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The Permanente Journal 2020People who live with dissociative disorders and a history of childhood trauma are less rare than commonly thought and can be challenging for unfamiliar medical...
People who live with dissociative disorders and a history of childhood trauma are less rare than commonly thought and can be challenging for unfamiliar medical practitioners. Many of us present as apparently normal people and live full and satisfying lives. But under the stress of a medical situation, we can become unpredictable. On the basis of my own experiences, I offer, in this article, some instructive anecdotes and tips for health care practitioners on how to work with patients with a trauma-related diagnosis such as a dissociative disorder.
Topics: Adult Survivors of Child Abuse; Aged; Dissociative Disorders; Female; Humans
PubMed: 31852054
DOI: 10.7812/TPP/19.094 -
Cognitive Neuropsychiatry Mar 2011Inconsistencies in the relationship between dissociation and hypnosis may result from heterogeneity among highly suggestible individuals, in particular the existence of...
INTRODUCTION
Inconsistencies in the relationship between dissociation and hypnosis may result from heterogeneity among highly suggestible individuals, in particular the existence of distinct highly suggestible subtypes that are of relevance to models of psychopathology and the consequences of trauma. This study contrasted highly suggestible subtypes high or low in dissociation on measures of hypnotic responding, cognitive functioning, and psychopathology.
METHODS
Twenty-one low suggestible (LS), 19 low dissociative highly suggestible (LDHS), and 11 high dissociative highly suggestible (HDHS) participants were administered hypnotic suggestibility scales and completed measures of free recall, working memory capacity, imagery, fantasy-proneness, psychopathology, and exposure to stressful life events.
RESULTS
HDHS participants were more responsive to positive and negative hallucination suggestions and experienced greater involuntariness during hypnotic responding. They also exhibited impaired working memory capacity, elevated pathological fantasy and dissociative symptomatology, and a greater incidence of exposure to stressful life events. In contrast, LDHS participants displayed superior object visual imagery.
CONCLUSIONS
These results provide further evidence for two highly suggestible subtypes: a dissociative subtype characterised by deficits in executive functioning and a predisposition to psychopathology, and a subtype that exhibits superior imagery and no observable deficits in functioning.
Topics: Adolescent; Adult; Cognition; Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Fantasy; Female; Humans; Hypnosis; Imagination; Individuality; Male; Memory, Short-Term; Mental Recall; Neuropsychological Tests; Psychiatric Status Rating Scales; Stress, Psychological; Suggestion; Young Adult
PubMed: 20721761
DOI: 10.1080/13546805.2010.503048 -
Journal of Traumatic Stress Feb 2019Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and...
Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self-injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web-based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web-based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample |d|s = 0.44-0.90, as well as reduced NSSI. The improvements in NSSI among the most self-injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation |d|s = 0.54-1.04 vs. |d|s = 0.24-0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.
Topics: Adult; Cognitive Behavioral Therapy; Dissociative Disorders; Education, Distance; Emotional Regulation; Female; Humans; Longitudinal Studies; Male; Mental Health; Middle Aged; Prospective Studies; Self-Injurious Behavior; Stress Disorders, Post-Traumatic; Suicide, Attempted
PubMed: 30698858
DOI: 10.1002/jts.22370 -
BMC Psychiatry Jan 2022Suicide attempt is the most predictive risk factor of suicide. Trauma - especially sexual abuse - is a risk factor for suicide attempt and suicide. A common reaction to...
BACKGROUND
Suicide attempt is the most predictive risk factor of suicide. Trauma - especially sexual abuse - is a risk factor for suicide attempt and suicide. A common reaction to sexual abuse is dissociation. Higher levels of dissociation are linked to self-harm, suicide ideation, and suicide attempt, but the role of dissociation in suicidal behavior is unclear.
METHODS
In this naturalistic study, ninety-seven acute psychiatric patients with suicidal ideation, of whom 32 had experienced sexual abuse, were included. Suicidal behaviour was assessed with The Columbia suicide history form (CSHF). The Brief trauma questionnaire (BTQ) was used to identify sexual abuse. Dissociative symptoms were assessed with Dissociative experiences scale (DES).
RESULTS
Patients who had experienced sexual abuse reported higher levels of dissociation and were younger at onset of suicidal thoughts, more likely to self-harm, and more likely to have attempted suicide; and they had made more suicide attempts. Mediation analysis found dissociative experiences to significantly mediate a substantive proportion of the relationship between sexual abuse and number of suicide attempts (indirect effects = 0.17, 95% CI = 0.05, 0.28, proportion mediated = 68%). Dissociative experiences significantly mediated the role of sexual abuse as a predictor of being in the patient group with more than four suicide attempts (indirect effects = 0.11, 95% CI = 0.02, 0.19, proportion mediated = 34%).
