Testing the dissociative taxon

A dissociative taxon has been proposed by Waller et al. (1996) to help identify individuals experiencing pathological dissociation. We studied the frequency of taxon membership and tested its validity. A total of 276 students and 204 psychiatric inpatients completed the Dissociative Experiences Scale (DES). In patients with higher DES ratings, the Dissociative Disorders Interview Schedule was administered. Taxon classification applied to 2.9% of non-patients and to 12.7% of patients. No statistically significant relationship was found between taxon membership and the clinical diagnosis of a dissociative disorder. Taxon membership indicates a higher frequency of dissociative experiences but cannot be equated with the presence of a dissociative disorder.     

Review of The dissociative mind

Reviews the book, The dissociative mind by Elizabeth F. Howell (see record 2005-14945-000). In her book, The Dissociative Mind, Elizabeth Howell presents a complex and thorough overview of what she describes as a "sea change" in psychoanalytic theory. From her vantage point as both psychoanalyst and traumatologist, she demonstrates how, in the last 15-20 years, relational trauma and the resulting impact on the individual mind-namely the splits and fissures that comprise dissociation- have made their way back into psychoanalytic thinking. Howell's elaboration of the overwhelmed, traumatized mind is very useful in clients who present with problems in thinking or who have limited capacity to symbolize. However, detailed clinical material of how an analyst thinking of dissociated self states would work with such a client, what Bromberg termed the "relational bridge," would support her fundamental assertions more effectively. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

The tactical-integration model for the treatment of dissociative identity disorder and allied dissociative disorders

The ebb and flow of the diagnosis of Dissociative Identity Disorder (DID) and other dissociative conditions has led to the evolution of theories and treatment modalities to resolve the fluctuating and ephemerous symptoms of these conditions. This paper summarizes the structured cognitive-behavioral-based treatment of dissociative disorders that will foster not only symptom relief but also an integration of the personalities and/or ego states into one mainstream of consciousness. This model of DID therapy is called the tactical integration model; it promotes proficiency over posttraumatic and dissociative symptoms, is collaborative and exploratory, and conveys a consistent message of empowerment to the patient.     

Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified

The aim of this study was to investigate axis-I comorbidity in patients with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). Using the Diagnostic Interview for Psychiatric Disorders, results from patients with DID (n = 44) and DDNOS (n = 22) were compared with those of patients with posttraumatic stress disorder (PTSD) (n = 13), other anxiety disorders (n = 14), depression (n = 17), and nonclinical controls (n = 30). No comorbid disorders were found in nonclinical controls. The average number of comorbid disorders in patients with depression or anxiety was 0 to 2. Patients with dissociative disorders averagely suffered from 5 comorbid disorders. The most prevalent comorbidity in DDNOS and DID was PTSD. Comorbidity profiles of patients with DID and DDNOS were very similar to those in PTSD (high prevalence of anxiety, somatoform disorders, and depression), but differed significantly from those of patients with depression and anxiety disorders. These findings confirm the hypothesis that PTSD, DID, and DDNOS are phenomenologically related syndromes that should be summarized within a new diagnostic category.     

The dissociative experiences of borderline patients

The study objective was to assess the severity and quality of dissociative experiences reported by borderline patients. Two hundred ninety criteria-defined borderline patients and 72 axis II controls completed the Dissociative Experiences Scale (DES), a 28-item self-report measure with demonstrated reliability and validity. Thirty-two percent of borderline patients had a low level of dissociation, 42% a moderate level, and 26% a high level similar to that reported by patients meeting criteria for posttraumatic stress disorder (PTSD) or dissociative disorders. The controls had a significantly different distribution of overall DES scores: 71% reported a low level of dissociation, 26% reported a moderate level, and only 3% reported a high level. In addition, borderline patients had a significantly higher score than the controls on 21 of 28 DES items and a significantly higher overall DES score, as well as the score on the 3 factors that have been found to underlie the DES, absorption, amnesia, and depersonalization. The results of this study suggest that the severity of dissociation experienced by borderline patients is more heterogeneous than previously reported. They also suggest that borderline patients have a wider range of dissociative experiences than are commonly recognized, including experiences of absorption and amnesia, as well as experiences of depersonalization.     

A case report of dissociative pseudodementia

The authors report the case of a patient admitted to a medical hospital for seizures and considered for more than 1 month to be demented. Psychiatric examination revealed a fluctuating cognitive capacity, suggesting a psychogenic etiology. Following a sodium amytal interview, the patient's symptoms dramatically resolved. Diagnosis, treatment, and the importance of considering dissociative pseudodementia are discussed.     

Cognitive behavioral hypnotherapy for dissociative disorders

Dissociative disorders (DD) prevail as sequelae to overwhelming experiences in childhood. These readily formed post-traumatic responses and trance states develop in high hypnotizable subjects whose dysregulations become organized into ego states. A cognitive behavioral hypnotherapeutic treatment model will effectively contain, explore, metabolize, and resolve these life-endangering conditions. This article will detail the cognitive hypnotic world of DD patients, the relational spaces of the ego states, and the triphasic treatment mode to successfully resolve the dissociative pathology. Structured and phase appropriate hypnotic interventions will be described.     

