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Tijdschrift Voor Psychiatrie 2019Dissociation is a prevalent symptom in borderline personality disorder (BPD), which can have detrimental effects on everyday functioning and treatment. Until now, little... (Review)
Review
Dissociation is a prevalent symptom in borderline personality disorder (BPD), which can have detrimental effects on everyday functioning and treatment. Until now, little is known about the brain networks implicated in dissociation in BPD. Research on dissociative disorders and posttraumatic stress disorder found alterations in networks implicated in cognitive control and arousal modulation. However, it is unknown whether these alterations are also affected in BPD.
AIM: To provide an overview of the definitions, neurobiological models, and neuroimaging research on dissociation in BPD.
METHOD: Review of the literature.
RESULTS: During dissociation in BPD, there is evidence for an altered recruitment and interplay of brain regions implicated in the regulation of stress responses and emotions, attention, memory, and self-referential processing (amygdala, anterior cingulate cortex, inferior frontal gyrus, medial prefrontal cortex, superior temporal gyrus, and inferior parietal lobule).
CONCLUSION: Dissociation is associated with alterations in brain networks that regulate affect-cognitive processing in BPD. Given the substantial impact of dissociation on treatment and neural processing, dissociative symptoms should be taken into account in future research and treatment of BPD, even if they are not the primary focus.Topics: Borderline Personality Disorder; Dissociative Disorders; Emotions; Humans; Neuroimaging
PubMed: 31017285
DOI: No ID Found -
PloS One 2021Dissociative experiences occur across a range of mental health disorders. However, the term 'dissociation' has long been argued to lack conceptual clarity and may...
BACKGROUND
Dissociative experiences occur across a range of mental health disorders. However, the term 'dissociation' has long been argued to lack conceptual clarity and may describe several distinct phenomena. We therefore aimed to conceptualise and empirically establish a discrete subset of dissociative experiences and develop a corresponding assessment measure.
METHODS
First, a systematic review of existing measures was carried out to identify themes across dissociative experiences. A theme of 'Felt Sense of Anomaly' (FSA) emerged. Second, assessment items were generated based on this construct and a measure developed using exploratory (EFA) and confirmatory (CFA) factor analyses of 8861 responses to an online self-report survey. Finally, the resulting measure was validated via CFA with data from 1031 patients with psychosis.
RESULTS
'Felt sense of anomaly' (FSA) was identified as common to many dissociative experiences, affecting several domains (e.g. body) and taking different forms ('types'; e.g. unfamiliarity). Items for a novel measure were therefore systematically generated using a conceptual framework whereby each item represented a type-by-domain interaction (e.g. 'my body feels unfamiliar'). Factor analysis of online responses found that FSA-dissociation manifested in seven ways: anomalous experiences of the self, body, and emotion, and altered senses of familiarity, connection, agency, and reality (Χ2 (553) = 4989.435, p<0.001, CFI = 0.929, TLI = 0.924, RMSEA = 0.052, SRMR = 0.047). Additionally, a single-factor 'global FSA' scale was produced (Χ2 (9) = 312.350, p<0.001, CFI = 0.970, TLI = 0.950, RMSEA = 0.107, SRMR = 0.021). Model fit was adequate in the clinical (psychosis) group (Χ2 (553) = 1623.641, p<0.001, CFI = 0.927, TLI = 0.921, RMSEA = 0.043, SRMR = 0.043). The scale had good convergent validity with a widely used dissociation scale (DES-II) (non-clinical: r = 0.802), excellent internal reliability (non-clinical: Cronbach's alpha = 0.98; clinical: Cronbach's alpha = 0.97), and excellent test-retest reliability (non-clinical: ICC = 0.92). Further, in non-clinical respondents scoring highly on a PTSD measure, CFA confirmed adequate model fit (Χ2 (553) = 4758.673, CFI = 0.913, TLI = 0.906, RMSEA = 0.052, SRMR = 0.054).
CONCLUSIONS
The Černis Felt Sense of Anomaly (ČEFSA) scale is a novel measure of a subset of dissociative experiences that share a core feature of FSA. It is psychometrically robust in both non-clinical and psychosis groups.
Topics: Dissociative Disorders; Factor Analysis, Statistical; Humans; Psychometrics; Self Report
PubMed: 33626089
DOI: 10.1371/journal.pone.0247037 -
Psychopharmacology Jul 2022A significant obstacle to an improved understanding of pathological dissociative and psychosis-like states is the lack of readily implemented pharmacological models of...
