Association between negatively perceived parenting attitudes and dissociation: a cross-sectional study on the general population in Japan

Objectives

Many studies have reported that early traumatic experiences, mainly abuse, are associated with forming dangerous attachments and a contributing factor to dissociation. On the other hand, other studies have investigated the association of non-abusive nurturing and attachment styles with dissociation. The aim of this study is to determine the frequency of dissociative experiences in the general Japanese population and investigate the effects of "overprotection" and "lack of care" as nurturing styles and "abandonment anxiety" and "avoidance of intimacy" as attachment styles on dissociation.

Methods

A total of 1,042 residents aged 18 to 69 years were administered with the Dissociative Experiences Scale (DES), the Japanese version of the WHO-5 Well-Being Index (WHO-5-J), the Parental Bonding Instrument (PBI), and the Experiences in Close Relationships Inventory-the-generalized-other-version (ECR-GO). Hierarchical multiple regression analyses on the effects of "overprotection" and "care" as nurturing attitudes "abandonment anxiety" and "avoidance of intimacy" as attachment styles on dissociation (DES-NDI and DES-T) were conducted.

Results

Based on the findings of this study, "care" and "overprotection" as nurturing attitudes were shown to be a contributing factor to dissociation (DES-NDI and DES-T). "Avoidance of intimacy" as an attachment style was shown to contribute to pathological dissociation. On the other hand, the influence of attachment style on the relationship between nurturing style and dissociation was not determined.

Discussion

This study provided essential data on the distribution of dissociative experiences in the general Japanese population. It was indicated that nurturing style, particularly overprotection, may be linked to nonfunctional stress coping and interpersonal anxiety and could be a contributing factor to mental disorders, including dissociation. Furthermore, considering that the effect of nurturing styles on dissociation does not vary with attachment styles, the effect of nurturing styles on dissociation may be more profound.

The Multidimensional Inventory of Dissociation (MID) in Depersonalization Disorder: General Findings with a Clinical Emphasis on Memory and Identity Disturbances

The Multidimensional Inventory of Dissociation (MID) was administered to 23 participants diagnosed with DSM-IV-TR Depersonalization Disorder (DDD) by structured interview. The MID has not been previously examined in DDD and does not generate a diagnostic formula for the disorder. Mean MID score for the sample was modestly elevated at 18.54, and was significantly correlated with Dissociative Experiences Scale, Cambridge Depersonalization Scale, and Childhood Trauma Questionnaire scores. Criterion A (General Dissociation) Depersonalization and Depersonalization scale scores were markedly elevated (41.70 and 40.98 respectively), followed by moderate elevations in the Identity Confusion (36.01), Trance (25.44), and Memory Problems (23.30) scales. Criterion B (Intrusions from partly dissociated self-states) mean score was modestly elevated (19.13) and declined to 13.67 once items overlapping with the Depersonalization and Identity Confusion scales were excluded. Criterion C (fully dissociated manifestations of other self-states) mean score was minimally elevated (6.57). Of the 168 pathological dissociation items, 55 were clinically elevated in DDD. Closer examination of the Intrusions and Amnesia items that were modestly elevated in DDD revealed that these items did not reflect the presence of alters, but rather represented known depersonalization-related phenomena. We propose a preliminary formula, based on cutoff scores for Criterion A Depersonalization and/or Derealization, Criterion B, and Criterion C (≥20, ≤28, ≤11) for the sensitive diagnosis of DDD (82.6% of participants), which would require future investigation for replication and determination of specificity vis-à-vis the other dissociative disorders.

The Dissociative Taxon and Dissociative Identity Disorder

A total of 491 participants from four previous studies, 443 of whom were diagnosed with dissociative identity disorder (DID) on the Dissociative Disorders Interview Schedule, completed the Dissociative Experiences Scale (DES). Their results were analyzed to determine how many were in the dissociative taxon (DES-T) on the DES. Of the 443 individuals with DID, 419 (94.6%) were in the taxon, 13 (2.9%) were out of the taxon and 11 (2.5%) were indeterminate. The DES-T is therefore very effective at identifying people with DID as being in the dissociative taxon, although it does have a false negative rate of 5.4%. Out of 48 people with no dissociative disorder on the Dissociative Disorders Interview Schedule, the DES-T identified 26 (54.2%) as being in the taxon and 22 (45.8%) as being out of the taxon with no indeterminate cases. The clinical diagnoses of these 48 individuals are unknown: all were inpatients in the same Trauma Program. Thus, the sensitivity of the DES-T for confirming that individuals with DID are in the dissociative taxon was 94.6% and the specificity of the DES-T for confirming that individuals with no dissociative disorder are not in the dissociative taxon was 45.8%. It is possible that the DES-T yields false positives for taxon membership; this possibility should be investigated in future research.