The Language of Dissociation

ABSTRACT

Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.     

Dissociation and Meditation

ABSTRCT

The purpose of the current paper is to compare meditational and dissociative states in terms of their effects on consciousness, attention, affect, cognition, identity, and pain sensitivity. To illustrate these dimensions of dissociation, a case example is presented of a veteran with combat-related posttraumatic stress disorder who had particularly severe dissociation symptoms. The Classical Yoga literature is reviewed to examine these dimensions as they pertain to meditational states. Although dissociative and meditational states can involve alterations in consciousness, attention, affect, cognition, identity, and pain sensitivity, the nature of changes in these two states is distinct. Applications of meditation in treatment contexts have made use of some of the powerful techniques for attention control but do not incorporate the full range of practices because of the secular setting of treatment and the goal of symptom relief. The use of meditation as a treatment for dissociation has not been systematically evaluated.     

耶鲁-布朗强迫症状清单调查强迫症状的初步应用

目的初步使用耶鲁-布朗强迫症状清单调查我国强迫症的症状类型。方法采用耶鲁-布朗强迫症状清单调查78例强迫症患者的症状及出现的频率,分析症状类型与人口学资料的相关性。结果 78例强迫症患者,强迫思维的症状数量(9.6±6.8)个,强迫行为的症状数量(4.7±4.2)个;排在前3位的强迫思维依次为怕污染的强迫思维(42.3%)、怕冲动的强迫思维(35.9%)、要求对称或精确的强迫思维(17.9%)。强迫行为前3位依次为强迫洗涤行为(39.8%)、强迫检查行为(38.4%)、强迫重复行为(28.2%)。男性患者20.9%存在有关性的强迫思维高于女性2.9%,差异有统计学意义(U=2.38,P=0.0172)。无职业者50.0%存在强迫洗涤行为高于有职业者25.0%,差异有统计学意义(U=2.22,P=0.0265)。结论耶鲁-布朗强迫症状清单能够有效涵盖所有强迫症状,初步应用成功。强迫症状类型与人口学资料存在相关性。     

Low plasma levels of l-arginine,impaired intraplatelet nitric oxide and platelet hyperaggregability: Implications for cardiovascular disease in depressive patients

BackgroundObsessive–compulsive disorder (OCD) is a chronic condition that normally presents high rates of psychiatric comorbidity. Depression, tic disorders and other anxiety disorders are among the most common comorbidities in OCD adult patients. There is evidence that the higher the number of psychiatric comorbidities, the worse the OCD treatment response. However, little is known about the impact of OCD treatment on the outcome of the psychiatric comorbidities usually present in OCD patients. The aim of this study was to investigate the impact of exclusive, conventional treatments for OCD on the outcome of additional psychiatric disorders of OCD patients, detected at baseline.MethodsSeventy-six patients with primary OCD admitted to the treatment protocols of the Obsessive–Compulsive Spectrum Disorders Program between July 2007 and December 2009 were evaluated at pre-treatment and after 12 months. Data were analyzed to verify possible associations between OCD treatment response and the outcome of psychiatric comorbidities.ResultsResults showed a significant association between OCD treatment response and improvement of major depression and dysthymia (p-value = 0.002), other anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, posttraumatic stress disorder, panic disorder, agoraphobia and anxiety disorder not otherwise specified) (p-value = 0.054) and tic disorders (p-value = 0.043).LimitationsThis is an open, non-blinded study, without rating scales for comorbid conditions. Further research is necessary focusing on the possible mechanisms by which OCD treatment could improve these specific disorders.ConclusionsOur results suggest that certain comorbid disorders may benefit from OCD-targeted treatment.     

The Axis-I Dissociative Disorder Comorbidity of Borderline Personality Disorder Among Psychiatric Outpatients

ABSTRACT

The aim of this study was to determine the frequency of dissociative disorders among psychiatric outpatients with borderline personality disorder (BPD). In order to ascertain the extent of the overlap between two diagnostic groups, the overall prevalence of both disorders were evaluated. Two hundred and forty (240) consecutive patients who presented to a university outpatient psychiatry unit were screened using the self-report questionnaire version of the BPD section of Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), the Dissociative Experiences Scale (DES) and the Somatoform Dissociation Questionnaire (SDQ). One hundred and twenty-nine (129) participants who had a score above the cut-off point on at least one of these instruments were evaluated using the interview version of the BPD section of the SCID-II, the Dissociative Disorders Interview Schedule (DDIS), and the PTSD module of the Structured Clinical Interview for DSM-III-R (SCID-I). All participants who were diagnosed as having BPD or a dissociative disorder were evaluated then with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). Twenty-five (25; 10.4%) participants had BPD and 33 participants (13.8%) had dissociative disorder in the final evaluation. Sixteen participants (64.0%) with BPD had the Axis I diagnosis of a dissociative disorder; all six participants (2.5%) with dissociative identity disorder were among them. The findings demonstrate that a significant part of psychiatric outpatients who fit the criteria of BPD have a DSM-IV dissociative disorder on Axis I. The presence of dissociative symptoms as a part of BPD should not lead to overlooking the possibility of a co-occurring dissociative disorder.     