Pharmacological modelling of dissociation and psychosis: an evaluation of the Clinician Administered Dissociative States Scale and Psychotomimetic States Inventory during nitrous oxide ('laughing gas')-induced anomalous states.
RATIONALE
A significant obstacle to an improved understanding of pathological dissociative and psychosis-like states is the lack of readily implemented pharmacological models of these experiences. Ketamine has dissociative and psychotomimetic effects but can be difficult to use outside of medical and clinical-research facilities. Alternatively, nitrous oxide (NO) - like ketamine, a dissociative anaesthetic and NMDAR antagonist - has numerous properties that make it an attractive alternative for modelling dissociation and psychosis. However, development and testing of such pharmacological models relies on well-characterized measurement instruments.
OBJECTIVES
To examine the factor structures of the Clinician Administered Dissociative States Scale (CADSS) and Psychotomimetic States Inventory (PSI) administered during NO inhalation in healthy volunteers.
METHODS
Secondary analyses of data pooled from three previous NO studies with healthy volunteers.
RESULTS
Effect sizes for NO-induced dissociation and psychotomimesis were comparable to effects reported in experimental studies with sub-anaesthetic ketamine in healthy volunteers. Although, like ketamine, a three-factor representation of NO-induced dissociation was confirmed, and a more parsimonious two-factor model might be more appropriate. Bayesian exploratory factor analysis suggested that NO-induced psychosis-like symptoms were adequately represented by two negative and two positive symptom factors. Hierarchical cluster analysis indicated minimal item overlap between the CADSS and PSI.
CONCLUSION
NO and ketamine produce psychometrically similar dissociative states, although parallels in their psychosis-like effects remain to be determined. The CADSS and PSI tap largely non-overlapping experiences under NO and we propose the use of both measures (or similar instruments) to comprehensively assess anomalous subjective states produced by dissociative NMDAR antagonists.
Topics: Anesthetics, Dissociative; Bayes Theorem; Dissociative Disorders; Humans; Ketamine; Nitrous Oxide; Psychotic Disorders; Receptors, N-Methyl-D-Aspartate
PubMed: 35348804
DOI: 10.1007/s00213-022-06121-9 -
BMJ (Clinical Research Ed.) Mar 1993
Topics: Dissociative Disorders; Humans; Ketamine; Social Environment; Substance-Related Disorders
PubMed: 8461808
DOI: 10.1136/bmj.306.6878.601 -
Psychiatry and Clinical Neurosciences Jun 2023Departing from existing neurobiological models of dissociation, the current study aims at conducting a quantitative meta-analytic review of neural responses to emotional... (Meta-Analysis)
Meta-Analysis Review
AIM
Departing from existing neurobiological models of dissociation, the current study aims at conducting a quantitative meta-analytic review of neural responses to emotional stimuli among individuals ascribed to the dissociative spectrum (DS). Accordingly, the study explored common and specific brain mechanisms across borderline personality disorder, conversion/somatoform disorders, posttraumatic stress disorder, posttraumatic stress disorder related to repeated interpersonal traumatic experiences, and dissociative disorders.
METHODS
The meta-analysis included studies that administered emotional stimuli during functional magnetic resonance imaging acquisition among individuals included in the DS. There were two conducted meta-analytic procedures: (i) a Bayesian network meta-analysis for a region-of-interest-based approach; and (ii) robust voxel-based approach.
RESULTS
Forty-four independent studies were included for a total of 1384 individuals (DS = 741 patients). The network meta-analysis showed specific patterns of neural activity considering an extended brain network involved in emotion regulation for each condition ascribed to the DS. The voxel-based meta-analysis highlighted an increased activity of dorsal anterior cingulate cortex as a common neurological signature of the DS.
CONCLUSION
The common neural feature of the DS captures an implicit appraisal of emotion-eliciting stimuli as threatening and/or noxious for mental and physical integrity of the individual together with painful subjective experiences associated with physiological emotional reactions. Specific brain responses across the DS suggested the engagement in different mechanisms to address emotional stimuli, including implicit avoidance reactions and attempts to overcontrol of affective states together with a disruption of integrative processes of emotional mind-body features.
Topics: Humans; Bayes Theorem; Emotions; Brain; Stress Disorders, Post-Traumatic; Dissociative Disorders; Magnetic Resonance Imaging
PubMed: 36938718
DOI: 10.1111/pcn.13547 -
Psychiatry and Clinical Neurosciences Apr 2004The purpose of the present study was to clarify the relationship between bulimic behavior, dissociative phenomenon and sexual/physical abuse histories in Japanese...
