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Clinical Psychology Review Nov 2019Dissociative experiences and symptoms have sparked intense scrutiny and debate for more than a century. Two perspectives, the trauma model (TM), which postulates a... (Review)
Review
Dissociative experiences and symptoms have sparked intense scrutiny and debate for more than a century. Two perspectives, the trauma model (TM), which postulates a direct and potent causal link between trauma and dissociation, and the sociocognitive model (SCM), which emphasizes social and cognitive variables (e.g., fantasy-proneness, media influences, suggestibility, suggestion, cognitive failures), currently vie for support. The intensive focus on controversies has stymied progress in understanding dissociation as much, if not more, than it has inspired research that transcends a single perspective. We assess strengths and limitations of these two perspectives and contend that neither provides a complete account of dissociation symptoms, which occur in the presence of many disorders. We provide a novel, narrative review of the link between dissociation and dissociative disorders and sleep disruptions, hyperassociativity, set shifts, deficits in meta-consciousness, and impaired self-regulation. We suggest that these transtheoretical variables (a) play a role in disorders that covary extensively with dissociative disorders (i.e., borderline personality disorder, schizophrenia spectrum disorders) and (b) provide the basis for overlapping foci of interests and potential collaborations among proponents of competing theoretical camps. Finally, we discuss limitations in knowledge and unresolved issues for future workers in the field to pursue.
Topics: Dissociative Disorders; Humans; Metacognition; Models, Psychological; Personality Disorders; Schizophrenia; Self-Control; Sleep Wake Disorders
PubMed: 31494349
DOI: 10.1016/j.cpr.2019.101755 -
Medical Hypotheses May 2021Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients demonstrate characteristic multistage progression and movement disorders, which are analogous to... (Review)
Review
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients demonstrate characteristic multistage progression and movement disorders, which are analogous to hystero-epilepsy in Jean-Martin Charcot's Tuesday Lessons. First, based on a review of the Tuesday Lessons recorded by Charcot's pupils, we hypothesized that there were patients with anti-NMDAR encephalitis among those diagnosed with hystero-epilepsy in the nineteenth century. We found acute-onset multiple neuropsychiatric manifestations resembling anti-NMDAR encephalitis among patients with hystero-epilepsy. Patients with drug withdrawal syndrome, dissociative and conversion disorders and patients under hypnosis from the modern point of view were also identified. These results suggested that hystero-epilepsy in the Tuesday Lessons could encompass dissociative and conversion disorders, hypnosis, drug withdrawal syndrome, and anti-NMDAR encephalitis-like manifestations. Based on Charcot's observations and current progress in molecular biology, such as the identification of glutamate/NMDAR system dysfunction in drug withdrawal syndrome, we then hypothesized that patients with dissociative and conversion disorders and those under hypnosis could also have hypofunction of the glutamatergic system. The NMDAR hypofunction hypothesis is emerging as a pathogenesis of schizophrenia. NMDAR antagonists are known to evoke symptoms similar to schizophrenia, anti-NMDAR encephalitis and near-death experiences. In current clinical reports, spectrum disorders such as dissociative disorder and conversion disorder have been observed in patients with anti-NMDAR encephalitis. Our hypothesis will offer an expansion of the NMDAR hypofunction hypothesis from psychosis to functional neurological disorders and normal specific situations, such as hypnosis, thanatosis, and near-death experiences.
Topics: Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Dissociative Disorders; Epilepsy; Humans; Receptors, Glutamate; Receptors, N-Methyl-D-Aspartate
PubMed: 33799161
DOI: 10.1016/j.mehy.2021.110567 -
The Israel Journal of Psychiatry and... 2015Post traumatic patients experience a wide range of symptoms, some of them existential in nature which we term "dissociative being." Many varied psychotherapeutic... (Review)
Review
Post traumatic patients experience a wide range of symptoms, some of them existential in nature which we term "dissociative being." Many varied psychotherapeutic approaches are available for the treatment of post traumatic patients. Nevertheless, in view of this disorder's complexity, therapists face shortcomings when employing each of these therapeutic interventions. In order to understand this, we posit the principle we call "dissociative reality" for the treatment of trauma survivors. Our proposed method "speaks the patient's own language," harnessing dissociative elements to help individuals recall, re-enact and integrate traumatic experiences, where words are insufficient, while still upholding reality. We believe that this may be seen as an effective part of the therapeutic dialogue, and suggest that therapists may consider supplementing this approach in their treatment "toolkit" for patients with post traumatic stress and other trauma related disorders, irrespective of their declared therapeutic approach.
