1
|
Aujoulat C, Vancappel A, Tapia G. [Effectiveness of psychotherapy on dissociative symptoms in adult populations: A PRISMA systematic review]. Encephale 2024:S0013-7006(24)00044-7. [PMID: 38523025 DOI: 10.1016/j.encep.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target. METHOD A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated. RESULTS Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another. DISCUSSION The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.
Collapse
Affiliation(s)
| | - Alexis Vancappel
- Laboratoire QualiPsy, EE 1901, université de Tours, Tours, France; Pôle Psychiatrie-addictologie, clinique psychiatrique universitaire - centre régional de psychotraumatologie-CVL, CHRU de Tours, Tours, France
| | - Géraldine Tapia
- Université de Bordeaux, Bordeaux, France; Université de Bordeaux, LabPsy, UR 4139, 33000 Bordeaux, France.
| |
Collapse
|
2
|
Carbone GA, De Rossi E, Prevete E, Tarsitani L, Corazza O, Massullo C, Farina B, Pasquini M, Taddei I, Biondi M, Imperatori C, Bersani FS. Dissociative experiences of compartmentalization are associated with food addiction symptoms: results from a cross-sectional report. Eat Weight Disord 2023; 28:28. [PMID: 36867281 DOI: 10.1007/s40519-023-01555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/04/2022] [Indexed: 03/04/2023] Open
Abstract
PURPOSE Studies have shown significant associations of dissociative symptoms with both eating and addictive disorders; however, the different forms of dissociation have been relatively understudied in relation to food addiction (FA). The main aim of this study was to investigate the association of certain forms of dissociative experiences (i.e., absorption, detachment and compartmentalization) with FA symptoms in a nonclinical sample. METHODS Participants (N = 755; 543 women; age range: 18-65; mean age: 28.22 ± 9.99 years) were evaluated using self-report measures of FA, dissociation, eating disturbances, and general psychopathology. RESULTS Compartmentalization experiences (defined as pathological over-segregation of higher mental functions) were independently associated with FA symptoms (β = 0.174; p = 0.013; CI = [0.008; 0.064]) even when confounding factors were controlled for. CONCLUSION This finding suggests that compartmentalization symptoms can have a role in the conceptualization of FA, with such two phenomena possibly sharing common pathogenic processes. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
Collapse
|
3
|
Ng ASY, Chan WS. Psychometric evaluation of the Hong Kong Chinese version of the Dissociative Experiences Measure, Oxford (HKC-DEMO). J Trauma Dissociation 2023; 24:321-332. [PMID: 36694476 DOI: 10.1080/15299732.2023.2171173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The Dissociative Experiences Measure, Oxford (DEMO) is a recently developed measure that reflects the current conceptualization of dissociation. However, psychometric investigations of the DEMO are still limited. The current study examined the factor structure and psychometric properties of the Hong Kong Chinese version of the DEMO (HKC-DEMO). Online survey data on 914 community-dwelling adults in Hong Kong was extracted from a primary preregistered study on sleep and dissociation. Confirmatory factor analyses revealed that a five-factor structure, identified as "unreality," "numbness and disconnectedness," "memory blanks," "zoned out," and "vivid internal world," fit the data adequately. The five-factor structure fit significantly better than a four-factor structure, which combined "zoned out" and "vivid internal world" as a single factor of "absorption." Furthermore, the HKC-DEMO demonstrated excellent reliability, and satisfactory convergent, and divergent validity. The current study was the first to translate the DEMO to other language and showed that the HKC-DEMO is reliable and valid for use in Hong Kong Chinese adults. Further validation of the HKC-DEMO with a clinical sample and samples with a wider age range would enhance the generalizability of the HKC-DEMO.
