Dissociative Symptoms and Interoceptive Integration

Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of interoception, the sense of the body's internal physiological state, adopting a transdiagnostic framework.Dissociative symptoms are associated with a blunting of autonomic reactivity and a reduction in interoceptive precision. In addition to the central function of interoception in homeostasis, afferent visceral signals and their neural and mental representation have been shown to shape emotional feeling states, support memory encoding, and contribute to self-representation. Changes in interoceptive processing and disrupted integration of interoceptive signals into wider cognition may contribute to detachment from the body and the world, blunted emotional experience, and altered subjective recall, as experienced by individuals who suffer from dissociation.A better understanding of the role of altered interoceptive integration across the symptom areas of dissociation could thus provide insights into the neurophysiological mechanisms underlying dissociative disorders. As new therapeutic approaches targeting interoceptive processing emerge, recognising the significance of interoceptive mechanisms in dissociation holds potential implications for future treatment targets.

Pathways to care and barriers in treatment among patients with Dissociative disorders

INTRODUCTION

Dissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process.

METHODS

Cross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment.

RESULTS

133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24-182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment.

CONCLUSION

Patients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.

Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure

OBJECTIVE

Dissociation, a disruption or discontinuity in psychological functioning, is often linked with worse psychiatric symptoms; however, the prognostic value of dissociation after trauma is inconsistent. Determining whether trauma-related dissociation is uniquely predictive of later outcomes would enable early identification of at-risk trauma populations. The authors conducted the largest prospective longitudinal biomarker study of persistent dissociation to date to determine its predictive capacity for adverse psychiatric outcomes following acute trauma.

METHODS

All data were part of the Freeze 2 data release from the Advancing Understanding of Recovery After Trauma (AURORA) study. Study participants provided self-report data about persistent derealization (N=1,464), a severe type of dissociation, and completed a functional MRI emotion reactivity task and resting-state scan 2 weeks posttrauma (N=145). Three-month follow-up reports were collected of posttraumatic stress, depression, pain, anxiety symptoms, and functional impairment.

RESULTS

Derealization was associated with increased ventromedial prefrontal cortex (vmPFC) activation in the emotion reactivity task and decreased resting-state vmPFC connectivity with the cerebellum and orbitofrontal cortex. In separate analyses, brain-based and self-report measures of persistent derealization at 2 weeks predicted worse 3-month posttraumatic stress symptoms, distinct from the effects of childhood maltreatment history and current posttraumatic stress symptoms.

CONCLUSIONS

The findings suggest that persistent derealization is both an early psychological and biological marker of worse later psychiatric outcomes. The neural correlates of trauma-related dissociation may serve as potential targets for treatment engagement to prevent posttraumatic stress disorder. These results underscore dissociation assessment as crucial following trauma exposure to identify at-risk individuals, and they highlight an unmet clinical need for tailored early interventions.

Psychiatric disorders, depression and quality of life in patients with psychogenic non-epileptic seizures and drug resistant epilepsy living in Argentina

OBJECTIVES

Psychiatric disorders are frequently found in both patients with PNES and DRE, making the differential diagnosis even more complex. The aim of this study was to analyze and compare psychiatric aspects and the quality of life in patients with psychogenic non-epileptic seizures (PNES) and drug resistant epilepsy (DRE).

METHODS

Patients admitted to video-electroencephalograpy (VEEG) unit with confirmed PNES and DRE were included. Demographical characteristics, psychiatric diagnosis according to SCID I and II of DSM IV, pharmacological treatment, general functioning measured with GAF (Global assessment of functionality), quality of life (QoL) using QlesQSF (Quality of Life Enjoyment and Satisfaction Questionnaire Short Form) and depression severity using BDI II (Beck depression inventory), were compared between the groups. Non-parametric tests, chi square test, and logistic regression were used for statistical analysis.

RESULTS

148 patients consecutively admitted to VEEG were included (DRE n = 97; PNES n = 51). Somatization disorder (RR: 13.02, 95% CI: 1.23-137.39, p = 0.03) and a history of trauma (RR: 8.66, 95% CI: 3.21-23.31, p = 0.001) were associated with PNES. The QlesQ score and the GAF score were lower with a higher prevalence of suicide attempts in the PNES group (p < 0.01). A negative correlation was observed between the severity of depression and the quality of life (DRE r = - 0.28, p = 0.013; PNES r = - 0.59, p = 0.001).