Topics: Dissociative Disorders; Humans; Psychotherapy; Stress Disorders, Post-Traumatic
PubMed: 25841110
DOI: No ID Found -
Der Nervenarzt Nov 2022The term "complex posttraumatic stress disorder" (cPTSD) appeared in the scientific literature 30 years ago and has now been included in a diagnostic catalogue for the...
The term "complex posttraumatic stress disorder" (cPTSD) appeared in the scientific literature 30 years ago and has now been included in a diagnostic catalogue for the first time, namely in the International Statistical Classification of Diseases and Related Health Problems 11 (ICD-11) which was officially published at the beginning of 2022. This usually severely debilitating disorder often poses great challenges to treating physicians and psychotherapists in everyday clinical practice. Due to the much-debated overlap of cPTSD with borderline personality disorder (BPD), which is very high in cases of comorbidity of BPD and PTSD, cPTSD became embroiled in scientific discussions about the raison d'être of BPD in the new dimensional concept of personality disorders (PD) in the ICD-11. In addition to a detailed explanation of the diagnostic criteria of cPTSD and their differentiation from other mental disorders, particularly from PTSD, BPD and dissociative disorders, this article summarizes the historical development of the concept of cPTSD to date and the currently available treatment options. The same criteria apply to cPTSD in childhood and adolescence as in adulthood, but there are some special features that are not addressed in this article.
Topics: Adult; Adolescent; Humans; Stress Disorders, Post-Traumatic; Dissociative Disorders; International Classification of Diseases; Borderline Personality Disorder; Comorbidity
PubMed: 36251027
DOI: 10.1007/s00115-022-01400-4 -
Expert Review of Neurotherapeutics Mar 2024Dissociative identity disorder (DID) is a treatable mental health condition that is associated with a range of psychobiological manifestations. However, historical... (Review)
Review
INTRODUCTION
Dissociative identity disorder (DID) is a treatable mental health condition that is associated with a range of psychobiological manifestations. However, historical controversy, modern day misunderstanding, and lack of professional education have prevented accurate treatment information from reaching most clinicians and patients. These obstacles also have slowed empirical efforts to improve treatment outcomes for people with DID. Emerging neurobiological findings in DID provide essential information that can be used to improve treatment outcomes.
AREAS COVERED
In this narrative review, the authors discuss symptom characteristics of DID, including dissociative self-states. Current treatment approaches are described, focusing on empirically supported psychotherapeutic interventions for DID and pharmacological agents targeting dissociative symptoms in other conditions. Neurobiological correlates of DID are reviewed, including recent research aimed at identifying a neural signature of DID.
EXPERT OPINION
Now is the time to move beyond historical controversy and focus on improving DID treatment availability and efficacy. Neurobiological findings could optimize treatment by reducing shame, aiding assessment, providing novel interventional brain targets and guiding novel pharmacologic and psychotherapeutic interventions. The inclusion of those with lived experience in the design, planning and interpretation of research investigations is another powerful way to improve health outcomes for those with DID.
Topics: Humans; Dissociative Identity Disorder; Neurobiology; Dissociative Disorders; Brain; Treatment Outcome
PubMed: 38357897
DOI: 10.1080/14737175.2024.2316153 -
European Journal of Paediatric... Jan 2018Dissociative disorders present a huge challenge in clinical settings. In contrast to other dissociative symptoms, dissociative sensibility disorders are rarely focused... (Review)
Review
CONTEXT
Dissociative disorders present a huge challenge in clinical settings. In contrast to other dissociative symptoms, dissociative sensibility disorders are rarely focused on.
OBJECTIVE
To identify the clinical characteristics and outcomes of dissociative sensibility disorders in children and adolescents, and to review the use of diagnostic procedures.
