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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 -
Archives of Women's Mental Health Feb 2022Pervasive pregnancy denial is a misunderstood reproductive anomaly which compromises the health of both mother and the developing fetus. Because in extreme cases, the... (Review)
Review
Pervasive pregnancy denial is a misunderstood reproductive anomaly which compromises the health of both mother and the developing fetus. Because in extreme cases, the death of the neonate at the hands of his/her mother has criminal repercussions, research has attempted to explain the origins of this clinical phenomenon. The purpose of this review is to analyze the evolution of understanding the association between pregnancy denial and neonaticide. This paper identifies the consistent similarities in symptom presentation, particularly dissociation, when a denied pregnancy ends with the death of the newborn. The common thread across the progression of the literature over time serves as a foundation for considering the development of diagnostic criteria for future inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This paper reviews the seminal research from 1969 to current research up to 2020 addressing pregnancy denial and its connection to neonaticide. Peer reviewed and published articles related to key terms around "pregnancy denial," "pregnancy concealment," "neonaticide," and "dissociation" were retrieved from major databases such as PubMed, PsychINFO, JSTOR, ProQEST, ScienceDirect, and Google Scholar. Reference lists of relevant articles were also scanned to search for further papers pertaining to similarities in symptom presentation across demographic profiles. Papers were excluded if they were not available in English, or if they did not contribute to identifying consistencies in clinical presentation when a pregnancy is denied. There are clear repetitive markers that occur across studies which pertain not only to the frequent absence of certain expected indicators of pregnancy, (i.e. no morning sickness, weight gain, or sensations of fetal movement), but also the misattribution of pregnancy-related symptoms, and the consistent experience of a dissociative episode while giving birth that can unintentionally result in neonaticide. This paper concludes that dissociation is a consistently seen symptom in pervasive pregnancy denial. Dissociation, in addition to other commonly seen symptoms across cases, suggests specific diagnostic criteria that lend themselves to inclusion in the Diagnostic and Statistical Manual of Mental Disorders.
Topics: Denial, Psychological; Dissociative Disorders; Female; Humans; Infant, Newborn; Infanticide; Male; Mothers; Parturition; Pregnancy
PubMed: 34392438
DOI: 10.1007/s00737-021-01176-7 -
Annual Review of Clinical Psychology 2005The dissociative disorders, including "psychogenic" or "functional" amnesia, fugue, dissociative identity disorder (DID, also known as multiple personality disorder),... (Review)
Review
The dissociative disorders, including "psychogenic" or "functional" amnesia, fugue, dissociative identity disorder (DID, also known as multiple personality disorder), and depersonalization disorder, were once classified, along with conversion disorder, as forms of hysteria. The 1970s witnessed an "epidemic" of dissociative disorder, particularly DID, which may have reflected enthusiasm for the diagnosis more than its actual prevalence. Traditionally, the dissociative disorders have been attributed to trauma and other psychological stress, but the existing evidence favoring this hypothesis is plagued by poor methodology. Prospective studies of traumatized individuals reveal no convincing cases of amnesia not attributable to brain insult, injury, or disease. Treatment generally involves recovering and working through ostensibly repressed or dissociated memories of trauma; at present, there are few quantitative or controlled outcome studies. Experimental studies are few in number and have focused largely on state-dependent and implicit memory. Depersonalization disorder may be in line for the next "epidemic" of dissociation.
Topics: Dissociative Disorders; Humans
PubMed: 17716088
DOI: 10.1146/annurev.clinpsy.1.102803.143925 -
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 -
Bulletin of the Menninger Clinic 2000The authors review the co-occurrences of dissociative symptoms and disorders with epilepsy and pseudo-seizures and examine newer diagnostic instruments that assist in... (Review)
Review
The authors review the co-occurrences of dissociative symptoms and disorders with epilepsy and pseudo-seizures and examine newer diagnostic instruments that assist in accurate diagnosis of persons with concomitant seizure behaviors and dissociative symptoms. They also review seizure behaviors and electroencephalographic findings in persons with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) and dissociative symptoms in persons with epilepsy and with pseudoseizures. Dissociative symptoms in 15 patients with epilepsy and 15 with pseudo-seizures were examined using the Dissociative Experiences Scale (DES) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). On the SCID-D, pseudo-seizure patients had significantly higher dissociative symptom scores than epileptic patients, but DES scores did not reliably distinguish epileptic and pseudo-seizure patients. Misdiagnosis of persons with seizures and dissociative symptoms can be avoided by careful adherence to DSM dissociative disorder criteria, the use of video-EEG monitoring, and systematic assessment of dissociative symptoms with the SCID-D.
