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Psychiatry Research Oct 2020The dissociative subtype of posttraumatic stress disorder (D-PTSD) is estimated to occur in approximately 14% of those with posttraumatic stress disorder (PTSD), and is...
The dissociative subtype of posttraumatic stress disorder (D-PTSD) is estimated to occur in approximately 14% of those with posttraumatic stress disorder (PTSD), and is characterized by clinically significant dissociative symptoms in addition to typical PTSD symptoms. Prior research has found childhood maltreatment contributes to dissociation and D-PTSD susceptibility, but more nuanced questions about the nature of childhood maltreatment remain unexplored. We investigated how childhood maltreatment type and severity are associated with the dissociative symptoms of D-PTSD among women with PTSD (N = 106) receiving psychiatric care at a program specializing in trauma-related disorders. Participants completed self-report surveys of psychiatric symptoms and prior trauma exposure including the PTSD Checklist for DSM-5, the Dissociative Subtype of PTSD Scale, and the Childhood Trauma Questionnaire. We used multivariate linear regression to model the association of childhood maltreatment types and dissociation. In our final model childhood emotional abuse and physical abuse significantly predicted the dissociative symptoms of D-PTSD. This suggests childhood maltreatment type and severity, in particular of emotional and physical abuse, are associated with the dissociative symptoms of D-PTSD. This work points toward potential etiological contributions to D-PTSD.
Topics: Adolescent; Adult; Adult Survivors of Child Abuse; Child Abuse; Cross-Sectional Studies; Depersonalization; Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Female; Humans; Male; Middle Aged; Physical Abuse; Predictive Value of Tests; Stress Disorders, Post-Traumatic; Surveys and Questionnaires; Young Adult
PubMed: 32736266
DOI: 10.1016/j.psychres.2020.113301 -
Genes May 2022Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness,... (Review)
Review
Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.
Topics: Dissociative Disorders; Emotions; Genome-Wide Association Study; Humans; Molecular Biology
PubMed: 35627228
DOI: 10.3390/genes13050843 -
Psychiatria Polska 2016The symptoms of dissociation, depersonalization and derealization are often associated with exposure of patients to mental and physical injuries, usually occurring in...
INTRODUCTION
The symptoms of dissociation, depersonalization and derealization are often associated with exposure of patients to mental and physical injuries, usually occurring in childhood. Most of these observations were carried out in populations of patients with various disorders (posttraumatic, conversion-dissociation, personality disorders - especially borderline), who reported their exposure to adverse life circumstances through questionnaire interviews.
AIM
Assessment of the risk associated with various traumatic events in childhood and adolescence concerning the symptoms of pain and tactile dissociation, depersonalization and derealization.
MATERIAL AND METHOD
The coexistence of the earlier life circumstances and the currently existing symptoms was examined on the basis of KO "0" Symptom Checklist and Life Inventory, completed prior to treatment in a day hospital for neurotic disorders.
RESULTS
In the group of 2582 women, patients of a day hospital for neurotic and personality disorders, the symptoms of pain and tactile dissociation, depersonalization and derealization were present in 24-36 % of patients, while the maximum severity of these symptoms reported approximately 4-8 % of patients. The studied patients reported the exposure during childhood and adolescence (before 18yo) to numerous traumatic events of varying severity and frequency, including hostility of one parent (approximately 5% of respondents), the sexual initiation before 13yo (1%), worse than peers material conditions (23%), harassment of the family of origin (2%), reluctance of their peers (9%). Conducted regression analysis showed illustrated by the coefficients OR (odds ratios) a statistically significant relationship between the majority of the analyzed symptoms and many of the listed events, such as being regarded as worse than siblings, mother's anger in the situation of the patient's disease in childhood, lack of support, indifference of parent, poverty and worseness of the family of origin, inferior position in the classroom and the school grades, total sexual unawareness, incest or its attempt.
CONCLUSIONS
The symptoms of dissociation, depersonalization and derealization occurred in significantly more patients reporting burdening life events - difficult situations in childhood and adolescence. Therefore, in clinical practice in patients presenting such symptoms, regardless of diagnosis (e. g. a specific neurotic disorder), we can expect revealing information about such events.
Topics: Adult; Adult Survivors of Child Adverse Events; Depersonalization; Dissociative Disorders; Female; Humans; Middle Aged; Neurotic Disorders; Pain; Women's Health
PubMed: 27086330
DOI: 10.12740/PP/OnlineFirst/36296 -
Journal of Vestibular Research :... 2021Magnetic Resonance Imaging (MRI) scanning can induce psychological effects. No studies have investigated the role of magnetic vestibular stimulation (MVS) in 3TMRI...
BACKGROUND
Magnetic Resonance Imaging (MRI) scanning can induce psychological effects. No studies have investigated the role of magnetic vestibular stimulation (MVS) in 3TMRI scanner-induced psychological reactions.
OBJECTIVE
To assess depersonalization/derealization (DD), state anxiety and motion-perception in a 3TMRI scanner, acutely and long-term.
