The Relationship Between Pathological Dissociation,Self-Injury and Childhood Trauma in Patients with Personality Disorders Using Taxometric Analyses

ABSTRACT

Objective: Dissociative phenomena exist on a spectrum ranging from psychological absorption to highly symptomatic disruptions of identity and memory. A statistical methodology called taxometric analysis has established a set of indicators that identify patients who have pathological dissociation, a qualitatively different form of dissociative phenomena. Using taxometric methodology, this study examines the relationship of pathological dissociation to personality diagnosis and self-directed injury, including suicide and history of childhood abuse, in a sample of outpatients with personality disorders.

Method: Patients were recruited from advertisements or referred from local clinicians. Participants completed a diagnostic interview and rating scales for dissociation, self-injury and childhood trauma. Pathological dissociation was identified using the Dissociative Experiences Scale-Taxon (DES-T; Waller, Putnam, & Carlson, 1996). Membership in the pathological dissociation taxon was established by calculating Bayesian posterior taxon membership probabilities; the method advocated by Waller, and compared to an approximation, used widely in the literature, based simply on the unweighted mean of the DES-T items.

Results: Overlapping, but not identical groups of patients were identified, indicating that the two methods are not interchangeable in this sample of personality disordered individuals. Surprisingly, no associations were detected between indices of childhood trauma and membership in the pathological dissociation taxon nor for the high dissociators identified through the approximation method.

Conclusions: This study serves as a replication of the ability to detect pathological dissociation as measured by the DES-T. Nonetheless, the failure to confirm our hypotheses regarding an association between pathological dissociation, childhood trauma, and personality diagnosis raise a challenge to some parts of existing etiologic theories.     

Childhood trauma and depression in alcoholics: relationship to hostility

OBJECTIVE: To examine for a relationship between childhood trauma and depression in alcoholics. METHODS: Euthymic depressed alcoholics (N = 23) were compared with never depressed alcoholics (N = 20) for their scores on the Childhood Trauma Questionnaire (CTQ). Subjects also completed the Hostility and Direction of Hostility Questionnaire (HDHQ). RESULTS: Euthymic depressed alcoholics had significantly higher scores on the CTQ for childhood emotional abuse, physical abuse, sexual abuse, and emotional neglect. They also had significantly higher hostility scores on the HDHQ. There were significant correlations between adult hostility scores and CTQ scores for childhood emotional neglect, physical neglect, sexual abuse and total childhood trauma. CONCLUSION: A history of childhood trauma was correlated with adult depression in male alcoholics: a hostile personality dimension might be a mediating variable. LIMITATION: Subjects were queried on their memories of childhood traumas. Prospective studies are needed.     

Temperament, character, and dissociation among detoxified male inpatients with alcohol dependency

The aim of this study was to determine possible relationships of pathological dissociation with temperament, character, and concurrent psychopathological features in a consecutive series of male alcohol-dependent patients. Fifty-eight patients with pathological dissociation were compared with 118 nondissociative patients classified by dissociative taxon membership. Beside higher scores on anxiety, depression, and alcoholism scales, a larger proportion of dissociative group reported childhood abuse, suicide attempts, and self-mutilation than did the nondissociative group. They also had higher scores of novelty seeking and harm avoidance, but lower scores of persistence, self-directedness, and cooperativeness. Trait anxiety, depression, and severity of alcoholism predicted dissociative experiences; however, none of the temperament or character measures did. Rather than being a derivative of temperament or character features, dissociative experiences of male alcohol-dependent patients are associated with overall concurrent psychopathology.     

Factors that predict scores on the Dissociative Experiences Scale

Bernstein and Putnam (1986) recently developed the Dissociative Experiences Scale (DES), a reliable and valid measure of dissociative experiences. The purpose of this study was to determine the relationship of the DES to other measures of psychopathology and cognitive functioning. Seventy-six female and 43 male university students were administered the DES, the Hopkins Symptom Checklist (HSCL-90), the Maudsley Obsessional-Compulsive Inventory (MOCI), the Tellegen Absorption Scale (TAS), and the Barnes-Vulcano Rationality Test (BVRT). A standard multiple regression was computed that used the DES as the criterion variable and the HSCL-90, MOCI, TAS, and BVRT as predictor variables. The results showed that 61% of the variance for DES scores could be predicted by three subscales of the HSCL-90 (Phobic Anxiety, Anger-Hostility, Somatization) and the TAS and BVRT. The importance of the relationship between the predictor variables and the DES for understanding dissociative disorders, especially multiple personality disorder, was discussed.     

