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The following selections were drawn from the collection of
the National Library of Medicine Online service, PubMed. These
references and abstracts are available to the public at PubMed
Search Engine of the National Library of Medicine. These
selections represent a variety of studies about dissociative
disorders from around the world. For additional information,
go to our Education Home
Page.
Articles (Abstracts):
Axis I dissociative disorder comorbidity
in borderline personality disorder and reports of childhood
trauma
Childhood
trauma, dissociation, and psychiatric comorbidity in patients
with conversion disorder
Dissociative experiences in obsessive-compulsive
disorder and trichotillomania: clinical and genetic findings
Dissociation, childhood interpersonal trauma, and family
functioning in patients with somatization
disorder
Prevalence of dissociative disorders in psychiatric outpatients
Prevalence of dissociative disorders
among psychiatric inpatients in a German university
clinic
Psychodynamics and psychiatric diagnoses of pseudoseizure
subjects
Relationship
of dissociation to self-mutilation and childhood abuse
in borderline personality
disorder
The role of childhood
interpersonal trauma in depersonalization disorder
Trauma and dissociation in China
Prevalence of dissociative disorders in psychiatric outpatients.
Am
J Psychiatry. 2006 Apr;163(4):566-8.
Foote
B,
Smolin
Y,
Kaplan
M,
Legatt
ME,
Lipschitz
D.
Klau-1 Psychiatric Outpatient Department, Montefiore Medical
Center, 111 E. 210th St., Bronx, NY 10467, USA. jbfoote@aol.com
OBJECTIVE: The purpose of the study was to assess the prevalence
of DSM-IV dissociative disorders in an inner-city outpatient
psychiatric population. METHOD: Subjects were 231 consecutive
admissions (84 men and 147 women, mean age=37 years) to an
inner-city, hospital-based outpatient psychiatric clinic. The
subjects completed self-report measures of dissociation (Dissociative
Experiences Scale) and trauma history (Traumatic Experiences
Questionnaire). Eighty-two patients (35%) completed a structured
interview for dissociative disorders (Dissociative Disorders
Interview Schedule). RESULTS: The 82 patients who were interviewed
did not differ significantly on any demographic measure or
on the self-report measures of trauma and dissociation from
the 149 patients who were not interviewed. Twenty-four (29%)
of the 82 interviewed patients received a diagnosis of a dissociative
disorder. Dissociative identity disorder was diagnosed in five
(6%) patients. Compared to the patients without a dissociative
disorder diagnosis, patients with a dissociative disorder were
significantly more likely to report childhood physical abuse
(71% versus 27%) and childhood sexual abuse (74% versus 29%),
but the two groups did not differ significantly on any demographic
measure, including gender. Chart review revealed that only
four (5%) patients in whom a dissociative disorder was identified
during the study had previously received a dissociative disorder
diagnosis. CONCLUSIONS: Dissociative disorders were highly
prevalent in this clinical population and typically had not
been previously diagnosed clinically. The high prevalence of
dissociative disorders found in this study may be related to
methodological factors (all patients were offered an interview
rather than only those who had scored high on a screening self-report
measure) and epidemiological factors (extremely high prevalence
rates for childhood physical and sexual abuse were present
in the overall study population). PMID: 16585436
-
Childhood trauma, dissociation,
and psychiatric comorbidity in patients with conversion
disorder.
Am
J Psychiatry. 2004 Dec;161(12):2271-6.
Sar
V,
Akyuz
G,
Kundakci
T,
Kiziltan
E,
Dogan
O.
Istanbul Tip Fakultesi Psikiyatri
Klinigi, 34390 Capa, Istanbul, Turkey. vsar@istanbul.edu.tr
OBJECTIVE: The aim of this study was to evaluate
dissociative disorder and overall psychiatric comorbidity
in patients with conversion disorder. METHOD: Thirty-eight
consecutive patients previously diagnosed with
conversion disorder were evaluated in two follow-up
interviews. The Structured Clinical Interview for
DSM-III-R, the Dissociation Questionnaire, the
Somatoform Dissociation Questionnaire, and the
Childhood Trauma Questionnaire were administered
during the first follow-up interview. The Structured
Clinical Interview for DSM-IV Dissociative Disorders
was conducted in a separate evaluation. RESULTS:
At least one psychiatric diagnosis was found in
89.5% of the patients during the follow-up evaluation.
Undifferentiated somatoform disorder, generalized
anxiety disorder, dysthymic disorder, simple phobia,
obsessive-compulsive disorder, major depression,
and dissociative disorder not otherwise specified
were the most prevalent psychiatric disorders.
