Dissociation in major depressive disorder: a pilot study

Self-hate, dissociation, and suicidal behavior in bulimia nervosa

BACKGROUND

Individuals with eating disorders (EDs) often struggle with markedly low self- esteem and are at risk for suicidal behavior. Dissociation and perceived burdensomeness are often cited as facilitators of suicidal outcomes. Specifically, perceived burdensomeness is comprised of self-hate and liability on others, although it remains unclear which variables most heavily influence suicidal behavior in EDs.

METHODS

In a sample of 204 women with bulimia nervosa, the present study examined the potential impact of self-hate and dissociation on suicidal behavior. We hypothesized that suicidal behavior would be equally, and potentially more strongly, related to self-hate than dissociation. Regression analyses investigated the unique effects of these variables on suicidal behavior.

RESULTS

Consistent with our hypothesis, a significant relationship emerged between self-hate and suicidal behavior (B = 0.262, SE = 0.081, p < .001, CIs = 0.035-0.110, R-squared =0.07) but not between dissociation and suicidal behavior (B = 0.010, SE = 0.007, p = .165, CIs = -0.389-2.26, R-squared =0.010). Additionally, when controlling for one another, both self-hate (B = 0.889, SE = 0.246, p < .001, CIs = 0.403-1.37) and capability for suicide (B = 0.233, SE = 0.080, p = .004, CIs = 0.076-0.391) were uniquely and independently associated with suicidal behavior.

LIMITATIONS

Future work should include longitudinal analyses to understand temporal relationships among study variables.

CONCLUSIONS

In sum, when considering suicidal outcomes, these findings support a view that highlights personal loathing rooted in self-hate rather than de-personalizing aspects of dissociation. Accordingly, self-hate may emerge as a particularly valuable target for treatment and suicide prevention in EDs.

High ethanol preference and dissociated memory are co-occurring phenotypes associated with hippocampal GABAAR-δ receptor levels

Alcohol use disorder (AUD) frequently co-occurs with dissociative disorders and disorders with dissociative symptoms, suggesting a common neurobiological basis. It has been proposed that facilitated information processing under the influence of alcohol, resulting in the formation of dissociated memories, might be an important factor controlling alcohol use. Access to such memories is facilitated under the effect of alcohol, thus further reinforcing alcohol use. To interrogate possible mechanisms associated with these phenotypes, we used a mouse model of dissociative amnesia, combined with a high-alcohol preferring (HAP) model of AUD. Dissociated memory was induced by activation of hippocampal extrasynaptic GABA type A receptor delta subunits (GABA_AR-δ), which control tonic inhibition and to which ethanol binds with high affinity. Increased ethanol preference was associated with increased propensity to form dissociated memories dependent on GABA_AR-δ in the dorsal hippocampus (DH). Furthermore, the DH level of GABA_AR-δ protein, but not mRNA, was increased in HAP mice, and was inversely correlated to the level of miR-365-3p, suggesting an miRNA-mediated post-transcriptional mechanism contributing to elevated GABA_AR-δ. The observed changes of DH GABA_AR-δ were associated with a severe reduction of excitatory projections stemming from GABA_AR-δ-containing pyramidal neurons in the subiculum and terminating in the mammillary body. These results suggest that both molecular and circuit dysfunction involving hippocampal GABA_AR-δ receptors might contribute to the co-occurrence of ethanol preference and dissociated information processing.

Biomarkers of Pathological Dissociation: A Systematic Review

Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a transdiagnostic manner to recommend the most promising research and treatment pathways in support of the precision medicine framework. A total of 205 unique studies that met inclusion criteria were included. Studies were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. The dorsomedial and dorsolateral prefrontal cortex, bilateral superior frontal regions, (anterior) cingulate, posterior association areas and basal ganglia are identified as neurofunctional biomarkers of pathological dissociation and decreased hippocampal, basal ganglia and thalamic volumes as neurostructural biomarkers. Increased oxytocin and prolactin and decreased tumor necrosis factor alpha (TNF-α) are identified as psychobiological markers. Psychophysiological biomarkers, including blood pressure, heart rate and skin conductance, were inconclusive. For the genetic biomarker category studies related to dissociation were limited and no clear directionality of effect was found to warrant identification of a genetic biomarker. Recommendations for future research pathways and possible clinical applicability are provided.