Dissociation and Schizophrenia

ABSTRACT

The authors administered the Dissociative Experiences Scale (DES), the Dissociative Disorders Interview Schedule (DDIS), the Scale for the Assessment of Positive Symptoms, and the Scale for Assessment of Negative Symptoms to 60 participants with schizophrenia. Participants were divided into two groups: those with scores below 10 on the DES and no dissociative disorder on the DDIS; and those with scores above 25 on the DES and/or a dissociative disorder on the DDIS. The dissociative participants had more severe trauma histories, more comorbidity and higher scores for both positive and negative symptoms. The authors interpret their findings as evidence in support of a trauma-dissociation subgroup within schizophrenia.     

Differential Diagnosis between Anomalous Experiences and Dissociation Disorder Using the Dissociative Disorders Interview Schedule (DDIS)

Background. It is important to understand the most diverse cultural aspects related to religiosity. Scientifically, it is important to understand religious manifestations and their relation to health, and to differentiate them from psychopathological manifestations. Objective. To evaluate the mental health of a group of mediums and compare it with that of a control group from the same religious context who do not manifest mediumship, using the Dissociative Disorders Interview Schedule (DDIS). Methods. This was a cross-sectional study, evaluating 47 mediums (Group 1) and comparing them with 22 non-medium volunteers from the same religious context (Group 2) using the DDIS questionnaire. All results were matched with historical data from patients with dissociative identity disorder (DID) who answered the DDIS. Results. Scores obtained from the DDIS were similar in both groups. The number of positive symptoms was comparable in a wide range of analyzed areas, involving but not being restricted to somatization disorder, major depressive episode, borderline personality disorder, extrasensory/paranormal experiences, physical/sexual abuse and five dissociative disorders. There were considerable differences when we compared these results with historical data from patients with DID. Conclusion. In agreement with the extant literature, these results showed that mediumship can be considered a non-pathological form of dissociative phenomena.     

Hypnosis and Traumatic Dissociation: Therapeutic Opportunities

ABSTRACT

Hypnosis and the related phenomenon of dissociation have long been linked to trauma. Evidence is reviewed regarding the relationship between trauma and dissociation, the prevalence of these dissociative symptoms in the acute aftermath of trauma, and their salience in predicting the development of later PTSD symptoms. The evidence reviewed regarding the prevalence of dissociative and other symptoms in the immediate aftermath of trauma formed the basis for including Acute Stress Disorder (ASD) as a new diagnosis in the DSM-IV. Dissociative amnesia is described as the key commonality between formally induced hypnosis and dissociative symptomatology, and controversy regarding traumatic amnesia is discussed. Finally principles of psychotherapy involving hypnosis and related techniques for dissociative and other post-traumatic symptoms are reviewed.     

Differentiating Dissociative Disorders from Other Diagnostic Groups Through Somatoform Dissociation in Turkey

Abstract

This study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the Somatoform Dissociation Questionnaire (SDQ-20). In this context, it investigated whether somatoform dissociation differentiates dissociative disorders from other diagnostic groups and non-clinical individuals. The Turkish Version of the SDQ-20 was administered to 50 patients with a dissociative disorder, 94 patients with psychiatric disorders other than dissociative disorder, and 175 non-clinical participants. To confirm the clinical diagnosis, all patients in the dissociative disorder group had been evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders. The internal consistency and the test-retest correlation of the SDQ-20 were excellent. The scale had strong correlations with the DES and the DIS-Q. There was a statistically significant difference between dissociative patients and other diagnostic groups on the SDQ-20 total score. The discriminative power of the SDQ-20 was as robust as that of the DES. There was no significant difference between the mean SDQ-20 total scores of Turkish and Dutch patients, but Turkish dissociative patients reported pseudoseizures more frequently than Dutch patients. The specificity of the short version of the scale (SDQ-5) was weak among Turkish patients. Dissociative disorders can be differentiated from other diagnostic groups through somatoform dissociation. The good psychometric characteristics of the SDQ-20 among Turkish participants support its cross-cultural validity.     