Collapse
Affiliation(s)
- Albe S Y Ng
- Department of Psychology, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Sze Chan
- Department of Psychology, the University of Hong Kong, Pok Fu Lam, Hong Kong
| |
Collapse
|
4
|
Fotia F, Van Dam L, Sykes JJ, Ambrosini E, Costantini M, Ferri F. Body structural representation in schizotypy. Schizophr Res 2022; 239:1-10. [PMID: 34775304 DOI: 10.1016/j.schres.2021.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
A deficient sense of self, typically observed in schizophrenia spectrum disorders, is often accompanied by abnormalities in bodily perception and awareness. These abnormalities are seemingly among the most powerful predictive factors for the onset of schizophrenic illnesses. According to the hypothesis of the psychosis continuum, high schizotypal traits in the general population may be characterized by a progressive sense of detachment from one's lived body. Building upon previous research that found an abnormal Body Structural Representation (BSR) in individuals with schizophrenia, this study aims to extend these findings to schizotypy. To investigate this, we utilized the Finger Localization Task (FLT), in which participants must identify the finger touched by the experimenter, and the In Between Task (IBT), in which two fingers are touched and participants must specify the number of fingers in between the two stimulated fingers. We found that individuals with high schizotypy were significantly less accurate than individuals with low schizotypy in determining the spatial configuration of their own fingers relative to each other. Most significantly, performances on both tasks were negatively correlated with the score on the Dissociative Experiences Scale (DES). These findings support the hypothesis that the progressive loss of one's sense of self is associated with abnormal bodily experiences and dissociative symptomatology which may represent a potential marker for schizophrenia proneness.
Collapse
Affiliation(s)
- Francesca Fotia
- Department of Psychology, University of Essex, Wivenhoe Park, UK.
| | - Loes Van Dam
- Department of Psychology, University of Essex, Wivenhoe Park, UK; Institute of Psychology, Centre for Cognitive Science, TU-Darmstadt, Germany
| | - John James Sykes
- Department of Philosophy and Communication Studies FILCOM, Bologna, Italy
| | | | - Marcello Costantini
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies, ITAB, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesca Ferri
- Institute for Advanced Biomedical Technologies, ITAB, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
5
|
Carbone GA, Imperatori C, Bersani FS, Massullo C, Orlando EM, Farina B. Dissociative-Traumatic Dimension and Triple Network: An EEG Functional Connectivity Study in a Sample of University Students. Psychopathology 2022; 55:28-36. [PMID: 34788760 DOI: 10.1159/000519563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 09/09/2021] [Indexed: 11/19/2022]
Abstract
AIMS We investigated the association among triple network electroencephalographic (EEG) functional connectivity, dissociative symptoms, and childhood trauma (CT) in a sample of university students. SAMPLING AND METHODS Seventy-six participants (30 males and 46 females; mean age 22.12 ± 2.35) completed self-report measures investigating dissociative symptoms, CT, and depressive symptoms. Participants also performed an eyes-closed resting-state EEG recording. EEG analyses were conducted through the exact low-resolution electromagnetic tomography (eLORETA) software. RESULTS A 2-step cluster analysis revealed 2 groups: participants (N = 23) with high dissociative-traumatic dimension symptoms (DTD+) and participants (N = 53) with low DTD symptoms (DTD-). Compared to DTD- subjects, DTD+ participants showed decreased theta connectivity between the salience network (SN) and central executive network (CEN), specifically between the right anterior insula and the left posterior parietal cortex. No significant correlation was detected between EEG data and clinical variables. CONCLUSION Our results raise the possibility of a dysfunctional connectivity pattern occurring between the SN and CEN in individuals with high DTD symptoms. Such connectivity pattern might reflect the neuropsychophysiological disintegration related to pathological dissociation.
Collapse
Affiliation(s)
- Giuseppe Alessio Carbone
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | | | - Chiara Massullo
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Egle Maria Orlando
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Benedetto Farina
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| |
Collapse
|
6
|
Chana SM, Wolford-Clevenger C, Faust A, Hemberg J, Ramaswamy M, Cropsey K. Associations among betrayal trauma, dissociative posttraumatic stress symptoms, and substance use among women involved in the criminal legal system in three US cities. Drug Alcohol Depend 2021; 227:108924. [PMID: 34333280 PMCID: PMC8464486 DOI: 10.1016/j.drugalcdep.2021.108924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Betrayal trauma, as defined by (Freyd, 1996), refers to a subcategory of trauma characterized by a significant violation of trust surrounding interpersonal maltreatment (physical, sexual, or emotional). Previous research has shown that people with betrayal trauma histories experience greater dissociative symptoms of posttraumatic stress disorder and co-morbid substance use disorder symptoms. Women in the criminal legal system commonly have significant histories of betrayal trauma and related posttraumatic stress symptoms and substance use. However, no studies have specifically explored the impact of dissociative posttraumatic stress symptoms on substance use outcomes in this population. Additionally, no studies have explored whether betrayal trauma relates to nonfatal overdoses. METHODS This cross-sectional survey study of N = 508 women with criminal legal system involvement examined the indirect effects of betrayal trauma history on substance use outcomes through dissociative posttraumatic stress symptoms. RESULTS Multivariate analyses supported an indirect effect of betrayal trauma on substance use severity, daily substance use, and history of overdose, but not alcohol use severity, through dissociative symptoms. CONCLUSIONS Women in the criminal legal system with betrayal trauma and dissociative symptoms may be at risk for substance use and related outcomes (i.e., overdose). Future work is needed to examine whether targeting such symptoms may improve substance use treatment and prevention of serious outcomes in this population.
