Depersonalization and derealization in self-report and clinical interview: The spectrum of borderline personality disorder,dissociative disorders,and healthy controls

Depersonalization (DEP) and derealization (DER) were examined among college students with and without borderline personality disorder (BPD) and/or dissociative disorders (DDs) by self-report and clinician assessment. The Steinberg Depersonalization Questionnaire (SDEPQ), the Steinberg Derealization Questionnaire (SDERQ), the Childhood Trauma Questionnaire, and the screening tool of the BPD section of the Structured Clinical Interview for DSM–IV (SCID-BPD) were administered to 1,301 students. Those with BPD (n = 80) according to the SCID-BPD and 111 non-BPD controls were evaluated using the Structured Clinical Interview for DSM–IV Dissociative Disorders by a psychiatrist blind to the diagnosis. Of the participants, 19.7% reported SDEPQ (17.8%) and/or SDERQ (11.0%) scores above cutoff levels and impairment from these experiences. Principal component analysis of 26 items of both scales yielded 4 factors: cognitive-emotional self-detachment, perceptual detachment, bodily self-detachment, and detachment from reality. Participants with concurrent DD and BPD had the highest scores for DEP and DER in the clinical interview and self-report. The total number of BPD criteria was associated with the severity of childhood trauma and dissociation. Both BPD and DD were associated with clinician-assessed and self-reported DER, self-reported DEP, and the cognitive-emotional self-detachment factor. Unlike BPD, DD was associated with clinician-assessed DEP, and BPD was related to the self-reported detachment from reality factor. Although the latter was correlated with the total childhood trauma score, possibly because of dissociative amnesia, clinician-assessed DER was not. Being the closest factor to BPD, the factor of detachment from reality warrants further study.     

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.     

Reliability and Validity of the Turkish Version of the Structured Clinical Interview for DSM–IV Dissociative Disorders (SCID-D): A Preliminary Study

A total of 34 consecutive patients with dissociative identity disorder or dissociative disorder not otherwise specified were evaluated using the Turkish version of the Structured Clinical Interview for DSM–IV Dissociative Disorders (SCID-D). They were compared with a matched control group composed of 34 patients who had a nondissociative psychiatric disorder. Interrater reliability was evaluated by 3 clinicians who assessed videotaped interviews conducted with 5 dissociative and 5 nondissociative patients. All subjects who were previously diagnosed by clinicians as having a dissociative disorder were identified as positive, and all subjects who were previously diagnosed as not having a dissociative disorder were identified as negative. The scores of the main symptom clusters and the total score of the SCID-D differentiated dissociative patients from the nondissociative group. There were strong correlations between the SCID-D and the Dissociative Experiences Scale total and subscale scores. These results are promising for the validity and reliability of the Turkish version of the SCID-D. However, as the present study was conducted on a predominantly female sample with very severe dissociation, these findings should not be generalized to male patients, to dissociative disorders other than dissociative identity disorder, or to broader clinical or nonclinical populations.     

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.     

Dissociative Identity Disorder Among Adolescents: Prevalence in a University Psychiatric Outpatient Unit

The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group.     

Comparing the symptoms and mechanisms of “dissociation” in dissociative identity disorder and borderline personality disorder

A total of 75 patients were diagnosed with the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised as having dissociative identity disorder (DID), and 100 patients were diagnosed with the Structured Interview for DSM–IV Personality as having borderline personality disorder (BPD). Both groups were administered the Multidimensional Inventory of Dissociation (MID). DID patients had significantly higher MID scores than BPD patients, different distributions of MID scores, and different MID subscale profiles in 3 ranges of MID scores (0–15, 15–30, 30–45). The core MID symptoms—exhibited at all ranges of MID scores—for DID patients (the presence of alters, identity confusion, and memory problems) and BPD patients (flashbacks, identity confusion, and memory problems) were ostensibly similar but were considered to be mostly produced by different underlying processes. Multiple regression analyses showed that the core MID symptoms of DID patients had different predictors than did the core MID symptoms of BPD patients. Alter identities seemed to generate most—but not all—dissociative phenomena in DID patients, whereas only the 24% highest scoring BPD patients (MID ≥45) seemed to manifest alter-driven dissociative experiences. Most BPD dissociative experiences appeared to be due to 5 other mechanisms: (a) BPD-specific, stress-driven, rapid shifts of self-state; (b and c) nondefensive disruptions of the framework of perceptual organization with or without an accompanying BPD-specific, dissociation-like disintegration of affective/neurocognitive functioning; (d) a defensive distancing or detachment from distress (i.e., simple depersonalization); and (e) Allen, Console, and Lewis’s (1999) severe absorptive detachment.     