Sensitivity to change of the Obsessive Beliefs Questionnaire

The Obsessive–Compulsive Beliefs Questionnaire‐87 (OBQ‐87) has been constructed by leading obsessive–compulsive disorder (OCD) experts to assess dysfunctional beliefs typical for OCD patients. The OBQ‐87 has recently been revised (Obsessive–Compulsive Beliefs Questionnaire‐44 [OBQ‐44]) to improve its psychometric properties. The current investigation entailed two goals: (1) to assess the sensitivity of both Obsessive Beliefs Questionnaire (OBQ) versions to treatment change and other OCD measures; and (2) to assess relations between symptom subtypes, OBQ beliefs and changes in beliefs as a consequence of treatment. One hundred and four patients have completed the OBQ before and after 12 sessions of behaviour therapy. Results suggest that (1) both OBQ versions exhibit an identical medium effect size; (2) overlap between clinical and non‐clinical populations limit the use of the OBQ as a primary measure of treatment change; and (3) the symptom dimension obsessions + checking was related to initial OBQ scores, but no symptom dimensions were related to OBQ pre‐treatment to post‐treatment changes. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Both versions of the OBQ demonstrate similar sensitivity to treatment change; however the clinical utility of this measure is doubtful.

     

Deconstructing the Dissociative Disorders

Abstract

Background: The religion Kardecism Spiritism accepts and fosters dissociative experiences such as spiritual incorporation, automatic writing and out-of-body experiences as part of its basic tenets. Mastery of these skills is valued and highly respected. Members undergo extensive formalized training under the guidance of experienced leaders who model socially appropriate religious behaviors.

Method: One hundred and ten subjects at a prominent Kardecist Center in São Paulo, Brazil, were assessed with a variety of questionnaires and scales which addressed socialization, happiness, religiosity, mediumship (for the measurement of religious-related dissociative behavior and its formal training), temperament (the Tridimensional Personality Questionnaire; TPQ), and general dissociative experiences (the Dissociative Experiences Scale; DES).

Results: Mediumship activity was associated with increased DES score in spite of good scores on socialization and adaptation. There was evidence for a positive association between mediumship training and the control of the religious-related dissociative experiences. Increased pathological dissociation was associated with younger age, less control of mediumship activity, poorer social support and more antecedent psychiatric symptomatology.

Conclusions: These findings partially support the sociocognitive theory for religious-related non-pathological dissociation. The results of pathological dissociators suggest a co-existing but distinct sub-population whose pathological dissociative experiences were not caused by social modeling.     

Hypochondriasis Y‐BOCS: a study of the psychometric properties of a clinician‐administered semi‐structured interview to assess hypochondriacal thoughts and behaviours

Introduction: This study investigated the psychometric properties of the first clinician‐administered semi‐structured interview for assessing the severity of hypochondriacal symptoms. The Hypochondriasis Yale‐Brown Obsessive–Compulsive Scale (H‐YBOCS) consisted of three a priori dimensions: hypochondriacal obsessions, compulsions and avoidance. Methods: The 16‐item interview was conducted with 112 participants with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, hypochondriasis. We analysed factor analytic structure, reliability, construct validity and sensitivity to change. Results: Factor analysis supported a three‐factor model similar to the a priori dimensions. Internal consistency ranged from satisfactory to good. Inter‐rater reliability was excellent. The construct validity was low to moderate. The H‐YBOCS was sensitive for measuring changes in symptom severity. Conclusion: The H‐YBOCS is a (factorially) valid and coherent interview with a high level of agreement across different raters. The relatively low discriminant validity could be due to co‐morbid anxiety and depressive disorders. Overall, the H‐YBOCS seems to be a promising contribution to the assessment of hypochondriasis. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? The hypochondriasis Y‐BOCS is a feasible clinician rated interview to assess the severity of hypochondriacal complaints.     

Cognitive behavioural treatment of obsessive compulsive personality disorder

Clients with Obsessive Compulsive Personality Disorder (OCPD) take normally positive characteristics such as conscientiousness and attention to detail to such an extreme that these characteristics become seriously dysfunctional This disorder has received only limited attention from cognitive-behavioural investigators and the one empirical investigation of the treatment of individuals with OCPD found that simply inducing these individuals to engage in treatment was difficult This paper presents a cognitive-behavioural conceptualization of OCPD and uses a detailed case example to illustrate an approach to intervention which shows promise for providing an effective approach to intervention.     

A comparative trial of psychotherapy in the treatment of post-trauma stress reactions

Forty-two patients with post-traumatic stress reactions were assessed 40 weeks after the traumatic event and given either an immediate (n = 29) or delayed (n = 13) eight sessions of psychotherapy. The patients in the delayed condition improved somewhat during the waiting list period, but at the end of treatment the two conditions were not significantly different. However, treatment gains were a little higher in the immediate group, with up to a 32% reduction in symptoms. There were no significant differences between therapists. The rate of improvement while under therapy was much higher than while awaiting assessment. Improvements were greatest for those with high Psychoticism and Obsessive Compulsive scores.     

