less focal attention. Therefore, our sample (N = 122) was divided into three experimental groups: Sad pictures were presented to two of the three groups differing in presentation mode (subliminal: n = 40, supraliminal: n = 41), neutral pictures were presented supraliminally to the control group (n = 41). Additionally, the effects of slow (3 cm/s) and fast (30 cm/s) stroking, applied either synchronously or asynchronously, were examined as the comforting effects of stroking might interfere with the emotion induction. Results showed that the supraliminal sadness induction was associated with a stronger subjective illusion, but not with a higher proprioceptive drift compared to the subliminal induction. In addition, a stronger subjective illusion after fast and synchronous stroking was found compared to slow and asynchronous stroking. A significant proprioceptive drift was detected independent of group and stroking style. Both slow and synchronous stroking were perceived as more comforting than their respective counterparts. Participants with higher dissociative symptoms were more susceptible to the subjective illusion, especially in the supraliminal group in the synchronous condition. We concluded that individual differences in emotion experience are likely to play a role in body ownership. However, we cannot clarify at this stage whether differences in proprioception and the subjective illusion depend on the type of emotion experienced (e.g. different levels of arousal) and on concomitant changes in multisensory integration processes.
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Affiliation(s)
| | - Bianca A Günther
- Faculty of Human Sciences, University of Regensburg, Regensburg, Germany
| | - Petra Jansen
- Faculty of Human Sciences, University of Regensburg, Regensburg, Germany
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Goldstein LH, Robinson EJ, Mellers JDC, Stone J, Carson A, Chalder T, Reuber M, Eastwood C, Landau S, McCrone P, Moore M, Mosweu I, Murray J, Perdue I, Pilecka I, Richardson MP, Medford N. Psychological and demographic characteristics of 368 patients with dissociative seizures: data from the CODES cohort. Psychol Med 2021; 51:2433-2445. [PMID: 32389147 PMCID: PMC8506352 DOI: 10.1017/s0033291720001051] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND We examined demographic, clinical, and psychological characteristics of a large cohort (n = 368) of adults with dissociative seizures (DS) recruited to the CODES randomised controlled trial (RCT) and explored differences associated with age at onset of DS, gender, and DS semiology. METHODS Prior to randomisation within the CODES RCT, we collected demographic and clinical data on 368 participants. We assessed psychiatric comorbidity using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and a screening measure of personality disorder and measured anxiety, depression, psychological distress, somatic symptom burden, emotional expression, functional impact of DS, avoidance behaviour, and quality of life. We undertook comparisons based on reported age at DS onset (<40 v. ⩾40), gender (male v. female), and DS semiology (predominantly hyperkinetic v. hypokinetic). RESULTS Our cohort was predominantly female (72%) and characterised by high levels of socio-economic deprivation. Two-thirds had predominantly hyperkinetic DS. Of the total, 69% had ⩾1 comorbid M.I.N.I. diagnosis (median number = 2), with agoraphobia being the most common concurrent diagnosis. Clinical levels of distress were reported by 86% and characteristics associated with maladaptive personality traits by 60%. Moderate-to-severe functional impairment, high levels of somatic symptoms, and impaired quality of life were also reported. Women had a younger age at DS onset than men. CONCLUSIONS Our study highlights the burden of psychopathology and socio-economic deprivation in a large, heterogeneous cohort of patients with DS. The lack of clear differences based on gender, DS semiology and age at onset suggests these factors do not add substantially to the heterogeneity of the cohort.
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Affiliation(s)
- Laura H. Goldstein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Emily J. Robinson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
- King's College London, School of Population Health and Environmental Sciences, UK
| | | | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Trudie Chalder
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Carole Eastwood
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Sabine Landau
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Paul McCrone
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Michele Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK
| | - Iris Mosweu
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Joanna Murray
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Iain Perdue
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Izabela Pilecka
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Mark P. Richardson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Nick Medford
- South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
BACKGROUND Endometrial tissue plays an important role in the regulation of female fertility and there is evidence that endometrial pathology (including endometriosis) is closely related to endocrine disorders. On the other hand, various neuroendocrine changes can be significantly affected by psychosocial stress. In connection with these findings, we tested the relationship between neuroendocrine changes, sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms in women with endometriosis. METHODS A total of 65 patients with endometriosis were included in the study. Clinical examinations were focused on the biochemical analysis of neuroendocrine markers of endometriosis (cancer antigen 125 [CA 125] and cancer antigen 19-9 [CA 19-9]), estradiol, psychometric evaluation of sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms. RESULTS The results showed significant Spearman correlations between the values of the revised range of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale), psychosocial/traumatic stress (Trauma Symptoms Checklist) (R = 0.31), and dissociative symptoms (Somatoform Dissociation Questionnaire) (R = 0.33). Positive correlations were also found between CA 125 and CA 19-9 (R = 0.63), and between CA 125 and the results of the values of the revised scale of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale) (R = 0.29). Also psychosocial/traumatic stress (Trauma Symptoms Checklist) significantly correlated with CA 125 (R = 0.38) and with CA 19-9 (R = 0.33). CONCLUSION These results represent the first findings regarding the relationship of the neuroendocrine markers CA 125 and CA 19-9 and sexual dysfunction with trauma/stress-related symptoms and dissociative symptoms in women with endometriosis.