Collapse
Affiliation(s)
- Sofía Mildrum Chana
- Department of Psychiatry and Behavioral Neurobiology, Volker Hall L107, 1670 University Blvd., Birmingham, Alabama 35233 USA
| | - Caitlin Wolford-Clevenger
- Department of Psychiatry and Behavioral Neurobiology, Volker Hall L107, 1670 University Blvd., Birmingham, Alabama 35233 USA
| | - Alexandra Faust
- Department of Psychiatry and Behavioral Neurobiology, Volker Hall L107, 1670 University Blvd., Birmingham, Alabama 35233 USA
| | - Jordana Hemberg
- Community Health and Implementation Research Program, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, California 94704 USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd, MS 1008, Kansas City, Kansas 66160
| | - Karen Cropsey
- Department of Psychiatry and Behavioral Neurobiology, Volker Hall L107, 1670 University Blvd., Birmingham, Alabama 35233 USA
| |
Collapse
|
7
|
Gainer DM, Crawford TN, Fischer KB, Wright MD. The relationship between dissociative symptoms and the medications used in the treatment of opioid use disorder. J Subst Abuse Treat 2020; 121:108195. [PMID: 33357605 DOI: 10.1016/j.jsat.2020.108195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/11/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
Opioid use disorder has long been associated with psychiatric symptoms, including dissociative experiences. Medications used to treat opioid use disorder can potentially impact dissociative symptoms, but the existing literature has not explored this. We examined the relationship between dissociative symptoms and opioid use disorder using the Dissociative Experiences Scale (DES). We studied subjects who were taking prescribed methadone, buprenorphine, or naltrexone for opioid use disorder. We gave the DES, the Patient Health Questionairre-9 (PHQ-9), and the PTSD Checklist for DSM-5 (PCL-5) with Criterion A to subjects in three substance use treatment facilities in Ohio. We conducted Analysis of Variance (ANOVA) and Spearman's Rank Correlations to examine associations between the variables and outcomes. We developed three separate multiple linear regression models. We included 116 participants in our exploratory and naturalistic study. The majority of participants were female (51.7%), white (89.5%), ≤ 40 years of age (64.7%), and taking buprenorphine (55%). The average DES score was 16.1 (standard deviation = 14.9) and we considered 80.9% to have low dissociation (score < 30). Approximately 55% (n = 64) of participants were taking prescribed buprenorphine. Approximately 27% (n = 32) were taking prescribed methadone and approximately 18% (n = 21) were taking prescribed naltrexone (oral or extended release). There was a significant association between opioid medication type and log dissociative symptoms (p = .01). Participants taking prescribed buprenorphine had higher mean log dissociation symptom scores (2.7) compared to those taking prescribed methadone (2.2) and prescribed naltrexone (2.1). Log dissociation symptom scores were significantly associated with last use of any opiates (rs = -0.21; p = .02) and time on medication (rs = -0.228; p = .01). Compared to those taking buprenorphine, those taking both methadone (β = -0.26; p = .01) and naltrexone (β = -0.27; p = .006) had significantly lower dissociation scores, controlling for the other variables in the model. Dissociation scores were positively correlated with depression scores (r = 0.45; p < .0001) and with PCL-5 scores (r = 0.51; p < .0001). Our study highlights the importance of diagnosing and monitoring dissociative symptoms in individuals who are taking prescribed medications for opioid use disorder, especially since dissociative symptoms can interfere with substance use treatment.