Evidence for a Dissociative Subtype of Post-Traumatic Stress Disorder Among Help-Seeking Childhood Sexual Abuse Survivors

ABSTRACT

This study examined evidence for a dissociative subtype of post-traumatic stress disorder (PTSD) among women seeking psychotherapy for childhood sexual abuse (CSA). One hundred and twenty-two women seeking treatment for CSA completed a battery of questionnaires assessing PTSD, dissociative symptoms, and child maltreatment. Using signal detection analysis, we identified high and low dissociation PTSD subgroups. A constellation of three PTSD symptoms-hypervigilance, sense of foreshortened future, and sleep difficulties–discriminated between these two subgroups (OR = 8.15). Further evidence was provided by the finding of a nonlinear relationship between severity of childhood maltreatment and dissociation in the women with PTSD. These results provide support for a dissociative subtype of PTSD that may stem from more severe childhood experiences of neglect and abuse.     

Emotion and internal experience in Obsessive Compulsive Disorder: Reviewing the role of alexithymia,anxiety sensitivity and distress tolerance

Increasing attention has focused on the role of emotion and internal experience in Obsessive Compulsive Disorder (OCD). This review examines three key constructs that capture different aspects of understanding, appraisal and tolerance of internal states in OCD — alexithymia, anxiety sensitivity (AS) and distress tolerance (DT). The review examines the evidence for the role each of these constructs plays in OCD and considers whether conclusions can be drawn about the implications for our understanding and treatment of OCD. There is evidence that all three are elevated in clinical cases compared to controls, but there is no evidence that any of the three shows specificity for OCD over other anxiety disorders. However, the review has highlighted significant methodological heterogeneity and consequent variation in findings that currently limits broader conclusions from being drawn. There is an indication that this is a valuable area to explore and future studies should focus on deriving greater conceptual clarity around these constructs, independently replicating findings, and establishing a common methodology to enhance the comparability of studies. Studies exploring the ways in which internal experience, cognitions and symptoms may relate to one another would be of significant value in developing models that then lead to improved treatment approaches.     

The Influence of Current Stress on Dissociative Experiences: An Exploratory Study in a Non-Clinical Population

ABSTRACT

In this study, the relationship between current stress, as perceived by an individual, and dissociative phenomena is explored. All subjects were in an acute and naturally caused stress-situation-sudden threat of dismissal from their jobs in a large multinational corporation. Dissociation and stress were measured at two different times over three months. Since information campaigns and psychological support programs were offered to all participants, levels of stress were expected to decrease significantly. The data show that dissociative experiences are elevated when subjects experience high levels of current stress, though scores fall within the normal non-pathological range. Furthermore, it appears that a decrease in stress level is associated with a significant decrease of dissociative symptoms. The results support a one-directional causal relationship: a decrease in perceived stress leads to a decrease in dissociative phenomena.     

Somatoform Dissociation

Abstract

In most of the recent scientific and clinical literature, dissociation has been equated with dissociative amnesia, depersonalization, derealization, and fragmentation of identity. However, according to Pierre Janet and several World War I psychiatrists, dissociation also pertains to a lack of integration of somatoform components of experience, reactions, and functions. Some clinical observations and contemporary studies have supported this view. Somatoform dissociation, which can be measured with the Somatoform Dissociation Questionnaire (SDQ-20), is highly characteristic of dissociative disorder patients, and a core feature in many patients with somatoform disorders and in a subgroup of patients with eating disorders. It is strongly associated with reported trauma among psychiatric patients and patients with chronic pelvic pain presenting in medical healthcare settings. Motor inhibitions and anesthesia/analgesia are somatoform dissociative symptoms that are similar to animal defensive reactions to major threat and injury. Among a wider range of somatoform dissociative symptoms, these particular symptoms are highly characteristic of patients with dissociative disorders. The empirical findings reviewed in this article should have implications for the contemporary conceptualization and definition of dissociation, as well as the categorization of somatoform disorders in a future version of the DSM.     

Dissociation and Schizophrenia

Abstract

Comorbidity of psychotic and dissociative disorders often is not reported. This 38 year-old female with a history of schizophrenic symptoms displayed evidence of dissociative identity disorder (DID) during admission to an inpatient psychiatric unit. The case illustrates how the presence of a dissociative disorder may influence the presentation of a co-morbid psychosis. The historical association and differential diagnosis between DID and schizophrenia is described. Implications of various treatment approaches for patients exhibiting dissociation in the context of psychosis are discussed.