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Affiliation(s)
- Ludek Fiala
- Institute of Sexology, Psychiatric Clinic, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Sexology, Department of Psychiatry, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Jiri Lenz
- Department of Pathology, Znojmo Hospital, Czech Republic
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Czech Republic
| | - Petr Bob
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Sojka P, Paredes-Echeverri S, Perez DL. Are Functional (Psychogenic Nonepileptic) Seizures the Sole Expression of Psychological Processes? Curr Top Behav Neurosci 2021; 55:329-351. [PMID: 33768494 DOI: 10.1007/7854_2021_225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional [psychogenic nonepileptic/dissociative] seizures (FND-seiz) and related functional neurological disorder subtypes were of immense interest to early founders of modern-day neurology and psychiatry. Unfortunately, the divide that occurred between the both specialties throughout the mid-twentieth century placed FND-seiz at the borderland between the two disciplines. In the process, a false Cartesian dualism emerged that labeled psychiatric conditions as impairments of the mind and neurological conditions as disturbances in structural neuroanatomy. Excitingly, modern-day neuropsychiatric perspectives now consider neurologic and psychiatric conditions as disorders of both brain and mind. In this article, we aim to integrate neurologic and psychiatric perspectives in the conceptual framing of FND-seiz. In doing so, we explore emerging relationships between symptoms, neuropsychological constructs, brain networks, and neuroendocrine/autonomic biomarkers of disease. Evidence suggests that the neuropsychological constructs of emotion processing, attention, interoception, and self-agency are important in the pathophysiology of FND-seiz. Furthermore, FND-seiz is a multi-network brain disorder, with evidence supporting roles for disturbances within and across the salience, limbic, attentional, multimodal integration, and sensorimotor networks. Risk factors, including the magnitude of previously experienced adverse life events, relate to individual differences in network architecture and neuroendocrine profiles. The time has come to use an integrated neuropsychiatric approach that embraces the closely intertwined relationship between physical health and mental health to conceptualize FND-seiz and related functional neurological disorder subtypes.
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Affiliation(s)
- Petr Sojka
- Department of Psychiatry, University Hospital Brno, Brno, Czech Republic.
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Divisions, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Perez
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology and Neuropsychiatry Divisions, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Álvarez MJ, Masramom H, Foguet-Boreu Q, Tasa-Vinyals E, García-Eslava JS, Roura-Poch P, Escoté-Llobet S, Gonzalez A. Childhhood Trauma in Schizophrenia Spectrum Disorders: Dissociative, Psychotic Symptoms, and Suicide Behavior. J Nerv Ment Dis 2021; 209:40-48. [PMID: 33079796 DOI: 10.1097/nmd.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Current evidence suggests a high prevalence of childhood trauma (CT) among adult patients diagnosed with schizophrenia spectrum disorders. Exposure to CT might lead to clinical differences eventually observed in these patients. We present a cross-sectional study with 54 patients with schizophrenia spectrum disorder (schizophrenia and schizoaffective disorder). We obtained sociodemographic data, as well as data on CT, dissociation, suicide history, and intensity of positive and negative psychotic symptoms. More than 75% of the patients reported a history of CT. We observed a link between CT and suicidal behavior. Patients showed high rates of dissociation. Dissociative experiences were related to CT, both in terms of intensity of trauma and number of traumas experienced. All CT forms except emotional neglect showed direct correlations with dissociative experiences. We found no correlation between intensity of CT and intensity of positive psychotic symptoms, yet we observed a moderate inverse correlation with negative psychotic symptoms.