Collapse
Affiliation(s)
- Danielle M Gainer
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America.
| | - Timothy N Crawford
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America
| | - Karley B Fischer
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America
| | - Mark D Wright
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America
| |
Collapse
|
8
|
Herzog S, Fogle BM, Harpaz-Rotem I, Tsai J, DePierro J, Pietrzak RH. Dissociative symptoms predict risk for the development of PTSD: Results from the National Health and Resilience in Veterans Study (NHRVS). J Psychiatr Res 2020; 131:215-219. [PMID: 32998083 DOI: 10.1016/j.jpsychires.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Dissociative symptoms following trauma exposure, such as derealization (i.e., feeling that one's experience is strange and unreal) and depersonalization (i.e., feeling detached from oneself) have been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). In the current study, we analyzed data from a 3-year prospective cohort study of a nationally representative sample of U.S. veterans to examine whether trait dissociative symptoms, which may impair adaptive emotion regulation following trauma exposure, predict risk for the development of PTSD in trauma-exposed veterans. Results revealed that derealization symptoms predicted a nearly 5-fold increase in relative risk of incident PTSD (relative risk ratio = 4.57, 95% confidence interval = 1.55-13.52), even after adjusting for relevant sociodemographic and trauma-related factors, and severity of PTSD symptoms at baseline. To our knowledge, this study is the first to suggest that trait dissociative symptoms-specifically derealization-may be an important population-based risk factor for the development of PTSD in trauma-exposed U.S. military veterans. These findings add to a body of literature on the prediction of PTSD that largely focuses on stable or immutable risk factors such as sociodemographic and trauma characteristics, or peritraumatic emotional reactions, and underscores the potential clinical utility of assessing, monitoring, and treating derealization symptoms in trauma-exposed U.S. military veterans at risk for PTSD.
Collapse
Affiliation(s)
- Sarah Herzog
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Brienna M Fogle
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA
| | - Jack Tsai
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA; U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, 13000 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Jonathan DePierro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA
| |
Collapse
|
9
|
Martino I, Cerasa A, Vasta R, Gambardella A, Labate A. The impact of sexual abuse on psychopathology of patients with psychogenic nonepileptic seizures. Neurol Sci 2021; 42:1423-8. [PMID: 32794127 DOI: 10.1007/s10072-020-04652-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/06/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES In the present study, we evaluated if the presence of sexual abuse in the clinical history of patients with psychogenic non-epileptic seizures (PNES) is associated with a different psychopathological profile. MATERIALS AND METHODS In a consecutive population of 63 PNES patients, we compared two demographically and clinically matched groups of patients with (no. 15) and without (no. 48) a history of sexual abuse using a comprehensive psychopathological assessment (Beck Depression Inventory, Hamilton Anxiety Rating Scale, Dissociative Experience Scale, Somatoform Dissociation Questionnaire, and Toronto Alexithymia Scale). RESULTS We found that the group of patients reporting sexual abuse is characterized by higher scores on Dissociative Experience Scale (p = 0.003) and Beck Depression Inventory (p = 0.001) with respect to the other group. No significant statistical differences in Hamilton Anxiety Rating Scale (p = 0.103), Toronto Alexithymia Scale (p = 0.137), and Somatoform Dissociation Questionnaire (p = 0.486) were captured. Moreover, we found that the negative effect on dissociate symptoms was also hampered by the increasing of seizure frequency. CONCLUSIONS This study reinforces the importance of traumatic screening in the clinical spectrum of PNES in order to implement and improve specific therapeutic strategies.
