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Simeon D, Knutelska M, Putnam FW, Schmeidler J, Smith LM. Attention and Memory in Depersonalization-Spectrum Dissociative Disorders: Impact of Selective-Divided Attentional Condition, Stimulus Emotionality, and Stress. J Trauma Dissociation 2023; 24:42-62. [PMID: 35616140 DOI: 10.1080/15299732.2022.2079798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We investigated cognition in depersonalization-spectrum dissociative disorders without comorbid posttraumatic stress disorder to explore evidence for emotionally avoidant information processing. Forty-eight participants with DSM-IV dissociative disorder (DD) (Depersonalization Disorder - 37, Dissociative Disorder NOS -11), 36 participants with Posttraumatic Stress Disorder (PTSD), and 56 healthy controls (HC) were administered the Weschler Adult Intelligence Scale-III (WAIS); the Weschler Memory Scale-III (WMS); and three Stroop tasks: the Standard Stroop, a selective-attention Emotional Stroop using neutral, dissociation, and trauma-related word categories, and a divided-attention Emotional Stroop using comparable words. Participants were also administered a paired-associates explicit and implicit memory test using emotionally neutral and negative words, before and after the Trier Social Stress Test. The DD and HC groups had comparable general intelligence and memory scores, though dissociation severity was inversely related to verbal comprehension and working memory. In the selective-attention condition, DD participants showed greater incidental recall across word categories with comparable interference. However in the divided-attention condition, DD participants significantly favored lesser attentional interference at the expense of remembering words. Across attentional conditions, DD participants had better recall for disorder-related than neutral words. Pre-stress, the DD group demonstrated better explicit memory for neutral versus negative words with reversal after stress, whereas the HC group demonstrated the opposite pattern; implicit memory did not differ. Cognition in the PTSD control group was generally dissimilar to the DD group. The findings in toto provide substantial evidence for emotionally avoidant information processing in DD, vulnerable to the impact of stress, at the level of both attention and memory.
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Affiliation(s)
- Daphne Simeon
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA
| | - Margaret Knutelska
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA
| | - Frank W Putnam
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA
| | - James Schmeidler
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA
| | - Lisa M Smith
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA
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2
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Kira IA, Shuwiekh H, Laddis A. The Linear and Non-Linear Association between Trauma, Dissociation, Complex PTSD, and Executive Function Deficits: A Longitudinal Structural Equation Modeling Study. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2101734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Ibrahim Aref Kira
- Center for Cumulative Trauma Studies, USA
- Center for Stress, Trauma, and Resilience, Georgia State University, Atlanta, USA
| | - Hanaa Shuwiekh
- Department of Psychology, Fayoum University, Fayoum, Egypt
| | - Andreas Laddis
- Private practice in Psychiatry and Neurology is in Framingham, Framingham, MA, USA
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Dimitrova L, Fernando V, Vissia EM, Nijenhuis ERS, Draijer N, Reinders AATS. Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: a replication and extension study. Eur J Psychotraumatol 2020; 11:1705599. [PMID: 32082509 PMCID: PMC7006753 DOI: 10.1080/20008198.2019.1705599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/14/2019] [Accepted: 11/13/2019] [Indexed: 10/26/2022] Open
Abstract
Background: Two aetiology models for dissociative identity disorder (DID) have been proposed, namely a childhood Trauma Model and an iatrogenic or Fantasy model. A recent study indicated that sleep disturbances underlie dissociative symptomatology. Objective: Our current study aims to test whether this finding can be replicated in an independent sample and to investigate if this finding still holds after correcting for childhood and adult traumatization. An experimental working memory task is included to investigate how sleep disturbance, traumatization, dissociation, and fantasy proneness impact cognitive functioning. Methods: Three groups of participants were included - individuals with DID, individuals with post-traumatic stress disorder (PTSD), and matched healthy controls. Sleep disturbances were measured and compared between the groups along with measures of childhood and adult traumatization, psychoform and somatoform [psychological and somatic] dissociative symptoms, and fantasy proneness. Cognitive capacity was assessed using a working memory task. Results: When controlled for traumatic experiences, sleep disturbances did not predict dissociative symptoms. When controlled for sleep disturbance and fantasy proneness, childhood traumatization did predict dissociative symptoms. Psychoform dissociative symptoms correlated with traumatic experiences more than with fantasy proneness. Working memory performance was similar among the participating groups. Propensity to fantasy did not discriminate individuals with DID and PTSD, and was a weak predictor of dissociative symptoms. Conclusion: Whereas DID and PTSD are associated with sleep disturbances, these features do not statistically predict dissociative symptoms in these disorders when traumatic experiences are taken into account. Fantasy proneness is not excessive in DID and PTSD. Hence, we found no evidence that sleep disturbances, propensity to fantasy and abnormal working memory capacity explain dissociative symptoms in DID and PTSD. In sum, the relationship between sleep and dissociative symptoms disappeared when potentially traumatizing events were controlled for.