Topics: Adult; Child; Conversion Disorder; Diagnosis, Differential; Dissociative Disorders; Electroencephalography; Epilepsy; Humans; Psychiatric Status Rating Scales; Seizures; Video Recording
PubMed: 10842446
DOI: No ID Found -
Journal of Trauma & Dissociation : the... 2014The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients....
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.
Topics: Adolescent; Child; Dissociative Disorders; Female; Humans; Interview, Psychological; Male; Outpatients; Prevalence; Psychiatric Status Rating Scales; Surveys and Questionnaires; Turkey
PubMed: 24283750
DOI: 10.1080/15299732.2013.864748 -
JNMA; Journal of the Nepal Medical... 2019Dissociative disorder is one of the common psychiatric problems encountered very frequently in the hospital setting. The aim of the study is to find out the prevalence...
INTRODUCTION
Dissociative disorder is one of the common psychiatric problems encountered very frequently in the hospital setting. The aim of the study is to find out the prevalence of dissociative convulsions type in patients suffering from dissociative disorder attending Psychiatry outpatient department of a tertiary care hospital.
METHODS
The descriptive cross-sectional study was carried out in a tertiary care hospital from February 2019 to July 2019 after taking ethical approval (MEMG/IRC/210/GA). The patients attending Psychiatry outpatient department of Manipal Teaching Hospital, Pokhara, Nepal were included in the study. The diagnosis of dissociative convulsion and other types of dissociative disorder was done according to the International Classification of Disease-10 Classification of Mental and Behavioural Disorders - Diagnostic Criteria for Research. Statistical Package for Social Sciences version 22 was used for the analysis of the data and point estimate at 95% Confidence interval was calculated along with frequency and proportion for binary data and the analysis was done.
RESULTS
Sixty six patients were included in the study. The prevalence of dissociative convulsion was 86.3% in the present study, at 95% Confidence interval, (78-94.6%). Five patients (7.6%) were found to be suffering from dissociative motor disorders and 4 (6.1%) patients were suffering from trance and possession disorder.
CONCLUSIONS
The prevalence of dissociative convulsion type is high in patients suffering from dissociative disorder in the Nepalese context. Future studies should be conducted to understand this disorder and to propose therapeutic guidelines.
Topics: Cross-Sectional Studies; Dissociative Disorders; Humans; Prevalence; Seizures; Tertiary Care Centers
PubMed: 32329456
DOI: 10.31729/jnma.4640 -
Journal of Trauma & Dissociation : the... 2009Although dissociative identity disorder, a condition in which multiple individuals appear to inhabit a single body, is a recognized psychiatric disorder, patients may... (Review)
Review
Although dissociative identity disorder, a condition in which multiple individuals appear to inhabit a single body, is a recognized psychiatric disorder, patients may yet encounter health professionals who declare that they simply "do not believe in multiple personalities." This article explores the proposal that resistance to the disorder represents a failure to apply an appropriate paradigm from which the disorder should be interpreted. Trauma and sociocognitive explanations of dissociative identity disorder are contrasted. The trauma hypothesis is further differentiated into paradigms in which trauma affects a defense mechanism, and one in which trauma serves to inhibit the normal integration sequence of parallel processes of the self in childhood. This latter paradigm is shown to be broadly consistent with current models of cortical processing in another system, the cortical visual system.
Topics: Attitude of Health Personnel; Brain Mapping; Consciousness; Dissociative Disorders; Dissociative Identity Disorder; Humans; Models, Psychological; Psychoanalytic Theory; Risk Factors; Visual Cortex; Visual Perception
PubMed: 19821176
DOI: 10.1080/15299730903143683 -
Depression and Anxiety Dec 2011We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an... (Review)
Review
BACKGROUND
We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria.
METHODS
This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders.
RESULTS
We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should include derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category.
CONCLUSIONS
There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Humans
PubMed: 22134959
DOI: 10.1002/da.20923 -
Depression and Anxiety Sep 2011We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an... (Review)
Review
BACKGROUND
We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria.
METHODS
This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders.
RESULTS
We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Should Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category.
CONCLUSIONS
There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms.
Topics: Comorbidity; Conversion Disorder; Depersonalization; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Evidence-Based Practice; Humans; International Classification of Diseases; Life Change Events; Psychotic Disorders; Risk Factors
PubMed: 21910187
DOI: 10.1002/da.20874