PARTICIPANTS
48 healthcare professionals and students were included, after preliminary rejection of claustrophobes and neuro-otology and psychiatry assessments.
PROCEDURES
Participants completed questionnaires on personal habits, dissociation, anxiety/depression and motion sickness susceptibility. Validated DD and state anxiety questionnaires were administered before and after magnetic exposure twice, entering the bore head and feet first in random order, one week apart. During the following week, dizziness/disorientation was reported daily. One month later, 11 subjects repeated the procedure to assess reproducibility.
RESULTS
Considerable individual susceptibility was observed, circa 40% of the subjects reported self-motion perception related to the exposure, with variable increase on DD symptoms. Multivariate analysis showed that DD scores after any exposure were influenced by entering the bore "feet first", motion-perception, and the mean sleep hours/week (MANCOVA, R = 0.58, p = 0.00001). There was no clear effect of scanner exposure on state anxiety, which was related to trait anxiey but not to DD scores. During repeated exposures, about half of all subjects re-entering the scan reported motion-perception, but DD or anxiety symptoms were not consistent.
CONCLUSION
Psychological effects during 3TMRI scanning result from multiple, interacting factors, including novelty of the procedure (first-exposure effect), motion-perception due to MVS, head/body orientation, sleeping habits and individual susceptibility. Forewarning subjects of these predisposing factors may increase tolerance to MRI scanning.
Topics: Adult; Anxiety; Depersonalization; Humans; Magnetic Resonance Imaging; Motion Perception; Reproducibility of Results
PubMed: 33325422
DOI: 10.3233/VES-201577 -
Brain Sciences Jul 2023Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in...
Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in individuals with PTSD may inform personalized exposure therapy development. The participants were 125 trauma-exposed adults (96 female) with a range of PTSD symptoms. Electromyography, electrocardiogram, and skin conductance were recorded at baseline, during dark-enhanced startle, and during fear conditioning and extinction. Using a cross-validated, hold-out sample prediction approach, three penalized regressions and conventional ordinary least squares were trained to predict fear-potentiated startle during extinction using 50 predictor variables (5 clinical, 24 self-reported, and 21 physiological). The predictors, selected by penalized regression algorithms, were included in multivariable regression analyses, while univariate regressions assessed individual predictors. All the penalized regressions outperformed OLS in prediction accuracy and generalizability, as indexed by the lower mean squared error in the training and holdout subsamples. During early extinction, the consistent predictors across all the modeling approaches included dark-enhanced startle, the depersonalization and derealization subscale of the dissociative experiences scale, and the PTSD hyperarousal symptom score. These findings offer novel insights into the modeling approaches and patient characteristics that may reliably predict fear extinction in PTSD. Penalized regression shows promise for identifying symptom-related variables to enhance the predictive modeling accuracy in clinical research.
PubMed: 37626488
DOI: 10.3390/brainsci13081131 -
Annals of Physical and Rehabilitation... Jun 2017This review article summarizes neuropsychological descriptions of abnormal body representations in brain-damaged patients and recent neuroscientific investigations of... (Review)
Review
This review article summarizes neuropsychological descriptions of abnormal body representations in brain-damaged patients and recent neuroscientific investigations of their sensorimotor underpinnings in healthy participants. The first part of the article describes unilateral disorders of the bodily self, such as asomatognosia, feelings of amputation, supernumerary phantom limbs and somatoparaphrenia, as well as descriptions of non-lateralized disorders of the bodily self, including Alice in Wonderland syndrome and autoscopic hallucinations. Because the sensorimotor mechanisms of these disorders are unclear, we focus on clinical descriptions and insist on the importance of reporting clinical cases to better understand the full range of bodily disorders encountered in neurological diseases. The second part of the article presents the advantages of merging neuroscientific approaches of the bodily self with immersive virtual reality, robotics and neuroprosthetics to foster the understanding of the multisensory, motor and neural mechanisms of bodily representations.
Topics: Agnosia; Alice in Wonderland Syndrome; Body Image; Brain Injuries; Delusions; Depersonalization; Hallucinations; Humans; Phantom Limb; Robotics; Virtual Reality
PubMed: 27318928
DOI: 10.1016/j.rehab.2016.04.007 -
Clinical Medicine & Research Jun 2023Burnout syndrome is common in physicians, but little is known about burnout in lung transplant physicians specifically. The purpose of this study was to explore burnout...
Burnout syndrome is common in physicians, but little is known about burnout in lung transplant physicians specifically. The purpose of this study was to explore burnout and its relationship to job factors and depression in lung transplant physicians. A cross-sectional study that included lung transplant pulmonologists and surgeons was performed via electronic survey. The lung transplant physicians surveyed practiced worldwide. The survey incorporated questions about demographics and job characteristics as well as the Maslach Burnout Inventory and Patient Health Questionnaire-2. Burnout was defined by high emotional exhaustion or depersonalization. Ninety physicians worldwide completed the survey. Of the 90 physicians who completed the entire survey, 44 (48.9%) had burnout with 38 (42.2%) having high emotional exhaustion, 15 (16.7%) having high depersonalization, and 9 (10.0%) with both. Of the respondents, 14 (15.6%) had high risk of depression, and of these, 13 also had high emotional exhaustion. There was a positive correlation between depression score and emotional exhaustion score (=0.67, <0.001). Depression was more common in surgeons compared with pulmonologists (35.7% versus 11.8%, =0.02). There was a trend toward more burnout by emotional exhaustion in physicians with more versus less work experience (68.4% versus 31.6%, =0.056). Emotional exhaustion is common in lung transplant physicians and is associated with depression and a negative impact on life.
