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Journal of Women & Aging 2007Dissociative disorders are rarely considered in the diagnostic assessment of older women, despite the fact that the existence, appearance and characteristics of certain... (Review)
Review
Dissociative disorders are rarely considered in the diagnostic assessment of older women, despite the fact that the existence, appearance and characteristics of certain dissociative disorders in older populations has been known and described since the 1980s. This communication reviews the core phenomena of Dissociative Identity Disorder and related forms of Dissociative Disorder Not Otherwise Specified, the natural history of their phenomena from youth to old age, and describes common presentations of Dissociative Disorders in older women. It also reviews the treatment of complex chronic dissociative disorders and discusses alternative approaches to their psychotherapy in the older female patient. It is crucial to recognize and respect the importance of appreciating individual differences among older dissociative patients and to individualize their treatments accordingly.
Topics: Age Factors; Aging; Borderline Personality Disorder; Depersonalization; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Female; Health Services for the Aged; Humans; Medical History Taking; Mental Health; Risk Factors; Severity of Illness Index; Women's Health; Women's Health Services
PubMed: 17588883
DOI: 10.1300/J074v19n01_08 -
Psychological Bulletin Jul 1996According to the sociocognitive model of dissociative identity disorder (DID; formerly, multiple personality disorder), DID is not a valid psychiatric disorder of... (Review)
Review
According to the sociocognitive model of dissociative identity disorder (DID; formerly, multiple personality disorder), DID is not a valid psychiatric disorder of posttraumatic origin; rather, it is a creation of psychotherapy and the media. Support for the model was recently presented by N.P. Spanos (1994). In this article, the author reexamines the evidence for the model and concludes that it is based on numerous false assumptions about the psychopathology, assessment, and treatment of DID. Most recent research on the dissociative disorders does not support (and in fact disconfirms) the sociocognitive model, and many inferences drawn from previous research appear unwarranted. No reason exists to doubt the connection between DID and childhood trauma. Treatment recommendations that follow from the sociocognitive model may be harmful because they involve ignoring the posttraumatic symptomatology of persons with DID.
Topics: Adult; Child; Child Abuse; Cognitive Behavioral Therapy; Dissociative Disorders; Dissociative Identity Disorder; Female; Humans; Male; Personality Development; Social Adjustment; Social Environment; Stress Disorders, Post-Traumatic
PubMed: 8711016
DOI: 10.1037/0033-2909.120.1.42 -
Issues in Mental Health Nursing 1997Nursing care of the alcoholic patient becomes multifaceted and complex with the presence of a psychiatric-mental health disorder. Although issues surrounding... (Review)
Review
Nursing care of the alcoholic patient becomes multifaceted and complex with the presence of a psychiatric-mental health disorder. Although issues surrounding dual-diagnosis patients have been addressed in the literature, there is a paucity of research and theory regarding care of the patient who has both alcoholism and dissociative identity disorder. This article presents a synthesis of the nursing literature with the author's experience to elucidate factors that enhance healing. Nursing interventions that are unique and sensitive for the alcoholic patient with dissociative identity disorder are discussed.
Topics: Alcoholics Anonymous; Alcoholism; Denial, Psychological; Dissociative Disorders; Humans; Nurse-Patient Relations; Psychiatric Nursing
PubMed: 9233169
DOI: 10.3109/01612849709010333 -
Child and Adolescent Psychiatric... Apr 2003This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the... (Review)
Review
This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.
Topics: Adolescent; Child; Comorbidity; Dissociative Disorders; Humans; Models, Psychological; Psychological Tests; Psychotherapy; Stress Disorders, Post-Traumatic
PubMed: 12725010
DOI: 10.1016/s1056-4993(02)00103-7 -
Harvard Review of Psychiatry 2016Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research... (Review)
Review
Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted.
Topics: Dissociative Disorders; Humans
PubMed: 27384396
DOI: 10.1097/HRP.0000000000000100 -
Harefuah Jul 1997
Review
Topics: Adolescent; Child; Dissociative Disorders; Humans; Morbidity
PubMed: 9332056
DOI: No ID Found -
The Journal of Nervous and Mental... May 2019Although children with dissociative disorders (DD) are referred to mental health inpatient units, no research exists to endorse this. We studied the outcomes of patients...
Although children with dissociative disorders (DD) are referred to mental health inpatient units, no research exists to endorse this. We studied the outcomes of patients with DD over a 5-year period on a national inpatient unit for children up to 12 years of age. Demographic, clinical, and satisfaction data were collected and compared with the data of other inpatients not having DD. Eight patients were identified, of whom six were female. All had several comorbidities. Mean Children's Global Assessment Scale scores improved from admission to discharge (from 31 to 61, respectively). Admissions in DD were longer by 53 days (p = 0.059), and parents were statistically less satisfied about professionals' ability to listen to worries they may have about their child (p = 0.049). Referrers should expect children with DD to respond as well to inpatient interventions as those with other diagnoses but potentially with marginally longer admissions and lower parental satisfaction.