Hopelessness, Dissociative Symptoms, and Suicide Risk in Major Depressive Disorder: Clinical and Biological Correlates

Background: Major depressive disorder (MDD) has different clinical presentations and is associated with neurobiological alterations. Hopelessness, anhedonia, and dissociation represent some of the most pervasive psychopathological symptoms that often lead to suicidal thoughts, attempts, and actions. To further research on the concept of depression endophenotypes, this study aimed to assess the possible relationships between hopelessness and other clinical and biological correlates (i.e., striatal dopaminergic dysfunction) in depressed patients. Methods: We recruited 51 subjects with MDD. All subjects underwent ¹²³I-FP-CIT SPECT to assess striatal dopamine transporter (DAT) availability and a psychometric evaluation using the psychometric scale to assess depressive, anxious, dissociative, and hopelessness symptoms aside from suicidal ideation. Result: An inverse correlation between the hopelessness score and dopamine transporter availability in all basal ganglia was bilaterally found. (Right Putamen, r = −0.445, p < 0.01; Left Putamen, r = −0.454, p < 0.01; Right Caudate, r = −0.398, p < 0.01; Left Caudate, r = −0.467, p < 0.01) Moreover, a positive correlation was also found between hopelessness and dissociative symptoms. Conclusions: These results provide important evidence on the neurobiological and clinical correlates of different psychopathological symptoms of depression with potential implications in terms of devising more effective treatment programs.

Dissociative Experiences In Iranian Depressed Patients

In the present study, 229 major depressive disorder (MDD) patients (57.6% female; 42.4% male) were selected by convenience sampling and examined for rate of dissociative experiences. Research tools were Dissociative Experiences Scale (DES) and demographic questionnaire. Group difference examinations were performed for gender, settlement region (place of residence), and chief complaints using standard t-test, analysis of variance, and Chi-square tests as appropriate. Ordinal regression was implemented for model building. The average age of the sample was 36.78 ± 10.73. Of which, 150 (65.5%) lived in the urban and 79 (34.5%) in the rural areas. The chief complaint of the 146 patients (63.8%) was psychiatric symptoms specific to MDD, and the remaining 83 patients (36.2%) had physical symptoms. The average DES score was 10.59 ± 13.59; and a significant mean DES score differences (P < 0.01) between patients' referred to physician for physical versus psychological complaints (physical: 23.61 ± 14.39; psychological: 3.19 ± 4.5) and geographic settlements (rural: 19.58 ± 15.13; urban: 5.86 ± 9.86) were observed. This study highlights the presence of subtype within MDD patients with significant dissociative tendencies. Given the relationship between trauma history and dissociation, this subgroup could be considered as probable cases with childhood history of abuse, lending to use dissociation as a defense mechanism. Given the evidence for promising results of trauma-focused psychotherapy in treating such patients, paying proper attention to childhood history of depression especially with somatization may minimize pain and suffering of these individuals overtime.

Gray Matter Alterations Associated With Dissociation in Female Survivors of Childhood Trauma

Objective

Across various axis-1 disorders, the severity of dissociative symptoms is significantly related to a history of childhood traumatization. Thus, the question arises if coping with childhood trauma leads to neural adaptations that enhance the frequency of dissociative processing during adulthood. The aim of the two reported studies therefore was to identify and replicate gray matter alterations associated with dissociation.

