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Brain : a Journal of Neurology Dec 2010Although generally considered as mutually exclusive, violence and sleep can coexist. Violence related to the sleep period is probably more frequent than generally... (Review)
Review
Although generally considered as mutually exclusive, violence and sleep can coexist. Violence related to the sleep period is probably more frequent than generally assumed and can be observed in various conditions including parasomnias (such as arousal disorders and rapid eye movement sleep behaviour disorder), epilepsy (in particular nocturnal frontal lobe epilepsy) and psychiatric diseases (including delirium and dissociative states). Important advances in the fields of genetics, neuroimaging and behavioural neurology have expanded the understanding of the mechanisms underlying violence and its particular relation to sleep. The present review outlines the different sleep disorders associated with violence and aims at providing information on diagnosis, therapy and forensic issues. It also discusses current pathophysiological models, establishing a link between sleep-related violence and violence observed in other settings.
Topics: Dissociative Disorders; Epilepsy; Forensic Medicine; Humans; Parasomnias; Polysomnography; Sleep Arousal Disorders; Sleep Wake Disorders; Sleep, REM; Violence
PubMed: 21126993
DOI: 10.1093/brain/awq296 -
Alcoholism, Clinical and Experimental... Feb 2022Up to 50% of individuals with posttraumatic stress disorder (PTSD) endorse problematic alcohol use. Typically, these individuals present with more complex and often more...
BACKGROUND
Up to 50% of individuals with posttraumatic stress disorder (PTSD) endorse problematic alcohol use. Typically, these individuals present with more complex and often more severe PTSD symptoms than those who do not report problematic alcohol use. Emerging literature suggests that heightened symptoms of dissociation are likewise associated with greater PTSD symptom severity. Despite this knowledge, the role of dissociation in the relation between PTSD severity and alcohol-related problems has yet to be examined. Here, we explore the mediating role of dissociative symptomatology on the association between PTSD severity and alcohol-related problems within a PTSD treatment-seeking sample.
METHODS
Structural equation modeling was used to test the mediating role of dissociative symptomatology between PTSD severity and alcohol-related problems. Participants [N = 334; mean age (SD) = 44.29 (9.77), 50% female] were drawn from a clinical intake battery database for PTSD in-patient treatment services at Homewood Health Care, Guelph, ON, Canada. A subset of battery measures assessing PTSD severity, dissociative symptomatology, and alcohol-related problems were submitted to analysis.
RESULTS
A significant positive association emerged between PTSD severity and alcohol-related problems (β = 0.127, p < 0.05) in the absence of dissociative symptomatology. Critically, however, when added to this model, dissociative symptomatology (six unique facets of dissociation assessed by the Multiscale Dissociation Inventory) mediated the relation between PTSD severity and alcohol-related problems. Specifically, greater PTSD severity was associated with greater dissociative symptomatology (β = 0.566, p < 0.0001), which was in turn associated with greater alcohol-related problems (β = 0.184, p < 0.05).
CONCLUSIONS
These results suggest that dissociative symptomatology plays a key role in explaining the relation between PTSD severity and alcohol-related problems. Future studies should examine the impact of targeting dissociative symptomatology specifically in treating individuals with PTSD who endorse alcohol-related problems.
Topics: Adult; Alcohol-Related Disorders; Cross-Sectional Studies; Dissociative Disorders; Emotional Regulation; Female; Humans; Male; Middle Aged; Severity of Illness Index; Stress Disorders, Post-Traumatic
PubMed: 35179786
DOI: 10.1111/acer.14764 -
Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder.Journal of Psychopathology and Clinical... May 2023Approximately 10%-30% of individuals with posttraumatic stress disorder (PTSD) exhibit a dissociative subtype of the condition defined by symptoms of depersonalization...
