Impact of dissociation on treatment of depressive and anxiety spectrum disorders with and without personality disorders.

PubMed

Prasko, Jan; Grambal, Ales; Kasalova, Petra; Kamardova, Dana; Ociskova, Marie; Holubova, Michaela; Vrbova, Kristyna; Sigmundova, Zuzana; Latalova, Klara; Slepecky, Milos; Zatkova, Marta

2016-01-01

The central goal of the study was to analyze the impact of dissociation on the treatment effectiveness in patients with anxiety/neurotic spectrum and depressive disorders with or without comorbid personality disorders. The research sample consisted of inpatients who were hospitalized in the psychiatric department and met the ICD-10 criteria for diagnosis of depressive disorder, panic disorder, generalized anxiety disorder, mixed anxiety-depressive disorder, agoraphobia, social phobia, obsessive compulsive disorder, posttraumatic stress disorder, adjustment disorders, dissociative/conversion disorders, somatoform disorder, or other anxiety/neurotic spectrum disorder. The participants completed these measures at the start and end of the therapeutic program - Beck Depression Inventory, Beck Anxiety Inventory, a subjective version of Clinical Global Impression-Severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale. A total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment on an outpatient basis and were referred for hospitalization for the 6-week complex therapeutic program, were enrolled in this study. Of them, 606 were statistically analyzed. Data from the remaining 234 (27.86%) patients were not used because of various reasons (103 prematurely finished the program, 131 did not fill in most of the questionnaires). The patients' mean ratings on all measurements were significantly reduced during the treatment. Also, 67.5% reached at least minimal improvement (42.4% showed moderate and more improvement, 35.3% of the patients reached remission). The patients without comorbid personality disorder improved more significantly in the reduction of depressive symptoms than those with comorbid personality disorder. However, there were no significant differences in change in anxiety levels and severity of the mental issues between the patients with and without personality disorders. Higher degree of dissociation at the beginning of the treatment predicted minor improvement, and also, higher therapeutic change was connected to greater reduction of the dissociation level. Dissociation is an important factor that influences the treatment effectiveness in anxiety/depression patients with or without personality disorders resistant to previous treatment. Targeting dissociation in the treatment of these disorders may be beneficial.

Self-Injury and Suicide Attempt in Relation with Trauma and Dissociation among Adolescents with Dissociative and Non-Dissociative Disorders.

PubMed

Kılıç, Filiz; Coşkun, Murat; Bozkurt, Hasan; Kaya, İlyas; Zoroğlu, Salih

2017-03-01

To explore the role of trauma and dissociation over self-injurious behaviors (SIB) and suicide attempts (SA) in adolescents. A total of 207 adolescents participated in the study. After conducting diagnostic interview, participants were divided into five groups as subjects with dissociative disorders (DD), attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD) and anxiety disorders (AD), and a control group (CG) without any psychiatric disorder. ADHD, MDD and AD groups were considered as non-dissociative disorders (non-DD group) in the present study. There is no significant difference between groups in terms of number and age of the subjects (p>0.05). Among all participants SIB was reported in 32.2% of females (n=37) and 25% of males (n=23) while SA was reported in 29.6% of females (n=34) and 4.4% of males (n=4). Adolescents with DD were found to experience higher rates of SIB and SA than the other groups. Dissociation was the most important variable contributing to SIB and female gender was the most efficient variable for SA. Total trauma scores were also found to be significantly higher in DD group followed by non-DD and CG respectively. SIB and SA are complex behavioral problems which may be associated with many psychiatric factors. However higher level dissociation seems as an important mediating factor, even regardless of psychiatric diagnosis, in the development of SIB and SA. More research is needed to further explore the factors effective over SIB and SA in adolescents.

Commentary on the Inclusion of Persistent Complex Bereavement-Related Disorder in DSM-5

ERIC Educational Resources Information Center

Boelen, Paul A.; Prigerson, Holly G.

2012-01-01

The DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group has proposed criteria for Persistent Complex Bereavement-Related Disorder (PCBRD) for inclusion in the appendix of DSM-5. The authors feel that it is important that dysfunctional grief will become a formal condition in DSM-5 because that would…

Dissociation: Defining the Concept in Criminal Forensic Psychiatry.

PubMed

Bourget, Dominique; Gagné, Pierre; Wood, Stephen Floyd

2017-06-01

Claims of amnesia and dissociative experiences in association with a violent crime are not uncommon. Research has shown that dissociation is a risk factor for violence and is seen most often in crimes of extreme violence. The subject matter is most relevant to forensic psychiatry. Peritraumatic dissociation for instance, with or without a history of dissociative disorder, is quite frequently reported by offenders presenting for a forensic psychiatric examination. Dissociation or dissociative amnesia for serious offenses can have legal repercussions stemming from their relevance to the legal constructs of fitness to stand trial, criminal responsibility, and diminished capacity. The complexity in forensic psychiatric assessments often lies in the difficulty of connecting clinical symptomatology reported by violent offenders to a specific condition included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This article provides a review of diagnostic considerations with regard to dissociation across the DSM nomenclature, with a focus on the main clinical constructs related to dissociation. Forensic implications are discussed, along with some guides for the forensic evaluator of offenders presenting with dissociation. © 2017 American Academy of Psychiatry and the Law.

Psychotherapeutic treatment of eating disorders improve dissociative experiences and impulse regulation but not alexithymia. A case series report.

PubMed

Caslini, Manuela; Rivolta, Laura; Zappa, Luigi Enrico; Carrà, Giuseppe; Clerici, Massimo

2015-01-01

Eating disorders (EDs) are complex conditions associated with disability and a high rate of mortality. Typical characteristics of these diseases are dissociation, alexithymia and impulse dysregulation, all strategies dealing with negative emotions and regulate negative affect and anxiety. Our study aimed to assess the effectiveness of intensive psychological treatment for EDs, with particular reference to the above mentioned clinical characteristics. Eight outpatients with eating disorders in psychotherapeutic treatment were evaluated in two stages after one year (T1 and T2), using the Eating Disorder Inventory II, the Toronto Alexithymia Scale 20, and the Dissociative Experiences Scale. Wilcoxon test showed significant reductions in DES score as well as in two subscales of the EDI-2, Impulse Regulation and Body Dissatisfaction (I-EDI2 and BD-EDI2), while alexithymia levels did not show any difference. We can confirm the effectiveness of psychotherapy in people with EDs as regards dissociative moments, impulsivity and body dissatisfaction. However, alexithymia remains unchanged, possibly because of its deep emotional nature.

Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder.

PubMed

Brand, Bethany L; Sar, Vedat; Stavropoulos, Pam; Krüger, Christa; Korzekwa, Marilyn; Martínez-Taboas, Alfonso; Middleton, Warwick

2016-01-01

Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted.

Helium defectoscopy of cerium gadolinium ceramics Ce0.8Gd0.2O1.9 with a submicrocrystalline structure in the impurity disorder region

NASA Astrophysics Data System (ADS)

Koromyslov, A. V.; Zhiganov, A. N.; Kovalenko, M. A.; Kupryazhkin, A. Ya.