Childhood trauma and neuroticism as an adult: possible implication for the development of the common psychiatric disorders and suicidal behaviour

BACKGROUND: Neuroticism is an important personality dimension associated with depressive and anxiety disorders. Both genetic and social factors are thought to contribute to neuroticism. This study aims to examine whether early childhood adversity may be a determinant of neuroticism. METHOD: Five hundred and thirty-two abstinent substance dependent patients completed both the Childhood Trauma Questionnaire (CTQ) and the Eysenck Personality Questionnaire (EPQ). RESULTS: There was a significant relationship between total childhood trauma scores on the CTQ and neuroticism scores on the EPQ. There were also significant relationships between neuroticism and CTQ subscores for emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. CONCLUSIONS: Childhood trauma may be a determinant of neuroticism. This may be one way in which childhood trauma plays a role in the development of psychiatric disorders. General population studies are needed.     

Awareness of identity alteration and diagnostic preference between borderline personality disorder and dissociative disorders

Aim: This study inquires into identity alteration among college students and its relationship to borderline personality disorder (BPD) and/or dissociative disorders (DDs). Methods: Steinberg Identity Alteration Questionnaire (SIAQ), Childhood Trauma Questionnaire (CTQ), and self-report screening tool of the BPD section of the Structured Clinical Interview for DSM-IV (SCID-BPD) were administered to 1301 college students. Participants who fit the diagnostic criteria of BPD (n = 80) according to the clinician-administered SCID-BPD and 111 non-BPD controls were evaluated using the Structured Clinical Interview for DSM-IV DDs (SCID-D) by two psychiatrists blind to the group membership and scale scores. Results: Test-retest evaluations and internal consistency analyses suggested that SIAQ was a reliable instrument. Of the participants, 11.3% reported a SIAQ score 25 or above alongside some impairment. SIAQ scores differentiated participants who fit the diagnostic criteria for a DD from those who did not. While self-report identity alteration was correlated with all childhood trauma types, clinician-assessed identity alteration was correlated with childhood sexual abuse only. Those who fit criteria for both disorders had the highest identity alteration scores in self-report and clinician-assessment. Although both syndromes had significant effect on self-report identity alteration total scores, in contrast to DD, BPD did not have an effect on the clinician-administered evaluation. Conclusion: An impression of personality disorder rather than a DD may seem more likely when identity alteration remains subtle in clinical assessment, notwithstanding its presence in self-report. Lack of recognition of identity alteration may lead to overdiagnosis of BPD among individuals who have a DD.     

Relationships among childhood trauma, posttraumatic stress disorder, and dissociation in men living with HIV/AIDS

This study examined the relationships among dissociation, childhood trauma and sexual abuse, and posttraumatic stress disorder (PTSD) symptoms in HIV-positive men. Data were collected from 167 men enrolled in a randomized clinical trial that examined a group therapy intervention to decrease HIV-related risk behavior and trauma-related stress symptoms. Participants completed the Trauma History Questionnaire, the Impact of Events Scale-Revised, and the Stanford Acute Stress Reaction Questionnaire. Overall, 35.3% of the participants reported having experienced childhood sexual abuse. A total of 55.7% of the sample met diagnostic criteria for PTSD. The intensity of dissociative symptoms that participants endorsed was positively associated with experience of childhood sexual abuse (r?=?.20, p < .01). Dissociative symptoms were also positively associated with specific PTSD symptoms, notably hyperarousal (r?=?.69, p < .001). Hierarchical regression indicated that hyperarousal symptoms accounted for more of the variance in dissociation than childhood sexual abuse. These results suggest that childhood sexual abuse may be involved in the development of dissociative symptoms in the context of adulthood stress reactions. Furthermore, the pattern of the association between dissociation and PTSD is consistent with the possibility of a dissociative PTSD subtype among HIV-positive men.     