Methods and Results

In a first study, whole-brain MRI data were acquired for 22 female in-patients with trauma-spectrum disorders and a history of severe childhood trauma. Voxel-based morphometry (VBM) was carried out to test for significant correlations between dissociation (depersonalization/derealization) severity and gray matter volume. Dissociation severity was positively associated with volume in the left angular gyrus. This result was diagnosis-invariant. The replication study involved 26 female in-patients with trauma-spectrum disorders and 25 healthy controls. No significant association between dissociation severity and brain volume in a left angular gyrus region of interest located at the peak identified in study 1 was identified and no significant group difference in this region could be established.

Conclusion

The angular gyrus has previously been implicated in the processing of agency and vestibular integration as well as dissociative processing. The current attempt at a direct replication of brain volume alterations however, failed. The data thus only partially support the notion that dissociative processing is associated trans-diagnostically with structural brain alterations in the left angular gyrus and independent replication in a larger patient sample is essential.

Psychotic-Like Symptoms and the Temporal Lobe in Trauma-Related Disorders: Diagnosis, Treatment, and Assessment of Potential Malingering

Objective

To overview the phenomenology, etiology, assessment, and treatment of psychotic-like symptoms in trauma-related disorders focusing on the proposed role of temporal lobe dysfunction.

Method

We describe the literature pertaining to (i) psychotic-like symptoms and temporal lobe dysfunction in trauma-related disorders and (ii) psychological testing profiles in trauma-related disorders. We define trauma-related disorders as borderline personality disorder, post-traumatic stress disorder, and the dissociative disorders. Our search terms were dissociative disorders, temporal lobe, trauma, post-traumatic stress disorder, borderline personality disorder, psychosis, and malingering.

Results

Trauma-related psychotic-like symptoms are common and can differ in phenomenology from primary psychotic symptoms. Hallucinations consist of auditory and nonauditory content that may or may not relate to traumatic content. Child voices are highly suggestive of complex dissociative disorders. Critically, not only do these symptoms resemble those seen in temporal lobe epilepsy, but the temporal lobe is implicated in trauma-related disorders, thus providing a plausible neurobiological explanation. Despite such evidence, these symptoms are frequently considered atypical and misdiagnosed. Indeed, common structured psychological assessment tools categorize these symptoms as possible indicators of invalid testing profiles.

Conclusion

Psychotic-like symptoms are common in trauma-related disorders, may be related to temporal lobe dysfunction, and are frequently misinterpreted. This may lead to ineffective treatment and inappropriate determinations of malingering in the forensic system.

Relation between patterns of intrinsic network connectivity, cognitive functioning, and symptom presentation in trauma-exposed patients with major depressive disorder

OBJECTIVE

The present study investigated resting fMRI connectivity within the default mode (DMN), salience (SN), and central executive (CEN) networks in relation to neurocognitive performance and symptom severity in trauma-exposed patients with major depressive disorder (MDD).

METHOD

Group independent component analysis was conducted among patients with MDD (n = 21), examining DMN, SN, and CEN connectivity in relation to neurocognitive performance and symptom severity. Activation in these networks was also compared between the patient group and healthy controls (n = 20).

RESULTS

Among the patient group, higher levels of performance on measures of verbal memory and executive functioning were related to increased connectivity within the DMN (i.e., inferior parietal lobe; precuneus). Greater depression severity was related to reduced connectivity between the SN and a node of the DMN (i.e., posterior cingulate cortex) and higher depersonalization symptoms were related to enhanced connectivity between the SN and a node of the DMN (i.e., middle temporal gyrus). Higher symptoms of depersonalization were also associated with reduced integration of the DMN with the medial frontal gyrus. Relative to controls, patients with MDD showed greater connectivity of the ventromedial prefrontal cortex within the DMN.

CONCLUSION

Intrinsic connectivity network patterns are related to cognitive performance and symptom presentation among trauma-exposed patients with MDD.

Association of peritraumatic dissociation with symptoms of depression and posttraumatic stress disorder

AIM

In this study, we evaluated whether peritraumatic dissociation (PD) was associated with symptoms of depression and posttraumatic stress disorder (PTSD), and whether this association was modified by trauma prior to police work.

