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Dialogues in Clinical Neuroscience Sep 2018Controversy about dissociation and the dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs... (Review)
Review
Controversy about dissociation and the dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence support a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and that DD are artefactual conditions produced by iatrogenesis and/or socio-cultural factors. Almost no research or clinical data support this view. DD are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior. Prospective treatment outcome studies of severely ill DD patients show significant improvement in symptoms including suicidal/self-destructive behaviors, with reductions in treatment cost. A major public health effort is needed to raise awareness about dissociation/DD, including educational efforts in all mental health training programs and increased funding for research.
Topics: Dissociative Disorders; History, 20th Century; History, 21st Century; Humans; Prospective Studies; Research; Stress Disorders, Post-Traumatic
PubMed: 30581293
DOI: 10.31887/DCNS.2018.20.3/rloewenstein -
International Review of Neurobiology 2020This chapter reviews the relationship between stress and brain function in patients with neuropsychiatric disorders, with an emphasis on disorders that have most clearly... (Review)
Review
This chapter reviews the relationship between stress and brain function in patients with neuropsychiatric disorders, with an emphasis on disorders that have most clearly been linked to traumatic stress exposure. These disorders, which have been described as trauma spectrum disorders, include posttraumatic stress disorder (PTSD), a subgroup of major depression, borderline personality disorder (BPD) and dissociative disorders; they share in common a neurobiological footprint, including smaller hippocampal volume, and are distinguished from other disorders that may share symptom similarities, like some of the anxiety disorders, but are not as clearly linked to stress. The relationship between environmental events such as stressors, especially in early childhood, and their effects on brain and neurobiology is important to understand in approaching these disorders as well as the development of therapeutic interventions. Addressing patients with stress-related disorders from multiple developmental (age at onset of trauma) as well as levels of analysis (cognitive, cultural, neurobiological) approaches will provide the most complete picture and result in the most successful treatment outcomes.
Topics: Animals; Borderline Personality Disorder; Brain; Dissociative Disorders; Humans; Mental Disorders; Stress Disorders, Post-Traumatic; Stress, Psychological; Wounds and Injuries
PubMed: 32450992
DOI: 10.1016/bs.irn.2020.01.004 -
Psychiatria Polska Feb 2023Dissociative identity disorder (DID) belongs to the complicated issues of psychiatry and psychology areas. The specificity of the disorder and its clinical picture imply... (Review)
Review
Dissociative identity disorder (DID) belongs to the complicated issues of psychiatry and psychology areas. The specificity of the disorder and its clinical picture imply numerous difficulties in the diagnosis and treatment process. The diagnosis of DID can also have significant legal consequences, especially in the context of criminal liability or the general ability to be a witness. Thus, DID is an interdisciplinary problem. In practice, DID is rarely diagnosed, although it is estimated that it occurs in about 1% of the general population. In many cases, the period from the first contact with the healthcare system to a correct diagnosis exceeds several years (on average, 6.7 to 8 years). The average misdiagnosis rate is 2.8 per patient. The lack of a quick and proper diagnosis makes it impossible to undertake adequate treatment, which extends the entire therapeutic process, affects its effectiveness and significantly increases costs. There is no doubt that in educating psychiatrists and clinical psychologists, greater emphasis should be placed on correctly detecting dissociative symptoms and the use of adequate diagnostic tools. The aim of this article is to present and identify the main problems that DID implies in the diagnostic and therapeutic (psychological and psychiatric) areas. The article discusses the existing diagnostic tools, the issues of comorbidity and the causes of incorrect diagnoses. The issues of false-positive diagnoses and difficulties in differentiating patients with DID from simulators were also discussed. The primary mistakes made during the therapy, such as the strategy of minimization or the actions leading to multiple therapist disorder, were analyzed. Legal aspects will be presented in a separate article.
Topics: Humans; Dissociative Identity Disorder; Dissociative Disorders; Psychiatry; Comorbidity; Diagnostic Errors
PubMed: 37350721
DOI: 10.12740/PP/146969 -
Psychiatria Danubina Oct 2023The Dissociative Identity Disorder has undergone significant transformations over the years. Once regarded as a rare condition, it gained popularity in the 1980s in the...
The Dissociative Identity Disorder has undergone significant transformations over the years. Once regarded as a rare condition, it gained popularity in the 1980s in the United States following the publication of a book on the subject, only to subsequently wane due to extensive controversies. Presently, we are witnessing a resurgence of adolescents who believe they may be afflicted by this disorder. This article delves into the changes that have occurred since the initial surge in 1980, with a particular focus on the role of social media in the dissemination of Dissociative Identity Disorder. The concepts of Mass Social Media-Induced Illness and Munchausen's by Internet are explored to elucidate this phenomenon. Additionally, we examine the criteria essential for distinguishing imitative Dissociative Identity Disorder from genuine cases, with the aim of aiding accurate diagnosis by psychiatrists. Mental health professionals may encounter new challenges when assessing young adults whose presentations are influenced by social media, necessitating awareness of the impact of social media on the dissemination of certain disorders.
Topics: Adolescent; Humans; Dissociative Identity Disorder; Psychiatry; Dissociative Disorders
PubMed: 37800227
DOI: No ID Found -
Biological Psychiatry Feb 2022
Topics: Dissociative Disorders; Dissociative Identity Disorder; Humans; Interview, Psychological; Neurosciences; Psychiatric Status Rating Scales
PubMed: 34961597
DOI: 10.1016/j.biopsych.2021.11.004 -
Sleep Medicine Clinics Mar 2024In sleep-related dissociative disorders, phenomena of the psychiatrically defined dissociative disorders emerge during the sleep period. They occur during sustained... (Review)
Review
In sleep-related dissociative disorders, phenomena of the psychiatrically defined dissociative disorders emerge during the sleep period. They occur during sustained wakefulness, either in the transition to sleep or following an awakening from sleep. Behaviors during episodes vary widely, and can result in injury to self or others. Daytime dissociative episodes and a background of trauma are almost always present; there is typically major co-existing psychopathology. Diagnosis is based on both clinical history and polysomnography; differential diagnosis primarily involves other parasomnias and nocturnal seizures. Information available about treatment is limited; in a few reported cases, psychological interventions have proven effective.
