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Medecine Sciences : M/S Apr 2023The category of dissociative identity disorder (DID) has puzzled medical science and fascinated popular culture for almost 200 years. Its occurrence in young people...
The category of dissociative identity disorder (DID) has puzzled medical science and fascinated popular culture for almost 200 years. Its occurrence in young people raises at least two new questions addressed by science studies and embedded philosophy: self-diagnosis (related to cyberchondria and mass media-induced illness) and transient disease (related to looping effect and identity claim specific to adolescence). In an attempt to refine the sociocognitive model, we analyze the impact of these notions in understanding the local ecological niche in which contemporary adolescent DID occurs.
Topics: Humans; Adolescent; Dissociative Identity Disorder; Dissociative Disorders
PubMed: 37094271
DOI: 10.1051/medsci/2023042 -
Neuropsychiatrie : Klinik, Diagnostik,... Jun 2023The present study investigated the interactions between emotion regulation strategies and cognitive distortions in posttraumatic stress disorder (PTSD). We also examined...
PURPOSE
The present study investigated the interactions between emotion regulation strategies and cognitive distortions in posttraumatic stress disorder (PTSD). We also examined differences in emotion regulation and cognitive distortions across the trauma spectrum.
METHODS
The study was conducted in France between December 2019 and August 2020 and was approved by the university ethics committee. We recruited 180 participants aged over 18, with 3 groups of 60 each: (1) patients diagnosed with PTSD, (2) trauma-exposed without PTSD, (3) no history of trauma. Exclusion criteria were a history of neurological or mental disorders, psychoactive substance abuse, and a history of physical injury that could affect outcomes. All participants completed the Life Events Checklist‑5 (LEC-5), Post-traumatic Check List‑5 (PCL-5), Dissociative Experiences Scale (DES), Cognitive Emotion Regulation Questionnaire (CERQ), and Cognitive Distortions scale for Adults (EDC-A). Correlation analysis was performed to observe the relationship between PTSD severity and cognitive functioning. Correlations between cognitive distortions and maladaptive emotion regulation strategies were calculated for the PTSD group. A moderation analysis of the whole sample was conducted to examine the relationship between cognitive distortions, emotion regulation strategies, and PTSD.
RESULTS
Participants with PTSD scored significantly higher on the PCL‑5 and for dissociation than the other groups. PCL‑5 scores were positively correlated with maladaptive emotion regulation strategies and acceptance. They were also correlated with positive and negative dichotomous reasoning and negative minimization. Analysis of the PTSD group revealed correlations between maladaptive emotion regulation strategies and negative cognitive distortions. The moderation analysis revealed the cognitive distortions explaining the relationship between emotion regulation strategies and trauma exposure overall, and how they exacerbate emotional problems in PTSD.
CONCLUSION
The study provides indications for management of PTSD patients. Inclusion of an intermediate group of individuals exposed to trauma without PTSD revealed differences in the observed alterations. It would be interesting to extend the cross-sectional observation design to study traumatic events that may cause a specific type of disorder.
Topics: Adult; Humans; Adolescent; Stress Disorders, Post-Traumatic; Emotional Regulation; Cross-Sectional Studies; Cognition; Substance-Related Disorders
PubMed: 36692809
DOI: 10.1007/s40211-022-00453-w -
The Eurasian Journal of Medicine Oct 2022We aimed to investigate the relationship between childhood trauma, dissociative experiences, and internet gaming disorder in male university students with probable...
OBJECTIVE
We aimed to investigate the relationship between childhood trauma, dissociative experiences, and internet gaming disorder in male university students with probable attention-deficit hyperactivity disorder determined by both childhood and current attention-deficit hyperactivity disorder symptoms.
MATERIALS AND METHODS
Volunteers were 376 university students who completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale, Wender Utah Rating Scale, Childhood Trauma Questionnaire, Dissociative Experiences Scale, Somatoform Dissociation Questionnaire, and Internet Gaming Disorder Scale-Short Form. Volunteers were divided into 2 groups as with and without probable attention-deficit hyperactivity disorder D based on both childhood and current attentiondeficit hyperactivity disorder symptoms.
RESULTS
Childhood Trauma Questionnaire (t=-3.94; P < .01), Dissociative Experiences Scale (t=-5.97; P < .01), Somatoform Dissociation Questionnaire (t=-3.80; P < .01), and Internet Gaming Disorder Scale-Short Form (t=-5.21; P < .01) scores were significantly higher in the group with probable attentiondeficit hyperactivity disorder than in those without. Two different hierarchical regression analysis models in which internet gaming disorder scores were dependent variables showed that dissociative experiences in first model (β=0.15, t=2.28, P = .023) and dissociative absorption in second model (β=0.22, t=2.76, P = .006) were associated with internet gaming disorder after controlling for childhood trauma and attentiondeficit hyperactivity disorder symptoms.
CONCLUSION
Dissociative absorption may contribute to internet gaming disorder independent of childhood trauma and attention-deficit hyperactivity disorder symptoms, however further studies are needed to investigate this claim.
