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Current Opinion in Psychiatry Jan 2006Although dissociative disorders have been described and diagnosed for some time, their aetiology, pathogenesis, phenomenology and management continues to arouse debate.... (Comparative Study)
Comparative Study Review
PURPOSE OF REVIEW
Although dissociative disorders have been described and diagnosed for some time, their aetiology, pathogenesis, phenomenology and management continues to arouse debate. It is only in recent times that researchers have made some progress by integrating trauma related theories with more contemporary cognitive theories and neurobiology.
RECENT FINDINGS
Dissociation as a phenomenon is reported to occur in a variety of disorders. This widespread occurrence has contributed to a better understanding of dissociation. An expansion of this concept may have contributed to the loss of its original significance. Recent studies in the field of dissociation that pertain to its aetiology, pathophysiology, neurobiology and management are critically reviewed.
SUMMARY
Dissociative disorder is conceptually a difficult disorder to study. Apart from exposure to trauma, certain primary personality attributes may contribute to the propensity to develop dissociative disorder. Recent advances in functional neuroimaging facilitated by enhanced knowledge in the neural representation of body state have helped to improve our understanding of dissociation. There is confusion over the use of various terms such as sexual abuse and physical abuse in explaining causality. Current classificatory systems have not been found suitable when applied across cultures. In spite of all of these limitations, there has been recent progress toward a better understanding of dissociative disorders.
Topics: Conversion Disorder; Culture; Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Humans; Prevalence; Somatoform Disorders; Stress Disorders, Post-Traumatic
PubMed: 16612181
DOI: 10.1097/01.yco.0000194811.83720.69 -
Journal of Trauma & Dissociation : the... 2015This study assessed childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with panic disorder (PD). A total of 92...
This study assessed childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with panic disorder (PD). A total of 92 psychotropic drug-naive patients with PD, recruited from outpatient clinics in the psychiatry department of a Turkish hospital, were involved in the study. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), Dissociation Questionnaire, Panic and Agoraphobia Scale, Panic Disorder Severity Scale, and Childhood Trauma Questionnaire. Of the patients with PD, 18 (19%) had a comorbid dissociative disorder diagnosis on screening with the SCID-D. The most prevalent disorders were dissociative disorder not otherwise specified, dissociative amnesia, and depersonalization disorders. Patients with a high degree of dissociation symptoms and dissociative disorder comorbidity had more severe PD than those without (p < .05). All of the childhood trauma subscales used were correlated with the severity of symptoms of dissociation and PD. Among all of the subscales, the strongest relationship was with childhood emotional abuse. Logistic regression analysis showed that emotional abuse and severity of PD were independently associated with dissociative disorder. In our study, a significant proportion of the patients with PD had concurrent diagnoses of dissociative disorder. We conclude that the predominance of PD symptoms at admission should not lead the clinician to overlook the underlying dissociative process and associated traumatic experiences among these patients.
Topics: Adult; Agoraphobia; Child; Child Abuse; Comorbidity; Cross-Sectional Studies; Dissociative Disorders; Female; Follow-Up Studies; Humans; Life Change Events; Male; Panic Disorder; Psychometrics; Surveys and Questionnaires; Turkey
PubMed: 26011585
DOI: 10.1080/15299732.2015.1019175 -
Bulletin of the Menninger Clinic 1993The increasing prevalence of dissociative disorders has spawned a range of diagnostic tools. The authors describe the use of several current methods--screening... (Review)
Review
The increasing prevalence of dissociative disorders has spawned a range of diagnostic tools. The authors describe the use of several current methods--screening instruments, structured interviews, psychological testing, and hypnosis--and they advocate enlisting the patient as an active collaborator in the diagnostic process.
Topics: Amnesia; Borderline Personality Disorder; Comorbidity; Diagnosis, Differential; Dissociative Disorders; Dissociative Identity Disorder; Female; Humans; Hypnosis; Interview, Psychological; Male; Psychiatric Status Rating Scales; Psychological Tests
PubMed: 8401385
DOI: No ID Found -
Comprehensive Psychiatry 1999This study attempted to determine the prevalence of dissociative identity disorder in the general population. The Dissociative Experiences Scale (DES) was administered...