The purpose of the present study was to clarify the relationship between bulimic behavior, dissociative phenomenon and sexual/physical abuse histories in Japanese subjects with habitual self-mutilation. Subjects consisted of 34 female outpatients who had cut their wrists or arms on more than 10 occasions. Two age-matched groups, which consisted of 31 general psychiatric outpatients and 26 non-clinical volunteers, served as controls. They were assessed with the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, Adolescent Dissociative Experience Scale, and an original self-reporting questionnaire concerning various problematic behaviors and sexual/physical abuse histories. The habitual self-mutilation and the two control groups were compared. The habitual self-mutilation group had significantly higher scores on the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, and Adolescent Dissociative Experience Scale than either of the two control groups (P < 0.001). Furthermore, the habitual self-mutilation group more frequently had a history of illicit psychoactive drug use (P = 0.001), shoplifting (P < 0.001), suicide attempts (P < 0.001), overdosing with medicine (P < 0.001), sexual abuse (P = 0.011), and childhood physical abuse (P = 0.001) than the general psychiatric controls. These results are consistent with those in Western studies. Habitual self-mutilation is likely to coexist with depression, bulimia, and dissociation. Such patients frequently have clinical features similar to those of 'multi-impulsive bulimia'. Evidence supports the association between habitual self-mutilation and sexual/childhood physical abuse in Japan.
Topics: Adolescent; Adult; Bulimia; Child; Child Abuse; Child Abuse, Sexual; Comorbidity; Disruptive, Impulse Control, and Conduct Disorders; Dissociative Disorders; Female; Habits; Hospitals, University; Humans; Illicit Drugs; Japan; Mental Disorders; Personality Inventory; Psychiatric Department, Hospital; Psychometrics; Risk Factors; Self Mutilation; Statistics as Topic; Substance-Related Disorders; Suicide, Attempted; Theft
PubMed: 15009826
DOI: 10.1111/j.1440-1819.2003.01216.x -
Current Psychiatry Reports Jan 2017Dissociation involves disruptions of usually integrated functions of consciousness, perception, memory, identity, and affect (e.g., depersonalization, derealization,... (Review)
Review
Dissociation involves disruptions of usually integrated functions of consciousness, perception, memory, identity, and affect (e.g., depersonalization, derealization, numbing, amnesia, and analgesia). While the precise neurobiological underpinnings of dissociation remain elusive, neuroimaging studies in disorders, characterized by high dissociation (e.g., depersonalization/derealization disorder (DDD), dissociative identity disorder (DID), dissociative subtype of posttraumatic stress disorder (D-PTSD)), have provided valuable insight into brain alterations possibly underlying dissociation. Neuroimaging studies in borderline personality disorder (BPD), investigating links between altered brain function/structure and dissociation, are still relatively rare. In this article, we provide an overview of neurobiological models of dissociation, primarily based on research in DDD, DID, and D-PTSD. Based on this background, we review recent neuroimaging studies on associations between dissociation and altered brain function and structure in BPD. These studies are discussed in the context of earlier findings regarding methodological differences and limitations and concerning possible implications for future research and the clinical setting.
Topics: Borderline Personality Disorder; Brain; Brain Mapping; Cerebral Cortex; Depersonalization; Dissociative Disorders; Humans; Limbic System; Neuroimaging; Stress Disorders, Post-Traumatic
PubMed: 28138924
DOI: 10.1007/s11920-017-0757-y -
European Journal of Psychotraumatology 2024Preliminary evidence provides support for the proposition that there is a dissociative subtype of Complex posttraumatic stress disorder (CPTSD). Research on this...
Preliminary evidence provides support for the proposition that there is a dissociative subtype of Complex posttraumatic stress disorder (CPTSD). Research on this proposition would extend our knowledge on the association between CPTSD and dissociation, guide contemporary thinking regarding placement of dissociation in the nosology of CPTSD, and inform clinically useful assessment and intervention. The present study aimed to investigate the co-occurring patterns of CPTSD and dissociative symptoms in a large sample of trauma exposed adolescents from China, and specify clinical features covariates of such patterns including childhood trauma, comorbidities with major depressive disorder (MDD) and generalized anxiety disorder (GAD), and functional impairment. Participants included 57,984 high school students exposed to the coronavirus disease 2019 (COVID-19) pandemic. CPTSD and dissociative symptoms, childhood traumatic experience, and functional impairment were measured with the Global Psychotrauma Screen for Teenagers (GPS-T). Major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Latent class analysis (LCA) was employed to test the co-occurring patterns of CPTSD and dissociative symptoms. Analysis of covariance (ANCOVA) and chi-square tests were respectively used to examine between-class differences in continuous and categorical clinical covariates. A 5-class model emerged as the best-fitting model, including resilience, predominantly PTSD symptoms, predominantly disturbances in self-organization (DSO)symptoms, predominantly CPTSD symptoms, and CPTSD dissociative subtype classes. The CPTSD dissociative subtype class showed the lowest level of functioning and the highest rates of MDD, GAD and childhood trauma. Our findings provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD, and inform for further research and clinical practice on traumatized individuals.