2013-12-01

The concentration of impurity anion vacancies formed upon the dissociation of gadolinium-vacancy complexes has been determined using helium defectoscopy of the cerium gadolinium ceramics Ce0.8Gd0.2O1.9 with a submicrocrystalline structure in the temperature range T = 740-1123 K and at saturation pressures ranging from 0.05 to 15 MPa. It has been found that the energy of dissociation of gadoliniumvacancy complexes is E {eff/ D }= 0.26 ± 0.06 eV, and the energy of dissolution of helium in anion vacancies in the impurity disorder region is E P = -0.31 ± 0.09 eV. The proposed mechanism of dissolution has been confirmed by the investigation of the electrical conductivity of the cerium gadolinium ceramics, as well as by the high-speed molecular dynamics simulation of the dissociation of gadolinium-vacancy complexes. It has been assumed that a decrease in the effective dissolution energy in comparison with the results of the previously performed low-temperature investigations is caused by the mutual repulsion of vacancies formed upon the dissociation of gadolinium-vacancy complexes in highly concentrated solutions of gadolinium in CeO2 with increasing temperature.

Where are we going? An update on assessment, treatment, and neurobiological research in dissociative disorders as we move toward the DSM-5.

PubMed

Brand, Bethany L; Lanius, Ruth; Vermetten, Eric; Loewenstein, Richard J; Spiegel, David

2012-01-01

This article provides an overview of the process of developing the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association with a focus on issues related to the trauma-related disorders, particularly the dissociative disorders (DD). We also discuss the highlights of research within the past 5 years in the assessment, treatment, and neurobiological basis of trauma disorders. Recent research shows that DD are associated with severe symptoms as well as a higher rate of utilization of mental health treatment compared with other psychiatric disorders. As a result, DD, like other complex posttraumatic disorders, exact a high economic as well as personal burden for patients and society. The latest research indicates that DD patients show a suboptimal response to standard exposure-based treatments for posttraumatic stress disorder as well as high levels of attrition from treatment. An emerging body of research on DD treatment, primarily of naturalistic and open trials, indicates that patients who receive specialized treatment that addresses their trauma-based, dissociative symptoms show improved functioning and reduced symptoms. Recent studies of the underlying neurobiological basis for dissociation support a model of excessive limbic inhibition in DD that is consistent with the phenomenology and clinical presentation of these patients. We are optimistic that the forthcoming DSM-5 will stimulate research on dissociation and the DD and suggest areas for future studies.

Psychiatric symptoms and dissociation in conversion, somatization and dissociative disorders.

PubMed

Espirito-Santo, Helena; Pio-Abreu, Jose Luis

2009-03-01

Conversion, dissociation and somatization are historically related in the long established concept of hysteria. Somewhere along the way they were separated due to the Cartesian dualistic view. The aim of the present study was to compare these pathologies and investigate whether symptoms of these pathologies overlap in their clinical appearance in a Portuguese sample. Twenty-six patients with conversion disorder, 38 with dissociative disorders, 40 with somatization disorder, and a comparison group of 46 patients having other psychiatric disorders answered questions about dissociation (Dissociative Experiences Scale), somatoform dissociation (Somatoform Dissociation Questionnaire), and psychopathological symptoms (Brief Symptom Inventory). Dissociative and somatoform symptoms were significantly more frequent in dissociative and conversion disorder than in somatization disorder and controls. There were no significant differences between dissociative and conversion patients. Conversion disorder is closely related to dissociative disorders. These results support the ICD-10 categorization of conversion disorder among dissociative disorders and the hypothesis of analogous psychopathological processes in conversion and dissociative disorders versus somatization disorder.

Group Therapy for Survivors of Severe Childhood Abuse: Repairing the Social Contract.

ERIC Educational Resources Information Center

Scott, Wayne

1999-01-01

Presents a model for conducting time-limited group therapy with adult survivors of severe childhood abuse who were diagnosed with complex post-traumatic and dissociative disorders. Group sessions are organized around verbal promises that encourage the client's active, attentive engagement. Gentle confrontation of dissociative defenses is integral…

Dissociative identity disorder: An empirical overview.

PubMed

Dorahy, Martin J; Brand, Bethany L; Sar, Vedat; Krüger, Christa; Stavropoulos, Pam; Martínez-Taboas, Alfonso; Lewis-Fernández, Roberto; Middleton, Warwick

2014-05-01

Despite its long and auspicious place in the history of psychiatry, dissociative identity disorder (DID) has been associated with controversy. This paper aims to examine the empirical data related to DID and outline the contextual challenges to its scientific investigation. The overview is limited to DID-specific research in which one or more of the following conditions are met: (i) a sample of participants with DID was systematically investigated, (ii) psychometrically-sound measures were utilised, (iii) comparisons were made with other samples, (iv) DID was differentiated from other disorders, including other dissociative disorders, (v) extraneous variables were controlled or (vi) DID diagnosis was confirmed. Following an examination of challenges to research, data are organised around the validity and phenomenology of DID, its aetiology and epidemiology, the neurobiological and cognitive correlates of the disorder, and finally its treatment. DID was found to be a complex yet valid disorder across a range of markers. It can be accurately discriminated from other disorders, especially when structured diagnostic interviews assess identity alterations and amnesia. DID is aetiologically associated with a complex combination of developmental and cultural factors, including severe childhood relational trauma. The prevalence of DID appears highest in emergency psychiatric settings and affects approximately 1% of the general population. Psychobiological studies are beginning to identify clear correlates of DID associated with diverse brain areas and cognitive functions. They are also providing an understanding of the potential metacognitive origins of amnesia. Phase-oriented empirically-guided treatments are emerging for DID. The empirical literature on DID is accumulating, although some areas remain under-investigated. Existing data show DID as a complex, valid and not uncommon disorder, associated with developmental and cultural variables, that is amenable to psychotherapeutic intervention.

Are major dissociative disorders characterized by a qualitatively different kind of dissociation?

PubMed

Rodewald, Frauke; Dell, Paul F; Wilhelm-Gossling, Claudia; Gast, Ursula

2011-01-01

A total of 66 patients with a major dissociative disorder, 54 patients with nondissociative disorders, and 30 nonclinical controls were administered the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised, the Dissociative Experiences Scale, the Multidimensional Inventory of Dissociation, and the Symptom Checklist 90-Revised. Dissociative patients reported significantly more dissociative and nondissociative symptoms than did nondissociative patients and nonclinical controls. When general psychopathology was controlled, the dissociation scores of dissociative patients were still significantly higher than those of both other groups, whereas the dissociation scores of nondissociative patients and nonclinical controls no longer differed. These findings appear to be congruent with a typological model of dissociation that distinguishes between 2 qualitatively different kinds of dissociation. Specifically, the results of this study suggest that the dissociation that occurs in major dissociative disorders (i.e., dissociative identity disorder [DID] and dissociative disorder not otherwise specified, Type 1 [DDNOS-1]) is qualitatively different from the dissociation that occurs in persons who do not have a dissociative disorder. In contrast to previous research, the dissociation of persons who do not have a dissociative disorder is not limited to absorption; it covers a much wider range of phenomena. The authors hypothesize that different mechanisms produce the dissociation of persons with DID and DDNOS-1 as opposed to the dissociation of persons who do not have a dissociative disorder.

Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder

PubMed Central

Brand, Bethany L.; Sar, Vedat; Stavropoulos, Pam; Krüger, Christa; Korzekwa, Marilyn; Martínez-Taboas, Alfonso; Middleton, Warwick

2016-01-01

Abstract Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted. PMID:27384396

Psychotherapy and pharmacotherapy for patients with dissociative identity disorder.

PubMed

Gentile, Julie P; Dillon, Kristy S; Gillig, Paulette Marie

2013-02-01

There is a wide variety of what have been called "dissociative disorders," including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Some of these diagnoses, particularly dissociative identity disorder, are controversial and have been questioned by many clinicians over the years. The disorders may be under-diagnosed or misdiagnosed, but many persons who have experienced trauma report "dissociative" symptoms. Prevalence of dissociative disorders is unknown, but current estimates are higher than previously thought. This paper reviews clinical, phenomenological, and epidemiological data regarding diagnosis in general, and illustrates possible treatment interventions for dissociative identity disorder, with a focus on psychotherapy interventions and a review of current psychopharmacology recommendations as part of a comprehensive multidisciplinary treatment plan.

38 CFR 4.130 - Schedule of ratings-mental disorders.

Code of Federal Regulations, 2012 CFR

2012-07-01

... disorder and/or agoraphobia 9413Anxiety disorder, not otherwise specified Dissociative Disorders 9416Dissociative amnesia; dissociative fugue; dissociative identity disorder (multiple personality disorder...

38 CFR 4.130 - Schedule of ratings-mental disorders.

Code of Federal Regulations, 2014 CFR

2014-07-01

... disorder and/or agoraphobia 9413Anxiety disorder, not otherwise specified Dissociative Disorders 9416Dissociative amnesia; dissociative fugue; dissociative identity disorder (multiple personality disorder...

38 CFR 4.130 - Schedule of ratings-mental disorders.

Code of Federal Regulations, 2013 CFR

2013-07-01

... disorder and/or agoraphobia 9413Anxiety disorder, not otherwise specified Dissociative Disorders 9416Dissociative amnesia; dissociative fugue; dissociative identity disorder (multiple personality disorder...

Childhood Traumatic Experiences, Dissociative Symptoms, and Dissociative Disorder Comorbidity Among Patients With Panic Disorder: A Preliminary Study.

PubMed

Ural, Cenk; Belli, Hasan; Akbudak, Mahir; Tabo, Abdulkadir

2015-01-01

This study assessed childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with panic disorder (PD). A total of 92 psychotropic drug-naive patients with PD, recruited from outpatient clinics in the psychiatry department of a Turkish hospital, were involved in the study. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), Dissociation Questionnaire, Panic and Agoraphobia Scale, Panic Disorder Severity Scale, and Childhood Trauma Questionnaire. Of the patients with PD, 18 (19%) had a comorbid dissociative disorder diagnosis on screening with the SCID-D. The most prevalent disorders were dissociative disorder not otherwise specified, dissociative amnesia, and depersonalization disorders. Patients with a high degree of dissociation symptoms and dissociative disorder comorbidity had more severe PD than those without (p < .05). All of the childhood trauma subscales used were correlated with the severity of symptoms of dissociation and PD. Among all of the subscales, the strongest relationship was with childhood emotional abuse. Logistic regression analysis showed that emotional abuse and severity of PD were independently associated with dissociative disorder. In our study, a significant proportion of the patients with PD had concurrent diagnoses of dissociative disorder. We conclude that the predominance of PD symptoms at admission should not lead the clinician to overlook the underlying dissociative process and associated traumatic experiences among these patients.

The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry

PubMed Central

2014-01-01

It has been claimed that the progress of psychiatry has lagged behind that of other medical disciplines over the last few decades. This may suggest the need for innovative thinking and research in psychiatry, which should consider neglected areas as topics of interest in light of the potential progress which might be made in this regard. This review is concerned with one such field of psychiatry: dissociation and dissociative disorders. Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity. While dissociative identity disorder (DID) is the most pervasive condition of all dissociative disorders, partial representations of this spectrum may be diagnosed as dissociative amnesia (with or without fugue), depersonalization disorder, and other specified dissociative disorders such as subthreshold DID, dissociative trance disorder, acute dissociative disorders, and identity disturbances due to exposure to oppression. In addition to constituting disorders in their own right, dissociation may accompany almost every psychiatric disorder and operate as a confounding factor in general psychiatry, including neurobiological and psycho-pharmacological research. While an anti- dissociative drug does not yet exist, appropriate psychotherapy leads to considerable improvement for many patients with dissociative disorders. PMID:25598819

[Epidemiological and clinical characteristics of dissociative disorders and somatoform disorders in Burkina Faso].

PubMed

Karfo, K; Barro, Y; Ouédraogo, A

2012-02-01

The aim of this study was to determine the epidemiological and clinical features of dissociative and somatoform disorders in the psychiatry department of the Centre Hospitalier Universitaire Yalgado Ouédraogo, in Burkina Faso. We carried out a retrospective and descriptive study over five years, from January 2003 to December 2007, of patients admitted in the psychiatric department for dissociative and somatoform disorders. The data were extracted from the medical notes and registers of consultation. After identification of the patients, the medical notes were exploited with a structured collect form for data on sociodemographic characteristics, life events and ICD-10 diagnoses. All the data were recorded by the same person. Data analysis was performed with Epi info 2007. During a period of 5 years, 3967 patients were registered, 179 had the diagnosis of dissociative and somatoform disorders (3.65% of the admissions) and 145 were included in our study. The majority of the patients were followed as outpatients (71%). Women were more represented with a sex ratio of four women to one man. The majority of the patients were young with an average age of 30 and mostly single (57.9%). The majority of the patients had a low academic standard, in connection with young age of the population. A striking biographic event was found in the majority of the cases; essentially family difficulties and death. Neurological symptoms were the most frequent in 63% of the cases. According to ICD-1O, dissociative disorders were most frequent (65.6%). Depression was mainly associated in15 cases. Dissociative disorders and somatoform disorders are frequent in our hospital; we must overcome the difficulties due to the complexity of the diagnosis and the cultural resistances to modern health care to determine the real prevalence of these disorders among the population in Burkina Faso. Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

[Differential diagnosis between dissociative disorders and schizophrenia].

PubMed

Shibayama, Masatoshi

2011-01-01

The differential diagnosis of dissociative disorders includes many psychiatric disorders, such as schizophrenia, bipolar disorders (especially bipolar II disorder), depressive disorder (especially atypical depression), epilepsy, Asperger syndrome, and borderline personality disorder. The theme of this paper is the differential diagnosis between dissociative disorders and schizophrenia. Schneiderian first-rank symptoms in schizophrenia are common in dissociative disorders, especially in dissociative identity disorder (DID). Many DID patients have been misdiagnosed as schizophrenics and treated with neuroleptics. We compared and examined Schneiderian symptoms of schizophrenia and those of dissociative disorders from a structural viewpoint. In dissociative disorders, delusional perception and somatic passivity are not seen. "Lateness" and "Precedence of the Other" originated from the concept of "Pattern Reversal" (H. Yasunaga)" is characteristic of schizophrenia. It is important to check these basic structure of schizophrenia in subjective experiences in differential diagnosis between dissociative disorders and schizophrenia.