Introducing treatment for dissociative identity disorder

This paper is a case presentation and study of the introduction of treatment for Dissociative Identity Disorder (DID). Since one manifestation of the pathology of DID is that sufferers avoid relying on others, at the start of treatment we try to stabilise the relationship between clinicians and patients; that is to say, we aim to build a treatment relationship which will be able to gradually overcome the patients' dread of relying on clinicians. In parallel with this we undertake a thorough psychiatric assessment of their condition. This is a standard treatment plan, which follows the general principles of clinical psychiatry. On the other hand, the specialist aspect of DID treatment calls for handling the unique behaviours of a group of mutually opposed alternating personalities appropriately, while always paying consistent attention to the traumatic memories which are connected to the formation and maintenance of the condition. This paper presents the first DID case which the author has taken charge of. There were some difficulties in the early stages of treatment, but after modifying some parts to acknowledge the alternating personalities as independent personalities in face-to-face interviews and psychological education for families, the stabilisation of the treatment structure progressed gradually and the stability of the relationship between clinicians and patients itself has become the focus.     

Dissociative phenomenology of dissociative identity disorder

The goal of this study was to investigate the dissociative phenomenology of dissociative identity disorder (DID). The Multidimensional Inventory of Dissociation (MID) was administered to 34 patients with DID, 23 patients with dissociative disorder not otherwise specified (DDNOS), 52 patients with mixed psychiatric disorders, and 58 normal individuals. DID patients obtained significantly higher scores than the other three groups on 27 dissociation-related variables. DDNOS patients had significantly higher scores than normals and mixed psychiatric patients on 17 and 15 dissociation-related variables, respectively. The findings of the present study are virtually identical to a large body of replicated findings about the dissociative phenomenology of DID. This broad range of dissociation-related phenomena, which routinely occurs in individuals with DID, is largely absent from the DSM-IV-TR account of DID. Factor analysis of the 11 dimensions of dissociation that are measured by the MID extracted only one factor that accounted for 85% of the variance. It was concluded that dissociation is a unifactorial taxon or natural type that has different aspects or epiphenomena (i.e., amnesia, depersonalization, voices, trance, etc.).     

Differential diagnosis between dissociative disorders and schizophrenia

The differential diagnosis of dissociative disorders includes many psychiatric disorders, such as schizophrenia, bipolar disorders (especially bipolar II disorder), depressive disorder (especially atypical depression), epilepsy, Asperger syndrome, and borderline personality disorder. The theme of this paper is the differential diagnosis between dissociative disorders and schizophrenia. Schneiderian first-rank symptoms in schizophrenia are common in dissociative disorders, especially in dissociative identity disorder (DID). Many DID patients have been misdiagnosed as schizophrenics and treated with neuroleptics. We compared and examined Schneiderian symptoms of schizophrenia and those of dissociative disorders from a structural viewpoint. In dissociative disorders, delusional perception and somatic passivity are not seen. "Lateness" and "Precedence of the Other" originated from the concept of "Pattern Reversal" (H. Yasunaga)" is characteristic of schizophrenia. It is important to check these basic structure of schizophrenia in subjective experiences in differential diagnosis between dissociative disorders and schizophrenia.     

Acute delusional disorder with dissociative symptoms--case report

Delusions are amongst the main symptoms of schizophrenia. Delusional states may be caused by stress, somatic illness, or may be idiopathic, such as the persistent delusional disorder. Determination of a cause is usually difficult, but it is really important for the treatment. A case report of acute delusional disorder complicated by dissociative symptoms, suggesting an organic cause of the disorder is presented. Delirium caused by neuroleptic intoxication was an additional complication. Detailed informations gathered from relatives and psychological examinations made it possible to determine personality disorder as a ground, and stress as a precipitating factor of acute delusional disorder. Hospitalisation and psychological support helped in getting rid of the psychotic symptoms.     

A case of probable dissociative disorder.

The case of a patient with symptoms suggestive of a dissociative disorder is presented. The consultant reviews the diagnosis of multiple personality disorder (MPD) as defined in DSM-III-R and DSM-IV in relation to the patient's dissociative states, hallucinations, memory loss, and other symptoms. He then highlights the distinctions among MPD, schizophrenia, borderline personality disorder, major depression, and complex partial seizures. After presenting the conceptualization of MPD as a chronic posttraumatic stress disorder, he concludes with a review of treatment approaches that address the traumatic history and that involve hypnosis to gain access to and control dissociative states.     

分离障碍的核心特征与治疗

在DSM-5中,分离障碍的代表性疾病是分离性身份障碍、分离性遗忘及人格解体/现实解体障碍。这组障碍的共同风险是创伤性或应激性事件。分离障碍引起个体正常的、整合的感知觉、身份、记忆与意识等的中断或不连续。分离性身份障碍患者存在以2个及上人格状态为特征的身份瓦解;分离性遗忘症的个体没有能力回忆起重要的关于自我经历的信息;人格解体/现实解体障碍患者存在持久或反复发作的对自身或环境的不真实感或分离的体验。分离障碍的治疗方法包括使用精神活性药物、心理咨询等。