CONCLUSIONS

Higher psychiatric comorbidity with poorer QoL were found in PNES patients compared to DRE. However, depression comorbidity negatively affected the QoL in both groups. Future studies based on illness perception will be orientated to complete this analysis.

Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale

OBJECTIVE

Dissociation is a complex, ubiquitous construct in psychopathology. Symptoms of dissociation are present in a variety of mental disorders and have been connected to higher burden of illness and poorer treatment response, and not only in disorders with high levels of dissociation. This meta-analysis offers a systematic and evidence-based study of the prevalence and distribution of dissociation, as assessed by the Dissociative Experiences Scale, within different categories of mental disorders, and it updates an earlier meta-analysis.

METHOD

More than 1,900 original publications were screened, and 216 were included in the meta-analysis, comprising 15,219 individuals in 19 diagnostic categories.

RESULTS

The largest mean dissociation scores were found in dissociative disorders (mean scores >35), followed by posttraumatic stress disorder, borderline personality disorder, and conversion disorder (mean scores >25). Somatic symptom disorder, substance-related and addictive disorders, feeding and eating disorders, schizophrenia, anxiety disorder, OCD, and most affective disorders also showed mean dissociation scores >15. Bipolar disorders yielded the lowest dissociation scores (mean score, 14.8).

CONCLUSIONS

The findings underline the importance of careful psychopathological assessment of dissociative symptoms in the entire range of mental disorders.

Borderline Personality Features in Students: the Predicting Role of Schema, Emotion Regulation, Dissociative Experience and Suicidal Ideation

BACKGROUND

Numerous studies have demonstrated that early maladaptive schemas, emotional dysregulation are supposed to be the defining core of borderline personality disorder. Many studies have also found a strong association between the diagnosis of borderline personality and the occurrence of suicide ideation and dissociative symptoms.

OBJECTIVES

The present study was designed to investigate the relationship between borderline personality features and schema, emotion regulation, dissociative experiences and suicidal ideation among high school students in Shiraz City, Iran.

PATIENTS AND METHODS

In this descriptive correlational study, 300 students (150 boys and 150 girls) were selected from the high schools in Shiraz, Iran, using the multi-stage random sampling. Data were collected using some instruments including borderline personality feature scale for children, young schema questionnaire-short form, difficulties in emotion-regulation scale (DERS), dissociative experience scale and beck suicide ideation scale. Data were analyzed using the Pearson correlation coefficient and multivariate regression analysis.

RESULTS

The results showed a significant positive correlation between schema, emotion regulation, dissociative experiences and suicide ideation with borderline personality features. Moreover, the results of multivariate regression analysis suggested that among the studied variables, schema was the most effective predicting variable of borderline features (P < 0.001).

CONCLUSIONS

The findings of this study are in accordance with findings from previous studies, and generally show a meaningful association between schema, emotion regulation, dissociative experiences, and suicide ideation with borderline personality features.

Predicting addiction potential on the basis of early traumatic events, dissociative experiences, and suicide ideation

Background:

There is a great deal of medical literature suggesting that substance use disorder is a serious clinical concern, affecting general population and associated with considerable economic, societal, and personal costs.

Objectives:

This study sought to clarify the relationship between early trauma, dissociative experience, and suicide ideation as predictive factors of active and passive addiction potential (A/PAP) in high-school students.

Patients and Methods:

Three hundred students with the mean age of 15.72 y were selected via multistage random sampling. All participants were asked to complete Iranian addiction potential scale, early trauma inventory, dissociative experiences scale, and Beck’s suicide ideation scale. Analyzing data was done using canonical correlation.

Results:

Structural coefficients showed that the pattern of high scores in A/PAP correlates with the pattern of high scores in early trauma, dissociative experience and suicide ideation. The findings of the study showed that the combination of low A/PAP can probably decrease the likelihood of early trauma, dissociative experience and suicide ideation.

Conclusions:

Early trauma, dissociative experience, and suicide ideation can predict A/PAP and explain the considerable variance of survival index.