DATA SOURCES
For the review, a literature search used Pubmed, Embase, Web of Science, and PubPsych (to 02/2015) and the reference lists of the studies identified.
STUDY SELECTION
Screening of titles and abstracts; full-text assessment by two reviewers.
DATA SELECTION
The original case series was identified by using the local data register.
DATA EXTRACTION
Two reviewers independently reviewed the data and, if they agreed on the relevance, extracted the data. In the original case series, data were extracted retrospectively from the records.
RESULTS
Sixteen studies and seven case reports were identified, including 931 cases with dissociative disorders. In 210 cases the patient suffered either from a single sensibility disorder or predominantly from sensibility disorders. We identified thirteen further cases in our cohort. In both groups there was female predominance; the mean age of manifestation was early adolescence. The timing of admissions was variable. In approximately 50% of cases a premorbid stressful life event could be identified. Over 75% of cases had a good prognosis with complete resolution.
LIMITATIONS
Retrospective character of our own data collection, partially missing differentiation between the subgroups of dissociative disorders in the reviewed studies.
CONCLUSIONS
There is no uniform procedure for diagnostic work-up. The overall short-term prognosis is good.
Topics: Adolescent; Child; Dissociative Disorders; Female; Humans; Male; Prognosis; Retrospective Studies
PubMed: 28899586
DOI: 10.1016/j.ejpn.2017.08.005 -
Journal of Trauma & Dissociation : the... 2023This systematic review and meta-analysis aimed to investigate the relationship between dissociation and obsessive-compulsive symptoms (OCS) and disorder (OCD).... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis aimed to investigate the relationship between dissociation and obsessive-compulsive symptoms (OCS) and disorder (OCD). Specifically, the study aimed to (a) estimate the pooled prevalence of dissociative disorders among individuals with OCD; (b) systematically review the prevalence of OCD among individuals with dissociative disorders; (c) compare the severity of dissociative symptoms between individuals with OCD and non-clinical controls; (d) estimate the association between OCS and dissociative symptoms in the clinical and non-clinical populations. A systematic search was carried out in biomedical databases from inception to January 2022 according to PRISMA guidelines. A total of 41 studies met inclusion criteria ( = 9,438, 34.3% males). The pooled prevalence of dissociative disorders in adult samples with OCD was 8% (95% CI [3, 15], = 5). Studies on adolescent and adult patients with dissociative disorders found that 17-32% reported comorbid OCD, while a prospective study of patients with early-onset dissociative disorders found no evidence of association with OCD. Individuals affected by OCD reported more dissociative symptoms than non-clinical controls ( = .67, 95% CI [.18, 1.16], = 9). A moderate correlation between dissociative symptoms and OCS was detected ( = .43, 95% CI [.36, .51], = 18). Sensitivity analyses showed small/moderate correlations between dissociative experiences and specific types of obsessions and compulsions. Findings suggest that dissociative symptoms are moderately related to OCS in both clinical and non-clinical populations. Interventions aimed to reduce dissociation might improve treatment response of patients suffering from OCD.
Topics: Adult; Male; Adolescent; Humans; Female; Obsessive-Compulsive Disorder; Prospective Studies; Comorbidity; Dissociative Disorders; Prevalence
PubMed: 36820493
DOI: 10.1080/15299732.2023.2181477 -
The International Journal of Social... Nov 2022Dissociative/conversion disorders affect almost 31% of children and adolescents in a clinical setting. These children experience significant impairments in their...
Dissociative/conversion disorders affect almost 31% of children and adolescents in a clinical setting. These children experience significant impairments in their academics, and daily functioning, with high chances of developing other psychiatric comorbidities such as anxiety and depression. However, there are no studies that explore the experiences of suffering from dissociative/conversion disorders from perspective of the sufferer. Therefore, the paper has aimed at exploring the subjective experiences of dissociative and conversion disorders among adolescents in the Indian context by examining their understanding about the illness and the reason they ascribe to the cause of their illness. The study used a qualitative semi-structured interview to understand their illness. In total, 10 adolescents of age group between 12 and 16 years participated. Eight out of the 10 participants were female and the mean age was 12 years. All of them were in-patients in the department of Child and Adolescent Psychiatry, NIMHANS, which is the tertiary mental health care Institute India and pioneer Institute of mental health in Asia. All participants have had at least one or more consultation history either with a traditional healer or/and physician. Thematic analysis identified vital themes such as (1) Adolescents' attributing factors of the illness, (2) Cognitive and emotional appraisal of stressful situation/s, (3) Adolescents' appraisal of different explanatory model, (4) Living with the Impact of the illness. This analysis about dissociative/conversion disorders from adolescents' perspective has a major contribution in enhancing the clinical knowledge and practice in planning and managing children/adolescents diagnosed with dissociative/conversion disorders.