A dissociative disorder was seen in 47.4% of the
patients. These patients had dysthymic disorder,
major depression, somatization disorder, and borderline
personality disorder more frequently than the remaining
subjects. They also reported childhood emotional
and sexual abuse, physical neglect, self-mutilative
behavior, and suicide attempts more frequently.
CONCLUSIONS: Comorbid dissociative disorder should
alert clinicians for a more chronic and severe
psychopathology among patients with conversion
disorder. PMID: 15569899
-
Dissociation,
childhood interpersonal trauma, and family functioning
in patients with somatization disorder
Am
J Psychiatry. 2005 May;162(5):899-905.
Brown
RJ, Schrag
A,
Trimble
MR.
Department of Clinical Neurology, Institute of Neurology,
London, UK. richard.james.brown@manchester.ac.ukOBJECTIVE:
The goals of this study were to determine 1) the occurrence
of various dissociative phenomena in patients with somatization
disorder, 2) the occurrence of six different types of childhood
interpersonal trauma in these patients, and 3) the nature
of these patients' early family environment. METHOD: Twenty-two
patients with somatization disorder and 19 medical comparison
subjects completed the Structured Clinical Interview for
DSM-IV Dissociative Disorders, the Childhood Trauma Interview,
and the Family Functioning Scale. RESULTS: The somatization
disorder patients reported significantly higher level of
dissociative amnesia than the comparison subjects. The
two groups reported similar levels of depersonalization,
derealization, identity confusion, and identity alteration.
Somatization disorder patients reported significantly greater
childhood emotional abuse and more severe forms of physical
abuse, relative to the comparison subjects, with chronic
emotional abuse being the best predictor of unexplained
symptoms. Childhood sexual abuse, separation/loss, and
witnessing violence were equally common in the two groups.
The somatization disorder group reported significantly
more family conflict and less family cohesion. CONCLUSIONS:
Only some types of dissociation are more severe in patients
with somatization disorder, relative to medical comparison
subjects. Many patients with somatization disorder are
raised in an emotionally cold, distant, and unsupportive
family environment characterized by chronic emotional and
physical abuse. Sexual abuse is not a necessary prerequisite
for the disorder. PMID: 15863791
-
Relationship
of dissociation to self-mutilation and childhood abuse
in borderline personality disorder
Am
J Psychiatry. 1995 Dec;152(12):1788-92
Brodsky
BS,
Cloitre
M,
Dulit
RA.
Department of Psychology,
Cornell University Medical Center, New York,
USA.
OBJECTIVE: This study sought to document
the prevalence of dissociative experiences
in adult female inpatients with borderline
personality disorder and to explore the relationship
between dissociation, self-mutilation, and
childhood abuse history. METHOD: A treatment history
interview, the Dissociative Experiences Scale,
the Sexual Experiences Questionnaire, and
the Hamilton Depression Rating Scale were
administered to 60 consecutively admitted
female inpatients with borderline personality
disorder as diagnosed by the Structured Clinical
Interview for DSM-III-R Personality Disorders.
RESULTS: Fifty percent of the subjects had
a score of 15 or more on the Dissociative
Experiences Scale, indicating pathological
levels of dissociation. Fifty-two percent
reported a history of self-mutilation, and
60% reported a history of childhood physical
and/or sexual abuse. The subjects who dissociated
were more likely than those who did not to
self-mutilate and to report childhood abuse.
They also had higher levels of current depressive
symptoms and psychiatric treatment. Multiple regression
analysis demonstrated that each of these variables
predicted dissociation when each of the others
was controlled for, and that self-mutilation
was the most powerful predictor of dissociation.
CONCLUSIONS: Female inpatients with borderline
personality disorder who dissociate may represent
a sizable subgroup of patients with the disorder
who are at especially high risk for self-mutilation,
childhood abuse, depression, and utilization
of psychiatric treatment. The strong correlation
between dissociation and self-mutilation independent
of childhood abuse history should alert clinicians
to address these symptoms first while exercising
caution in attributing them to a history
of abuse. PMID: 8526247
-
Axis
I dissociative disorder comorbidity in borderline personality
disorder and reports of childhood trauma
J
Clin Psychiatry. 2006
Oct;67(10):1583-90
Sar
V,
Akyuz
G,
Kugu
N,
Ozturk
E,
Ertem-Vehid
H.
Department of Psychiatry, Clinical Psychotherapy Unit
and Dissociative Disorders Program, Medical Faculty of
Istanbul, Turkey. vsar@istanbul.edu.tr
OBJECTIVE: The purpose of this study was to examine
the dissociative disorder comorbidity of borderline
personality disorder and its relation to childhood
trauma reports in a nonclinical population. METHOD:
In April 2003, 1301 college students were screened
for borderline personality disorder using the Structured
Clinical Interview for DSM-IV Personality Disorders.