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.     

Experiences of Possession and Paranormal Phenomena Among Women in the General Population: Are They Related to Traumatic Stress and Dissociation?

This study sought to determine the prevalence of experiences of possession and paranormal phenomena (PNP) in the general population and their possible relations to each other and to traumatic stress and dissociation. The study was conducted on a representative female sample recruited from a town in central eastern Turkey. The Dissociative Disorders Interview Schedule, the posttraumatic stress disorder (PTSD) and borderline personality disorder sections of the Structured Clinical Interviews for DSM–IV Axis-I and Personality Disorders, and the Childhood Abuse and Neglect Questionnaire were administered to 628 women. Of these, 127 (20.2%) women reported at least 1 type of PNP and 13 (2.1%) women reported possession. Women with a dissociative disorder reported all types of possession and PNP (except telepathy) more frequently than those without. Whereas women with a trauma history in childhood and adulthood or PTSD reported possession more frequently than those without, PNP were associated with childhood trauma only. Factor analysis yielded 4 dimensions: possession by and/or contact with nonhuman entities, extrasensory communications, possession by a human entity, and precognition. These factors correlated with number of secondary features of dissociative identity disorder and Schneiderian symptoms. Latent class analysis identified 3 groups. The most traumatized group, with predominantly dissociative and trauma-related disorders, had the highest scores on all factors. Notwithstanding their presence in healthy individuals, possession and PNP were associated with trauma and dissociation in a subgroup of affected participants. Both types of experience seem to be normal human capacities of experiencing that may be involved in response to traumatic stress. Given the small numbers, this study should be considered preliminary.     

Discriminating Dissociative Identity Disorder from Schizophrenia and Feigned Dissociation on Psychological Tests and Structured Interview

ABSTRACT

Objective: The purpose of this study was to evaluate the relative efficacy of a number of psychological tests and interviews in discriminating dissociative identity disorder (DID) from feigned dissociation and schizophrenia.

Method: Three measures of dissociation (SCID-D, DES, SDQ-5) two personality measures (MMPI-2, Millon-III) and a brief measure of hypnotic susceptibility (Spiegel & Spiegel's Eye-Roll Sign) were assessed for their ability to differentiate these diagnostic groups.

Results: Results indicate that the SCID-D was clearly the most efficacious instrument in discriminating DID from schizophrenia and from feigned dissociation. The DES-Taxon and the SDQ-5 were adequate in screening pathological dissociation from schizophrenia but were less discriminative of feigned dissociation. The commonly used personality inventories were unable to detect feigned dissociation and the DID group tended to have higher elevations on scales measuring psychotic symptoms than did the schizophrenic group. The Eye-Roll Sign discriminated feigned dissociation from those with dissociative disorders.

Conclusions: Structured interviews such as the SCID-D, although resource consuming, are essential in comprehensive assessment of dissociative disorders. Comprehensive assessment of psychotic disorders should include some measure of dissociation.     

Co-Occurrence of Dissociative Identity Disorder and Borderline Personality Disorder

The literature indicates that, among individuals with borderline personality disorder, pathological dissociation correlates with a wide range of impairments and difficulties in psychological function. It also predicts a poorer response to dialectical behavior therapy for borderline personality disorder. We hypothesized that (a) dissociative identity disorder commonly co-occurs with borderline personality disorder and vice versa, and (b) individuals who meet criteria for both disorders have more comorbidity and trauma than individuals who meet criteria for only 1 disorder. We interviewed a sample of inpatients in a hospital trauma program using 3 measures of dissociation. The most symptomatic group was those participants who met criteria for both borderline personality disorder and dissociative identity disorder on the Dissociative Disorders Interview Schedule, followed by those who met criteria for dissociative identity disorder only, then those with borderline personality disorder only, and finally those with neither disorder. Greater attention should be paid to the relationship between borderline personality disorder and dissociative identity disorder.     

