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The American Journal of Psychiatry Feb 2021
Topics: Brain; Depersonalization; Dissociative Disorders; Humans
PubMed: 33517751
DOI: 10.1176/appi.ajp.2020.20121728 -
European Journal of Psychotraumatology 2022Most individuals with dissociative disorders (DDs) report engaging in self-injury.
BACKGROUND
Most individuals with dissociative disorders (DDs) report engaging in self-injury.
OBJECTIVE
The present study aimed to understand the reasons for self-injury among a clinical sample of 156 DD patients enrolled in the TOP DD Network study.
METHOD
Participants answered questions about self-injury, including a prompt asking how often they are aware of the reasons they have urges to self-injure, as well as a prompt asking them to list three reasons they self-injure.
RESULTS
Six themes of reasons for self-injury, each with subthemes, were identified in the qualitative data: (1) Trauma-related Cues, (2) Emotion Dysregulation, (3) Stressors, (4) Psychiatric and Physical Health Symptoms, (5) Dissociative Experiences, and (6) Ineffective Coping Attempts. Participants reported that they were able to identify their reasons for self-injuring sometimes (60.26%) or almost always (28.85%), with only 3.20% unable to identify any reasons for their self-injury.
CONCLUSION
Results suggest that the vast majority of DD patients (92.31%) reported being at least partially unaware of what leads them to have self-injury urges, and many individuals with DDs experience some reasons for self-injury that are different from those with other disorders. The treatment implications of these findings are discussed.
Topics: Adult; Cues; Dissociative Disorders; Female; Health Status; Humans; Male; Self-Injurious Behavior; Stress, Psychological; Surveys and Questionnaires; Wounds and Injuries
PubMed: 35126883
DOI: 10.1080/20008198.2022.2026738 -
Annual Review of Clinical Psychology May 2022For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that... (Review)
Review
For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identifyempirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation.
Topics: Dissociative Disorders; Humans; Metacognition; Stress Disorders, Post-Traumatic
PubMed: 35226824
DOI: 10.1146/annurev-clinpsy-081219-102424 -
Genes May 2022Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness,... (Review)
Review
Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.
Topics: Dissociative Disorders; Emotions; Genome-Wide Association Study; Humans; Molecular Biology
PubMed: 35627228
DOI: 10.3390/genes13050843 -
Issues in Mental Health Nursing May 2022
Topics: Adolescent; Dissociative Disorders; Humans
PubMed: 34641755
DOI: 10.1080/01612840.2021.1980639 -
Neuroscience and Biobehavioral Reviews Jan 2022Dissociative disorders (DD) and conversion disorders (CD) are frequent in general and psychiatric populations. Some evidence suggest that the hypothalamic-pituitary axis... (Review)
Review
Dissociative disorders (DD) and conversion disorders (CD) are frequent in general and psychiatric populations. Some evidence suggest that the hypothalamic-pituitary axis (HPA) and autonomic nervous system (ANS) are dysregulated in both disorders. We carried out a systematic review of the literature to summarize the existing knowledge on the stress response, via HPA and/or ANS, in patients with DD, CD, or dissociative symptoms. We systematically searched Medline and Web of Science using the Medical Subject Headings related to stress axis, CD, DD, and dissociative symptoms following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results suggest that in participants without psychiatric history, high cortisol secretion is related to high dissociation scores. Conversely the stress system might be blunted in patients with post-traumatic stress disorder who develop dissociative symptoms. Stress response changes seem to be associated with the emergence and persistence of dissociative and conversion disorders. Hence, monitoring the stress response and examining closely the history of stress exposure in DD and CD should be encouraged in future larger studies.
Topics: Autonomic Nervous System; Conversion Disorder; Dissociative Disorders; Humans; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Stress Disorders, Post-Traumatic
PubMed: 34740754
DOI: 10.1016/j.neubiorev.2021.10.049 -
Behavioral Sciences & the Law 2023Because a wide range of disorders incorporate dissociative symptoms, evaluators should be familiar with evidence-based approaches to evaluating dissociation claims in... (Review)
Review
Because a wide range of disorders incorporate dissociative symptoms, evaluators should be familiar with evidence-based approaches to evaluating dissociation claims in the clinical and forensic context. This article provides specific guidelines for practitioners when conducting a forensic assessment of individuals who report dissociative symptoms. We review the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition disorders that include dissociation as a symptom, highlight how to distinguish genuine versus atypical symptoms of dissociative identity disorder, and summarize strengths and weaknesses of structured assessments in the evaluation of dissociative claims.
Topics: Humans; Dissociative Disorders; Diagnostic and Statistical Manual of Mental Disorders
PubMed: 37010094
DOI: 10.1002/bsl.2622 -
Australasian Psychiatry : Bulletin of... Dec 2019Auditory verbal hallucinations (AVH) frequently co-occur with borderline personality disorder (BPD) and can lead to misdiagnosis with schizophrenia (SCZ) or other... (Review)
Review
OBJECTIVE
Auditory verbal hallucinations (AVH) frequently co-occur with borderline personality disorder (BPD) and can lead to misdiagnosis with schizophrenia (SCZ) or other primary psychotic disorders. Misdiagnosis is more common when AVH meet criteria for Schneiderian first rank symptoms (FRS). This paper's objective is to improve diagnostic accuracy by outlining particular clinical features that can assist the distinction between BPD and psychotic disorders in these cases.