This study attempted to determine the prevalence of dissociative identity disorder in the general population. The Dissociative Experiences Scale (DES) was administered to 994 subjects in 500 homes who constituted a representative sample of the population of Sivas City, Turkey. The mean DES score was 6.7+/-6.1 (mean +/- SD). Of the 62 respondents who scored above 17 on the DES, 32 (51.6%) could be contacted during the second phase of the study. They were matched for age and gender with a group of respondents who scored below 10 on the scale, and the Dissociative Disorders Interview Schedule (DDIS) was then administered to both groups. Seventeen subjects (1.7%) received a diagnosis of dissociative disorder according to the structured interview. In the third phase, eight of 17 subjects who had a dissociative disorder on the structured interview could be contacted for a clinical evaluation. They were matched with a nondissociative control group and interviewed by a clinician blind to the structured interview diagnosis. Four of eight subjects were diagnosed clinically with dissociative identity disorder, yielding a minimum prevalence of 0.4%. Dissociative identity disorder is not rare in the general population. Self-rating instruments and structured interviews can be used successfully for screening these cases. Our data, derived from a population with no public awareness about dissociative identity disorder and no exposure to systematic psychotherapy, suggest that dissociative identity disorder cannot be considered simply an iatrogenic artifact, a culture-bound syndrome, or a phenomenon induced by media influences.
Topics: Adolescent; Adult; Aged; Culture; Dissociative Disorders; Female; Humans; Interview, Psychological; Male; Middle Aged; Prevalence; Psychiatric Status Rating Scales; Turkey
PubMed: 10080263
DOI: 10.1016/s0010-440x(99)90120-7 -
The Psychiatric Clinics of North America Sep 1998A wide variety of dissociative disorders, including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and various... (Review)
Review
A wide variety of dissociative disorders, including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and various forms of dissociative disorder not otherwise specified. In many instances, these disorders are either underdiagnosed or misdiagnosed secondary to the clinician's mistaken belief that dissociative disorders are rare. Recent research shows that dissociative disorders may comprise 5% to 10% of psychiatric populations. This article reviews the epidemiology and clinical symptomatology of these disorders. In addition, various screening and diagnostic instruments, such as the DES, Structured Clinical Interview for Dissociative Disorders, and MMPI, are discussed.
Topics: Amnesia; Amobarbital; Depersonalization; Dissociative Disorders; Dissociative Identity Disorder; Epilepsy, Complex Partial; Female; Humans; Hypnosis; Interview, Psychological; MMPI; Male; Malingering; Psychiatric Status Rating Scales
PubMed: 9774801
DOI: 10.1016/s0193-953x(05)70028-9 -
International Journal of Law and... 2016Few assessors receive training in assessing dissociation and complex dissociative disorders (DDs). Potential differential diagnoses include anxiety, mood, psychotic,...
Few assessors receive training in assessing dissociation and complex dissociative disorders (DDs). Potential differential diagnoses include anxiety, mood, psychotic, substance use, and personality disorders, as well as exaggeration and malingering. Individuals with DDs typically elevate on many clinical and validity scales on psychological tests, yet research indicates that they can be distinguished from DD simulators. Becoming informed about the testing profiles of DD individuals and DD simulators can improve the accuracy of differential diagnoses in forensic settings. In this paper, we first review the testing profiles of individuals with complex DDs and contrast them with DD simulators on assessment measures used in forensic contexts, including the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Personality Assessment Inventory (PAI), and the Structured Inventory of Reported Symptoms (SIRS), as well as dissociation-specific measures such as the Dissociative Experiences Scale (DES) and Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). We then provide recommendations for assessing complex trauma and dissociation through the aforementioned assessments.
Topics: Diagnosis, Differential; Dissociative Disorders; Forensic Psychiatry; Humans; Interview, Psychological; Malingering; Neuropsychological Tests; Psychiatric Status Rating Scales; Psychological Tests; Trauma and Stressor Related Disorders
PubMed: 28029435
DOI: 10.1016/j.ijlp.2016.10.006 -
Journal of Trauma & Dissociation : the... 2007This study examined the dissociative comorbidity reported by psychiatric inpatients with and without borderline personality disorder. The Dissociative Disorders...
This study examined the dissociative comorbidity reported by psychiatric inpatients with and without borderline personality disorder. The Dissociative Disorders Interview Schedule and Dissociative Experiences Scale were administered to 201 general adult psychiatric inpatients; of these, 110 also received the Structured Clinical Interview for DSM-IV-TR Dissociative Disorders. The patients were then divided into two groups--a group of 93 who met criteria for borderline personality disorder on the Dissociative Disorders Interview Schedule and 108 who did not. The two groups were then compared on dissociative symptoms and disorders. The inpatients with borderline personality disorder reported significantly more dissociative symptoms and disorders on all measures. On the Dissociative Disorders Interview Schedule, 59% of the borderline patients met criteria for a dissociative disorder compared with 22% of the non-borderline patients. Chronic, complex dissociative symptoms and disorders are common in borderline personality disorder. The ninth DSM-IV-TR criterion for borderline personality disorder does not adequately describe the dissociative comorbidity in the disorder.