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Affiliation(s)
| | | | | | - Elisabet Tasa-Vinyals
- Department of Psychiatry and Mental Health, Osona Salut Mental, Consorci Hospitalari de Vic
| | | | | | - Santiago Escoté-Llobet
- Department of Psychiatry and Mental Health, Osona Salut Mental, Consorci Hospitalari de Vic
| | - Anabel Gonzalez
- Mental Health Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Ren Z, Hood RW, Su Q, Sa A. Traditionality, Spirituality and Somatoform Dissociation Symptoms in Chinese Buddhists. J Relig Health 2020; 59:3257-3269. [PMID: 30919227 DOI: 10.1007/s10943-019-00793-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To evaluate the relationship between spiritual experience and hysterical experiences in Buddhist participants in ethnic groups in China, this cross-sectional study recruited 39 participants aged 16-57 years old, and self-administered surveys were administered in two villages, one city and one town by four research assistants in the Inner Mongolia and Qinhai areas. Binary logistic regression analyses were used to evaluate the factors associated with somatoform dissociation symptoms. Surveys were completed by 639 participants (mean age 31 years; 54.6% females) in 2017. Binary regression models showed that diverging from tradition and having a college education or above were associated with suffering from somatoform dissociation symptoms. By contrast, participants with higher experiences and older people were less likely to experience somatoform dissociation symptoms. Our current research highlights the contribution of spiritual experiences and traditional values to reducing somatization dissociation symptoms, and the findings could help to promote a new relationship between psychiatry and spiritual experiences that will benefit both mental health professionals and those who seek their assistance.
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Affiliation(s)
- Zhengjia Ren
- Department of Clinical Psychology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
| | - Ralph W Hood
- Department of Psychology, University of Tennessee at Chattanooga, Chattanooga, USA
| | - Qiuyu Su
- Culverhouse College of Commerce, University of Alabama, Tuscaloosa, USA
| | - Angsi Sa
- Southwest MinZu University, Chengdu, China
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Read J, Jordan H, Perdue I, Purnell J, Murray J, Chalder T, Reuber M, Stone J, Goldstein LH. The experience of trial participation, treatment approaches and perceptions of change among participants with dissociative seizures within the CODES randomized controlled trial: A qualitative study. Epilepsy Behav 2020; 111:107230. [PMID: 32640411 PMCID: PMC7581898 DOI: 10.1016/j.yebeh.2020.107230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/17/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nested within a large, multicenter randomized controlled trial (RCT) for people with dissociative seizures (DS), the study used purposive sampling to explore participants' experience of participating in an RCT, their experience of DS-specific cognitive behavioral therapy (CBT) and another component of the RCT, Standardized Medical Care (SMC) and their perceptions of and reflections on seizure management and change. METHODS A qualitative study using semistructured interviews was conducted with 30 participants in an RCT (the COgnitive behavioral therapy vs standardized medical care for adults with Dissociative non-Epileptic Seizures (CODES) Trial) investigating the effectiveness of two treatments for DS. Key themes and subthemes were identified using thematic framework analysis (TFA). RESULTS Analysis yielded three overarching themes: taking part in a treatment trial - "the only thing out there", the experience of treatment techniques that were perceived to help with seizure management, and reflections on an "unpredictable recovery". CONCLUSIONS People with DS are amenable to participating in a psychotherapy RCT and described a largely positive experience. They also described the applicability of aspects of DS-specific CBT and SMC in the management of their DS, received within the confines of the CODES trial. Factors that appeared to account for the variability in response to treatment delivery included individual preferences for the nature of sessions, the nature of therapeutic relationships, readiness to discuss trauma, other aspects of emotional avoidance, and whether therapy provided something new.
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Affiliation(s)
- Julie Read
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Harriet Jordan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Iain Perdue
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - James Purnell
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Joanna Murray
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Trudie Chalder
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Jon Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Laura H Goldstein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
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Abstract
A psychosomatic model of dissociation is proposed that addresses the ever adjusting mind-body relation-the constant titration of the quality and degree of the psyche's embeddedness in the sensorial and temporal life of the body. The model highlights the function of hypnoid mechanisms (autohypnosis, distraction, somatic autostimulation) and of altered states of consciousness in facilitating and masking the work of mind-body dissociation. Transient altered states, which enable new and creative forms of mind-body experience in everyday life and in the therapy situation, are contrasted with pathological forms of retreat into alter worlds-rigidly organized, timeless, often inescapable trancelike states of mind-body dislocation. These pathological dissociative structures reshape the life of the mind and of the body, requiring new clinical approaches to these phenomena.