The Childhood Trauma Questionnaire and Steinberg's
dissociation questionnaires were also administered.
During May and June 2003, 80 students with a diagnosis
of borderline personality disorder and 111 nonborderline
students were evaluated using the Structured Clinical
Interview for DSM-IV Dissociative Disorders by an
interviewer blind to the diagnosis and scores obtained
during the first phase. RESULTS: The prevalence of
borderline personality disorder was 8.5%. A significant
majority (72.5%; 58/80) of the borderline personality
disorder group had a dissociative disorder, whereas
this rate was only 18.0% (20/111) for the comparison
group (p < .001). Childhood emotional and sexual
abuse, physical neglect, and total childhood trauma
scores had significant effect for borderline personality
disorder (p < .001, p = .038, p = .044, and p
= .003, respectively), whereas emotional neglect
and diminished minimization of childhood trauma had
significant effect for dissociative disorder (p =
.020 and p = .007, respectively). CONCLUSION: A significant
proportion of subjects with borderline personality
disorder have a comorbid dissociative disorder. Lack
of interaction between dissociative disorder and
borderline personality disorder diagnoses for any
type of childhood trauma contradicts the opinion
that both disorders together might be a single disorder.
Recognizing highly prevalent but usually neglected
Axis I dissociative disorder comorbidity in patients
with borderline personality disorder may contribute
to conceptual clarification of this spectrum of psychopathology.
PMID: 17107251
-
The
role of childhood interpersonal trauma in depersonalization
disorder
Am
J Psychiatry. 2001 Jul;158(7):1027-33
Simeon
D,
Guralnik
O,
Schmeidler
J,
Sirof
B,
Knutelska
M.
Department of Psychiatry,
Mount Sinai School of Medicine, New York
10029, USA.
daphne.simeon@mssm.edu
OBJECTIVE:
In contrast to trauma's relationship with
the other dissociative disorders, the relationship
of trauma to depersonalization disorder
is unknown. The purpose of this study was
to systematically investigate the role
of childhood interpersonal trauma in depersonalization
disorder. METHOD: Forty-nine subjects with
DSM-IV depersonalization disorder and 26
healthy comparison subjects who were free
of lifetime axis I and II disorders and of comparable age
and gender were administered the Dissociative Experiences
Scale and the Childhood Trauma Interview, which measures
separation or loss, physical neglect, emotional abuse,
physical abuse, witnessing of violence, and sexual abuse.
RESULTS: Childhood interpersonal trauma as a whole was
highly predictive of both a diagnosis of depersonalization
disorder and of scores denoting dissociation, pathological
dissociation, and depersonalization. Emotional abuse, both
in total score and in maximum severity, emerged as the
most significant predictor both of a diagnosis of depersonalization
disorder and of scores denoting depersonalization but not
of general dissociation scores, which were better predicted
by combined emotional and sexual abuse. The majority of
the perpetrators of emotional abuse were either or both
parents. Although different types of trauma were modestly
correlated, only a few of these relationships were statistically
significant, underscoring the importance of comprehensively
considering different types of trauma in research studies.
CONCLUSIONS: Childhood interpersonal trauma and, in particular,
emotional abuse may play a role in the pathogenesis of
depersonalization disorder. Compared to other types of
childhood trauma, emotional maltreatment is a relatively
neglected entity in psychiatric research and merits more
attention.
PMID: 11431223
-
Prevalence
of dissociative disorders among psychiatric inpatients
in a German university clinic.
J
Nerv Ment Dis. 2001 Apr;189(4):249-57
Gast
U,
Rodewald
F,
Nickel
V,
Emrich
HM.
Department of Psychiatry
and Psychotherapy, Medizinische Hochschule
Hannover, Germany.
The aim of the study was
to determine the frequency of dissociative
disorders among psychiatric inpatients in
Germany and to investigate the relationship
between childhood trauma and dissociation.
The German version of the Dissociative Experiences
Scale (DES), the Fragebogen fur Dissoziative Symptome
(FDS), was used to screen 115 consecutive inpatients
admitted to the psychiatric clinic of a university hospital.
Patients with FDS scores higher than 20 were interviewed
by a trained clinician, using the German translation of
the Structured Clinical Interview for DSM-IV Dissociative
Disorders (SCID-D-R). The German version of the Childhood
Trauma Questionnaire (CTQ) was administered to investigate
prevalence of childhood trauma and relations between childhood
trauma and dissociation in adult life. Twenty-five of the
115 patients (21.7%) had a score higher than 20 on the
FDS. Of these, 15 patients were interviewed with the SCID-D-R.