Psychometric Utility of the Childhood Trauma Questionnaire with Female Street-Based Sex Workers

ABSTRACT

The present study examines the psychometric properties of a verbal, face-to-face administration of the Childhood Trauma Questionnaire (CTQ) with female street-based sex workers (N = 171). Confirmatory Factor Analysis (CFA) indicated a poor fit between our data and the instrument's established 5-factor structure. Exploratory Factor Analysis (EFA) yielded four stable and usable factors corresponding to the Emotional Abuse, Emotional Neglect, Physical Abuse, and Sexual Abuse subscales of the CTQ; the Physical Neglect subscale did not emerge as a stable factor. Cross loading of many CTQ items onto more than one factor most likely produced the poor CFA fit, and indicated that abuse/neglect constructs were not conceptually distinct for our sample. Mean trauma scores did not differ significantly from published scores for female substance abusers. According to the CTQ Minimization/Denial scale, 42% of participants minimized their childhood maltreatment experiences. A combination of qualitative and quantitative methods may be optimal for the acquisition of sensitive trauma information with wary and vulnerable street populations.     

儿童期受虐与肠易激综合征关系的临床研究

目的:探讨儿童期受虐在肠易激综合征(IBS)发生及患者精神心理状态、生活质量中所起的作用。方法:72例IBS患者(患者组)评定儿童期虐待问卷(CTQ),评估儿童期受虐情况,并与92例正常健康人(对照组)进行对照。IBS患者同时还评定抑郁自评量表(SDS)、焦虑自评量表(SAS)、肠易激综合征患者生活质量表(IBSQOL)。结果:1患者组CTQ评分显著高于对照组,差异有统计学意义(t=3.590,P0.001);患者组儿童期受虐发生率为44.4%,高于对照组的27.2%,差异有统计学意义(χ~2=5.313,P0.05);2与无儿童期受虐的IBS患者(40例)比较,有儿童期受虐的IBS患者(32例)SAS评分显著较高,差异有统计学意义(t=2.099,P0.05);3有儿童期受虐的IBS患者QOL评分显著高于无儿童期受虐的IBS患者,差异有统计学意义(t=-2.223,P0.05)。结论:儿童期受虐可能是IBS发生的社会心理学因素之一,并可能对IBS患者的心理状况、生活质量产生不良的影响。     

Resilience mitigates the suicide risk associated with childhood trauma

Objective

We wished to examine whether resilience might be a protective factor in relation to suicidal behavior.

Method

To do this resilience was examined in relation to childhood trauma, a well established risk factor for suicidal behavior, in two samples. In a preliminary sample 20 abstinent substance abuse patients who had attempted suicide were matched for age and their score on the Childhood Trauma Questionnaire (CTQ) with 20 substance abuse patients who had never attempted suicide. The two age and CTQ matched attempter (N = 20) and non-attempter (N = 20) groups were then compared for their scores on the Connor-Davidson Resilience Scale (CD-RISC). In the second sample 166 prisoners who had attempted suicide were matched for age and their scores on the CTQ with 166 prisoners who had never attempted suicide. These two age and CTQ matched attempter (N = 166)and non-attempter (N = 166) groups were similarly compared for their CD-RISC resilience scores.

Results

In the preliminary substance abuse sample, patients who had never attempted suicide (N = 20) had significantly higher mean CD-RISC resilience scores than the age and CTQ matched patients who had attempted suicide (N = 20). Similarly in the prisoner sample, those who had never attempted suicide (N = 166) had significantly higher CD-RISC resilience scores than the age and CTQ matched prisoners who had attempted suicide (N = 166).

Conclusions

The results from these two studies suggest that resilience may be a protective factor mitigating the risk of suicidal behavior associated with childhood trauma.     

Childhood maltreatment, complex trauma symptoms, and unresolved attachment in an at-risk sample of adolescent mothers

Associations between unresolved attachment, abuse history, and a wide range of trauma-related symptomatology were examined in an at-risk sample (N = 62). Fifty percent reported severe childhood physical and/or sexual abuse. An independent trauma interview elicited more reports of childhood sexual abuse than the Adult Attachment Interview (AAI); conversely, the AAI elicited more reports of physical abuse. Childhood physical abuse, sexual abuse, and general maltreatment were associated with unresolved status. Furthermore, sexual abuse history and general maltreatment predicted unresolved loss, suggesting that they adversely affected the integration of other emotional and/or traumatic experiences. Women classified as Unresolved reported higher levels of dissociation, confusion regarding self-identity, and relationship problems. Findings complement and extend empirical support for the theorized association between dissociative processes and unresolved attachment.     