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Gómez JM. It Hurts When You're Close: High Betrayal Sexual Trauma, Dissociation, and Suicidal Ideation in Young Adults. Violence Vict 2020; 35:712-723. [PMID: 33060252 DOI: 10.1891/vv-d-19-00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual trauma (e.g., rape), is associated with dissociation and suicidal ideation (SI). Sexual trauma is additionally harmful when perpetrated by a person(s) who is close or trusted (known as high betrayal). With young adulthood as a high-risk period for mental instability, the purpose of the current study is to examine the roles of high betrayal sexual trauma and dissociation in SI among young adults. Participants (N = 192) were college students who completed the 30-minute online survey. A multivariate analysis of variance (MANOVA) found that high betrayal sexual trauma was associated with dissociation and SI. Moreover, there was an indirect effect of high betrayal sexual trauma on SI through dissociation. Empirical implications include examining these associations longitudinally, with a focus on the impact of revictimization over time.
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Longo P, Panero M, Amodeo L, Demarchi M, Abbate-Daga G, Marzola E. Psychoform and somatoform dissociation in anorexia nervosa: A systematic review. Clin Psychol Psychother 2020; 28:295-312. [PMID: 32918777 DOI: 10.1002/cpp.2517] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
Dissociation is a debilitating condition often present as comorbidity in patients with eating disorders, but to date only sparse findings are available on this topic. Additionally, very little data exist on the classification of dissociation, namely, psychoform and somatoform, in anorexia nervosa (AN). This review aimed to provide an updated view on the literature about dissociation in AN, with a focus on AN subtypes (i.e., restricter and binge-purging) as well as dissociation type (i.e., psychoform and somatoform), when available. We screened 304 studies, and after title and abstract selection and full-text reading, 29 of them were included in this review. Most of the studies investigated psychoform dissociation, whereas just four publications considered somatoform dissociation. Dissociation resulted to be present in AN more than in healthy controls and in individuals with other psychiatric disorders, and it was related mostly to the binge-purging subtype of AN. Moreover, dissociation was linked to traumatic events, self-harm and negative treatment outcomes, especially in patients affected by the binge-purging subtype of AN. However, results on these matters are scarce and partially discordant. The methodological assessment we performed revealed an overall fair quality of the included studies, although several flaws emerged as well. The present review reported on one hand the relevance of dissociation in AN, but on the other hand the need to stimulate the scientific debate on (a) a deeper investigation of somatoform dissociation in AN and (b) the relationship between dissociation and both clinical severity and treatment response/resistance in AN.
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Affiliation(s)
- Paola Longo
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Panero
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Laura Amodeo
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matilde Demarchi
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
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Abstract
OBJECTIVE Several studies have raised doubts about the effectiveness of posttraumatic growth (PTG) as a mechanism that promotes functioning. This study explored this issue in several directions: First, it examined whether functioning is negatively associated with posttraumatic symptoms (PTS), dissociation, and depression. Second, it determined whether PTG is positively associated with functioning. Finally, the study investigated whether PTG moderates the relationship between functioning and PTS, as well as between functioning and dissociation and depression. METHOD The participants were 301 residents of an area exposed to the 2006 war in northern Israel. A structured questionnaire assessing posttraumatic stress disorder, depression, dissociation, PTG, and functioning was used 6 years following the war. RESULTS Functioning was found to be negatively associated with PTS, dissociation, and depression. PTG was found to be positively associated with functioning. In addition, PTG was found to moderate the relationship between functioning and PTS, as well as between functioning and dissociation and depression. CONCLUSIONS Contrary to the approach that considers PTG to be an illusion, and possibly even a mechanism that may hinder a return to efficient functioning, the findings of this research suggest that PTG may reflect a growth phenomenon that includes functioning, thus implying a characteristic of the individual's relation to the world. Therefore, it may be concluded that PTG is not an illusion-a process that occurs only in one's head-but rather reflects actual functioning. The theoretical and practical implications of these findings are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Lawson DM, Akay-Sullivan S. Considerations of Dissociation, Betrayal Trauma, and Complex Trauma in the Treatment of Incest. J Child Sex Abus 2020; 29:677-696. [PMID: 32520663 DOI: 10.1080/10538712.2020.1751369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/14/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
Child sexual abuse committed by a parent (incest) is related to particularly severe physical and psychological symptoms across the life span. Incest is associated with low self-esteem, self-loathing, feelings of contamination, worthlessness, and helplessness, as well as somatization and low self-efficacy. A child's negative constructions often are attempts to derive some meaning that justifies the incest, such as, "it is because of my badness that it happens to me." Survival often involves voluntary or involuntary disconnection from self, others, and the environment, or compartmentalization of the traumatic experiences. Dissociation with survivors of child abuse, especially when the perpetrators are from within the child's caregiver system, can be accounted for by the concept of betrayal trauma. However, with few exceptions, little appears in the literature integrating dissociation, betrayal trauma, complex trauma, and incest for the purpose of treatment. Our purpose of this review to examine the relationship between trauma-related dissociation, betrayal trauma, and complex trauma, and how understanding these concepts and their relationship can inform the treatment of incest.