Topics: Adult; Borderline Personality Disorder; Dissociative Disorders; Female; Humans; Male; Psychiatric Status Rating Scales
PubMed: 17409055
DOI: 10.1300/J229v08n01_05 -
Journal of Personality Assessment Jun 1996Although dissociative trance disorders, especially possession disorder, are probably more common than is usually though, precise clinical data are lacking. Ten persons...
Although dissociative trance disorders, especially possession disorder, are probably more common than is usually though, precise clinical data are lacking. Ten persons undergoing exorcisms for devil trance possession state were studied with the Dissociative Disorders Diagnostic Schedule and the Rorschach test. These persons had many traits in common with dissociative identity disorder patients. They were overwhelmed by paranormal experiences. Despite claiming possession by a demon, most of them managed to maintain normal social functioning. Rorschach findings showed that these persons had a complex personality organization: Some of them displayed a tendency to oversimplify stimulus perception whereas others seemed more committed to psychological complexity. Most had severe impairment of reality testing, and 6 of the participants had an extratensive coping stile. In this group of persons reporting demon possession, dissociative trance disorder seems to be a distinct clinical manifestation of a dissociative continuum, sharing some features with dissociative identity disorder.
Topics: Adult; Catholicism; Ceremonial Behavior; Delusions; Dissociative Disorders; Female; Humans; Magic; Male; Middle Aged; Parapsychology; Personality Assessment; Reality Testing; Religion and Psychology; Rorschach Test; Social Adjustment
PubMed: 8667145
DOI: 10.1207/s15327752jpa6603_4 -
Brain Injury Apr 1999Several episodes of dissociative disorder, including depersonalization and multiple personality, have been observed in a 32-year old man during a period of a few months...
Several episodes of dissociative disorder, including depersonalization and multiple personality, have been observed in a 32-year old man during a period of a few months following a mild traumatic brain injury. The psychogenic or organic aetiology of these psychiatric disorders remains undetermined. This case highlights the need to consider dissociative disorder among the possible (temporary) outcomes of a brain injury.
Topics: Adult; Brain Injuries; Cognition Disorders; Dissociative Disorders; Humans; Male; Neuropsychological Tests; Psychiatric Status Rating Scales; Time Factors; Tomography, Emission-Computed, Single-Photon
PubMed: 10230523
DOI: 10.1080/026990599121593 -
Journal of Trauma & Dissociation : the... 2013This study screened the prevalence and correlates of dissociative disorders among depressive women in the general population. The Dissociative Disorders Interview...
This study screened the prevalence and correlates of dissociative disorders among depressive women in the general population. The Dissociative Disorders Interview Schedule and the posttraumatic stress disorder (PTSD) and borderline personality disorder sections of the Structured Clinical Interview for DSM-IV were administered to 628 women in 500 homes. The prevalence of current major depressive episode was 10.0%. Of the women, 26 (40.6%) had the lifetime diagnosis of a DSM-IV, dissociative disorder, yielding a prevalence of 4.1% for dissociative depression. This group was younger (mean age = 30.7 years) than the nondissociative depression women (mean age = 39.6 years). There was no difference between the 2 groups on comorbid somatization disorder, PTSD, or borderline personality disorder. Besides suicide attempts, the dissociative group was characterized by secondary features of dissociative identity disorder; Schneiderian symptoms; borderline personality disorder criteria; and extrasensory perceptions, including possession experiences. They reported suicidality, thoughts of guilt and worthlessness, diminished concentration and indecisiveness, and appetite and weight changes more frequently than the nondissociative group. Early cessation of school education and childhood sexual abuse were frequently reported by the dissociative depression group. With its distinct features, the concept of dissociative depression may facilitate understanding of treatment resistance in, development of better psychotherapy strategies for, and new thinking on the neurobiology and pharmacotherapy of depressive disorders.
Topics: Adolescent; Adult; Aged; Comorbidity; Depressive Disorder, Major; Dissociative Disorders; Female; Humans; Interview, Psychological; Middle Aged; Prevalence; Turkey
PubMed: 23796173
DOI: 10.1080/15299732.2012.753654