Dissociation and psychosis in dissociative identity disorder and schizophrenia

Dissociative symptoms, first-rank symptoms of schizophrenia, and delusions were assessed in 40 schizophrenia patients and 40 dissociative identity disorder (DID) patients with the Multidimensional Inventory of Dissociation (MID). Schizophrenia patients were diagnosed with the Structured Clinical Interview for the DSM-IV Axis I Disorders; DID patients were diagnosed with the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised. DID patients obtained significantly (a) higher dissociation scores; (b) higher passive-influence scores (first-rank symptoms); and (c) higher scores on scales that measure child voices, angry voices, persecutory voices, voices arguing, and voices commenting. Schizophrenia patients obtained significantly higher delusion scores than did DID patients. What is odd is that the dissociation scores of schizophrenia patients were unrelated to their reports of childhood maltreatment. Multiple regression analyses indicated that 81% of the variance in DID patients' dissociation scores was predicted by the MID's Ego-Alien Experiences Scale, whereas 92% of the variance in schizophrenia patients' dissociation scores was predicted by the MID's Voices Scale. We propose that schizophrenia patients' responses to the MID do not index the same pathology as do the responses of DID patients. We argue that neither phenomenological definitions of dissociation nor the current generation of dissociation instruments (which are uniformly phenomenological in nature) can distinguish between the dissociative phenomena of DID and what we suspect are just the dissociation-like phenomena of schizophrenia.     

The self-report Dissociative Disorders Interview Schedule: A preliminary report

A self-report version of the Dissociative Disorders Interview Schedule (SR-DDIS) was administered to 100 inpatients in a hospital-based trauma program. All participants had previously completed the interviewer-administered version of the DDIS. When we compared the overall results on the DDIS and SR-DDIS for the 100 inpatients, the findings were very consistent for both symptom clusters and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5), diagnoses. The agreement rate between the 2 versions for DSM–5 diagnoses was fair to substantial using Cohen’s kappa, with agreement being substantial for 4 out of the 7 diagnoses made by the DDIS. It appears likely that the SR-DDIS can be used instead of the DDIS, at least in clinical populations, with no clinically or conceptually significant differences between the results obtained with the 2 versions.     

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.     

Why the Diagnostic Criteria for Dissociative Identity Disorder Should Be Changed

Abstract

This paper examines the psy chi at ricdiagnosis of dissociative identity disorder (DID)inlightofthedevelopmentsinpsychi at ricclassification that have guided the last four re vi sions of the Diagnostic and Sta tis ti calMan ualforMen talDis or ders (DSM) (Amer i can Psychiatric Association, 1980, 1987, 1994, 2000). The author argues that multiple per son al ity 's pas sage from DSM-III, through DSM-III-R, to its current form as DID in DSM-IV-TR has left the di ag no sis out of step with the state of the art of psy chi atric classification. Ten dis advantages of the Diagnostic and Sta tis ti calMan ual of Men talDis or ders, Fourth Edi tion- Text Revision (DSM-IV-TR) cri te riafor DID are iden ti fied. The DSM-IV-TR cri te ria for DID: (1) are out of step with the state of the art of psy chi at ric clas si fi cation; (2) are not based on taxometric anal y sis of the symp toms of DID; (3) in correctly im ply that DID is a closed con cept; (4) have poor con tent valid ity; (5) throw away im portantinformation; (6) dis courage taxonomic research; (7) have poor reliability and cause frequent misdiagnoses; (8) are not “user-friendly”; (9) are un nee es sar ily con tro versial; and (10) along with pre vi ous ver sions of the DSM, have pro duced an artifactually low base-rate of DID for the past 20 years. In an effort to remedy these disadvantages, a re liable, user-friendly, polythetic set of diagnostic criteria for “Major Dissociative Disorder” is proposed for DSM-V. Using these polythetic cri te ria, the dissociative dis or ders (presently con cep tu al ized as Dissociative Am ne sia, Dissociative Fugue, DID, Depersonalization Disorder, and Dissociative Disorder Not Otherwise Spec ified) can be re struc tured into an eas ily un der stood and more re liable set of di ag nos tic en ti ties. This al ter nate nosology of the dissociative disorders consists of Sim pie Dissociative Dis or der (with at least three). sub types), Gen er al ized Dissociative Dis or der, Major Dissociative Disorder (with two subtypes), and Dissociative Disorder Not Otherwise Specified.     