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Affiliation(s)
- David M Lawson
- Department of Counselor Education, Sam Houston State University , Huntsville, TX
| | - Sinem Akay-Sullivan
- Department of Counselor Education, Sam Houston State University , Huntsville, TX
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Koreki A, Garfkinel SN, Mula M, Agrawal N, Cope S, Eilon T, Gould Van Praag C, Critchley HD, Edwards M, Yogarajah M. Trait and state interoceptive abnormalities are associated with dissociation and seizure frequency in patients with functional seizures. Epilepsia 2020; 61:1156-1165. [PMID: 32501547 PMCID: PMC7737228 DOI: 10.1111/epi.16532] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Dissociative traits represent a disturbance in selfhood that may predispose to, and trigger, functional seizures (FSs). The predictive representation and control of the internal physiological state of the body (interoception) are proposed to underpin the integrity of the sense of self ("minimal selfhood"). Therefore, discrepancies between objective and subjective aspects of interoception may relate to symptom expression in patients with FSs. Here, we tested whether individual differences in trait measures of interoception relate to dissociative symptoms, and whether state interoceptive deficits predict FS occurrence. METHODS Forty-one participants with FSs and 30 controls completed questionnaire ratings of dissociation, and measures of (1) interoceptive accuracy (IA)-objective performance on heartbeat detection tasks; (2) trait interoceptive sensibility-subjective sensitivity to internal sensations (using the Porges Body Perception Questionnaire); and (3) state interoceptive sensibility-subjective trial-by-trial measures of confidence in heartbeat detection. Interoceptive trait prediction error (ITPE) was calculated from the discrepancy between IA and trait sensibility, and interoceptive state prediction error (ISPE) from the discrepancy between IA and state sensibility. RESULTS Patients with FSs had significantly lower IA and greater trait interoceptive sensibility than healthy controls. ITPE was the strongest predictor of dissociation after controlling for trait anxiety and depression in a regression model. ISPE correlated significantly with FS frequency after controlling for state anxiety. SIGNIFICANCE Patients with FSs have disturbances in interoceptive processing that predict both dissociative traits reflecting the disrupted integrity of self-representation, and the expression of FSs. These findings provide insight into the pathophysiology of functional neurological disorder, and could lead to novel diagnostic and therapeutic approaches.
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Affiliation(s)
- Akihiro Koreki
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Department of NeuropsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
| | - Sarah N. Garfkinel
- Brighton and Sussex Medical School and The Sackler Centre for Consciousness ScienceUniversity of SussexSussexUK
| | - Marco Mula
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
| | - Niruj Agrawal
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
- Department of NeuropsychiatrySouth West London and St George's Mental Health TrustLondonUK
| | - Sarah Cope
- Department of NeuropsychiatrySouth West London and St George's Mental Health TrustLondonUK
| | - Talia Eilon
- Department of NeuropsychiatrySouth West London and St George's Mental Health TrustLondonUK
| | - Cassandra Gould Van Praag
- Brighton and Sussex Medical School and The Sackler Centre for Consciousness ScienceUniversity of SussexSussexUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Hugo D. Critchley
- Brighton and Sussex Medical School and The Sackler Centre for Consciousness ScienceUniversity of SussexSussexUK
| | - Mark Edwards
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
| | - Mahinda Yogarajah
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
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Birmes P, Brunet A, Benoit M, Defer S, Hatton L, Sztulman H, Schmitt L. Validation of the Peritraumatic Dissociative Experiences Questionnaire self-report version in two samples of French-speaking individuals exposed to trauma. Eur Psychiatry 2020; 20:145-51. [PMID: 15797699 DOI: 10.1016/j.eurpsy.2004.06.033] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Accepted: 06/21/2004] [Indexed: 11/16/2022] Open
Abstract
AbstractBackgroundPeritraumatic dissociation is a risk factor for developing PTSD. The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a self-report inventory used to assess dissociation that occurred at the time of a trauma. The aim of this study was the validation the PDEQ in French.MethodsNinety French speaking traumatized victims presenting to the emergency department were recruited. They were administered the PDEQ shortly after exposure and others trauma-related measures 2 weeks and 1 month posttrauma.ResultsPrincipal components factor analyses suggested a single factor solution for the PDEQ. Significant correlations between the PDEQ and acute and posttraumatic stress symptoms indicated moderate to strong convergent validity. The PDEQ also showed satisfactory test–retest reliability and internal consistency.ConclusionsThis study is the first one to investigate such detailed psychometric findings on the PDEQ. This confirms the unity of the concept of peritraumatic dissociation and the value of the PDEQ-French Version to assess it.