One patient was diagnosed with a dissociative identity
disorder, three with dissociative disorders not otherwise
specified, and one patient with depersonalization disorder.
All diagnoses were confirmed clinically. A significant
positive relationship was found between the severity of
childhood trauma and dissociation. Dissociative disorders
are common among German psychiatric inpatients. Clinicians
who work in psychiatric inpatient units should be mindful
of these disorders. PMID: 11339321
-
Dissociative
experiences in obsessive-compulsive disorder and trichotillomania:
clinical and genetic findings.
Compr
Psychiatry. 2004
Sep-Oct;45(5):384-91
Lochner
C,
Seedat
S,
Hemmings
SM,
Kinnear
CJ,
Corfield
VA,
Niehaus
DJ,
Moolman-Smook
JC,
Stein
DJ.
Medical Research
Council Unit on Anxiety Disorders,
Department of Psychiatry, University
of Stellenboch, Cape Town, South
Africa.
A link between dissociation
proneness in adulthood and self-reports
of childhood traumatic events (including
familial loss in childhood, sexual/physical
abuse and neglect) has been documented.
Several studies have also provided
evidence for an association between
dissociative experiences and trauma
in patients with various psychiatric
disorders, including post-traumatic
stress disorder, borderline personality,
dissociative identity and eating
disorders. Based on the relative
paucity of data on dissociation and
trauma in obsessive-compulsive disorder
(OCD) and trichotillomania (TTM),
the primary objective of this study
was to examine the relationship between
trauma and dissociative experiences
(DE) in these two diagnostic groups.
Furthermore, the availability of
clinical and genetic data on this
sample allowed us to explore clinical
and genetic factors relevant to this
association. A total of 110 OCD and
32 TTM patients were compared with
respect to the degree of dissociation
(using the Dissociative Experiences
Scale [DES]) and childhood trauma
(using the Childhood Trauma Questionnaire
[CTQ]). Patients were classified
on the DES as either "high" (mean
DES score >/= 30) or "low" (mean
DES score < 30) dissociators.
Additional clinical and genetic factors
were also explored with chi-square
and t tests as appropriate. A total
of 15.8% of OCD patients and 18.8%
of TTM patients were high dissociators.
OCD and TTM groups were comparable
on DES and CTQ total scores, and
in both OCD and TTM groups, significant
positive correlations were found
between mean DES scores and mean
CTQ subscores of emotional abuse,
physical abuse, sexual abuse, and
physical neglect. In the OCD group,
high dissociators were significantly
younger than low dissociators, and
significantly more high dissociators
than low dissociators reported a
lifetime (current and past) history
of tics (P <.001), Tourette's
syndrome (P =.019), bulimia nervosa
(P =.003), and borderline personality
disorder (P =.027). In the TTM group,
significantly more high dissociators
than low dissociators reported (lifetime)
kleptomania (P =.005) and depersonalisation
disorder (P =.005). In the Caucasian
OCD patients (n = 114), investigation
of genetic polymorphisms involved
in monoamine function revealed no
significant differences between high
and low dissociator groups. This
study demonstrates a link between
childhood trauma and DE in patients
with OCD and TTM. High dissociative
symptomatology may be present in
a substantial proportion of patients
diagnosed with these disorders. High
dissociators may also be differentiated
from low dissociators on some demographic
features (e.g., lower age) and comorbidity
profile (e.g., increased incidence
of impulse dyscontrol disorders).
Additional work is necessary before
conclusions about the role of monoaminergic
systems in mediating such dissociation
can be drawn. PMID: 15332202
-
Psychodynamics
and psychiatric diagnoses of pseudoseizure subjects
Am
J Psychiatry. 1996
Jan;153(1):57-63.
Bowman
ES,
Markand
ON.
Department of Psychiatry, Indiana
University School of Medicine, Indianapolis 46202,
USA.