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.     

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).     

Combat-Induced Dissociative Amnesia

Abstract

Dissociative amnesia following combat trauma in various wars has been extensively documented. In this article, we describe theoretical constructs related to dissociative amnesia, and integrate them with clinical practice through the presentation of a case. Although there is ample documentation of this condition in combat soldiers, in actual clinical practice such dissociative amnesia is probably underdiagnosed and undertreated. This may be detrimental to therapeutic progress, given the fact that ongoing memory deficits constitute one of the core symptoms of chronic PTSD in combat veterans. As illustrated in our case example of combat-induced generalized dissociative amnesia, combat-induced amnesia may also reflect previously existing dissociated traumatic memories that become reactivated during trauma. In this case, intensive treatment using hypnosis within a larger therapeutic milieu involved both the uncovering and processing of recent dissociated traumatic experiences, and, by necessity, other traumas of the past.     

Temporal Disintegration in Depersonalization Disorder

ABSTRACT

Distortions of the experience of time are central to some types of dissociative experiences. In this study, we investigated the relationship between a self-report measure of temporal disintegration and symptoms of dissociation in depersonalization disorder (DPD). Fifty-two DPD and thirty non-clinical control participants were administered the Dissociative Experience Scale (DES) and Temporal Integration Inventory (TII). The DPD group had significantly higher TII scores than the control group. Within the DPD group, there was a significant positive correlation between DES total score and TII total score, and between TII-time distinction subscale score and TII-agency subscale score. In the DPD group, TII scores were not associated with age of onset or duration of illness. Of the three dissociative domains of absorption, amnesia, and depersonalization/derealization, only absorption was a significant predictor of TII total and subscale scores by stepwise linear regression analyses. We conclude that the experience of temporal disintegration in DPD is not directly related to the core symptoms of depersonalization/derealization, but exists when the depersonalized experience involves more prominent absorption.     

Dissociative Depression Among Women with Fibromyalgia or Rheumatoid Arthritis

The aim of this study was to inquire about the possible relations of childhood trauma, anger, and dissociation to depression among women with fibromyalgia or rheumatoid arthritis. Fifty female patients diagnosed as having fibromyalgia (n = 30) or rheumatoid arthritis (n = 20) participated in the study. The Childhood Trauma Questionnaire, Somatoform Dissociation Questionnaire (SDQ), Dissociation Questionnaire (DIS-Q), Beck Depression Inventory (BDI), Spielberger State-Trait Anger Expression Inventory, and Dissociative Disorders Interview Schedule were administered to all participants. Women with a lifetime diagnosis of depressive disorder had higher scores for somatoform and psychoform dissociation than the nondepressive patients. However, childhood trauma scores did not differ between the 2 groups. In regression analysis, current severity of depression (BDI) was predicted by psychoform dissociation (DIS-Q) and lower education, and lifetime diagnosis of major depression was predicted by somatoform dissociation (SDQ). Whereas childhood emotional neglect predicted somatoform dissociation, psychoform dissociation was predicted by childhood sexual abuse. Mental processing of anger seems to be 1 of the dimensions of psychodynamics in trauma-related depressive conditions. In the context of the perceived threat of loss of control due to expressed anger and mental disintegration, somatoform dissociation seems to contribute to overmodulation of emotions in dissociative depression. Among patients suffering from physical illness with possible psychosomatic dimensions, assessment of somatoform dissociation in addition to psychoform dissociation may be helpful to understand diverse psychopathological trajectories emerging in the aftermath of childhood adversities. The recently proposed category of “dissociative depression” (Sar, 2011) seems to be a promising concept for future research on psychosomatic aspects of traumatic stress.