Topics: Humans; Cross-Sectional Studies; Depersonalization; Burnout, Psychological; Burnout, Professional; Surveys and Questionnaires; Surgeons
PubMed: 37407217
DOI: 10.3121/cmr.2023.1809 -
BMC Health Services Research Nov 2022Burnout is common among physicians and has detrimental effects on patient care and physician health. Recent editorials call attention to perfectionism in medicine;...
BACKGROUND
Burnout is common among physicians and has detrimental effects on patient care and physician health. Recent editorials call attention to perfectionism in medicine; however, no studies to date have examined the effect of perfectionism on burnout in physicians practicing in the United States. This study examined associations among demographics, perfectionism and personality traits, and burnout among practicing physicians.
METHODS
This cross-sectional study included general pediatric and pediatric sub-specialist physicians. Out of the 152 physicians contacted, 69 enrolled (Mean = 44.16 ± 9.98; 61% female). Emotional exhaustion, depersonalization, and personal accomplishment burnout were assessed via the Maslach Burnout Inventory. Validated instruments were used to measure personality and perfectionism. Data were analyzed using linear regression models.
RESULTS
Across physicians assessed, 42% reported either high emotional exhaustion burnout or depersonalization burnout. High self-critical perfectionism uniquely predicted both high emotional exhaustion burnout (B = 0.55, 95%CI 0.25-0.85) and depersonalization burnout (B = 0.18, 95%CI 0.05-0.31). Low conscientiousness (B = -6.12; 95%CI, -10.95- -1.28) predicted higher emotional exhaustion burnout and low agreeableness (B = -3.20, 95%CI -5.93- -0.46) predicted higher depersonalization burnout.
CONCLUSIONS
Perfectionism is understudied among physicians and the current findings suggest that addressing system and individual-level factors that encourage perfectionism is warranted and may reduce risk for physician burnout.
Topics: Female; Humans; Child; Adult; Middle Aged; Male; Perfectionism; Cross-Sectional Studies; Burnout, Psychological; Physicians; Medicine
PubMed: 36443726
DOI: 10.1186/s12913-022-08785-7 -
Frontiers in Human Neuroscience Oct 2013The vestibular system is a sensory system that has evolved to detect linear and angular acceleration of the head in all planes so that the brain is not predominantly... (Review)
Review
The vestibular system is a sensory system that has evolved to detect linear and angular acceleration of the head in all planes so that the brain is not predominantly reliant on visual information to determine self-motion. Since the vestibular system first evolved in invertebrate species in order to detect gravitational vertical, it is likely that the central nervous system has developed a special dependence upon vestibular input. In addition to the deficits in eye movement and postural reflexes that occur following vestibular dysfunction, there is convincing evidence that vestibular loss also causes cognitive and emotional disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and neocortex play in the sense of spatial orientation. Beyond this, however, patients with vestibular disorders have been reported to experience other personality changes that suggest that vestibular sensation is implicated in the sense of self. These are depersonalization and derealization symptoms such as feeling "spaced out", "body feeling strange" and "not feeling in control of self". We propose in this review that these symptoms suggest that the vestibular system may make a unique contribution to the concept of self through information regarding self-motion and self-location that it transmits, albeit indirectly, to areas of the brain such as the temporo-parietal junction (TPJ).
PubMed: 24194706
DOI: 10.3389/fnhum.2013.00678 -
Frontiers in Psychiatry 2022Dissociative disorders are an important group of trauma-related disorders associated with significant disability. The co-occurrence of dissociative disorders (DD) and... (Review)
Review
Dissociative disorders are an important group of trauma-related disorders associated with significant disability. The co-occurrence of dissociative disorders (DD) and symptoms (DS) in bipolar disorder has been relatively understudied, but there is some evidence that this comorbidity may have significant mechanistic and clinical implications. This paper presents the results of a scoping review of the frequency and correlates of DS and DD in bipolar disorder. Based on the available evidence, DS/DD are more common in bipolar disorder than in healthy controls or in unipolar depression, are related to childhood trauma, and are associated with psychotic symptoms, suicide attempts, and a poorer response to treatment in patients with bipolar disorder. The implications of these findings, and possible mechanistic pathways underlying them, are discussed based on the current literature. Clinicians should be aware of the frequent occurrence of significant DS or DD when treating patients with bipolar disorder. A tentative future research agenda for this field, based on clinical, risk factor-related and neurobiological considerations, is outlined.
PubMed: 35722564
DOI: 10.3389/fpsyt.2022.925983