-
Comprehensive Psychiatry Nov 2023To determine whether dissociative experiences moderate online problem gambling treatment effectiveness, and to characterize the temporal persistence of the relationship...
AIMS
To determine whether dissociative experiences moderate online problem gambling treatment effectiveness, and to characterize the temporal persistence of the relationship between dissociation and problem gambling.
DESIGN
Repeatedly measured self-report data on a guided online cognitive behavioral therapy for problem gambling collected on four occasions: before treatment, after treatment, and at 6- and 12-month follow-ups.
SETTING AND PARTICIPANTS
The data (N = 1243, 59.2% males) were collected in Finland between 2019 and 2021.
MEASUREMENTS
The primary outcome variable was the self-reported level of problem gambling. The predictors were the treatment phase and dissociative experiences, their interaction, and the demographic covariates of age, education, income, and gender.
FINDINGS
Problem gambling scores and dissociative experiences declined significantly following treatment and remained low through the follow-ups (retention rates: 52.6% [post-treatment], 26.3% [at the 6-month follow-up], and 16.1% [at the 12-month follow-up]). However, the treatment was significantly less effective in reducing problem gambling for individuals who kept experiencing dissociation after the treatment.
CONCLUSIONS
Dissociation is an integral sign of problem gambling severity and sustained dissociative experiences may significantly reduce the long-term effectiveness of online problem gambling treatments. Treatment efforts should be customized to account for individual differences in dissociative tendencies, and future research should broaden the study of dissociative experiences to other behavioral addictions.
Topics: Male; Humans; Female; Gambling; Cognitive Behavioral Therapy; Self Report; Treatment Outcome; Dissociative Disorders
PubMed: 37688936
DOI: 10.1016/j.comppsych.2023.152414 -
Psychological Research Apr 2022In recent years, research on interoceptive abilities (i.e., sensibility, accuracy, and awareness) and their associations with emotional experience has flourished. Yet...
In recent years, research on interoceptive abilities (i.e., sensibility, accuracy, and awareness) and their associations with emotional experience has flourished. Yet interoceptive abilities in alexithymia-a personality trait characterized by a difficulty in the cognitive interpretation of emotional arousal, which impacts emotional experience-remain under-investigated, thereby limiting a full understanding of subjective emotional experience processing. Research has proposed two contrasting explanations thus far: in one model, the dimensions of interoceptive sensibility and accuracy in alexithymia would increase; in the other model, they would decrease. Surprisingly, the contribution of interoceptive awareness has been minimally researched. In this study (N = 182), the relationship between participants' level of alexithymia and the three interoceptive dimensions was tested. Our results show that the higher the level of alexithymia is, the higher interoceptive accuracy and sensibility (R = 0.29 and R = 0.14); conversely, the higher the level of alexithymia is, the lower interoceptive awareness (R = 0.36). Moreover, an ROC analysis reveals that interoceptive awareness is the most accurate predictor of alexithymia, yielding over 92% accuracy. Collectively, these results support a coherent understanding of interoceptive abilities in alexithymia, whereby the dissociation of interoceptive accuracy and awareness may explain the underlying psycho-physiological mechanisms of alexithymia. A possible neurocognitive mechanism is discussed which suggests insurgence of psychosomatic disorders in alexithymia and related psychotherapeutic approaches.
Topics: Affective Symptoms; Arousal; Dissociative Disorders; Emotions; Humans
PubMed: 34097132
DOI: 10.1007/s00426-021-01538-x -
European Journal of Psychotraumatology 2023Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has...
BACKGROUND
Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms.
OBJECTIVE
This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms.
METHODS
We analyzed longitudinal data from an international sample of people self-reporting depressive emotions ( = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31).
RESULTS
More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally ( = .286 to .528, < .001) and longitudinally ( = .181 to .462, < .001) correlated with depressive symptoms. A sense of current threat ( = .146, < .05) and negative self-concept ( = .173, < .05) at baseline significantly predicted depressive symptoms after one year.