Collapse
|
10
|
Herzog S, Fogle BM, Harpaz-Rotem I, Tsai J, Pietrzak RH. Dissociative Symptoms in a Nationally Representative Sample of Trauma-Exposed U.S. Military Veterans: Prevalence, Comorbidities, and Suicidality. J Affect Disord 2020; 272:138-45. [PMID: 32379605 DOI: 10.1016/j.jad.2020.03.177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/29/2020] [Accepted: 03/29/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Dissociative symptoms have been documented in diverse clinical and non-clinical populations, and are associated with poor mental health outcomes. Yet, research on dissociative symptoms is frequently limited to PTSD samples, and therefore little is known about the prevalence, clinical correlates, and risk factors related to dissociative symptoms in broader, representative trauma-exposed populations. METHODS The current study assessed dissociative symptoms in a contemporary, nationally representative sample of trauma-exposed U.S. veterans irrespective of PTSD diagnostic status. We then compared sociodemographic, military, and psychiatric characteristics, trauma histories, level of functioning, and quality of life in veterans with dissociative symptoms to those without dissociative symptoms; and determined the incremental association between dissociative symptoms, and suicidality, functioning, and quality of life, independent of comorbidities. RESULTS A total 20.8% of U.S. veterans reported experiencing mild-to-severe dissociative symptoms. Compared to veterans without dissociative symptoms, veterans with dissociative symptoms were younger, and more likely to be non-white, unmarried/partnered and unemployed, had lower education and income, and were more likely to have been combat-exposed and use the VA are their primary source of healthcare. They also had elevated rates of psychiatric comorbidities, lower functioning and quality of life, and a 5-fold greater likelihood of current suicidal ideation and 4-fold greater likelihood of lifetime suicide attempt history. LIMITATIONS Cross-sectional data limit inference of the directionality of findings, and results may not generalize to non-veteran populations. CONCLUSIONS Dissociative symptoms are prevalent in U.S. veterans and may be an important transdiagnostic marker of heightened risk for suicidality and psychiatric comorbidities. These results underscore the importance of assessing, monitoring, and treating dissociative symptoms in this population.
Collapse
|
11
|
Tuineag M, Therman S, Lindgren M, Rouanet M, Nahon S, Bertrand L, Saury S, Renaud S, Beaulieu S, Linnaranta O. Dissociative symptoms as measured by the Cambridge Depersonalization Scale in patients with a bipolar disorder. J Affect Disord 2020; 263:187-192. [PMID: 31818776 DOI: 10.1016/j.jad.2019.11.137] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/25/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Cambridge Depersonalization Scale (CDS) characterizes the quality, frequency, and duration of dissociative symptoms. While the psychometric properties of the CDS have been evaluated in primary dissociative disorder, this has been insufficiently addressed among other psychiatric patient groups such as patients with a bipolar disorder (BD). METHODS Outpatients with variable mood (n = 73) responded to a survey that assessed dissociative symptoms and other characteristics. We used factor analysis and McDonald's omega to evaluate psychometric properties of the CDS, and correlations with other characteristics. RESULTS Previously suggested multifactorial models of the CDS were not supported, but the single-dimensional model fit both dichotomized (p = 0.31, CFI = 0.99, RMSEA = 0.02, ECV 70%) and trichotomized CDS responses (p = 0.06, CFI = 0.96, RMSEA = 0.04, ECV 47%). The CDS showed high internal consistency (ω = 0.96). CDS factor scores correlated with symptom severity on the Quick Inventory for Depressive Symptoms (QIDS-SR-16) (ρ = 0.59), the Social Phobia Inventory (ρ = 0.52), the American Association of Psychiatry Severity measure for Panic Disorders (ρ = 0.46), the Childhood Trauma Questionnaire (ρ = 0.44), and the Trauma Screening Questionnaire (ρ = 0.53). Two abbreviated versions of the CDS, retaining the best 14 or 7 items were proposed. LIMITATIONS The sample size remained moderate. CONCLUSIONS The CDS is a psychometrically sound, unidimensional measure with clinical impact to detect and characterize dissociative symptoms in BD patients. Establishing the reliability and validity of the abbreviated scales for screening necessitates further study.