Psychotherapy and Pharmacotherapy for Patients with Dissociative Identity Disorder

PubMed Central

Gentile, Julie P.; Dillon, Kristy S.

2013-01-01

There is a wide variety of what have been called “dissociative disorders,” including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Some of these diagnoses, particularly dissociative identity disorder, are controversial and have been questioned by many clinicians over the years. The disorders may be under-diagnosed or misdiagnosed, but many persons who have experienced trauma report “dissociative” symptoms. Prevalence of dissociative disorders is unknown, but current estimates are higher than previously thought. This paper reviews clinical, phenomenological, and epidemiological data regarding diagnosis in general, and illustrates possible treatment interventions for dissociative identity disorder, with a focus on psychotherapy interventions and a review of current psychopharmacology recommendations as part of a comprehensive multidisciplinary treatment plan. PMID:23556139

Dissociative disorders in a psychiatric institute in India--a selected review and patterns over a decade.

PubMed

Chaturvedi, Santosh K; Desai, Geetha; Shaligram, Deepika

2010-09-01

The prevalence--and type--of dissociative disorders is considered to vary across cultures and over time. The aim of the study was to examine patterns of dissociative disorders among subjects attending psychiatric services over a period of 10 years. The sample consisted of both inpatients and outpatients attending a psychiatric hospital between 1999 and 2008. Information of those subjects diagnosed to have dissociative disorders was reviewed. A semi-structured proforma was used to collect information about demographic details and diagnosis. A total of 893 patients had been diagnosed with dissociative disorder over the past decade: 591 (66%) were outpatients and 302 (34%) were inpatients. The proportion of patients diagnosed with dissociative disorders ranged between 1.5 and 15.0 per 1,000 for outpatients and between 1.5 and 11.6 per 1,000 for inpatients. The majority of patients were diagnosed with dissociative motor disorder (43.3% outpatients, 37.7% inpatients), followed by dissociative convulsions (23% outpatients, 27.8% inpatients). Female preponderance was seen across all sub-types of dissociative disorder except dissociative fugue. Dissociative disorders are still commonly diagnosed in both inpatient and outpatient settings. Dissociative motor disorders and dissociative convulsions are the most common disorders. Unlike in the West, dissociative identity disorders were rarely diagnosed; instead, possession states were commonly seen in the Indian population, indicating cross-cultural disparity.

Psychiatric comorbidity in patients with conversion disorder and prevalence of dissociative symptoms.

PubMed

Yayla, Sinan; Bakım, Bahadır; Tankaya, Onur; Ozer, Omer Akil; Karamustafalioglu, Oguz; Ertekin, Hulya; Tekin, Atilla

2015-01-01

The 1st objective of the current study was to investigate the frequency and types of dissociative symptoms in patients with conversion disorder (CD). The 2nd objective of the current study was to determine psychiatric comorbidity in patients with and without dissociative symptoms. A total of 54 consecutive consenting patients primarily diagnosed with CD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria who were admitted to the psychiatric emergency outpatient clinic of Sisli Etfal Research and Teaching Hospital (Istanbul, Turkey) were included in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders, Structured Interview for DSM-IV Dissociative Disorders, and Dissociative Experiences Scale were administered. Study groups consisted of 20 patients with a dissociative disorder and 34 patients without a diagnosis of any dissociative disorder. A total of 37% of patients with CD had any dissociative diagnosis. The prevalence of dissociative disorders was as follows: 18.5% dissociative disorder not otherwise specified, 14.8% dissociative amnesia, and 3.7% depersonalization disorder. Significant differences were found between the study groups with respect to comorbidity of bipolar disorder, past hypomania, and current and past posttraumatic stress disorder (ps = .001, .028, .015, and .028, respectively). Overall comorbidity of bipolar disorder was 27.8%. Psychiatric comorbidity was higher and age at onset was earlier among dissociative patients compared to patients without dissociative symptoms. The increased psychiatric comorbidity and early onset of conversion disorder found in patients with dissociative symptoms suggest that these patients may have had a more severe form of conversion disorder.

Dissociative disorders and possession experiences in Israel: a comparison of opiate use disorder patients, Arab women subjected to domestic violence, and a nonclinical group.

PubMed

Somer, Eli; Ross, Colin; Kirshberg, Revital; Bakri, Rana Shawahdy; Ismail, Shefa

2015-02-01

This study examined the association between exposure to domestic violence and dissociative symptoms. A sample of 68 Israeli opiate use disorder patients in recovery, 80 battered Arab Israeli women, and 103 respondents from a community sample participated in structured interviews that included the Dissociative Disorders Interview Schedule (DDIS), the Dissociative Trance Disorder Interview Schedule (DTDIS), and the Dissociative Experiences Scale (DES). As predicted, community participants reported significantly less exposure to traumatizing events and lower levels of dissociative psychopathology than individuals sampled from specialized treatment centers. In all, 91% of battered female participants were taxon-positive for dissociative disorder with 1 of every 2 respondents reporting symptoms corresponding to dissociative amnesia and depersonalization disorder, suggesting that this group may be particularly vulnerable to dissociative psychopathology. Extrasensory and paranormal experiences (ESP) and dissociative trance disorder experiences were strongly related to dissociative experiences and features of dissociative identity disorder (DID). These statistical associations suggest that dissociative disorders and ESP/trance experiences may share an underlying construct. Further research is needed on trauma and dissociation among female victims of domestic abuse in patriarchal, collectivist societies, particularly in the Arab world. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Co-occurrence of dissociative identity disorder and borderline personality disorder.

PubMed

Ross, Colin A; Ferrell, Lynn; Schroeder, Elizabeth

2014-01-01

The literature indicates that, among individuals with borderline personality disorder, pathological dissociation correlates with a wide range of impairments and difficulties in psychological function. It also predicts a poorer response to dialectical behavior therapy for borderline personality disorder. We hypothesized that (a) dissociative identity disorder commonly co-occurs with borderline personality disorder and vice versa, and (b) individuals who meet criteria for both disorders have more comorbidity and trauma than individuals who meet criteria for only 1 disorder. We interviewed a sample of inpatients in a hospital trauma program using 3 measures of dissociation. The most symptomatic group was those participants who met criteria for both borderline personality disorder and dissociative identity disorder on the Dissociative Disorders Interview Schedule, followed by those who met criteria for dissociative identity disorder only, then those with borderline personality disorder only, and finally those with neither disorder. Greater attention should be paid to the relationship between borderline personality disorder and dissociative identity disorder.