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Affiliation(s)
- Lora Dimitrova
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.,Department of Psychiatry, Amsterdam UMC, location VUMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Vinuri Fernando
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.,Department of Psychiatry, Amsterdam UMC, location VUMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Eline M Vissia
- Heelzorg, Centre for Psychotrauma, Zwolle, The Netherlands
| | - Ellert R S Nijenhuis
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Nel Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Renard SB, Huntjens RJC, Lysaker PH, Moskowitz A, Aleman A, Pijnenborg GHM. Unique and Overlapping Symptoms in Schizophrenia Spectrum and Dissociative Disorders in Relation to Models of Psychopathology: A Systematic Review. Schizophr Bull 2017; 43:108-121. [PMID: 27209638 PMCID: PMC5216848 DOI: 10.1093/schbul/sbw063] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Schizophrenia spectrum disorders (SSDs) and dissociative disorders (DDs) are described in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as 2 categorically distinct diagnostic categories. However, several studies indicate high levels of co-occurrence between these diagnostic groups, which might be explained by overlapping symptoms. The aim of this systematic review is to provide a comprehensive overview of the research concerning overlap and differences in symptoms between schizophrenia spectrum and DDs. For this purpose the PubMed, PsycINFO, and Web of Science databases were searched for relevant literature. The literature contained a large body of evidence showing the presence of symptoms of dissociation in SSDs. Although there are quantitative differences between diagnoses, overlapping symptoms are not limited to certain domains of dissociation, nor to nonpathological forms of dissociation. In addition, dissociation seems to be related to a history of trauma in SSDs, as is also seen in DDs. There is also evidence showing that positive and negative symptoms typically associated with schizophrenia may be present in DD. Implications of these results are discussed with regard to different models of psychopathology and clinical practice.
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Affiliation(s)
- Selwyn B Renard
- Department of Clinical Psychology and Experimental Psychopathology, Rijksuniversiteit Groningen, Groningen, The Netherlands;
| | - Rafaele J C Huntjens
- Department of Clinical Psychology and Experimental Psychopathology, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Paul H Lysaker
- Department of Psychiatry, Roudeboush VA Medical Center, Indianapolis, IN
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | | | - André Aleman
- Department of Neuroscience, University of Groningen, BCN Neuroimaging Center (NIC), University Medical Center, Groningen, The Netherlands
| | - Gerdina H M Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, Rijksuniversiteit Groningen, Groningen, The Netherlands
- Department of Psychotic Disorders, GGZ Noord-Drenthe, Assen, The Netherlands
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Özdemir O, Güzel Özdemir P, Boysan M, Yilmaz E. The Relationships Between Dissociation, Attention, and Memory Dysfunction. Noro Psikiyatr Ars 2015; 52:36-41. [PMID: 28360673 DOI: 10.5152/npa.2015.7390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/22/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Dissociation is a disruption in the integrated functions of consciousness, memory, identity, and perception. Dissociative symptoms include derealization/depersonalization, absorption, and amnesia. These experiences can cause a loss of control over mental processes, including memory and attention. In literature, there is a paucity of research concerning the relationships between dissociation and memory performance. In this study, our aim was to investigate the relationships between dissociative experiences, attention, and memory performance in a non-clinical community sample. METHODS In this study, we examined the relationship between dissociation and cognitive dysfunction among 60 healthy volunteers. We administered the Wechsler Memory Scale-Revised, Auditory Verbal Learning Test, Stroop Color Word Interference Test, and Dissociative Experience Scale. Here we examined the relationships between the subtypes of dissociation and memory performance as assessed by neuropsychological tests. RESULTS We found that verbal memory was negatively associated with dissociative experiences. Pathological dissociation, particularly amnesia and depersonalization/derealization, was reversely linked to general memory performance and long-term memory. Moreover, low dissociators reported higher scores on verbal memory, general memory performance, and long-term memory but lower scores on recognition than high dissociators. CONCLUSION The results of our study suggested that there are significant linkages between dissociative experiences and memory performance.