Evaluation of the Swedish Version of Dissociation Questionnaire (DIS-Q), Dis-Q-Sweden,Among Adolescents

ABSTRACT

The aim of this study was to investigate the psychometric properties of the Swedish version of the Dissociation Questionnaire in a normative adolescent population and also to investigate dissociative symptoms associated with trauma including sexual and physical abuse. A normative sample of 449 adolescents between the ages of 12 and 19 and a clinical group of 74 adolescents with known experiences of trauma, sexual and/or physical abuse was given Dis-Q-Sweden. A mixed group of 22 abused and non-abused adolescents who answered Dis-Q-Sweden was also interviewed by using the Structural Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability concerning both internal consistency and test-retest stability. Validity was tested in several ways (criterion, predictive, construct and concurrent) and found to be satisfactory. Significant differences for the total sum scores of Dis-Q-Sweden were found between the normative group and the clinical group with known sexual abuse (p < 0.001). The prevalence of dissociative symptoms (cut-off score > 2.5) was 2.3% in the normative group and 50% in the clinical group. Dis-Q-Sweden has proven to be a screening instrument with good psychometric properties and has proven to be able to capture dissociative symptoms in adolescents with self-reported trauma and known trauma (sexual abuse).     

Dissociation as a Mediator of the Relationship Between Childhood Trauma and Nonsuicidal Self-Injury in Females: A Path Analytic Approach

New theoretical models of nonsuicidal self-injury (NSSI) postulate that symptoms subsequent to childhood maltreatment rather than childhood maltreatment itself may lead to engagement in NSSI. However, little is known concerning which specific syndromes serve as underlying mechanisms. In this study we sought to examine the mediating effects of dissociative, posttraumatic, and depressive symptoms, 3 often comorbid syndromes following childhood trauma. In addition, we aimed to assess differences between women with and without NSSI. A sample of 87 female inpatients with a history of childhood abuse and neglect was divided into 2 subgroups (NSSI: n = 42, no NSSI: n = 45). The assessment included measures of NSSI characteristics; adverse childhood experiences; and posttraumatic, dissociative, and depressive symptoms. The NSSI group reported significantly more cases of childhood maltreatment and higher levels of current dissociative, posttraumatic, and depressive symptoms than patients without NSSI. The results of a path analysis showed that only dissociation mediated the relationship between a history of child maltreatment and NSSI when all 3 psychopathological variables were included in the model. The findings point toward a strong and rather specific association between dissociative experiences and NSSI and therefore have important implications for clinical practice.     

Suicide and history of childhood trauma among street youth

BackgroundStreet youth represent a marginalized population marked by early mortality and elevated risk for suicide. It is not known to what extent childhood abuse and neglect predispose to suicide in this difficult-to-study population. This study is among the first to examine the relationship between childhood trauma and subsequent attempted suicide during adolescence and young adulthood among street youth.MethodsFrom October 2005 to November 2007, data were collected for the At Risk Youth Study (ARYS), a cohort of 495 street-recruited youth aged 14–26 in Vancouver, Canada. Self-reported attempted suicide in the preceding six months was examined in relation to childhood abuse and neglect, as measured by the Childhood Trauma Questionnaire (CTQ), using logistic regression.ResultsOverall, 46 (9.3%) youth reported a suicide attempt during the preceding six months. Childhood physical and sexual abuse were highly prevalent, with 201 (40.6%) and 131 (26.5%) of youth reporting history of each, respectively. Increasing CTQ score was related to risk for suicide attempt despite adjustment for confounders (adjusted odds ratio [AOR], 1.45 per standard deviation increase in score; 95% confidence interval [CI], 1.08–1.91).LimitationsUse of snowball sampling may not have produced a truly random sample, and reliance on self-report may have resulted in underreporting of risk behaviors among participants. Moreover, use of cross-sectional data limits the degree to which temporality can be concluded from the results of this study alone.ConclusionsThere exists a strong and graded association between childhood trauma and subsequent attempted suicide among street youth, an otherwise ‘hidden’ population. There is a need for effective interventions that not only prevent maltreatment of children but also aid youth at increased risk for suicide given prior history of trauma.     

The impact of child abuse on dissociative symptoms:a study of incarcerated women.

One-hundred and ninety-two incarcerated women who were participating in a trauma and abuse psychoeducation program were evaluated for childhood abuse, maltreatment and current dissociative symptoms. The link between childhood abuse and adult criminal behavior has been well studied but the mental health status of adult female inmates and the possible implications for their treatment and behavior is the next step. The participants reported high levels of childhood abuse, 68% reported molestation, 72% rape, 26% emotional abuse, 51% physical abuse. Almost half of the participants reported a clinically significant level of dissociative symptoms. The dissociative group was found to have higher rates of sexual, emotional and physical abuse. They were younger and had shorter sentences. A logistic regression model was developed with only physical abuse being a predictor of clinically significant dissociative symptoms. Results are discussed in terms of how the high level of dissociative symptoms may impact future delinquency and corrections staff and possible future research.     

