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World Journal of Psychiatry Oct 2019Dissociation, which is defined as the failure to associate consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior into an...
BACKGROUND
Dissociation, which is defined as the failure to associate consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior into an integrated whole, has long been assumed to be generated by trauma. If dissociation is a product of trauma exposure, then dissociation would be a major mental health outcome observed in studies of disaster survivors. Although some studies have examined dissociation in disasters, no systematic literature reviews have been conducted to date on the topic.
AIM
To systematically evaluate the literature on the association between disaster and dissociation to determine the prevalence and incidence of dissociation after exposure to disaster and further examine their relationship.
METHODS
EMBASE, Medline, and PsychINFO were searched from inception to January 1, 2019 to identify studies examining dissociative disorders or symptoms related to a disaster in adult or child disaster survivors and disaster responders. Studies of military conflicts and war, articles not in English, and those with samples of 30 or more participants were excluded. Search terms used were "disaster*" and dissociation ("dissociat*," "multiple personality," "fugue," "psychogenic amnesia," "derealization," and "depersonalization"). Reference lists of identified articles were scrutinized to identify studies for additional articles.
RESULTS
The final number of articles in the review was 53, including 36 articles with samples of adults aged 18 and above, 5 of children/adolescents under age 18, and 12 of disaster workers. Included articles studied several types of disasters that occurred between 1989 and 2017, more than one-third (38%) from the United States. Only two studies had a primary aim to investigate dissociation in relation to disaster and none reported data on dissociative disorders. All of the studies used self-report symptom scales; none used structured interviews providing full diagnostic assessment of dissociative disorders or other psychopathology. Several studies mixed exposed and unexposed samples or did not differentiate outcomes between exposure groups. Studies examining associations between dissociation and disaster exposure have been inconclusive. The majority (75%) of the studies compared dissociation with posttraumatic stress, with inconsistent findings. Dissociation was found to be associated with a wide range of other psychiatric disorders, symptoms, and negative emotional, cognitive, and functional states.
CONCLUSION
The studies reviewed had serious methodological limitations including problems with measurement of psychopathology, sampling, and generation of unwarranted conclusions, precluding conclusions that dissociation is an established outcome of disaster.
PubMed: 31649861
DOI: 10.5498/wjp.v9.i6.83 -
Schizophrenia Bulletin Jan 2017Schizophrenia spectrum disorders (SSDs) and dissociative disorders (DDs) are described in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders... (Review)
Review
Schizophrenia spectrum disorders (SSDs) and dissociative disorders (DDs) are described in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as 2 categorically distinct diagnostic categories. However, several studies indicate high levels of co-occurrence between these diagnostic groups, which might be explained by overlapping symptoms. The aim of this systematic review is to provide a comprehensive overview of the research concerning overlap and differences in symptoms between schizophrenia spectrum and DDs. For this purpose the PubMed, PsycINFO, and Web of Science databases were searched for relevant literature. The literature contained a large body of evidence showing the presence of symptoms of dissociation in SSDs. Although there are quantitative differences between diagnoses, overlapping symptoms are not limited to certain domains of dissociation, nor to nonpathological forms of dissociation. In addition, dissociation seems to be related to a history of trauma in SSDs, as is also seen in DDs. There is also evidence showing that positive and negative symptoms typically associated with schizophrenia may be present in DD. Implications of these results are discussed with regard to different models of psychopathology and clinical practice.
Topics: Dissociative Disorders; Humans; Psychological Trauma; Psychotic Disorders; Schizophrenia
PubMed: 27209638
DOI: 10.1093/schbul/sbw063 -
Epilepsia Feb 2016Psychogenic nonepileptic seizures (PNES) often have a debilitating effect on patients' lives. Patients, family members, and clinicians have yet to fully understand the... (Review)
Review
Psychogenic nonepileptic seizures (PNES) often have a debilitating effect on patients' lives. Patients, family members, and clinicians have yet to fully understand the mechanisms and treatment of this disorder. Although reviews exist about epileptic seizures, there have been no systematic reviews of studies focusing on the impact of PNES. This review considers research on factors associated with the health-related quality of life (HRQoL) of patients with PNES. Searches of Medline, PsycINFO, CINAHL, and Cochrane Library were conducted. Search terms identified studies that examined factors associated with HRQoL in PNES. Factors fell into three categories: (1) seizure and somatic factors, (2) psychological factors, and (3) coping strategies and family functioning. Fourteen articles were included. The majority of studies were cross-sectional and were of weak to moderate quality. Depressive symptoms were negatively associated with HRQoL. Other factors associated with poorer HRQoL included dissociation, somatic symptoms, escape-avoidance coping strategies, and family dysfunction. Variables such as seizure frequency and demographic factors were not significantly associated with HRQoL. Psychological and interpersonal factors, not seizure reduction, are important for the HRQoL of patients with PNES. The avoidance of emotions is proposed as a perpetuating factor in the difficulties associated with poorer HRQoL. A biopsychosocial approach has relevance for both the clinical and theoretical understanding of PNES. Larger scale research on psychological and relational factors is needed to inform therapeutic approaches to enhance HRQoL in patients with PNES.
Topics: Adaptation, Psychological; Adult; Depression; Dissociative Disorders; Family Relations; Health Status; Humans; Quality of Life; Seizures; Somatoform Disorders
PubMed: 26701628
DOI: 10.1111/epi.13268