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Affiliation(s)
- Philippe Birmes
- Department of Psychiatry and Douglas Hospital Research Center, Psychosocial Research Division, McGill University, Montreal, Que. Canada.
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Keefe KM, Hetzel-Riggin MD, Sunami N. The Mediating Roles of Hostility and Dissociation in the Relationship Between Sexual Assault and Suicidal Thinking in College Students. J Interpers Violence 2020; 35:1635-1653. [PMID: 29294684 DOI: 10.1177/0886260517698282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sexual assault and suicide are two serious public health concerns. Research has documented the relationship between sexual assault and suicidal thinking and attempts; however, limited research explores the more multifaceted relationships between posttraumatic stress reactions and suicidal ideation in college students through unsuccessful modulation of emotion. The authors hypothesized a mediation model where the relationship between sexual assault and suicidal ideation is mediated by dissociation and hostility. In total, 1,677 undergraduate students were administered modified versions of the Traumatic Life Events Questionnaire (TLEQ), Symptom Checklist-90-Revised (SCL-90-R), and Peritraumatic Dissociative Experiences Questionnaire (PDEQ). The results revealed both significant partial but equal mediators of hostility and dissociation. However, a portion of the direct effect between sexual assault and suicidal ideation remained unaccounted for by indirect effects. The current model supports previous work on dialectical behavior therapy that says either side of the dialectic between extreme expression and suppression of hostility increases the likelihood of suicidal thinking after sexual assault. With sexual assault survivors, practitioners should use strategies that emphasize both anger expression and healthy avoidance as a way to modulate emotion to potentially reduce suicidal thoughts. Future research should focus on different gender models, additional possible mediators such as alcohol use and guilt, and different forms of sexual assault. Limitations of the correlational, cross-sectional methodology are discussed.
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Affiliation(s)
| | | | - Naoyuki Sunami
- Western Illinois University, Macomb, USA
- University of Delaware, Newark, USA
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44
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Boisclair Demarble J, Fortin C, D'Antono B, Guay S. Gender Differences in the Prediction of Acute Stress Disorder From Peritraumatic Dissociation and Distress Among Victims of Violent Crimes. J Interpers Violence 2020; 35:1229-1250. [PMID: 29294663 DOI: 10.1177/0886260517693000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Peritraumatic dissociation and distress are strong predictors of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) development. However, there is limited data concerning gender differences in these relations, particularly among victims of violent crimes (VVC). The objective of this study is to examine whether peritraumatic dissociation and distress predict the number of ASD symptoms differently for men and women VVC. In all, 162 adults (97 women, M age = 39.6 years), 63% of whom experienced physical assaults, completed the Acute Stress Disorder Interview, the Peritraumatic Dissociative Experience Questionnaire, and the Peritraumatic Distress Inventory. Analyses included t tests and multiple hierarchical regressions models controlling for known PTSD risk factors. The regression model showed dissociation and distress to be significant predictors of ASD for both men and women (β = .349 and β =.312 respectively; all p < .001). A significant three-way interaction was also observed between peritraumatic distress (PDI), past potentially traumatic experiences, and gender. In simple slopes analyses, the combination of high levels of PDI and of a high number of past potentially traumatic events were associated with greater risk of ASD in men only (b = 3.78, p < .001). However, women experienced greater PDI, t(157) = 5.844, p = .005, than men, and elevated distress was associated with more ASD symptoms independently of past traumatic events. Gender differences were revealed as a function of past potentially traumatic experiences. There is a cumulative impact of past potential traumas and current distress that predicts ASD in men, while in women, it contributes to ASD via increased distress.