CONCLUSION
The results illustrate the importance of assessment and treatment of sexual abuse and trauma-related symptoms such as dissociation in suicide prevention. Dissociation can be a contributing factor to why some people act on their suicidal thoughts.
Topics: Dissociative Disorders; Humans; Risk Factors; Self-Injurious Behavior; Sex Offenses; Suicidal Ideation; Suicide, Attempted
PubMed: 35012509
DOI: 10.1186/s12888-021-03662-9 -
BMC Psychiatry May 2022Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment.
METHODS
Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group-treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties.
RESULTS
Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period.
CONCLUSION
In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning.
TRIAL REGISTRATION
Clinical Trials ( NCT02450617 ).
Topics: Child; Child Abuse; Cognitive Behavioral Therapy; Comorbidity; Dissociative Disorders; Humans; Psychotherapy; Stress Disorders, Post-Traumatic; Treatment Outcome
PubMed: 35578194
DOI: 10.1186/s12888-022-03970-8 -
European Journal of Psychotraumatology 2022A dissociative subtype of posttraumatic stress disorder (D-PTSD) was introduced into the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)...
BACKGROUND
A dissociative subtype of posttraumatic stress disorder (D-PTSD) was introduced into the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) but latent profiles and clinical correlates of D-PTSD remain controversial.
OBJECTIVE
The aims of our study were to identify subgroups of individuals with distinct patterns of PTSD symptoms, including dissociative symptoms, by means of latent class analyses (LCA), to compare these results with the categorization of D-PTSD vs. PTSD without dissociative features according to the CAPS-5 interview, and to explore whether D-PTSD is associated with higher PTSD severity, difficulties in emotion regulation, and depressive symptoms.
METHOD
A German sample of treatment-seeking individuals was investigated ( = 352). We conducted an LCA on the basis of symptoms of PTSD and dissociation as assessed by the CAPS-5. Moreover, severity of PTSD (PCL-5), difficulties in emotion regulation (DERS), and depressive symptoms (BDI-II) were compared between patients with D-PTSD according to the CAPS-5 interview and patients without dissociative symptoms.
RESULTS
LCA results suggested a 5-class model with one subgroup showing the highest probability to fulfill criteria for the dissociative subtype and high scores on both BDI and DERS. Significantly higher scores on the DERS, BDI and PCL-5 were found in the D-PTSD group diagnosed with the CAPS-5 ( = 75; 35.7%). Sexual trauma was also reported more often by this subgroup. When comparing the dissociative subtype to the LCA results, only a partial overlap could be found.
CONCLUSIONS
Our findings suggest that patients with D-PTSD have significantly more problems with emotion regulation, more depressive symptoms, and more severe PTSD-symptoms. Given the results of our LCA, we conclude that the dissociative subtype seems to be more complex than D-PTSD as diagnosed by means of the CAPS-5.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Humans; Latent Class Analysis; Sexual Trauma; Stress Disorders, Post-Traumatic
PubMed: 35273782
DOI: 10.1080/20008198.2022.2031591 -
Epilepsy & Behavior : E&B Mar 2024The term 'functional/dissociative seizures (FDS)' refers to a paroxysmal, transient clinical manifestation that may include motor, sensory, vegetative, psychological and... (Review)
Review
INTRODUCTION
The term 'functional/dissociative seizures (FDS)' refers to a paroxysmal, transient clinical manifestation that may include motor, sensory, vegetative, psychological and cognitive signs, similar to the manifestations observed in epileptic seizures. In recent years, there has been an increase of literature in the field of brain imaging research on functional neurological disorders and, more specifically, on FDS. However, most of the studies have been carried out on limited samples. We propose an update of this review work by performing a systematic review of studies performed since 2017 in the field of neuroimaging in patients with FDS.
METHODS
We conducted a systematic review of the literature using the PRISMA methodology and reproduced most of the methodological elements of the latest systematic literature review.
RESULTS
Our work over the last five years has identified 14 articles. It is still difficult to isolate a distinct structure or network specifically involved in the mechanism of FDS. However, certain structures are recurrently involved in imaging studies, notably the amygdala, the orbitofrontal cortex, and the anterior cingulate cortex.