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Affiliation(s)
- Osman Özdemir
- Department of Psychiatry, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Pınar Güzel Özdemir
- Department of Psychiatry, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Murat Boysan
- Department of Psychology, Faculty of Art, Yüzüncü Yıl University, Van, Turkey
| | - Ekrem Yilmaz
- Department of Psychiatry, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
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Brewin CR, Ma BY, Colson J. Effects of experimentally induced dissociation on attention and memory. Conscious Cogn 2013; 22:315-23. [DOI: 10.1016/j.concog.2012.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 07/24/2012] [Accepted: 08/11/2012] [Indexed: 11/29/2022]
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Williamson DJ, Holsman M, Chaytor N, Miller JW, Drane DL. Abuse, Not Financial Incentive, Predicts Non-Credible Cognitive Performance in Patients With Psychogenic Non-Epileptic Seizures. Clin Neuropsychol 2012; 26:588-98. [DOI: 10.1080/13854046.2012.670266] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Alexithymia, absorption, and cognitive failures in depersonalization disorder: a comparison to posttraumatic stress disorder and healthy volunteers. J Nerv Ment Dis 2009; 197:492-8. [PMID: 19597356 DOI: 10.1097/nmd.0b013e3181aaef6b] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alexithymia, absorption, and cognitive failures are traits that have been implicated in dissociative psychopathology. Forty-six participants with depersonalization disorder (DPD), 21 with posttraumatic stress disorder, and 35 healthy controls completed measures of dissociation, alexithymia, absorption, cognitive failures, and childhood trauma. The DPD and posttraumatic stress disorder groups had significantly and comparably elevated absorption and cognitive failures scores. Only the DPD group had significantly elevated alexithymia scores, specifically in "difficulty identifying feelings." Regression analyses revealed that "alexithymia-difficulty identifying feelings" was predictive of both DPD diagnosis and depersonalization scores. In contrast, amnesia scores were predicted by childhood trauma and absorption. In conclusion, the link between depersonalization and alexithymia appeared to be specific rather than broadly related to early trauma or to trauma-spectrum psychopathology.
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Abstract
Depersonalization disorder (DPD) is a dissociative disorder characterized by a subjective sense of unreality and detachment, and has been associated with deficits in perception and short-term memory. In this study, 21 DPD and 17 healthy comparison participants free of psychiatric disorders were administered a comprehensive neuropsychologic battery. The groups did not differ in full-scale, verbal, and performance IQ (Wechsler Adult Intelligence Scale), in working memory (Paced Auditory Serial Addition Test), or in selective attention (Digit Span with Distracters). The DPD group performed significantly worse on immediate visual and verbal recall (Wechsler Memory Scale, Revised), but not on delayed recall. Dissociation severity was significantly correlated with processing slowness and distractibility. We conclude that DPD is associated with cognitive disruptions in early perceptual and attentional processes.
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10
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Judd PH. Neurocognitive impairment as a moderator in the development of borderline personality disorder. Dev Psychopathol 2006; 17:1173-96. [PMID: 16613436 DOI: 10.1017/s0954579405050558] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Borderline personality disorder (BPD) is characterized by a pervasive instability of interpersonal relationships, affects, self-image, marked impulsivity, dissociation, and paranoia. The cognitive dimension of the disorder has received relatively little attention and is poorly understood. This paper proposes that neurocognitive impairment is a key moderator in the development of BPD and elaborates a possible pathway for the expression of the cognitive domain. Neurocognitive impairment is hypothesized to moderate the relationship between caretaking and insecure disorganized attachment and pathological dissociation in the formation of the disorder contributing to impaired metacognition and a range of cognitive difficulties. The empirical evidence from studies of cognitive processes, brain function, attachment, and dissociation that support this theory are reviewed and discussed. Areas for future research that might verify or refute this theory are suggested.
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Affiliation(s)
- Patricia Hoffman Judd
- University of California, San Diego, Department of Psychiatry, Outpatient Psychiatric Services, 92103, USA.