Topics: Adolescent; Adolescent Psychiatry; Anxiety Disorders; Child; Comorbidity; Conversion Disorder; Dissociative Disorders; Female; Humans; Male
PubMed: 34387515
DOI: 10.1177/00207640211036178 -
European Journal of Psychotraumatology 2022Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To...
BACKGROUND
Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To the best of our knowledge, however, the link between emotion dysregulation and self-injury has not yet been examined within a DD population.
OBJECTIVE
The present study investigated relations between emotion dysregulation, dissociation, and self-injury in DD patients, and explored patterns of emotion dysregulation difficulties among DD patients with and without recent histories of self-injury.
METHOD
We utilized linear and logistic regressions and -test statistical methods to examine data from 235 patient-clinician dyads enrolled in the TOP DD Network Study.
RESULTS
Analyses revealed emotion dysregulation was associated with heightened dissociative symptoms and greater endorsement of self-injury in the past six months. Further, patients with a history of self-injury in the past six months reported more severe emotion dysregulation and dissociation than those without recent self-injury. As a group, DD patients reported the greatest difficulty engaging in goal-directed activities when distressed, followed by lack of emotional awareness and nonacceptance of emotional experiences. DD patients demonstrated similar patterns of emotion dysregulation difficulties irrespective of recent self-injury status.
CONCLUSIONS
Results support recommendations to strengthen emotion regulation skills as a means to decrease symptoms of dissociation and self-injury in DD patients.
Topics: Adult; Aged; Cross-Sectional Studies; Dissociative Disorders; Emotional Regulation; Female; Humans; Male; Middle Aged; Self-Injurious Behavior; Surveys and Questionnaires
PubMed: 35145611
DOI: 10.1080/20008198.2022.2031592 -
Comprehensive Psychiatry Nov 2023To determine whether dissociative experiences moderate online problem gambling treatment effectiveness, and to characterize the temporal persistence of the relationship...
AIMS
To determine whether dissociative experiences moderate online problem gambling treatment effectiveness, and to characterize the temporal persistence of the relationship between dissociation and problem gambling.
DESIGN
Repeatedly measured self-report data on a guided online cognitive behavioral therapy for problem gambling collected on four occasions: before treatment, after treatment, and at 6- and 12-month follow-ups.
SETTING AND PARTICIPANTS
The data (N = 1243, 59.2% males) were collected in Finland between 2019 and 2021.
MEASUREMENTS
The primary outcome variable was the self-reported level of problem gambling. The predictors were the treatment phase and dissociative experiences, their interaction, and the demographic covariates of age, education, income, and gender.
FINDINGS
Problem gambling scores and dissociative experiences declined significantly following treatment and remained low through the follow-ups (retention rates: 52.6% [post-treatment], 26.3% [at the 6-month follow-up], and 16.1% [at the 12-month follow-up]). However, the treatment was significantly less effective in reducing problem gambling for individuals who kept experiencing dissociation after the treatment.
CONCLUSIONS
Dissociation is an integral sign of problem gambling severity and sustained dissociative experiences may significantly reduce the long-term effectiveness of online problem gambling treatments. Treatment efforts should be customized to account for individual differences in dissociative tendencies, and future research should broaden the study of dissociative experiences to other behavioral addictions.
Topics: Male; Humans; Female; Gambling; Cognitive Behavioral Therapy; Self Report; Treatment Outcome; Dissociative Disorders
PubMed: 37688936
DOI: 10.1016/j.comppsych.2023.152414