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Affiliation(s)
- Julie Boisclair Demarble
- Department of Psychology, Université de Montreal, Québec, Canada
- Institut Universitaire en Santé Mentale de Montreal, Montreal, Quebec, Canada
| | - Christophe Fortin
- Trauma Studies Center, Institut Universitaire en Santé Mentale de Montreal
- Department of Psychology, Université d'Ottawa, Ottawa, Canada
| | - Bianca D'Antono
- Department of Psychology, Université de Montreal, Québec, Canada
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Stéphane Guay
- Trauma Studies Center, Institut Universitaire en Santé Mentale de Montreal
- School of Criminology, Université de Montreal, Québec, Canada
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Aymerich C, Madrazo A, Bustamante S, Blanco J, Gómez-Guimaraes D, Sesma E, González-Torres MÁ. Possession Phenomena: a Case Report. Actas Esp Psiquiatr 2020; 48:91-93. [PMID: 32463915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/01/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Clàudia Aymerich
- Servicio de Psiquiatría. Hospital de Basurto. Osakidetza, Bilbao
| | - Aranzazu Madrazo
- Servicio de Psiquiatría. Hospital de Basurto. Osakidetza, Bilbao
| | - Sonia Bustamante
- Servicio de Psiquiatría. Hospital de Basurto. Osakidetza, Bilbao
| | - Jorge Blanco
- Servicio de Psiquiatría. Hospital de Basurto. Osakidetza, Bilbao
| | | | - Eva Sesma
- Servicio de Psiquiatría. Hospital de Basurto. Osakidetza, Bilbao
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Černis E, Freeman D, Ehlers A. Describing the indescribable: A qualitative study of dissociative experiences in psychosis. PLoS One 2020; 15:e0229091. [PMID: 32074139 PMCID: PMC7029850 DOI: 10.1371/journal.pone.0229091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Despite its long history, dissociation remains under-recognised clinically, partly due to difficulties identifying dissociative symptoms. Qualitative research may support its recognition by providing a lived experience perspective. In non-affective psychosis, identification of dissociation may be particularly important given that such experiences have been implicated its development and maintenance. Therefore, this study aimed to understand in the context of psychosis: what it is like to experience dissociation; the impact dissociation might have; what factors begin, maintain or end dissociative experiences; and what beliefs people hold about dissociation. Methods Qualitative interviews were carried out with twelve NHS patients with non-affective psychosis diagnoses and experience of dissociation. Data were analysed using Thematic Analysis. Results Dissociation involves subjective strangeness, unreality, disconnection, and shifts in perception. It impacts on mental health (including psychotic experiences), daily functioning, emotional connection, and can lead to social withdrawal. Stress, fatigue, and excessive internal focus may be involved in development and maintenance. Participants found it very difficult to describe the experience of dissociation, and, as a result, often did not mention it to others. Even when shared, interviewees reported that their descriptions were misunderstood and therefore they did not receive information or support specific to dissociation. The consensus was that experiences of dissociation are negative, but that understanding them better helped to enable coping. Conclusions The core subjective experience of dissociation appears to be a felt sense of anomaly (FSA), and we therefore suggest clinicians proactively enquire about such experiences. Dissociation is distressing, and has multiple impacts, but can easily be overlooked due to difficulties describing it and behavioural similarities to negative psychotic symptoms such as withdrawal.
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Affiliation(s)
- Emma Černis
- Department of Psychiatry, Oxford Cognitive Approaches to Psychosis, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Daniel Freeman
- Department of Psychiatry, Oxford Cognitive Approaches to Psychosis, University of Oxford, Oxford, United Kingdom
| | - Anke Ehlers
- Department of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, University of Oxford, Oxford, United Kingdom
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Bartels RM, Harkins L, Beech AR. The Influence of Fantasy Proneness, Dissociation, and Vividness of Mental Imagery on Male's Aggressive Sexual Fantasies. J Interpers Violence 2020; 35:964-987. [PMID: 29294653 DOI: 10.1177/0886260517691523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many researchers have studied the prevalence and content of men's aggressive sexual fantasies, including their link with rape-supportive cognition. However, little to no research has examined the link between imaginal ability and the use of such fantasies. Based on existing research and theory, we propose that men who hold hostile beliefs toward women will use aggressive sexual fantasies more often if they possess a greater ability to engage in a "rich fantasy life." Operationally, we argue this involves (a) a proneness to fantasize in general, (b) an ability to vividly envision mental imagery, and (c) frequent experiences of dissociation. To test this, the present study hypothesized that a latent variable termed "rich fantasy life," via "hostile beliefs about women," influences the use of "aggressive sexual fantasies." A sample of 159 community males was recruited. Each participant completed a measure of fantasy proneness, dissociation, and vividness of mental imagery, along with two measures that assess hostile beliefs about women. Assessing how often the participants fantasized about rape-related and sadistic themes provided a measure of aggressive sexual fantasies. Structural equation modeling (along with bootstrapping procedures) indicated that the data had a very good fit with the hypothesized model. The results offer an important contribution to our understanding of aggressive sexual fantasies, which may have implications for clinical assessment and treatment. The limitations of the study are discussed, along with suggestions for future research.