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11
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Levin R, Sirof B, Simeon D, Guralnick O. Role of fantasy proneness, imaginative involvement, and psychological absorption in depersonalization disorder. J Nerv Ment Dis 2004; 192:69-71. [PMID: 14718779 DOI: 10.1097/01.nmd.0000106003.46153.54] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ross Levin
- Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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12
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Papageorgiou C, Lykouras L, Ventouras E, Uzunoglu N, Christodoulou GN. Abnormal P300 in a case of delusional misidentification with coinciding Capgras and Frégoli symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26:805-10. [PMID: 12188110 DOI: 10.1016/s0278-5846(01)00293-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Delusional Misidentification Syndrome (DMS) is thought to be related to dissociation between recognition and identification processes. Working memory (WM) is considered responsible for the integration and online manipulation of information, so that it is available for further processing. Since the P300 component of event-related potentials (ERPs) is considered as an index of the on-line updating of WM, the present study is focused on auditory P300 elicited during a WM test in DMS, compared with that in healthy controls. ERPs, elicited during a WM test, in a case suffering from coinciding Capgras and Frégoli symptoms, were recorded. Peak amplitude and latency of the averaged P300 waveforms, as well as memory performance of this case, were compared to the patterns obtained from healthy controls. In relation to normal controls, the patient exhibited significantly attenuated amplitude of P300 at the F4, P3 and Pz abductions. The patient also showed significantly prolonged latencies of P300 at all abductions used. These findings suggest that DMS may be accompanied by WM dysfunction affecting brain regions outside the prefrontal cortex, as well as within, and by diffuse failure to allocate attention resources to a stimulus, as they are reflected by P300 amplitudes and latencies respectively. Additionally, it may be suggested that techniques designed to explore cognitive operations, such as recording of ERPs, and more specifically P300, during WM tasks, could provide further insights into the relationship between neural functioning and the cognitive deficits in DMS.
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Somer E. POSTTRAUMATIC DISSOCIATION AS A MEDIATOR OF THE EFFECTS OF TRAUMA ON DISTRESSFUL INTROSPECTIVENESS. SOCIAL BEHAVIOR AND PERSONALITY 2002. [DOI: 10.2224/sbp.2002.30.7.671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This paper focuses on the stable personality trait of introspectiveness, exploring the relationship between introspectiveness and childhood trauma, dissociation and emotional distress. Ninety Israeli women were recruited from emergency counseling services and from academic and
office employment settings. Pearson correlations between traumatic experiences and various dimensions of introspectiveness revealed significant links. Negative emotional and sexual experiences were the trauma variables that contributed most to this relationship, whereas a tendency to be aware
of feelings toward family and about mortality were the dimensions of introspection that added most to this association. Prior trauma history, dissociation, introspectiveness, and emotional distress were significantly interrelated. The data from a path analysis performed suggest that introspectiveness
may be better explained by the independent effect of dissociation rather than directly by trauma or by emotional distress. Theoretical and clinical implications are discussed.
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Dorahy MJ. Dissociative identity disorder and memory dysfunction: the current state of experimental research and its future directions. Clin Psychol Rev 2001; 21:771-95. [PMID: 11434230 DOI: 10.1016/s0272-7358(00)00068-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Memory dysfunction is a central feature of dissociative identity disorder (DID). Following the memorial anomalies outlined by Putnam [Putnam, F. W. (1994). Dissociation and disturbances of self. In: D. Cicchetti & S. L. Toth (Eds.), Disorders and dysfunctions of the self, vol. 5 (pp. 251-265). Rochester, NY: University of Rochester Press; Putnam, F. W. (1995). Development of dissociative disorders. In: D. Chicchetti & D. J. Cohen (Eds.), Developmental psychopathology, vol. 2 (pp. 581-608). New York: Wiley], the experimental research using DID case studies and samples is reviewed. As a whole, research suggests that amnesic barriers between alter personalities are typically impervious to explicit stimuli, as well as conceptually driven implicit stimuli. Autobiographical memory deficits are also experimentally evident in DID. Although no experimental studies have addressed the issue of source amnesia or pseudomemories, there is some evidence that pseudomemories are an infrequent but real phenomenon in DID patients. Finally, potential deficits in working memory are outlined, including those relating to cognitive inhibition. Research directions are discussed throughout to further elucidate the nature of memory dysfunction in DID.
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Affiliation(s)
- M J Dorahy
- School of Psychology, University of New England, Armidale, 2351, NSW, Australia.
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Abstract
Earlier clinical hypotheses regarding borderline personality disorder, based on projective psychological testing and intelligence tests, are examined. Recent findings of comparative deficits in this population in the domains of verbal and visual memory as well as visual perception are reviewed, together with clinical relevance. Efforts to examine the way individuals with this disorder process emotion-laden material are discussed, with suggestions for further research.
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Affiliation(s)
- K M O'Leary
- Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, USA
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