METHOD

Symptoms of depression, PTSD, peritraumatic dissociative experience (PDE), and trauma prior to police work were measured using the Center for Epidemiologic Studies Depression scale, PTSD Checklist-Civilian, PDE questionnaire, and the Brief Trauma questionnaire, respectively, in 328 police officers. Separate regression models were used to assess if either symptoms of depression or PTSD were associated with PD stratified by prior trauma. Means were adjusted for race, number of drinks per week, and smoking.

RESULTS

PD was associated with symptoms of PTSD and depression (β = 0.65, p < .001 and β = 0.27, p < .001, respectively). PD was positively associated with symptoms of PTSD regardless of prior trauma (β = 0.61, p < .001(without prior trauma), 0.75, p < .001 (with prior trauma). In contrast to PTSD, depression symptoms were significantly associated with PD scores in individuals with prior trauma (β = 0.47, p < .001), but not in individuals without prior trauma (β = 0.13, p = .165).

LIMITATIONS

This is a cross-sectional study. Outcomes were obtained via self-report and were not clinically diagnosed. Aspects of both the trauma event as well as the symptoms and severity of PD may have introduced recall bias.

CONCLUSION

These results add to the literature indicating that PD plays a role in symptoms of PTSD and depression and how prior trauma may modify this relationship. (PsycINFO Database Record

Parental bonding and neuropsychological performance are associated with episodic simulation of future events in trauma-exposed patients with major depressive disorder

INTRODUCTION

Major depressive disorder (MDD) and trauma-related disorders are associated with deficits in remembering the past and imagining the future (i.e., episodic simulation). We examined parental bonding and neuropsychological performance in relation to episodic simulation in trauma-exposed patients with recurrent MDD.

METHODS

Trauma-exposed patients with MDD (n = 21) and matched controls (n = 20) completed a future-oriented Autobiographical Interview, the Parental Bonding Instrument, and a standardized neuropsychological battery.

RESULTS

Patients with major depressive disorder generated fewer episodic details for future neutral events compared to controls. Although higher reported levels of maternal care were associated with increased specificity of negative future events among the patient group, higher maternal overprotection was related to decreased specificity of negative and positive future events. Higher levels of performance on measures of intelligence, verbal memory, executive functioning, and sustained attention were associated with increased specificity of future events.

CONCLUSIONS

Maternal relations during childhood and neuropsychological performance are related to the specificity of episodic simulation in adult patients with MDD. Childhood experience continues to influence memory performance into adulthood.

Dissociative symptoms are associated with reduced neuropsychological performance in patients with recurrent depression and a history of trauma exposure

BACKGROUND

Although preliminary work suggests that dissociative symptoms may impact neuropsychological performance in trauma-exposed populations, the relation between dissociation and cognitive performance has not been explored in patients with depression.

OBJECTIVE

The present study examined dissociative symptoms in relation to neuropsychological performance in participants with a primary diagnosis of recurrent major depressive disorder (MDD) and a history of trauma exposure.

METHOD

Twenty-three participants with MDD and 20 healthy controls who did not differ in age, sex, education, or IQ were assessed. In addition to a standardized neuropsychological battery assessing frontotemporally mediated cognitive processes, participants completed clinical measures assessing dissociative symptoms, illness severity, and past history of trauma exposure.

RESULTS

Among participants with MDD, greater severity of derealization was associated with reduced performance on measures of delayed visuospatial recall and recognition on a task of verbal memory recognition. In addition, more severe depersonalization was associated with slower processing speed and a response style lending itself toward better performance in a less active environment.

CONCLUSIONS

These findings point toward dissociative symptoms as a transdiagnostic factor associated with neuropsychological dysfunction in patients with depression and a history of trauma. Limitations and recommendations for future research are discussed.