CONCLUSIONS
These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice.
Topics: Humans; Follow-Up Studies; Depression; Stress Disorders, Post-Traumatic; Comorbidity; Dissociative Disorders
PubMed: 37818716
DOI: 10.1080/20008066.2023.2263314 -
Canadian Medical Association Journal Oct 1964Individuals can carry out complex activity while in a state of impaired consciousness, a condition termed "automatism". Consciousness must be considered from both an...
Individuals can carry out complex activity while in a state of impaired consciousness, a condition termed "automatism". Consciousness must be considered from both an organic and a psychological aspect, because impairment of consciousness may occur in both ways. Automatism may be classified as normal (hypnosis), organic (temporal lobe epilepsy), psychogenic (dissociative fugue) or feigned. Often painstaking clinical investigation is necessary to clarify the diagnosis. There is legal precedent for assuming that all crimes must embody both consciousness and will. Jurists are loath to apply this principle without reservation, as this would necessitate acquittal and release of potentially dangerous individuals. However, with the sole exception of the defence of insanity, there is at present no legislation to prohibit release without further investigation of anyone acquitted of a crime on the grounds of "automatism".
Topics: Automatism; Classification; Consciousness; Conversion Disorder; Crime; Diagnosis, Differential; Dissociative Disorders; Epilepsy; Epilepsy, Temporal Lobe; Forensic Medicine; Humans; Hypnosis; Hysteria; Malingering; Physiology; Temporal Lobe
PubMed: 14199824
DOI: No ID Found -
European Journal of Psychotraumatology 2023Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about...
OBJECTIVE
Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms.
METHOD
Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (= 111) or the dissociative subtype of PTSD ( = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated.
RESULTS
Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome.
CONCLUSION
The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.
Topics: Humans; Dissociative Disorders; Stress Disorders, Post-Traumatic; Treatment Outcome; Eye Movement Desensitization Reprocessing
PubMed: 37846662
DOI: 10.1080/20008066.2023.2265182 -
Neurosciences (Riyadh, Saudi Arabia) Jul 2017To assess the relationships between the dissociative features of FMS and the pain, psychological status, and functional status.
OBJECTIVE
To assess the relationships between the dissociative features of FMS and the pain, psychological status, and functional status.
METHODS
Twenty-seven women with fibromyalgia syndrome (FMS) and 24 controls from the Istanbul Physical Medicine and Rehabilitation Hospital (2013-2015) were included in this cross-sectional study. The Diagnostic and Statistical Manual of Mental Disorders Structured Clinical Interview for Axis I Disorders was used to evaluate the participants. A visual analogous scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to assess the levels of pain, quality of sleep and functional and psychological statuses. The Dissociative Experiences Scale (DES) was used to evaluate the dissociative features.
RESULTS
The BDI, BAI and DES scores were statistically significantly higher in the cases of FMS. There were remarkable associations between all but 2 of the DES and FIQ scores, while positive correlations were found between the DES and, VAS pain and sleep quality scores. The prevalences of current and lifelong dysthymia, and major depressive disorder; not otherwise specified, common anxiety and somatoform disorders were higher in the cases of FMS.
CONCLUSION
Pain, physical function and emotional status appear to be associated with dissociative features in FMS. Further studies are required to define these relationships and improve treatment.
Topics: Adult; Case-Control Studies; Comorbidity; Cross-Sectional Studies; Dissociative Disorders; Female; Fibromyalgia; Humans; Mental Disorders; Middle Aged; Pain; Pain Measurement; Psychiatric Status Rating Scales; Sleep Initiation and Maintenance Disorders; Turkey; Young Adult
PubMed: 28678214
DOI: 10.17712/nsj.2017.3.20160538 -
Ugeskrift For Laeger Jan 2022ICD-11 introduces a new diagnosis of complex PTSD and a fundamentally new approach to personality disorders. The two diagnoses share substantial features including... (Review)
Review
ICD-11 introduces a new diagnosis of complex PTSD and a fundamentally new approach to personality disorders. The two diagnoses share substantial features including impairment of self and interpersonal functioning and emotional dysregulation. This review outlines the overlap and boundaries between ICD-11 definitions of Complex PTSD and Personality Disorder. A set of principles related to trauma, onset, emotion dysregulation, self and interpersonal functioning, and dissociative and psychotic-like states are put forward to guide practitioners.