CONCLUSION
The contribution of neuroimaging may allow a more precise explanation of the disorder for patients, avoiding the stigma frequently associated with this diagnosis. as with other 'conversion' phenomena which have traditionally been considered only as 'medically unexplained'. In the longer term and beyond a better understanding of the physiopathology of the disorder, the challenge of this neuroimaging work would be to identify specific imaging biomarkers for a diagnosis of FDS.
Topics: Humans; Psychogenic Nonepileptic Seizures; Conversion Disorder; Dissociative Disorders; Seizures; Epilepsy
PubMed: 38281393
DOI: 10.1016/j.yebeh.2024.109654 -
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 -
Deconstructing dissociation: a triple network model of trauma-related dissociation and its subtypes.Neuropsychopharmacology : Official... Dec 2022Trauma-related pathological dissociation is characterized by disruptions in one's sense of self, perceptual, and affective experience. Dissociation and its...
Trauma-related pathological dissociation is characterized by disruptions in one's sense of self, perceptual, and affective experience. Dissociation and its trauma-related antecedents disproportionately impact women. However, despite the gender-related prevalence and high individual and societal costs, dissociation remains widely underappreciated in clinical practice. Moreover, dissociation lacks a synthesized neurobiological model across its subtypes. Leveraging the Triple Network Model of psychopathology, we sought to parse heterogeneity in dissociative experience by examining functional connectivity of three core neurocognitive networks as related to: (1) the dimensional dissociation subtypes of depersonalization/derealization and partially-dissociated intrusions; and, (2) the diagnostic category of dissociative identity disorder (DID). Participants were 91 women with and without: a history of childhood trauma, current posttraumatic stress disorder (PTSD), and varied levels of dissociation. Participants provided clinical data about dissociation, PTSD symptoms, childhood maltreatment history, and completed a resting-state functional magnetic resonance imaging scan. We used a novel statistical approach to assess both overlapping and unique contributions of dissociation subtypes. Covarying for age, childhood maltreatment and PTSD severity, we found dissociation was linked to hyperconnectivity within central executive (CEN), default (DN), and salience networks (SN), and decreased connectivity of CEN and SN with other areas. Moreover, we isolated unique connectivity markers associated with depersonalization/derealization in CEN and DN, to partially-dissociated intrusions in CEN, and to DID in CEN. This suggests dissociation subtypes have robust functional connectivity signatures that may serve as targets for PTSD/DID treatment engagement. Our findings underscore dissociation assessment as crucial in clinical care, in particular, to reduce gender-related health disparities.
Topics: Humans; Female; Dissociative Disorders; Stress Disorders, Post-Traumatic; Magnetic Resonance Imaging; Interpersonal Relations
PubMed: 36202907
DOI: 10.1038/s41386-022-01468-1 -
American Journal of Men's Health 2019Studies of different cultures have reported that expectant fathers experience physiological and psychological changes during their partner's pregnancy. These symptoms...
Studies of different cultures have reported that expectant fathers experience physiological and psychological changes during their partner's pregnancy. These symptoms are classed as Couvade Syndrome (sympathetic pregnancy) symptoms. The main aim of this study was to determine the prevalence of Couvade Syndrome among Jordanian expectant fathers. A descriptive quantitative research design that utilized the Men's Health During Partners' Pregnancy (MHDPP) questionnaire was employed to collect data from three Maternal and Child Health Care Centers in public hospitals. A total of 449 participants completed the questionnaire. Descriptive statistics were used to describe the characteristics of the sample and the main variables. Chi-square tests were conducted to find the relationship between the pregnancy trimester and the specific Couvade Syndrome symptom. Jordanian expectant fathers experienced high rates of Couvade Syndrome (59.1%). The prevalence of Couvade Syndrome among the participants is considered to be the highest reported rate when compared to the results of previous studies. This rate may be due to the tendency among men in Jordan to have a strong desire for children soon after marriage and to have a strong commitment to family life. With a better understanding of the expectant father's response to pregnancy, health-care providers would be better able to provide them with the necessary support and education. This could contribute to the health and well-being of expectant fathers and their families.
Topics: Adult; Cross-Sectional Studies; Developing Countries; Dissociative Disorders; Fathers; Female; Gestational Age; Humans; Incidence; Jordan; Male; Pregnancy; Stress, Physiological; Stress, Psychological; Surveys and Questionnaires; Syndrome
PubMed: 30387694
DOI: 10.1177/1557988318810243