Belastungen in der Kindheit und dissoziative Symptomatik bei Patienten mit psychischen Störungen

Theoretischer Hintergrund: Dissoziative Symptome treten bei verschiedenen psychischen Störungen auf und werden bei einigen Störungen mit traumatischen Erfahrungen assoziiert. Fragestellung: Wird der Zusammenhang zwischen dissoziativer Symptomatik und belastenden Erfahrungen moduliert durch die Art der Erfahrung und das Alter zum Zeitpunkt der Belastung? Methode: Bei 82 Patienten (Borderline-Persönlichkeitsstörung, BPS; Major Depression Disorder, MDD) und 54 gesunden Kontrollpersonen wurden per Interview belastende Erfahrungen während Kindheit und Jugend (3 – 16 Jahre) ermittelt. Zusammenhänge zwischen Belastung und dissoziativer Symptomatik wurden regressionsanalytisch unter Berücksichtigung von Diagnose und komorbider Posttraumatischer Belastungsstörung (PTBS) untersucht. Ergebnisse: Dissoziative Symptomatik korreliert bei BPD und MDD (mit komorbider PTBS) positiv mit emotionalem (neben sexuellem) Missbrauch und mit Belastungen in der Pubertät. Schlussfolgerung: Therapeutische Berücksichtigung emotionaler und pubertärer Belastung könnte die (Behandlung erschwerende) dissoziative Symptomatik reduzieren.

Differential effects of childhood abuse and neglect: mediation by posttraumatic distress in neurotic disorder and negative symptoms in schizophrenia?

Dissociation, though understood as a response to trauma, lacks a proven etiology. The assumption of a dose-response relationship between trauma, dissociation and Schneiderian symptoms led to the proposal of a dissociative subtype of schizophrenia characterized by severe child maltreatment, dissociation and psychosis. Child maltreatment and dissociation are common features of neurotic disorders as well, and the link between trauma, dissociation, and hallucinations is not specific for schizophrenia. This study compares childhood abuse and neglect, posttraumatic distress and adult dissociation in patients with psychotic vs. non-psychotic disorder. Thirty-five participants with non-psychotic disorder and twenty-five with schizophrenia were analyzed using the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Montgomery-Åsberg Depression Rating Scale (MADRS), the Posttraumatic Stress Diagnostic Scale PDS (PDS), the Childhood Trauma Questionnaire (CTO) and the Arbeitsgemeinschaft Methodik und Dokumentation in der Psychiatrie (AMDP)-module on dissociation. Trauma and clinical syndromes were compared by means of T-testing and logistic regression between 1) the diagnoses and 2) groups with and without post-traumatic stress disorder (PTSD), marked dissociation and psychotic symptoms. While non-psychotic disorder was related to abuse, schizophrenia showed an association with neglect. Childhood trauma predicted posttraumatic symptomatology and negative symptoms. Childhood abuse and neglect may effectuate different outcomes in neurotic and psychotic disorder. The underlying mechanisms, including dissociation, dovetail with cognitive, emotional and behavioural changes involved in depression, posttraumatic distress and chronic schizophrenia symptoms rather than being directly linked to trauma.

Predictive factors of excessive online poker playing

Despite the widespread rise of online poker playing, there is a paucity of research examining potential predictors for excessive poker playing. The aim of this study was to build on recent research examining motives for Texas Hold'em play in students by determining whether predictors of other kinds of excessive gambling apply to Texas Hold'em. Impulsivity, negative mood states, dissociation, and boredom proneness have been linked to general problem gambling and may play a role in online poker. Participants of this study were self-selected online poker players (N = 179) who completed an online survey. Results revealed that participants played an average of 20 hours of online poker a week and approximately 9% of the sample was classified as a problem gambler according to the Canadian Problem Gambling Index. Problem gambling, in this sample, was uniquely predicted by time played, dissociation, boredom proneness, impulsivity, and negative affective states, namely depression, anxiety, and stress.