Topics: Dissociative Disorders; Humans; International Classification of Diseases; Personality Disorders; Stress Disorders, Post-Traumatic
PubMed: 35088694
DOI: No ID Found -
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 -
Psychiatry Research May 2020Dissociation is associated with risk for suicide in adults, but this link is not well studied in adolescents, in spite of their marked suicide risk. This study assessed...
Dissociation is associated with risk for suicide in adults, but this link is not well studied in adolescents, in spite of their marked suicide risk. This study assessed adolescents' dissociative experiences in daily life and evaluated the association between dissociative experiences and suicide risk, including the independence of this relationship from related affective and clinical states and demographic characteristics. Clinically referred early adolescents (N = 162; aged 11-13) were assessed via multi-informant clinical interview, questionnaires, and 4-day ecological momentary assessment protocol. Adolescents were classified as being at elevated suicide risk using multi-informant, multi-method reports of suicide risk behavior and/or at elevated proximal risk using the 4-day EMA only. Suicide risk was associated with daily dissociative experiences, and this relationship was independent of daily negative and positive affect and co-occurring borderline personality symptoms. Gender differences emerged, such that the relationship between daily dissociative experiences and suicide risk was only significant in adolescent girls. Overall, findings suggest dissociation may be independently relevant to adolescent suicide risk, above and beyond effects of psychopathology and affective disturbance, and especially in girls. Daily dissociative experiences may help understand and detect suicide risk among early adolescents and warrant further research.
Topics: Activities of Daily Living; Adolescent; Borderline Personality Disorder; Child; Dissociative Disorders; Female; Humans; Interview, Psychological; Male; Risk Factors; Sex Factors; Suicide; Surveys and Questionnaires
PubMed: 32171125
DOI: 10.1016/j.psychres.2020.112870 -
Social Psychiatry and Psychiatric... Jan 2018Studies conducted in the USA, Canada and Denmark have supported the existence of the dissociative PTSD subtype, characterized primarily by symptoms of depersonalization...
PURPOSE
Studies conducted in the USA, Canada and Denmark have supported the existence of the dissociative PTSD subtype, characterized primarily by symptoms of depersonalization and derealization. The current study aimed to examine the dissociative PTSD subtype in an Eastern European, predominantly female (83.16%) sample, using an extended set of dissociative symptoms.
METHODS
A latent profile analysis was applied to the PTSD and dissociation data from 689 trauma-exposed university students from Slovakia.
RESULTS
Four latent profiles of varying PTSD and dissociation symptomatology were uncovered. They were named non-symptomatic, moderate PTSD, high PTSD and dissociative PTSD. The dissociative PTSD profile showed elevations on depersonalization and derealization, but also the alternative dissociative indicators of gaps in awareness and memory, sensory misperceptions and cognitive and behavioural re-experiencing. The core PTSD symptoms of 'memory impairment' and 'reckless or self-destructive behaviour' were also significantly elevated in the dissociative PTSD profile. Moreover, anxiety and anger predicted membership in the dissociative PTSD profile.
CONCLUSION
The results provide support for the proposal that the dissociative PTSD subtype can be characterized by a variety of dissociative symptoms.
Topics: Adolescent; Adult; Dissociative Disorders; Female; Humans; Male; Slovakia; Stress Disorders, Post-Traumatic; Young Adult
PubMed: 29043375
DOI: 10.1007/s00127-017-1445-2