Topics: Humans; Stress Disorders, Post-Traumatic; Adolescent; China; Male; Female; Dissociative Disorders; COVID-19; Depressive Disorder, Major; Latent Class Analysis; Anxiety Disorders; SARS-CoV-2; Comorbidity; East Asian People
PubMed: 38809665
DOI: 10.1080/20008066.2024.2351292 -
The Australian and New Zealand Journal... Oct 2022Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more... (Review)
Review
BACKGROUND
Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more severe trauma exposure, emotional dysregulation and worse treatment outcomes in Posttraumatic Stress Disorder and Dissociative Disorders, with implications for BPD.
OBJECTIVE
A systematic scoping review was conducted to assess the extent of current literature regarding the impact of dissociation on BPD and to identify knowledge gaps.
METHODS
Four electronic databases (MEDLINE, APA PsycINFO, EMBASE, CINAHL Plus) were searched, and English peer-reviewed studies with adults with BPD were included, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension for scoping reviews (PRISMA-ScR) 2018 guidelines.
RESULTS
Most of the 70 included studies were observational (98%) with first authors from Germany (59%). Overall, dissociation was associated with increased BPD symptom severity, self-harm and reduced psychotherapy treatment response; findings regarding suicide risk were mixed. Dissociation was associated with working memory and cognitive deficits, decreased pain perception, altered body ownership, no substance abuse or the abuse of sedative substances, increased fantasy proneness, personality fragmentation, fearful attachment, dream anxiety, perceived stress and altered stress responses, increased cumulative body mass index, decreased water consumption, several neurological correlates and changes in gene expression.
CONCLUSION
BPD with significant dissociative symptoms may constitute a more severe and at-risk subgroup of BPD patients. However, there are significant research gaps and methodological issues in the area, including the possibility of unrecognized Dissociative Disorders in BPD study populations confounding results. Further studies are needed to better understand the impact of dissociation on BPD course and treatment, and to clarify the most appropriate assessment tools for clinical practice. In addition, interventional studies are needed to develop dissociation-specific BPD treatments to determine whether targeting dissociation in BPD can improve treatment outcomes.
Topics: Adult; Borderline Personality Disorder; Dissociative Disorders; Humans; Hypnotics and Sedatives; Psychotherapy; Self-Injurious Behavior
PubMed: 35152771
DOI: 10.1177/00048674221077029 -
Tijdschrift Voor Psychiatrie 2020Fantasy proneness has been linked to dissociative symptoms and adverse childhood experiences.
AIM: To review and meta-analyze the empirical literature on fantasy... (Meta-Analysis)Meta-Analysis Review
Fantasy proneness has been linked to dissociative symptoms and adverse childhood experiences.
AIM: To review and meta-analyze the empirical literature on fantasy proneness (as indexed by the Creative Experiences Questionnaire) that appeared between 2000 and 2018.
METHOD: We searched Google Scholar to identify relevant papers and subjected them to inspection. In doing so, we specifically looked at correlations between fantasy proneness, on the one hand, and dissociative symptoms, magical ideation, depression, anxiety, trauma, and susceptibility to false memories, on the other hand. Correlations were weighted using the Hunter-Schmidt approach.
RESULTS: We identified 97 studies that together included 16.999 research participants. Fantasy proneness strongly correlated with both dissociative symptoms and magical ideation. The association of fantasy proneness with depression and anomalistic was moderate. Its association with trauma and anxiety was small, albeit significant, and much the same was true for false memories.
CONCLUSION: The psychopathological relevance of fantasy proneness is broader than just dissociative symptoms. The modest correlation between trauma and fantasy proneness suggests that, apart from trauma, other causal antecedents of fantasy proneness exist. What fantasy proneness, dissociation, and magical ideation have in common is that they are manifestations of apophenia, i.e., the tendency to overinterpret reality.Topics: Dissociative Disorders; Fantasy; Humans; Psychopathology; Surveys and Questionnaires
PubMed: 32583866
DOI: No ID Found