Dissociative symptoms and dissociative disorders comorbidity in obsessive compulsive disorder: Symptom screening, diagnostic tools and reflections on treatment

PubMed Central

Belli, Hasan

2014-01-01

Borderline personality disorder, conversion disorder and obsessive compulsive disorder frequently have dissociative symptoms. The literature has demonstrated that the level of dissociation might be correlated with the severity of obsessive compulsive disorder (OCD) and that those not responding to treatment had high dissociative symptoms. The structured clinical interview for DSM-IV dissociative disorders, dissociation questionnaire, somatoform dissociation questionnaire and dissociative experiences scale can be used for screening dissociative symptoms and detecting dissociative disorders in patients with OCD. However, a history of neglect and abuse during childhood is linked to a risk factor in the pathogenesis of dissociative psychopathology in adults. The childhood trauma questionnaire-53 and childhood trauma questionnaire-40 can be used for this purpose. Clinicians should not fail to notice the hidden dissociative symptoms and childhood traumatic experiences in OCD cases with severe symptoms that are resistant to treatment. Symptom screening and diagnostic tools used for this purpose should be known. Knowing how to treat these pathologies in patients who are diagnosed with OCD can be crucial. PMID:25133142

Dissociative symptoms and dissociative disorders comorbidity in obsessive compulsive disorder: Symptom screening, diagnostic tools and reflections on treatment.

PubMed

Belli, Hasan

2014-08-16

Borderline personality disorder, conversion disorder and obsessive compulsive disorder frequently have dissociative symptoms. The literature has demonstrated that the level of dissociation might be correlated with the severity of obsessive compulsive disorder (OCD) and that those not responding to treatment had high dissociative symptoms. The structured clinical interview for DSM-IV dissociative disorders, dissociation questionnaire, somatoform dissociation questionnaire and dissociative experiences scale can be used for screening dissociative symptoms and detecting dissociative disorders in patients with OCD. However, a history of neglect and abuse during childhood is linked to a risk factor in the pathogenesis of dissociative psychopathology in adults. The childhood trauma questionnaire-53 and childhood trauma questionnaire-40 can be used for this purpose. Clinicians should not fail to notice the hidden dissociative symptoms and childhood traumatic experiences in OCD cases with severe symptoms that are resistant to treatment. Symptom screening and diagnostic tools used for this purpose should be known. Knowing how to treat these pathologies in patients who are diagnosed with OCD can be crucial.

Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder.

PubMed

van Dijke, Annemiek; Hopman, Juliette A B; Ford, Julian D

2018-01-01

Objective : Complex posttraumatic stress disorder (CPTSD) as defined by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) formulation is associated with childhood relational trauma and involves relational impairment, affect dysregulation, and identity alterations. However, the distinct contributions of relational impairment (operationalized in the form fears of closeness or abandonment), affect dysregulation (operationalized in the form of overregulation and under-regulation of affect), and identity alterations (operationalized in the form of positive or negative psychoform or somatoform dissociation) to the relationship between childhood trauma and CPTSD/DESNOS have not been systematically tested. Method and Results : In a clinical sample of adults diagnosed with severe and chronic psychiatric and personality disorders ( n  = 472; M  = 34.7 years, SD  = 10.1), structural equation modelling with bootstrap 95% confidence intervals demonstrated that the association between childhood trauma and CPTSD/DESNOS symptoms in adulthood was partially mediated by under-regulation of affect, negative psychoform dissociation, and adult relational fears of closeness and of abandonment. These results also were independent of the effects of borderline personality disorder (BPD) symptoms. Conclusions : Some, but not all, hypothesized components of the DESNOS formulation of CPTSD statistically mediate the relationship between childhood trauma and adult CPTSD/DESNOS. These relationships appear specific to CPTSD/DESNOS and not to the effects of another potential sequelae of childhood trauma BPD. Replication with prospective longitudinal studies is needed.

Oscillatory magnetic brain activity is related to dissociative symptoms and childhood adversities - A study in women with multiple trauma.

PubMed

Schalinski, I; Moran, J K; Elbert, T; Reindl, V; Wienbruch, C

2017-08-15

Individuals with trauma-related disorders are complex and heterogeneous; part of this complexity derives from additional psychopathology like dissociation as well as environmental adversities such as traumatic stress, experienced throughout the lifespan. Understanding the neurophysiological abnormalities in Post-traumatic stress disorder (PTSD) requires a simultaneous consideration of these factors. Resting state magnetoencephalography (MEG) recordings were obtained from 41 women with PTSD and comorbid depressive symptoms, and 16 healthy women. Oscillatory brain activity was extracted for five frequency bands and 11 source locations, and analyzed in relation to shutdown dissociation and adversity-related measures. Dissociative symptoms were related to increased delta and lowered beta power. Adversity-related measures modulated theta and alpha oscillatory power (in particular childhood sexual abuse) and differed between patients and controls. Findings are based on women with comorbid depressive symptoms and therefore may not be applicable for men or groups with other clinical profiles. In respect to childhood adversities, we had no reliable source for the early infancy. Trauma-related abnormalities in neural organization vary with both exposure to adversities as well as their potential to evoke ongoing shutdown responses. Copyright © 2017 Elsevier B.V. All rights reserved.

“I can’t tell whether it’s my hand”: a pilot study of the neurophenomenology of body representation during the rubber hand illusion in trauma-related disorders

PubMed Central

Rabellino, Daniela; Harricharan, Sherain; Frewen, Paul A.; Burin, Dalila; McKinnon, Margaret C.; Lanius, Ruth A.

2016-01-01

Background Early traumatic experiences are thought to be causal factors in the development of trauma-related dissociative experiences, including depersonalization and derealization. The rubber hand illusion (RHI), a well-known paradigm that measures multi-sensorial integration of a rubber hand into one’s own body representation, has been used to investigate alterations in the experience of body ownership and of body representation. Critically, however, it has never been studied in individuals with trauma-related disorders. Objective To investigate body representation distortions occurring in trauma-related disorders in response to the RHI. Method The RHI was administered to three individuals with the dissociative subtype of posttraumatic stress disorder (PTSD), and subjective, behavioral, cardiovascular and skin conductance responses were recorded. Results Participants’ subjective experiences of the RHI were differentiated and complex. The illusion was induced following both synchronous and asynchronous brushing and variably evoked subjective distress, depersonalization and derealization experiences, tonic immobility, increased physiological arousal and flashbacks. Conclusions The present findings point towards the RHI as a strong provocation stimulus that elicits individual patterns of symptom presentation, including experiences of distress and dissociation, in individuals with trauma-related disorders, including the dissociative subtype of PTSD. Highlights of the article The rubber hand illusion (RHI) elicits distress, tonic immobility, depersonalization and derealization, and autonomic responses in individuals with trauma-related disorders, including the dissociative subtype of posttraumatic stress disorder (PTSD). RHI effects related to body misrepresentation may trigger altered experiences related to body ownership. The RHI represents a promising paradigm for studying the neurophenomenology of body distortion in individuals experiencing trauma-related altered states of consciousness (TRASC). PMID:27876453