Collapse
Affiliation(s)
- Maria Tuineag
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Mood disorders Psychopharmacology Unit, University of Toronto, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
| | - Sebastian Therman
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Maija Lindgren
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Manon Rouanet
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sara Nahon
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Lia Bertrand
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sybille Saury
- Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Suzanne Renaud
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| |
Collapse
|
12
|
Boysan M, Yıldırım A, Beşiroğlu L, Kefeli MC, Kağan M. Development and Preliminary Psychometric Properties of an Instrument for the Measurement of Obsessional Dissociative Experiences: The Van Obsessional Dissociation Questionnaire (VOD-Q). Psychiatr Q 2018; 89:549-568. [PMID: 29302772 DOI: 10.1007/s11126-017-9555-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A growing body of research evidence documents the substantial associations between obsessive-compulsive disorder (OCD) and dissociation. This article describes the development and preliminary psychometric properties of the Van Obsessional Dissociation Questionnaire (VOD-Q). Obsessional dissociation is defined as a tendency to dissociate in reaction to distressing, unwanted and intrusive thoughts, images and impulses. The screening tool is conceptualized to tap obsessional dissociation across three dimensions: obsessional absorption, obsessional depersonalization/ derealization and obsessional amnesia. The VOD-Q, the Padua Inventory-Revised (PI-R), the Dissociative Experiences Scale (DES), and the Obsessive Belief Questionnaire (OBQ-44) were administered in this study. The results showed that the VOD-Q had excellent test-retest reliability (ranging from 0.73 to 0.90) and internal consistency (ranging from 0.90 to 0.97). The VOD-Q total and subscale scores were significantly associated with measures of obsessive-compulsive symptoms and dissociative experiences. OCD patients scored significantly higher on the VOD-Q than community participants. Based on the present findings, the VOD-Q appears to be a reliable and valid instrument for the measurement of obsessional dissociative experiences.
Collapse
Affiliation(s)
- Murat Boysan
- Department of Psychology, Yüzüncü Yıl University Faculty of Social Sciences, Van, Turkey
| | - Abdullah Yıldırım
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Lütfullah Beşiroğlu
- Department of Psychiatry, Kâtip Çelebi University School of Medicine, İzmir, Turkey
| | - Mehmet Celal Kefeli
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Mücahit Kağan
- Department of Psychological Counseling, Erzincan University Faculty of Education, Erzincan, Turkey
| |
Collapse
|
13
|
Tapancı Z, Yıldırım A, Boysan M. Neurological soft signs, dissociation and alexithymia in patients with obsessive-compulsive disorder (OCD) and healthy subjects. Psychiatry Res 2018; 260:90-97. [PMID: 29175504 DOI: 10.1016/j.psychres.2017.11.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/09/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
A body of evidence has supported that patients with obsessive-compulsive disorder (OCD) have increased rates of various neurological soft signs (NSS) compared to controls. Various lines of research has documented robust relationships between OCD and dissociative symptomatology. The study aimed to examine the associations between obsessive-compulsive symptoms, dissociative experiences alexithymia, and NSS. The study included thirty OCD patients and thirty healthy controls, matched for age, marital status, education, and income. The Neurological Evaluation Scale (NES), Padua Inventory-Revised (PI-R), Dissociative Experiences Scale (DES) and Toronto Alexithymia Scale (TAS-20) were administered. In comparison to healthy controls, patients with OCD had difficulty sequencing for complex motor acts and greater absorption/ imaginative involvement. Using latent class analysis, the study sample was classified into two homogenous subsets as mild NSS (n = 45) and severe NSS (n = 15). Majority of the participants who were grouped into severe NSS latent class were OCD patient (n = 14, 93.3%). Furthermore, those with severe NSS reported greater levels of alexithymia and more severe obsessive-compulsive symptoms, particularly precision. We concluded that relationships between OCD severity and NSS appear to be of crucial importance. Our data along with accumulated evidence suggest that OCD associated with pronounced NSS may represent a specific subtype of the disorder.
Collapse
Affiliation(s)
- Zafer Tapancı
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Abdullah Yıldırım
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Murat Boysan
- Department of Psychology, Yüzüncü Yıl University Faculty of Social Sciences, Van, Turkey.
| |
Collapse
|
14
|
Kianpoor M, Rahmanian P, Mojahed A, Amouchie R. Secondary traumatic stress, dissociative and somatization symptoms in spouses of veterans with PTSD in Zahedan, Iran. Electron Physician 2017; 9:4202-4206. [PMID: 28607656 PMCID: PMC5459293 DOI: 10.19082/4202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/17/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Secondary traumatic stress is a disorder which occurs in spouses and people with close relation to someone with posttraumatic stress disorder. Like PTSD, it seems that STS also occurs with other psychiatric problems like somatization and dissociation. This study aimed to determine the relationship between STS and somatization and dissociation symptoms. Methods This cross-sectional study was done in 2015 and lasted for one year. Self-report questionnaires assessing secondary traumatic stress symptoms, dissociation symptoms and somatization symptoms were distributed among spouses of veterans with PTSD in Zahedan, Iran. The relationship between STS symptoms and somatization symptoms and also between STS symptoms and dissociation symptoms were determined by Pearson correlation test. SPSS version 23 was used for data analysis. Results Occurrence of secondary traumatic stress symptoms were correlated with dissociation symptoms and also with somatization symptoms. Conclusions As the rate of secondary traumatic stress rose, the rate of somatization and dissociation symptoms in spouses of veterans increased.