Approximately 10%-30% of individuals with posttraumatic stress disorder (PTSD) exhibit a dissociative subtype of the condition defined by symptoms of depersonalization and derealization. This study examined the psychometric evidence for the dissociative subtype of PTSD in a sample of young, primarily male post-9/11-era Veterans ( = 374 at baseline and = 163 at follow-up) and evaluated its biological correlates with respect to resting state functional connectivity (default mode network [DMN]; = 275), brain morphology (hippocampal subfield volume and cortical thickness; = 280), neurocognitive functioning ( = 337), and genetic variation ( = 193). Multivariate analyses of PTSD and dissociation items suggested a class structure was superior to dimensional and hybrid ones, with 7.5% of the sample comprising the dissociative class; this group showed stability over 1.5 years. Covarying for age, sex, and PTSD severity, linear regression models revealed that derealization/depersonalization severity was associated with: decreased DMN connectivity between bilateral posterior cingulate cortex and right isthmus ( = .015; adjusted- [] = .097); increased bilateral whole hippocampal, hippocampal head, and molecular layer head volume ( = .010-.034; = .032-.053); worse self-monitoring ( = .018; = .079); and a candidate genetic variant (rs263232) in the adenylyl cyclase 8 gene ( = .026), previously associated with dissociation. Results converged on biological structures and systems implicated in sensory integration, the neural representation of spatial awareness, and stress-related spatial learning and memory, suggesting possible mechanisms underlying the dissociative subtype of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Male; Stress Disorders, Post-Traumatic; Multivariate Analysis; Gyrus Cinguli; Dissociative Disorders; Hippocampus
PubMed: 37023279
DOI: 10.1037/abn0000795 -
Tijdschrift Voor Psychiatrie 2021
Topics: Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Humans; Standard of Care; Stress Disorders, Post-Traumatic
PubMed: 33779970
DOI: No ID Found -
Tijdschrift Voor Psychiatrie 2021Conversion and dissociation in their relationship have made a lot of pendulum movements over time between moving together and away from each other. In the run-up to the... (Review)
Review
BACKGROUND
Conversion and dissociation in their relationship have made a lot of pendulum movements over time between moving together and away from each other. In the run-up to the introduction of DSM-5, it was argued that conversion should be classified as a dissociative disorder, but this didn't happen.
AIM
In this article, the clinical scientific evidence is examined for the relationship between conversion and dissociation. We provide an overview of the recent clinical studies that examine both syndromes together. We also investigate the main overlapping predisposing characteristics and psychopathological explanatory models of both syndromes.
METHOD
Literature review in PubMed and PsycArticles.
RESULTS
Our findings confirm that there is a large comorbidity between conversive and dissociative symptoms in clinical reality. Both syndromes have a high prevalence of reported trauma and emotion dysregulation. However, evidence for present biomarkers is still llimited. The underlying explanation models are applicable for both conversion and dissociation.
CONCLUSION
We want to draw attention to the plea to bring conversion disorders back together with dissociative disorders. Moreover, the possible presence of trauma, the influential role of psychosocial stressors, the present psychiatric co-morbidity and the style of emotion regulation seem to justify the approach to conversion problems from a biopsychosocial perspective rather than from a purely biomedical perspective.
Topics: Comorbidity; Conversion Disorder; Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Emotions; Humans
PubMed: 34231865
DOI: No ID Found -
European Journal of Psychotraumatology 2022Most individuals with dissociative disorders (DDs) report engaging in self-injury.
BACKGROUND
Most individuals with dissociative disorders (DDs) report engaging in self-injury.
OBJECTIVE
The present study aimed to understand the reasons for self-injury among a clinical sample of 156 DD patients enrolled in the TOP DD Network study.
METHOD
Participants answered questions about self-injury, including a prompt asking how often they are aware of the reasons they have urges to self-injure, as well as a prompt asking them to list three reasons they self-injure.
RESULTS
Six themes of reasons for self-injury, each with subthemes, were identified in the qualitative data: (1) Trauma-related Cues, (2) Emotion Dysregulation, (3) Stressors, (4) Psychiatric and Physical Health Symptoms, (5) Dissociative Experiences, and (6) Ineffective Coping Attempts. Participants reported that they were able to identify their reasons for self-injuring sometimes (60.26%) or almost always (28.85%), with only 3.20% unable to identify any reasons for their self-injury.
CONCLUSION
Results suggest that the vast majority of DD patients (92.31%) reported being at least partially unaware of what leads them to have self-injury urges, and many individuals with DDs experience some reasons for self-injury that are different from those with other disorders. The treatment implications of these findings are discussed.