Hypnotizability,dissociation and trauma in patients with a conversion disorder: an exploratory study

Little research has been conducted on the assumed high hypnotizability of conversion patients and on their dissociative experiences. Moreover, a relation is described between trauma, dissociation, somatization, psychopathology and conversion disorder. One hundred and two patients with motor conversion symptoms were tested for hypnotizability, dissociative experiences, trauma, somatization, general level of psychopathology and physical impairment. Our sample did not have higher levels of hypnotizability but they reported more dissociative experiences than normals. The trauma subgroup had higher levels of hypnotizability and dissociative experiences, psychopathology, somatization, and physical impairment than the non‐trauma subgroup. Uncorrected for general psychopathology, the trauma category ‘otherwise’ predicted 9.6% of the variance in the hypnotizability scores. After correction, only an additional 4.2%. The trauma category ‘emotional abuse’ contributed 18.9% to the prediction of the variance in the dissociation scores. After correction for general psychopathology, which explained 67.3% of the variance, only the sum score of the trauma categories contributed an additional 3.3%. Copyright © 2001 John Wiley & Sons, Ltd.     

Childhood Psychological and Physical Abuse: Psychopathology,Dissociation, and Axis I Diagnosis

ABSTRACT

The present study compared (1) college students who reported childhood physical and psychological abuse (combined; N = 35) with (2) students who reported psychological abuse alone (psychological; N = 30), and with (3) students who reported no history of childhood abuse (no abuse; N = 35). Combined abuse and psychological abuse participants were more likely to receive an Axis I diagnosis on a structured interview and to report more dissociative experiences than were no abuse participants. In addition, a structured interview for dissociative disorders was the single measure that differentiated psychologically abused participants from participants reporting combined abuse and no abuse. However, the most psychological impairment was evident in the combined abuse group. Relative to participants who reported no abuse history, combined abuse participants reported more dissociative symptoms on a structured interview and more symptoms of general psycho-pathology, depression, and state and trait anger on self-report measures.     

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.     

Dissociative Experiences in China

ABSTRACT

The Dissociative Experiences Scale was administered to a non-clinical sample in Shanghai, China (N = 618) and the results were compared with a previous sample of the general population from Winnipeg, Canada (N = 1055). The Dissociative Disorders Interview Schedule was administered to the 618 Chinese participants and results were compared with those of the Canadian participants (N = 502). In addition, both measures were administered to a sample of Chinese psychiatric in-patients (N = 423) and outpatients (N = 304). Rates of childhood trauma and dissociation were far lower in the Chinese non-clinical sample than in the two Chinese psychiatric patient groups, and far lower than in the Canadian general population. Among the 618 respondents in the Chinese non-clinical sample, no childhood sexual abuse was reported and only one person reported childhood physical abuse. These rates of childhood abuse were far lower than in other non-clinical samples from China; for example, rates were 16.7% for sexual abuse of girls and 10.5% for sexual abuse of boys in a previous study. Among the more traumatized Chinese psychiatric patients, and among the Canadian respondents, dissociative experiences were much more common than in the Chinese general population. The data provide a base frequency for dissociation in non-clinical samples reporting little or no childhood physical and sexual abuse.     

大学生B群人格障碍患者童年期创伤性经历的研究

目的：了解大学生B群人格障碍被试童年期创伤性经历的特点。方法：先用PDQ＋4问卷筛查，冉以PDI—IV对筛查的阳性被试进行半定式查询确诊B群人格障碍患者，然后用童年期创伤性经历问卷（CTQ）测查所有被试的章年负性经历。结果：除情感忽视因子外，B群人格障碍组CTQ各因子和总分均显著高于正常对照组。进一步将边缘型人格障碍（Borderline Personality Disordel ，BPD）组和自恋型人格障碍（Narcissistic Personality Disorder．NPD）组分别与正常对照组比较．发现BPD组情感虐待和情感忽视的因子分和总分屁著高于正常对照组。NPD组与对照组比较无鼎著性差异。结论：大学生B群人格障碍被试的童年期创伤较正常组严重。BPD在情感方面的创伤性经历尤其明显，提示情感虐待和忽视是大学生BPD发病的特征性因素。