Topics: Humans; Parasomnias; Sleep Wake Disorders; Dissociative Disorders; Sleep, REM; Sleep
PubMed: 38368062
DOI: 10.1016/j.jsmc.2023.10.003 -
The American Journal of Psychiatry Jan 2018Dissociation is a complex, ubiquitous construct in psychopathology. Symptoms of dissociation are present in a variety of mental disorders and have been connected to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Dissociation is a complex, ubiquitous construct in psychopathology. Symptoms of dissociation are present in a variety of mental disorders and have been connected to higher burden of illness and poorer treatment response, and not only in disorders with high levels of dissociation. This meta-analysis offers a systematic and evidence-based study of the prevalence and distribution of dissociation, as assessed by the Dissociative Experiences Scale, within different categories of mental disorders, and it updates an earlier meta-analysis.
METHOD
More than 1,900 original publications were screened, and 216 were included in the meta-analysis, comprising 15,219 individuals in 19 diagnostic categories.
RESULTS
The largest mean dissociation scores were found in dissociative disorders (mean scores >35), followed by posttraumatic stress disorder, borderline personality disorder, and conversion disorder (mean scores >25). Somatic symptom disorder, substance-related and addictive disorders, feeding and eating disorders, schizophrenia, anxiety disorder, OCD, and most affective disorders also showed mean dissociation scores >15. Bipolar disorders yielded the lowest dissociation scores (mean score, 14.8).
CONCLUSIONS
The findings underline the importance of careful psychopathological assessment of dissociative symptoms in the entire range of mental disorders.
Topics: Dissociative Disorders; Humans; Mental Disorders; Prevalence; Psychiatric Status Rating Scales; Psychopathology
PubMed: 28946763
DOI: 10.1176/appi.ajp.2017.17010025 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2021This paper reviews the literature on functional neurological disorders (Dissociative (conversion disorders - F44). The authors present a change in views on the etiology... (Review)
Review
This paper reviews the literature on functional neurological disorders (Dissociative (conversion disorders - F44). The authors present a change in views on the etiology and the main mechanisms of the pathogenesis of this pathology during the period of its study. The modern ideas about the types of cerebral dysfunction characteristic of functional neurological disorders are considered. The description of the most characteristic mental and somatic symptoms observed in dissociative disorders and the features of their clinical manifestations are given. The current approaches to the therapy of functional neurological disorders are considered.
Topics: Brain Diseases; Conversion Disorder; Dissociative Disorders; Humans
PubMed: 33580769
DOI: 10.17116/jnevro202112101198 -
Journal of the American Academy of... Dec 2017The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by...
OBJECTIVE
The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by evaluating evidence for the depersonalization/derealization dissociative subtype of PTSD as defined by the DSM-5 and then examining a broader set of dissociation symptoms.
METHOD
A sample of treatment-seeking, trauma-exposed adolescents 12 to 16 years old (N = 3,081) from the National Child Traumatic Stress Network Core Data Set was used to meet the study objectives. Two models of PTSD/dissociation co-occurrence were estimated using latent class analysis, one with 2 dissociation symptoms and the other with 10 dissociation symptoms. After model selection, groups within each model were compared on demographics, trauma characteristics, and psychopathology.
RESULTS
Model A, the depersonalization/derealization model, had 5 classes: dissociative subtype/high PTSD; high PTSD; anxious arousal; dysphoric arousal; and a low symptom/reference class. Model B, the expanded dissociation model, identified an additional class characterized by dissociative amnesia and detached arousal.
CONCLUSION
These 2 models provide new information about the specific ways PTSD and dissociation co-occur and illuminate some differences between adult and adolescent trauma symptom expression. A dissociative subtype of PTSD can be distinguished from PTSD alone in adolescents, but assessing a wider range of dissociative symptoms is needed to fully characterize adolescent traumatic stress responses.
Topics: Adolescent; Child; Depersonalization; Dissociative Disorders; Female; Humans; Male; Models, Psychological; Models, Statistical; Psychiatric Status Rating Scales; Stress Disorders, Post-Traumatic
PubMed: 29173740
DOI: 10.1016/j.jaac.2017.09.425 -
Der Nervenarzt May 2017Patients with factitious disorders intentionally fabricate, exaggerate or feign physical and/or psychiatric symptoms for various open and covert psychological reasons.... (Review)
Review
Patients with factitious disorders intentionally fabricate, exaggerate or feign physical and/or psychiatric symptoms for various open and covert psychological reasons. There are many issues regarding the diagnostic state and classification of factitious disorders. Both the categorical differentiation of and clinical continuum ranging from somatoform/dissociative disorders to malingering are being controversially debated. Epidemiological studies on the frequency of factitious disorder meet basic methodological difficulties. Reported rates of prevalence and incidence in the professional literature most probably have to be considered underestimations. Illness deception and self-harm as core features of the abnormal illness behaviour in factitious disorder may refer to various highly adverse and traumatic experiences during early development in a subgroup of patients. Chronic courses of illness prevail; however, there are also episodic variants.
Topics: Diagnosis, Differential; Dissociative Disorders; Evidence-Based Medicine; Factitious Disorders; Humans; Malingering; Self-Injurious Behavior; Somatoform Disorders; Treatment Outcome
PubMed: 28451707
DOI: 10.1007/s00115-017-0337-8