Collapse
Affiliation(s)
- Mohsen Kianpoor
- M.D. of Psychiatry, Associate Professor, Zahedan Medical School, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Parisa Rahmanian
- M.Sc. of Clinical Psychology, Zahedan Medical School, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Azizollah Mojahed
- Ph.D. of Clinical Psychology, Faculty Member of Psychology, Zahedan Medical School, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ramin Amouchie
- Clinical Psychology, Ph.D. Student, Department of Clinical Psychology, School of Behavior Science, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
15
|
Merckelbach H, Boskovic I, Pesy D, Dalsklev M, Lynn SJ. Symptom overreporting and dissociative experiences: A qualitative review. Conscious Cogn 2017; 49:132-144. [PMID: 28187372 DOI: 10.1016/j.concog.2017.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 10/05/2016] [Accepted: 01/23/2017] [Indexed: 02/07/2023]
Abstract
We discuss a phenomenon that has received little attention to date in research on dissociative phenomena, namely that self-reports of these phenomena overlap with the tendency to overendorse eccentric items. We review the literature documenting the dissociation-overreporting link and then briefly discuss various interpretations of this link: (1) overreporting is an artifact of measuring dissociative symptoms; (2) dissociative psychopathology engenders overreporting of eccentric symptoms through fantasy proneness or impairments in internal monitoring; (3) an overreporting response style as is evident in malingerers, for example, promotes reports of dissociative symptoms. These three interpretations are not mutually exclusive. Also, the dissociation-overreporting link may have different origins among different samples. Because overreporting may introduce noise in datasets, we need more research specifically aimed at disentangling the dissociation-overreporting link. We suggest various avenues to accomplish this goal.
Collapse
Affiliation(s)
- H Merckelbach
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands.
| | - I Boskovic
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - D Pesy
- Department of Neurology, Franziskus Hospital, Mönchengladbach, Germany
| | - M Dalsklev
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - S J Lynn
- Binghamton University - State University of New York, Binghamton, NY, USA
| |
Collapse
|
16
|
van Heugten-Van der Kloet D, Giesbrecht T, van Wel J, Bosker WM, Kuypers KPC, Theunissen EL, Spronk DB, Jan Verkes R, Merckelbach H, Ramaekers JG. MDMA, cannabis, and cocaine produce acute dissociative symptoms. Psychiatry Res 2015; 228:907-12. [PMID: 26003508 DOI: 10.1016/j.psychres.2015.04.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 03/31/2015] [Accepted: 04/18/2015] [Indexed: 11/16/2022]
Abstract
Some drugs of abuse may produce dissociative symptoms, but this aspect has been understudied. We explored the dissociative potential of three recreational drugs (3,4-methylenedioxymethamphetamine (MDMA), cannabis, and cocaine) during intoxication and compared their effects to literature reports of dissociative states in various samples. Two placebo-controlled studies were conducted. In Study 1 (N=16), participants received single doses of 25, 50, and 100 mg of MDMA, and placebo. In Study 2 (N=21), cannabis (THC 300 µg/kg), cocaine (HCl 300 mg), and placebo were administered. Dissociative symptoms as measured with the Clinician-Administered Dissociative States Scale (CADSS) significantly increased under the influence of MDMA and cannabis. To a lesser extent, this was also true for cocaine. Dissociative symptoms following MDMA and cannabis largely exceeded those observed in schizophrenia patients, were comparable with those observed in Special Forces soldiers undergoing survival training, but were lower compared with ketamine-induced dissociation. Cocaine produced dissociative symptoms that were comparable with those observed in schizophrenia patients, but markedly less than those in Special Forces soldiers and ketamine users. Thus, MDMA and cannabis can produce dissociative symptoms that resemble dissociative pathology. The study of drug induced dissociation is important, because it may shed light on the mechanisms involved in dissociative psychopathology.