Dissociative Disorders Among Chinese Inpatients Diagnosed With Schizophrenia

PubMed Central

Yu, Junhan; Ross, Colin A.; Keyes, Benjamin B.; Li, Ying; Dai, Yunfei; Zhang, Tianhong; Wang, Lanlan; Fan, Qing; Xiao, Zeping

2010-01-01

The purpose of the study was to assess the prevalence of dissociative disorders in a sample of Chinese psychiatric inpatients. Participants in the study consisted of 569 consecutively admitted inpatients at Shanghai Mental Health Center, China, of whom 84.9% had a clinical diagnosis of schizophrenia based on the Chinese Classification and Diagnostic Criteria for Mental Disorders, Version 3 (CCMD-3). All participants completed a self-report measure of dissociation, the Dissociative Experiences Scale (DES) and none had a prior diagnosis of a dissociative disorder. Ninety-six randomly selected participants were interviewed with a structured interview, the Dissociative Disorders Interview Schedule (DDIS) and a clinical interview. These 96 patients did not differ significantly from the 473 patients who were not interviewed on any demographic measures or on the self-report measure dissociation. A total of 28 (15.3%, after weighting of the data) patients received a clinical diagnosis of a dissociative disorder based on DSM-IV-TR criteria. Dissociative identity disorder was diagnosed in 2 (0.53%, after weighting) patients. Compared to the patients without a dissociative disorder, patients with dissociative disorders were significantly more likely to report childhood abuse (57.1% versus 22.1%), but the two groups did not differ significantly on any demographic measures. Dissociative disorders were readily identified in an inpatient psychiatric population in China. PMID:20603768

Dissociative disorders among Chinese inpatients diagnosed with schizophrenia.

PubMed

Yu, Junhan; Ross, Colin A; Keyes, Benjamin B; Li, Ying; Dai, Yunfei; Zhang, Tianhong; Wang, Lanlan; Fan, Qing; Xiao, Zeping

2010-01-01

The purpose of this study was to assess the prevalence of dissociative disorders in a sample of Chinese psychiatric inpatients. Participants in the study were 569 consecutively admitted inpatients at Shanghai Mental Health Center, China, of whom 84.9% had a clinical diagnosis of schizophrenia based on the Chinese Classification and Diagnostic Criteria of Mental Disorders, Version 3. All participants completed a self-report measure of dissociation (the Dissociative Experiences Scale), and none had a prior diagnosis of a dissociative disorder. A total of 96 randomly selected participants were interviewed with a structured interview (the Dissociative Disorders Interview Schedule) and a clinical interview. These 96 patients did not differ significantly from the 473 patients who were not interviewed on any demographic measures or who did not complete the self-report dissociation measure. A total of 28 patients (15.3%, after weighting of the data) received a clinical diagnosis of a dissociative disorder based on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria. Dissociative identity disorder was diagnosed in 2 patients (0.53%, after weighting). Compared to the patients without a dissociative disorder, patients with dissociative disorders were significantly more likely to report childhood abuse (57.1% vs. 22.1%), but the 2 groups did not differ significantly on any demographic measures. Dissociative disorders were readily identified in an inpatient psychiatric population in China.

Reliability and validity of the Turkish version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D): a preliminary study.

PubMed

Kundakçi, Turgut; Sar, Vedat; Kiziltan, Emre; Yargiç, Ilhan L; Tutkun, Hamdi

2014-01-01

A total of 34 consecutive patients with dissociative identity disorder or dissociative disorder not otherwise specified were evaluated using the Turkish version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). They were compared with a matched control group composed of 34 patients who had a nondissociative psychiatric disorder. Interrater reliability was evaluated by 3 clinicians who assessed videotaped interviews conducted with 5 dissociative and 5 nondissociative patients. All subjects who were previously diagnosed by clinicians as having a dissociative disorder were identified as positive, and all subjects who were previously diagnosed as not having a dissociative disorder were identified as negative. The scores of the main symptom clusters and the total score of the SCID-D differentiated dissociative patients from the nondissociative group. There were strong correlations between the SCID-D and the Dissociative Experiences Scale total and subscale scores. These results are promising for the validity and reliability of the Turkish version of the SCID-D. However, as the present study was conducted on a predominantly female sample with very severe dissociation, these findings should not be generalized to male patients, to dissociative disorders other than dissociative identity disorder, or to broader clinical or nonclinical populations.

Childhood emotional abuse, dissociation, and suicidality among patients with drug dependency in Turkey.

PubMed

Tamar-Gurol, Defne; Sar, Vedat; Karadag, Figen; Evren, Cuneyt; Karagoz, Mustafa

2008-10-01

The aim of the present study was to determine the prevalence and correlates of dissociative disorders among patients with drug dependency. The Dissociative Experiences Scale (DES) was used to screen 104 consecutive patients at an addiction treatment center. Thirty-seven patients who had scores >or=30 were compared with 21 patients who scored <10 on the DES. Both groups were then evaluated using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for Dissociative Disorders (SCID-D). The interviewers were blind to the DES scores. Twenty-seven patients (26.0%) had a dissociative disorder according to the SCID-D. Dissociative patients were younger than the non-dissociative group. History of suicide attempt and/or childhood emotional abuse was significant predictors of a dissociative disorder. The majority (59.3%) of dissociative drug users reported that dissociative experiences had existed prior to substance use. More patients in the dissociative disorder than in the non-dissociative group stopped their treatment prematurely. A considerable proportion of drug users have a dissociative disorder, which may also interfere with treatment process. The relatively young age of this subgroup of patients and frequent reports of childhood emotional abuse underline potential preventive benefits of early intervention among adolescents with developmental trauma history and dissociative psychopathology.

Dissociative, depressive, and PTSD symptom severity as correlates of nonsuicidal self-injury and suicidality in dissociative disorder patients.

PubMed

Webermann, Aliya R; Myrick, Amie C; Taylor, Christina L; Chasson, Gregory S; Brand, Bethany L

2016-01-01

The present study investigates whether symptom severity can distinguish patients diagnosed with dissociative identity disorder and dissociative disorder not otherwise specified with a recent history of nonsuicidal self-injury (NSSI) and suicide attempts from those patients without recent self-harm. A total of 241 clinicians reported on recent history of patient NSSI and suicide attempts. Of these clinicians' patients, 221 completed dissociative, depressive, and posttraumatic stress disorder symptomatology measures. Baseline cross-sectional data from a naturalistic and prospective study of dissociative disorder patients receiving community treatment were utilized. Analyses evaluated dissociative, depressive, and posttraumatic stress disorder symptom severity as methods of classifying patients into NSSI and suicide attempt groupings. Results indicated that dissociation severity accurately classified patients into NSSI and suicidality groups, whereas depression severity accurately classified patients into NSSI groups. These findings point to dissociation and depression severity as important correlates of NSSI and suicidality in patients with dissociative disorders and have implications for self-harm prevention and treatment.

[Low dose naltrexone in the treatment of dissociative symptoms].