PubMed: 35950830
DOI: 10.5152/eurasianjmed.2021.21179 -
Asian Journal of Psychiatry Jul 2023Mood stabilizers are psychotropic drugs mainly used to treat bipolar disorder in the acute phase or for maintenance therapy to prevent relapse. In clinical practice,...
OBJECTIVE
Mood stabilizers are psychotropic drugs mainly used to treat bipolar disorder in the acute phase or for maintenance therapy to prevent relapse. In clinical practice, mood stabilizers are commonly prescribed for conditions other than bipolar disorder. This study investigated the distribution of mood stabilizer prescriptions for different psychiatric diagnoses and studied differences in the drugs, dosage, and plasma concentration in 10 Asian countries including Taiwan, South Korea, Malaysia, China, Thailand, India, Pakistan, Singapore, Indonesia, and Myanmar.
METHODS
Patients prescribed mood stabilizers (lithium, carbamazepine, valproic acid, or lamotrigine) for a psychiatric condition other than bipolar disorder (codes F31.0-F31.9 in the International Classification of Diseases, 10th Edition, Clinical Modification) were recruited through convenience sampling. A website-based data entry system was used for data collection.
RESULTS
In total, 1557 psychiatric patients were enrolled. Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29, 55.8 %) was the most common diagnosis, followed by non-bipolar mood disorders (F30, F31- F39, 25.3 %), organic mental disorder (F00-F09, 8.8 %), mental retardation (F70-F79, 5.8 %) and anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48, 4.4 %). The most frequently targeted symptoms (>20 %) were irritability (48 %), impulsivity (32.4 %), aggression (29.2 %), anger (20.8 %), and psychosis (24.1 %). Valproic acid was the most frequently used medication.
CONCLUSIONS
Clinicians typically prescribe mood stabilizers as empirically supported treatment to manage mood symptoms in patients with diagnoses other than bipolar disorders, though there is on official indication for these disorders. The costs and benefits of this add-on symptomatic treatment warrant further investigation.
Topics: Humans; Bipolar Disorder; Valproic Acid; Antimanic Agents; Antipsychotic Agents; Anticonvulsants; Pakistan
PubMed: 37163943
DOI: 10.1016/j.ajp.2023.103613 -
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 -
Current Psychiatry Reports Apr 2021The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in... (Review)
Review
PURPOSE OF REVIEW
The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD.
RECENT FINDINGS
Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.
Topics: Borderline Personality Disorder; Dissociative Disorders; Emotions; Frontal Lobe; Humans; Stress Disorders, Post-Traumatic
PubMed: 33909198
DOI: 10.1007/s11920-021-01246-8 -
European Journal of Psychotraumatology 2023Guilt and Shame, two core self-related emotions, often emerge following trauma and play an important role in the development and maintenance of post-traumatic stress...
Guilt and Shame, two core self-related emotions, often emerge following trauma and play an important role in the development and maintenance of post-traumatic stress disorder (PTSD). Importantly, Guilt and Shame exhibit specific focal and non-specific global impacts of trauma on self-perception, respectively. Integrating psychological theories with neuroscientific knowledge, we suggest a scheme of two diverging clinical phenotypes of PTSD, associated with distinct self-related processes and differential functionality of relevant neural networks. The Guilt-driven phenotype is characterized by preoccupation with negative self-attributes of one's actions in the traumatic event. It involves altered functionality of both the salience network (SN) and the default-mode network (DMN), associated with heightened interoceptive signalling and ruminative introspection which may lead to hyperarousal and intrusive symptoms, respectively. On the contrary, the Shame-driven phenotype is characterized by global, identity-related negative self-attributions. It involves altered functionality of both the SN and the DMN, associated with blunted interoceptive signalling and diminished introspection which may result in withdrawal and anhedonia symptoms together with dissociative experiences, respectively. The proposed PTSD phenotypes may inform neuropsychological therapeutic interventions (e.g. self-focused psychotherapy and neuromodulation) aiming to restore the function of large-scale self-related neural processing.
Topics: Humans; Stress Disorders, Post-Traumatic; Guilt; Shame; Emotions; Self Concept
PubMed: 37166158
DOI: 10.1080/20008066.2023.2202060 -
Cureus Sep 2023This case report highlights the unique presentation of dissociative amnesia masking an underlying brief psychotic disorder, triggered by a very intense psycho-social...
This case report highlights the unique presentation of dissociative amnesia masking an underlying brief psychotic disorder, triggered by a very intense psycho-social stressor. Learning points from this report center around the importance of considering psychotic as well as affective disorders alongside a presentation of dissociative amnesia, and not only the expected anxious, post-traumatic or personality-oriented states. Our patient, a 37-year-old gentleman, was brought to our emergency department via police referral. He had gaps in his autobiographical memory that, upon receiving a regular dose of benzodiazepines, unraveled bizarre, uncooperative, and agitated behavior as well as marked fluctuations in his daily mental state examinations. Biological management through antipsychotic monotherapy, psychological management through insight-oriented therapy as well as psychological support, and social management revolving around the alleviation of surrounding stressors enabled his safe recovery.