Topics: Adult; Cues; Dissociative Disorders; Female; Health Status; Humans; Male; Self-Injurious Behavior; Stress, Psychological; Surveys and Questionnaires; Wounds and Injuries
PubMed: 35126883
DOI: 10.1080/20008198.2022.2026738 -
Medical Hypotheses May 2021Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients demonstrate characteristic multistage progression and movement disorders, which are analogous to... (Review)
Review
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients demonstrate characteristic multistage progression and movement disorders, which are analogous to hystero-epilepsy in Jean-Martin Charcot's Tuesday Lessons. First, based on a review of the Tuesday Lessons recorded by Charcot's pupils, we hypothesized that there were patients with anti-NMDAR encephalitis among those diagnosed with hystero-epilepsy in the nineteenth century. We found acute-onset multiple neuropsychiatric manifestations resembling anti-NMDAR encephalitis among patients with hystero-epilepsy. Patients with drug withdrawal syndrome, dissociative and conversion disorders and patients under hypnosis from the modern point of view were also identified. These results suggested that hystero-epilepsy in the Tuesday Lessons could encompass dissociative and conversion disorders, hypnosis, drug withdrawal syndrome, and anti-NMDAR encephalitis-like manifestations. Based on Charcot's observations and current progress in molecular biology, such as the identification of glutamate/NMDAR system dysfunction in drug withdrawal syndrome, we then hypothesized that patients with dissociative and conversion disorders and those under hypnosis could also have hypofunction of the glutamatergic system. The NMDAR hypofunction hypothesis is emerging as a pathogenesis of schizophrenia. NMDAR antagonists are known to evoke symptoms similar to schizophrenia, anti-NMDAR encephalitis and near-death experiences. In current clinical reports, spectrum disorders such as dissociative disorder and conversion disorder have been observed in patients with anti-NMDAR encephalitis. Our hypothesis will offer an expansion of the NMDAR hypofunction hypothesis from psychosis to functional neurological disorders and normal specific situations, such as hypnosis, thanatosis, and near-death experiences.
Topics: Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Dissociative Disorders; Epilepsy; Humans; Receptors, Glutamate; Receptors, N-Methyl-D-Aspartate
PubMed: 33799161
DOI: 10.1016/j.mehy.2021.110567 -
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 -
European Journal of Psychotraumatology 2022Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To...
BACKGROUND
Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To the best of our knowledge, however, the link between emotion dysregulation and self-injury has not yet been examined within a DD population.
OBJECTIVE
The present study investigated relations between emotion dysregulation, dissociation, and self-injury in DD patients, and explored patterns of emotion dysregulation difficulties among DD patients with and without recent histories of self-injury.
METHOD
We utilized linear and logistic regressions and -test statistical methods to examine data from 235 patient-clinician dyads enrolled in the TOP DD Network Study.
RESULTS
Analyses revealed emotion dysregulation was associated with heightened dissociative symptoms and greater endorsement of self-injury in the past six months. Further, patients with a history of self-injury in the past six months reported more severe emotion dysregulation and dissociation than those without recent self-injury. As a group, DD patients reported the greatest difficulty engaging in goal-directed activities when distressed, followed by lack of emotional awareness and nonacceptance of emotional experiences. DD patients demonstrated similar patterns of emotion dysregulation difficulties irrespective of recent self-injury status.
CONCLUSIONS
Results support recommendations to strengthen emotion regulation skills as a means to decrease symptoms of dissociation and self-injury in DD patients.
Topics: Adult; Aged; Cross-Sectional Studies; Dissociative Disorders; Emotional Regulation; Female; Humans; Male; Middle Aged; Self-Injurious Behavior; Surveys and Questionnaires
PubMed: 35145611
DOI: 10.1080/20008198.2022.2031592 -
Nature Communications Dec 2020Ketamine produces immediate antidepressant effects and has inspired research into next-generation treatments. Ketamine also has short term dissociative effects, in which... (Review)
Review
Ketamine produces immediate antidepressant effects and has inspired research into next-generation treatments. Ketamine also has short term dissociative effects, in which individuals report altered consciousness and perceptions of themselves and their environment. However, whether ketamine's dissociative side effects are necessary for its antidepressant effects remains unclear. This perspective examines the relationship between dissociative effects and acute and longer-lasting antidepressant response to ketamine and other N-methyl-D-aspartate (NMDA) receptor antagonists. Presently, the literature does not support the conclusion that dissociation is necessary for antidepressant response to ketamine. However, further work is needed to explore the relationship between dissociation and antidepressant response at the molecular, biomarker, and psychological levels.
Topics: Animals; Antidepressive Agents; Dissociative Disorders; Humans; Ketamine; Receptors, N-Methyl-D-Aspartate
PubMed: 33353946
DOI: 10.1038/s41467-020-20190-4