OBJECTIVE: The goal of this study was to
determine current and lifetime rates of DSM-III-R
disorders in patients with pseudoseizures and
to ascertain whether trauma is associated with
the occurrence of pseudoseizures. METHODS: Adult
pseudoseizure patients (N = 45) were interviewed
regarding seizure course and life events, and they
were given the Structured Clinical Interview for
DSM-III-R--Patient Version, the Structured Clinical
Interview for DSM-III-R Dissociative Disorders, the
Dissociative Experiences Scale, and the Personality
Diagnostic Questionnaire--Revised. The pseudoseizures were
diagnosed in a tertiary-care video-EEG facility. Most of
the subjects (78%) were female, and the mean age of the
overall patient group was 37.5 years (SD = 9.7). RESULTS:
The mean duration of the subjects' seizure history was
8.3 years (SD = 8.0). Common current psychiatric diagnoses
included somatoform disorders (89%), dissociative disorders
(91%), affective disorders (64%), personality disorders
(62%), posttraumatic stress disorder (PTSD) (49%), and
other anxiety disorders (47%). The lifetime occurrence
of nonseizure conversion disorders was 82%. The mean Dissociative
Experiences Scale score was 20.2 (SD = 18.2). Trauma was
reported by 84% of the subjects: sexual abuse by 67%, physical
abuse by 67%, and other traumas by 73%. CONCLUSIONS: Pseudoseizure
subjects have high rates of the psychiatric disorders found
in traumatized groups; they closely resemble patients with
dissociative disorders. Reclassification of conversion
seizures with the dissociative disorders should be considered.
Pseudoseizures often appear to express distress related
to abuse reports. Clinicians should screen pseudoseizure
patients for adult and childhood trauma, dissociative disorders,
depression, and PTSD.PMID: 8540592
-
Childhood
trauma and perceived parental dysfunction in the etiology
of dissociative symptoms in psychiatric inpatients
Am
J Psychiatry. 1999
Mar;156(3):379-85.
Draijer
N,
Langeland
W.
Department of Psychiatry, Vrije
Universiteit, Amsterdam, The Netherlands.
OBJECTIVE:
Research on the etiology of dissociation in adults
has focused primarily on childhood sexual abuse.
The role of co-occurring childhood stressors
and of more chronic adverse conditions such as
neglect is less clear. This study examined the
level of dissociation in relation to childhood
trauma (sexual/physical abuse, witnessing interparental
violence), early separation from a parent, and
perceived parental dysfunction. METHOD: One hundred
sixty inpatients consecutively admitted to a
general psychiatric hospital were administered
the Dissociative Experiences Scale and the Structured
Trauma Interview. RESULTS: The mean Dissociative
Experiences Scale score was 17.4; 18.0% of the
patients scored beyond 30. Early separation was
reported by 26.4% of the patients; 30.1% had
witnessed interparental violence; 23.6% reported
physical abuse; 34.6% reported sexual abuse; 11.7% reported
rape before age 16; and 42.1% reported sexual and/or
physical abuse. The level of dissociation was primarily
related to reported overwhelming childhood experiences
(sexual and physical abuse). When sexual abuse was severe
(involving penetration, several perpetrators, lasting
more than 1 year), dissociative symptoms were even more
prominent. Highest dissociation levels were found in
patients reporting cumulative sexual trauma (intrafamilial
and extrafamilial) or both sexual and physical abuse.
In particular, maternal dysfunction was related to the
level of dissociation. With control for gender and age,
stepwise multiple regression analysis indicated that
the severity of dissociative symptoms was best predicted
by reported sexual abuse, physical abuse, and maternal
dysfunction. CONCLUSIONS: These findings indicate that
dissociation, although trauma-related, is neglect-related
as well. This implies the importance of object relations
and attachment in the diagnosis and treatment of patients
with dissociative disorders.PMID: 10080552
-
-
Trauma and dissociation in China
Am
J Psychiatry. 2006 Aug;163(8):1388-91. Xiao
Z, Yan
H, Wang
Z, Zou
Z, Xu
Y, Chen
J, Zhang
H, Ross
CA, Keyes
BB.
Shanghai Mental Health Center, China.
OBJECTIVE: In order to determine whether pathological dissociation occurs in
China, the authors conducted a survey among psychiatric inpatients, outpatients,
and the general population in Shanghai, China. There is virtually no popular
or professional knowledge of dissociative identity disorder in China, and therefore
professional and popular contamination cannot exist. METHOD: Chinese versions
of the Dissociative Experiences Scale and the Dissociative Disorders Interview
Schedule were administered to 423 inpatients, 304 outpatients, and 618 factory
workers in Shanghai by Chinese psychiatrists working at the Shanghai Mental Health
Center. RESULTS: Dissociative disorders were diagnosed in 24 respondents by structured
interview, and 15 respondents fell into the dissociative taxon on the Dissociative
Experiences Scale. The outpatients reported the highest rates of childhood physical
and/or sexual abuse and of pathological dissociation. CONCLUSIONS: Pathological
dissociation can be detected readily among psychiatric outpatients in China but
is much less common in the general population. Pathological dissociation is more
frequent in more traumatized subsamples of the Chinese population. The findings
are not consistent with the sociocognitive, contamination, or iatrogenic models
of dissociative identity disorder. PMID: 16877651
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