Collapse
Affiliation(s)
- Dalena van Heugten-Van der Kloet
- Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Timo Giesbrecht
- Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Janelle van Wel
- Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Wendy M Bosker
- Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Kim P C Kuypers
- Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Eef L Theunissen
- Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Desirée B Spronk
- Department of Psychiatry (966), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Robbert Jan Verkes
- Department of Psychiatry (966), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Harald Merckelbach
- Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | | |
Collapse
|
17
|
van Heugten-van der Kloet D, Giesbrecht T, Merckelbach H. Sleep loss increases dissociation and affects memory for emotional stimuli. J Behav Ther Exp Psychiatry 2015; 47:9-17. [PMID: 25462597 DOI: 10.1016/j.jbtep.2014.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/29/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Because of their dreamlike character, authors have speculated about the role that the sleep-wake cycle plays in dissociative symptoms. We investigated whether sleep loss fuels dissociative symptoms and undermines cognitive efficiency, particularly memory functioning. METHODS Fifty-six healthy undergraduate students were randomly assigned to an experimental group (n = 28) and a control group (n = 28). The experimental group was deprived of sleep for 36 h in a sleep laboratory; the control group had a regular night of sleep. Sleepiness, mood, and dissociative symptoms were assessed 6 times in the experimental group (control group: 4 times). Several cognitive tasks were administered. RESULTS Sleep deprivation led to an increase in dissociative symptoms, which was mediated by levels of general distress. Feelings of sleepiness preceded an increase of dissociative symptoms and deterioration of mood. Finally, sleep loss also undermined memory of emotional material, especially in highly dissociative individuals. LIMITATIONS Limitations included moderate reliability of the mood scale, limited generalizability due to student sample, and a relatively short period of intensive sleep deprivation rather than lengthy but intermittent sleep loss, representative of a clinical population. CONCLUSIONS We found that sleep deprivation had significant effects on dissociation, sleepiness, and mood. Specifically, sleepiness and dissociation increased during the night, while mood deteriorated. Our findings stress the importance of sleep deficiencies in the development of dissociative symptoms. They support the view that sleep disruptions fuel distress, but also degrade memory and attentional control. It is against this background that dissociative symptoms may arise.
Collapse
|
18
|
Colizzi M, Costa R, Todarello O. Dissociative symptoms in individuals with gender dysphoria: is the elevated prevalence real? Psychiatry Res 2015; 226:173-80. [PMID: 25656174 DOI: 10.1016/j.psychres.2014.12.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/26/2014] [Accepted: 12/31/2014] [Indexed: 02/03/2023]
Abstract
This study evaluated dissociative symptomatology, childhood trauma and body uneasiness in 118 individuals with gender dysphoria, also evaluating dissociative symptoms in follow-up assessments after sex reassignment procedures were performed. We used both clinical interviews (Dissociative Disorders Interview Schedule) and self-reported scales (Dissociative Experiences Scale). A dissociative disorder of any kind seemed to be greatly prevalent (29.6%). Moreover, individuals with gender dysphoria had a high prevalence of lifetime major depressive episode (45.8%), suicide attempts (21.2%) and childhood trauma (45.8%), and all these conditions were more frequent in patients who fulfilled diagnostic criteria for any kind of dissociative disorder. Finally, when treated, patients reported lower dissociative symptoms. Results confirmed previous research about distress in gender dysphoria and improved mental health due to sex reassignment procedures. However, it resulted to be difficult to ascertain dissociation in the context of gender dysphoria, because of the similarities between the two conditions and the possible limited application of clinical instruments which do not provide an adequate differential diagnosis. Therefore, because the body uneasiness is common to dissociative experiences and gender dysphoria, the question is whether dissociation is to be seen not as an expression of pathological dissociative experiences but as a genuine feature of gender dysphoria.
Collapse
Affiliation(s)
- Marco Colizzi
- Department of Medical Basic Sciences, Neuroscience and Sense Organs, University of Bari, BA 70124, Italy.
| | - Rosalia Costa
- Department of Medical Basic Sciences, Neuroscience and Sense Organs, University of Bari, BA 70124, Italy
| | - Orlando Todarello
- Department of Medical Basic Sciences, Neuroscience and Sense Organs, University of Bari, BA 70124, Italy
| |
Collapse
|