PubMed: 37799250
DOI: 10.7759/cureus.44619 -
JAMA Network Open Apr 2022Psychiatric disorders may be associated with an increased risk for SARS-CoV-2 breakthrough infection after vaccination, but no studies have tested this hypothesis.
IMPORTANCE
Psychiatric disorders may be associated with an increased risk for SARS-CoV-2 breakthrough infection after vaccination, but no studies have tested this hypothesis.
OBJECTIVE
To evaluate whether past diagnoses of psychiatric disorders are associated with an increased incidence of SARS-CoV-2 breakthrough infection among fully vaccinated individuals.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study included data from the administrative and electronic health records of US Department of Veterans Affairs (VA) patients from February 20, 2020, to November 16, 2021. Participants included 263 697 patients who accessed VA health care during the study period, had at least 1 SARS-CoV-2 test recorded in the electronic health record, had no record of SARS-CoV-2 infection prior to vaccination, and had completed a full SARS-CoV-2 vaccination regimen 14 days or more prior.
EXPOSURES
Psychiatric disorder diagnoses in the past 5 years, including depressive, posttraumatic stress, anxiety, adjustment, alcohol use, substance use, bipolar, psychotic, attention-deficit/hyperactivity, dissociative, and eating disorders.
MAIN OUTCOMES AND MEASURES
SARS-CoV-2 breakthrough infections, defined as positive SARS-CoV-2 tests, among fully vaccinated individuals.
RESULTS
Of 263 697 fully vaccinated VA patients (239 539 men [90.8%]; mean [SD] age, 66.2 [13.8] years), 135 481 (51.4%) had at least 1 psychiatric disorder diagnosis, and 39 109 (14.8%) developed a breakthrough infection. A diagnosis of any psychiatric disorder was associated with increased incidence of breakthrough infection, both in models adjusted for potential confounders (adjusted relative risk [aRR], 1.07; 95% CI, 1.05-1.09) and additionally adjusted for medical comorbidities and smoking (aRR, 1.03; 95% CI, 1.01-1.05). Most specific psychiatric disorder diagnoses were associated with an increased incidence of breakthrough infection, with the highest relative risk observed for adjustment disorder (aRR, 1.13; 95% CI, 1.10-1.16) and substance use disorders (aRR, 1.16; 95% CI, 1.12-1.21) in fully adjusted models. Stratifying the sample at 65 years of age revealed that associations between psychiatric diagnoses and incident breakthrough infection were present in both age groups but were stronger and robust to adjustment for medical comorbidities and smoking among older patients.
CONCLUSIONS AND RELEVANCE
This cohort study suggests that psychiatric disorder diagnoses were associated with an increased incidence of SARS-CoV-2 breakthrough infection among VA patients, with the strongest associations observed for older individuals. Individuals with psychiatric disorders may be at heightened risk for contracting COVID-19 even after vaccination, suggesting the need for targeted prevention efforts.
Topics: Adult; Aged; COVID-19; COVID-19 Vaccines; Cohort Studies; Female; Humans; Incidence; Male; Mental Disorders; Retrospective Studies; SARS-CoV-2
PubMed: 35420660
DOI: 10.1001/jamanetworkopen.2022.7287 -
The Australian and New Zealand Journal... Oct 2022Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more... (Review)
Review
BACKGROUND
Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more severe trauma exposure, emotional dysregulation and worse treatment outcomes in Posttraumatic Stress Disorder and Dissociative Disorders, with implications for BPD.
OBJECTIVE
A systematic scoping review was conducted to assess the extent of current literature regarding the impact of dissociation on BPD and to identify knowledge gaps.
METHODS
Four electronic databases (MEDLINE, APA PsycINFO, EMBASE, CINAHL Plus) were searched, and English peer-reviewed studies with adults with BPD were included, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension for scoping reviews (PRISMA-ScR) 2018 guidelines.
RESULTS
Most of the 70 included studies were observational (98%) with first authors from Germany (59%). Overall, dissociation was associated with increased BPD symptom severity, self-harm and reduced psychotherapy treatment response; findings regarding suicide risk were mixed. Dissociation was associated with working memory and cognitive deficits, decreased pain perception, altered body ownership, no substance abuse or the abuse of sedative substances, increased fantasy proneness, personality fragmentation, fearful attachment, dream anxiety, perceived stress and altered stress responses, increased cumulative body mass index, decreased water consumption, several neurological correlates and changes in gene expression.
CONCLUSION
BPD with significant dissociative symptoms may constitute a more severe and at-risk subgroup of BPD patients. However, there are significant research gaps and methodological issues in the area, including the possibility of unrecognized Dissociative Disorders in BPD study populations confounding results. Further studies are needed to better understand the impact of dissociation on BPD course and treatment, and to clarify the most appropriate assessment tools for clinical practice. In addition, interventional studies are needed to develop dissociation-specific BPD treatments to determine whether targeting dissociation in BPD can improve treatment outcomes.
Topics: Adult; Borderline Personality Disorder; Dissociative Disorders; Humans; Hypnotics and Sedatives; Psychotherapy; Self-Injurious Behavior
PubMed: 35152771
DOI: 10.1177/00048674221077029