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Affiliation(s)
| | - Leigh Harkins
- University of Ontario Institute of Technology, Oshawa, Canada
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48
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Abstract
The importance of human relations in understanding and treating trauma is evident not only from the severity of traumatization inflicted by human agency and the dissociation that ensues from traumatic interpersonal relations, but also from the analyst's affective participation which is essential to the reparation of the serious psychopathologies that originate in traumatization. Developing Ferenczi's theorizations, on the identification with the aggressor, I propose that after the abuse the traumatized subject identifies partly with the persecutor and partly with the victim, which sometimes is represented by the body itself, becoming the object of the destructiveness. Such unconscious identifications are accompanied by the dynamics of experiencing complex feelings of guilt and shame (the victim side) and the aggressiveness and anger, (the persecutor/persecuting side). It was Ferenczi who first described the potential for a therapist, acting benevolently and supportively as sole witness, to create the preconditions for the patient to re-contact long-dissociated parts, thanks to the implicit non-verbal and corporal exchange, a concept which is here explained as embodied testimony/witnessing and enactment, and unconscious communication of the right hemispheres of therapist and patient.
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Kolek A, Prasko J, Vanek J, Kantor K, Holubova M, Slepecky M, Nesnidal V, Latalova K, Ociskova M, Grambal A. Severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders Part 1: Relationships between clinical, psychosocial and demographic factors in pharmacoresistant panic disorder patients. Neuro Endocrinol Lett 2019; 40:233-246. [PMID: 32112548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Little is known about the relation between severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders. The aim of this study is to look for the intercorrelations between these factors. METHOD The study explores the relation between clinical, demographic and social factors in panic disorder using cross sectional design. The inpatients with pharmacoresistant panic disorder with and without agoraphobia were included in the study. Participants were also assessed for comorbidity with other anxiety or personality disorder. The Clinical Global Impression (CGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Dissociative Experiences Scale (DES), Internalized Stigma of Mental Illness (ISMI), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Panic Disorder Severity Scale (PDSS) and demographic data were used as measurement tools. RESULTS A total of 142 pharmacoresistant patients with panic disorder with or without agoraphobia were admitted for 6-week cognitive behavioral therapy inpatient program in psychotherapeutic department between November 2015 and July 2019. One hundred and five inpatients (33 males and 72 females) with mean age 37.8 + 12.1 years were included in the study. Sixty-nine patients suffer from additional comorbid anxiety disorder and 43 had comorbid personality disorder.
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Affiliation(s)
- Antonín Kolek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, 77520 Olomouc, Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, 77520 Olomouc, Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, 77520 Olomouc, Czech Republic
| | - Krystof Kantor
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, 77520 Olomouc, Czech Republic
| | | | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Slovakia
| | - Vlastimil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, 77520 Olomouc, Czech Republic
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, 77520 Olomouc, Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, 77520 Olomouc, Czech Republic
| | - Ales Grambal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, 77520 Olomouc, Czech Republic
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50
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Delcroix MH, Gomez C, Bayle B, Paraf F, Rusch E, Braillon A. [Total denial of pregnancy and childbirth: The death of the newborn is not criminal]. Presse Med 2019; 48:1580-1582. [PMID: 31757734 DOI: 10.1016/j.lpm.2019.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/30/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michel-Henri Delcroix
- APPRI maternité sans tabac à l'établissement public de santé mentale des Flandres, 59270 Bailleul, France
| | | | - Benoit Bayle
- Établissement public de santé Barthélémy-Durand, 91152 Étampes, France
| | - François Paraf
- Service de médecine légale, CHU Dupuytren, 87042 Limoges cedex 6, France
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