Topics: Child; Dissociative Disorders; Female; Hospitalization; Humans; Male; Parents; Patient Admission; Severity of Illness Index
PubMed: 30925508
DOI: 10.1097/NMD.0000000000000980 -
Psychological Trauma : Theory,... Jan 2020The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) introduced a dissociative subtype for patients... (Comparative Study)
Comparative Study
INTRODUCTION
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) introduced a dissociative subtype for patients with posttraumatic stress disorder (PTSD) and depersonalization and/or derealization symptoms. Despite high comorbidity rates between PTSD and dissociative disorders (DDs), research has not paid attention to the differentiation or overlap between the dissociative subtype of PTSD and DDs. This raises a question: To what extent do patients with dissociative PTSD differ from patients with PTSD and comorbid DDs?
METHOD
We compared three groups of complex patients with trauma-related disorders and/or personality disorders (n = 150): a dissociative PTSD, a nondissociative PTSD, and a non-PTSD group of patients with mainly personality disorders. We used structured clinical interviews and self-administered questionnaires on dissociative symptoms and disorders, personality disorders, trauma histories, depression, anxiety, and general psychopathology. The Dissociative Experiences Scale (DES; ≥20) and the depersonalization/derealization subscale of the DES were used for differentiating dissociative PTSD from nondissociative PTSD.
RESULTS
Of all patients, 33% met criteria for dissociative PTSD. More than half of the dissociative PTSD patients (54%) met criteria for one or more DDs; using the depersonalization/derealization subscale of the DES, even 66% had a comorbid DD. But also of the non-PTSD patients, 24% had a mean DES score of ≥20. There were no symptomatic differences (e.g., depression and anxiety) between dissociative PTSD with and without comorbid DDs.
CONCLUSION
Overlap between dissociative PTSD and DD is large and we recommend replication of previous studies, using structured clinical assessment of DDs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Topics: Adolescent; Adult; Aged; Comorbidity; Diagnosis, Differential; Dissociative Disorders; Female; Humans; Male; Middle Aged; Personality Disorders; Stress Disorders, Post-Traumatic; Young Adult
PubMed: 31107045
DOI: 10.1037/tra0000474 -
The Journal of Nervous and Mental... Sep 2020Auditory hallucinations are widely regarded as symptoms of brain disease treated with medications. In an alternative paradigm, voices are understood as trauma-driven...
Auditory hallucinations are widely regarded as symptoms of brain disease treated with medications. In an alternative paradigm, voices are understood as trauma-driven dissociated, disowned, or disavowed aspects of self; the goal is not to suppress them but to integrate them during psychotherapy. Auditory hallucinations are common in dissociative identity disorder, borderline personality disorder, and complex posttraumatic stress disorder and are not specific to psychosis. The features that differentiate psychotic from dissociative voices include the qualities of the voices themselves, as well as other symptoms: for example, compared with dissociative voices, psychotic voices are accompanied by less sociability, more formal thought disorder, more negative symptoms including blunted affect, and more delusions. The author proposes that the psychotherapy of dissociative voices can be indicated trans-diagnostically, including in a subgroup of individuals with diagnoses of schizophrenia. Psychotherapeutic strategies are illustrated with a case example.
Topics: Borderline Personality Disorder; Dissociative Disorders; Dissociative Identity Disorder; Hallucinations; Humans; Psychotherapy; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology; Stress Disorders, Post-Traumatic
PubMed: 32868688
DOI: 10.1097/NMD.0000000000001206 -
Psychotherapy and Psychosomatics 2011Dissociative identity disorder (DID) remains a controversial diagnosis due to conflicting views on its etiology. Some attribute DID to childhood trauma and others... (Review)
Review
BACKGROUND
Dissociative identity disorder (DID) remains a controversial diagnosis due to conflicting views on its etiology. Some attribute DID to childhood trauma and others attribute it to iatrogenesis. The purpose of this article is to review the published cases of childhood DID in order to evaluate its scientific status, and to answer research questions related to the etiological models.
METHODS
I searched MEDLINE and PsycINFO records for studies published since 1980 on DID/multiple personality disorder in children. For each study I coded information regarding the origin of samples and diagnostic methods.
RESULTS
The review produced a total of 255 cases of childhood DID reported as individual case studies (44) or aggregated into empirical studies (211). Nearly all cases (93%) emerged from samples of children in treatment, and multiple personalities was the presenting problem in 23% of the case studies. Four US research groups accounted for 65% of all 255 cases. Diagnostic methods typically included clinical evaluation based on Diagnostic and Statistical Manual of Mental Disorder criteria, but hypnosis, structured interviews, and multiple raters were rarely used in diagnoses.
CONCLUSION
Despite continuing research on the related concepts of trauma and dissociation, childhood DID itself appears to be an extremely rare phenomenon that few researchers have studied in depth. Nearly all of the research that does exist on childhood DID is from the 1980s and 1990s and does not resolve the ongoing controversies surrounding the disorder.
Topics: Child; Dissociative Disorders; Humans
PubMed: 21829044
DOI: 10.1159/000323403