PubMed

Pape, W; Wöller, W

2015-03-01

Following the hypothesis that blocking opioid receptors leads to a decline in opiate-modulated dissociative phenomena, experiences with naltrexone as medication for dissociative symptoms have been gained since 1999 (mainly in doses of 25-100 mg/day). In this study patients with severe trauma-related and dissociative disorders were treated with naltrexone in doses of 2-6 mg/day (0.06 mg/kg body weight). The low dose treatment with naltrexone proved to be effective whereby 11 out of 15 patients reported immediate positive effects and 7 described a lasting helpful effect. The majority of patients who felt positive effects reported a clearer perception of both their surroundings and their inner life. Assessment of reality and dealing with it improved as did the perception of their own body and affects as well as self-regulation. The treatment was very low in side effects. Treatment with low-dose naltrexone may be a helpful element in the treatment of patients with complex posttraumatic stress disorder. However, it has to be realized that the decrease of dissociation may lead patients to a not yet resolvable challenge, in as much as dissociation had previously been a necessary mechanism of self-protection.

Dissociative disorders in DSM-5.

PubMed

Spiegel, David; Lewis-Fernández, Roberto; Lanius, Ruth; Vermetten, Eric; Simeon, Daphne; Friedman, Matthew

2013-01-01

The rationale, research literature, and proposed changes to the dissociative disorders and conversion disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are presented. Dissociative identity disorder will include reference to possession as well as identity fragmentation, to make the disorder more applicable to culturally diverse situations. Dissociative amnesia will include dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia but does not always include confused wandering or loss of personality identity. Depersonalization disorder will include derealization as well, since the two often co-occur. A dissociative subtype of posttraumatic stress disorder (PTSD), defined by the presence of depersonalization or derealization in addition to other PTSD symptoms, is being recommended, based upon new epidemiological and neuroimaging evidence linking it to an early life history of adversity and a combination of frontal activation and limbic inhibition. Conversion disorder (functional neurological symptom disorder) will likely remain with the somatic symptom disorders, despite considerable dissociative comorbidity.

Dissociative identity disorder among adolescents: prevalence in a university psychiatric outpatient unit.

PubMed

Sar, Vedat; Onder, Canan; Kilincaslan, Ayse; Zoroglu, Süleyman S; Alyanak, Behiye

2014-01-01

The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group.

Dissociative disorders in DSM-5.

PubMed

Spiegel, David; Loewenstein, Richard J; Lewis-Fernández, Roberto; Sar, Vedat; Simeon, Daphne; Vermetten, Eric; Cardeña, Etzel; Brown, Richard J; Dell, Paul F

2011-12-21

We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria. This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders. We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should include derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category. There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms. © 2011 Wiley Periodicals, Inc.

Dissociative disorders in DSM-5.

PubMed

Spiegel, David; Loewenstein, Richard J; Lewis-Fernández, Roberto; Sar, Vedat; Simeon, Daphne; Vermetten, Eric; Cardeña, Etzel; Dell, Paul F

2011-09-01

We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria. This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders. We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Should Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category. There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms. © 2011 Wiley-Liss, Inc.

Dissociative disorders in medical settings.

PubMed

MacPhee, Edward

2013-10-01

Despite the challenges of conducting research on dissociation and the dissociative disorders, our understanding has grown greatly over the past three decades, including our knowledge of the often overlooked sensorimotor manifestations of dissociation, more commonly referred to as somatoform dissociation. This article will first review the definitions and presentations of dissociation in general along with recent research on the concept of somatoform dissociation. Then, each of the dissociative disorders and conversion disorder will be discussed in further detail as well as how they might present in a medical setting. Current recommendations for diagnosis and treatment will also be provided.

Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder.

PubMed

Krause-Utz, Annegret; Frost, Rachel; Winter, Dorina; Elzinga, Bernet M

2017-01-01

Dissociation involves disruptions of usually integrated functions of consciousness, perception, memory, identity, and affect (e.g., depersonalization, derealization, numbing, amnesia, and analgesia). While the precise neurobiological underpinnings of dissociation remain elusive, neuroimaging studies in disorders, characterized by high dissociation (e.g., depersonalization/derealization disorder (DDD), dissociative identity disorder (DID), dissociative subtype of posttraumatic stress disorder (D-PTSD)), have provided valuable insight into brain alterations possibly underlying dissociation. Neuroimaging studies in borderline personality disorder (BPD), investigating links between altered brain function/structure and dissociation, are still relatively rare. In this article, we provide an overview of neurobiological models of dissociation, primarily based on research in DDD, DID, and D-PTSD. Based on this background, we review recent neuroimaging studies on associations between dissociation and altered brain function and structure in BPD. These studies are discussed in the context of earlier findings regarding methodological differences and limitations and concerning possible implications for future research and the clinical setting.

Somatoform and dissociative disorders in children and adolescents: A comparative study

PubMed Central

Malhotra, Savita; Singh, Gagandeep; Mohan, Ashwin

2005-01-01

Background: Somatoform and dissociative (conversion) disorders in adults have been reported to have a close relationship because of a diagnostic overlap and comparable aetiological models. The literature on these disorders in children and adolescents is scarce. Aim: The present study attempted to compare these two disorders in children and adolescents since antecedents of these disorders are said to be laid in childhood. Methods: Case files of 118 patients (69 of somatoform disorders and 49 of dissociative disorders) were reviewed and the two groups were compared with respect to sociodemographic profile, clinical profile, neurotic traits, behavioural problems, temperament, intelligence and family dysfunction. Results: Age at presentation and intelligence were significantly higher in those with somatoform disorders than in those with dissociative disorders. Patients with dissociative disorders had a significantly higher number of co-morbid somatoform symptoms. Conclusion: Somatoform and dissociative disorders are closely linked.

Three dimensions of dissociative amnesia.

PubMed

Dell, Paul F

2013-01-01

Principal axis factor analysis with promax rotation extracted 3 factors from the 42 memory and amnesia items of the Multidimensional Inventory of Dissociation (MID) database (N = 2,569): Discovering Dissociated Actions, Lapses of Recent Memory and Skills, and Gaps in Remote Memory. The 3 factors' shared variance ranged from 36% to 64%. Construed as scales, the 3 factor scales had Cronbach's alpha coefficients of .96, .94, and .93, respectively. The scales correlated strongly with mean Dissociative Experiences Scale scores, mean MID scores, and total scores on the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). What is interesting is that the 3 amnesia factors exhibited a range of correlations with SCID-D-R Amnesia scores (.52, .63, and .70, respectively), suggesting that the SCID-D-R Amnesia score emphasizes gaps in remote memory over amnesias related to dissociative identity disorder. The 3 amnesia factor scales exhibited a clinically meaningful pattern of significant differences among dissociative identity disorder, dissociative disorder not otherwise specified-1, dissociative amnesia, depersonalization disorder, and nonclinical participants. The 3 amnesia factors may have greater clinical utility for frontline clinicians than (a) amnesia as discussed in the context of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nosology of the dissociative disorders or (b) P. Janet's (1893/1977 ) 4-fold classification of dissociative amnesia. The author recommends systematic study of the phenomenological differences within specific dissociative symptoms and their differential relationship to specific dissociative disorders.

[Clinical Handling of Patients with Dissociative Disorders].