CONCLUSION
The overall clinical presentation when AVH occur in BPD can assist in determining a primary diagnosis of BPD when frank psychotic disorder is absent. AVH in BPD cannot be distinguished phenomenologically from AVH in SCZ. Clinical experience and increasing research suggest that AVH in BPD are often dissociative in origin and highly correlated with the presence of FRS, elevated levels of dissociation and a history of childhood trauma. When AVH occur in BPD in the absence of co-occurring psychotic disorder, formal thought disorder is usually absent, negative symptoms minimal or absent, bizarre symptoms absent, affect reactive and the patient retains sociability. Psychotropic medication may be less effective for the AVH in these cases, while they may improve or remit during psychotherapy for BPD.
Topics: Adverse Childhood Experiences; Borderline Personality Disorder; Dissociative Disorders; Hallucinations; Humans; Psychological Trauma; Psychotic Disorders; Schizophrenia
PubMed: 31304765
DOI: 10.1177/1039856219859290 -
Alcoholism, Clinical and Experimental... Feb 2022Up to 50% of individuals with posttraumatic stress disorder (PTSD) endorse problematic alcohol use. Typically, these individuals present with more complex and often more...
BACKGROUND
Up to 50% of individuals with posttraumatic stress disorder (PTSD) endorse problematic alcohol use. Typically, these individuals present with more complex and often more severe PTSD symptoms than those who do not report problematic alcohol use. Emerging literature suggests that heightened symptoms of dissociation are likewise associated with greater PTSD symptom severity. Despite this knowledge, the role of dissociation in the relation between PTSD severity and alcohol-related problems has yet to be examined. Here, we explore the mediating role of dissociative symptomatology on the association between PTSD severity and alcohol-related problems within a PTSD treatment-seeking sample.
METHODS
Structural equation modeling was used to test the mediating role of dissociative symptomatology between PTSD severity and alcohol-related problems. Participants [N = 334; mean age (SD) = 44.29 (9.77), 50% female] were drawn from a clinical intake battery database for PTSD in-patient treatment services at Homewood Health Care, Guelph, ON, Canada. A subset of battery measures assessing PTSD severity, dissociative symptomatology, and alcohol-related problems were submitted to analysis.
RESULTS
A significant positive association emerged between PTSD severity and alcohol-related problems (β = 0.127, p < 0.05) in the absence of dissociative symptomatology. Critically, however, when added to this model, dissociative symptomatology (six unique facets of dissociation assessed by the Multiscale Dissociation Inventory) mediated the relation between PTSD severity and alcohol-related problems. Specifically, greater PTSD severity was associated with greater dissociative symptomatology (β = 0.566, p < 0.0001), which was in turn associated with greater alcohol-related problems (β = 0.184, p < 0.05).
CONCLUSIONS
These results suggest that dissociative symptomatology plays a key role in explaining the relation between PTSD severity and alcohol-related problems. Future studies should examine the impact of targeting dissociative symptomatology specifically in treating individuals with PTSD who endorse alcohol-related problems.
Topics: Adult; Alcohol-Related Disorders; Cross-Sectional Studies; Dissociative Disorders; Emotional Regulation; Female; Humans; Male; Middle Aged; Severity of Illness Index; Stress Disorders, Post-Traumatic
PubMed: 35179786
DOI: 10.1111/acer.14764 -
Psychopathology 2015Some concept of self has been used by many, although not all, researchers and clinicians as an 'organising construct' for borderline personality disorder (BPD). There is... (Review)
Review
Some concept of self has been used by many, although not all, researchers and clinicians as an 'organising construct' for borderline personality disorder (BPD). There is considerable variation in this usage and how clearly researchers have defined the self. Given this diversity, and that 'self' is often used interchangeably with parallel concepts (e.g., psyche, brain-mind, 'person') or with features of self (e.g., self-awareness, identity), unqualified use of the term is problematic. This is further complicated by the heterogeneity and 'comorbidity' of BPD and the limitations of syndromally based psychiatric nosology. Still, BPD remains in current classification systems and can be reliably diagnosed. A considerable body of research on self and BPD has accrued, including a recent profusion and confluence of neuroscientific and sociopsychological findings. These have generated supporting evidence for a supra-ordinate, functionally constituted entity of the self ranging over multiple, interacting levels from an unconscious, 'core' self, through to a reflective, phenotypic, 'idiographic' and relational self constituted by interpersonal and sociocultural experience. Important insights have been generated regarding emotional and social-cognitive dysregulation, disorder of self-awareness, relationality, identity, and coherence and continuity of the self. Many of these are shared by various trauma-related, dissociative disorders. A construct of the self could be useful as an explanatory principle in BPD, which could be construed as a 'self-state' (and relational) disorder, as opposed to a less severe disorder of aspects of the self (e.g., mood or memory). We offer a tentative description of 'Self' in this context, noting that any such construct will require a clear definition and to be evaluable.
Topics: Borderline Personality Disorder; Comorbidity; Dissociative Disorders; Emotions; Humans; Self Concept
PubMed: 26346462
DOI: 10.1159/000438827