PubMed

Okano, Kenichiro

2015-01-01

This paper discusses the way informed psychiatrists are expected to handle dissociative patients in clinical situations, with a specific focus on dissociative identity disorders and dissociative fugue. On the initial interview with dissociative patients, information on their history of trauma and any nascent dissociative symptoms in their childhood should be carefully obtained. Their level of stress in their current life should also be assessed in order to understand their symptomatology, as well as to predict their future clinical course. A psychoeducational approach is crucial; it might be helpful to give information on dissociative disorder to these patients as well as their family members in order to promote their adherence to treatment. Regarding the symptomatology of dissociative disorders, detailed symptoms and the general clinical course are presented. It was stressed that dissociative identity disorder and dissociative fugue, the most high-profile dissociative disorders, are essentially different in their etiology and clinical presentation. Dissociative disorders are often confused with and misdiagnosed as psychotic disorders, such as schizophrenia. Other conditions considered in terms of the differential diagnosis include borderline personality disorder as well as temporal lobe epilepsy. Lastly, the therapeutic approach to dissociative identity disorder is discussed. Each dissociative identity should be understood as potentially representing some traumatically stressful event in the past. The therapist should be careful not to excessively promote the creation or elaboration of any dissociative identities. Three stages are proposed in the individual psychotherapeutic process. In the initial stage, a secure environment and stabilization of symptoms should be sought. The second stage consists of aiding the "host" personality to make use of other more adaptive coping skills in their life. The third stage involves coaching as well as continuous awareness of their comorbid psychiatric conditions. Lastly, factors preventing the patients' smooth recovery process are mentioned. They include their contact with past and current aggressors, chronic and ongoing stress within the family, including abuse and violence, and comorbid conditions such as depression and chronic medical conditions.

Reconsidering the autohypnotic model of the dissociative disorders.

PubMed

Dell, Paul F

2018-03-22

The dissociative disorders field and the hypnosis field currently reject the autohypnotic model of the dissociative disorders, largely because many correlational studies have shown hypnotizability and dissociation to be minimally related (r = .12). Curiously, it is also widely accepted that dissociative patients are highly hypnotizable. If dissociative patients are highly hypnotizable because only highly hypnotizable individuals can develop a dissociative disorder - as the author proposes - then the methodology of correlational studies of hypnotizability and dissociation in random clinical and community samples would necessarily be constitutively unable to detect, and statistically unable to reflect, that fact. That is, the autohypnotic, dissociative distancing of that small subset of highly hypnotizable individuals who repeatedly encountered intolerable circumstances is statistically lost among the data of (1) the highly hypnotizable subjects who do not dissociate and (2) subjects (of all levels of hypnotizability) who manifest other kinds of dissociation. The author proposes that, when highly hypnotizable individuals repeatedly engage in autohypnotic distancing from intolerable circumstances, they develop an overlearned, highly-motivated, automatized pattern of dissociative self-protection (i.e., a dissociative disorder). The author urges that theorists of hypnosis and the dissociative disorders explicitly include in their theories (a) the trait of high hypnotizability, (b) the phenomena of autohypnosis, and (c) the manifestations of systematized, autohypnotic pathology. Said differently, the author is suggesting that autohypnosis and autohypnotic pathology are unacknowledged nodes in the nomothetic networks of both hypnosis and dissociation.

Dissociation predicts treatment response in eye-movement desensitization and reprocessing for posttraumatic stress disorder.

PubMed

Bae, Hwallip; Kim, Daeho; Park, Yong Chon

2016-01-01

Using clinical data from a specialized trauma clinic, this study investigated pretreatment clinical factors predicting response to eye-movement desensitization and reprocessing (EMDR) among adult patients diagnosed with posttraumatic stress disorder (PTSD). Participants were evaluated using the Clinician-Administered PTSD Scale (CAPS), the Symptom Checklist-90-Revised, the Beck Depression Inventory, and the Dissociative Experiences Scale before treatment and were reassessed using the CAPS after treatment and at 6-month follow-up. A total of 69 patients underwent an average of 4 sessions of EMDR, and 60 (87%) completed the posttreatment evaluation, including 8 participants who terminated treatment prematurely. Intent-to-treat analysis revealed that 39 (65%) of the 60 patients were classified as responders and 21 (35%) as nonresponders when response was defined as more than a 30% decrease in total CAPS score. The nonresponders had higher levels of dissociation (depersonalization and derealization) and numbing symptoms, but other PTSD symptoms, such as avoidance, hyperarousal, and intrusion, were not significantly different. The number of psychiatric comorbidities was also associated with treatment nonresponse. The final logistic regression model yielded 2 significant variables: dissociation (p < .001) and more than 2 comorbidities compared to none (p < .05). These results indicate that complex symptom patterns in PTSD may predict treatment response and support the inclusion of the dissociative subtype of PTSD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Dissociative amnesia in dissociative disorders and borderline personality disorder: self-rating assessment in a college population.

PubMed

Sar, Vedat; Alioğlu, Firdevs; Akyuz, Gamze; Karabulut, Sercan

2014-01-01

Dissociative amnesia (DA) among subjects with a dissociative disorder and/or borderline personality disorder (BPD) recruited from a nonclinical population was examined. The Steinberg Dissociative Amnesia Questionnaire (SDAQ), the Childhood Trauma Questionnaire, and the self-report screening tool of the BPD section of the Structured Clinical Interview for DSM-IV(SCID-BPD) were administered to 1,301 college students. A total of 80 participants who were diagnosed with BPD according to the clinician-administered SCID-BPD and 111 nonborderline controls were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) by a psychiatrist blind to diagnosis and scale scores. Internal consistency analyses and test-retest evaluations suggested that the SDAQ is a reliable instrument for the population studied. Of the participants, 20.6% reported an SDAQ score of 20 or above and impairment by DA. Those who had both dissociative disorder and BPD (n = 78) had the highest SDAQ scores. Both disorders had significant effects on the SCID-D total and amnesia scores in the variance analysis. On SDAQ scores, however, only BPD had this effect. There was a significant interaction between the 2 disorders for the SCID-D total but not for the SDAQ or SCID-D amnesia scores. BPD represented the severity of dissociation and childhood trauma in this study group. However, in contrast to the dissociative disorders, BPD was characterized by better awareness of DA in self-report. The discrepancies between self-report and clinical interview associated with BPD and dissociative disorders are discussed in the context of betrayal theory (J. J. Freyd, 1994) of BPD and perceptual theory (D. B. Beere, 2009) of dissociative disorders.

An Archetype of the Collaborative Efforts of Psychotherapy and Psychopharmacology in Successfully Treating Dissociative Identity Disorder with Comorbid Bipolar Disorder

PubMed Central

Lakshmanan, Manu N.; Meier, Stacey L. Colton; Meier, Robert S.

2010-01-01

We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient’s comorbid bipolar disorder contributed to the patient’s instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method. PMID:20805917

An archetype of the collaborative efforts of psychotherapy and psychopharmacology in successfully treating dissociative identity disorder with comorbid bipolar disorder.

PubMed

Lakshmanan, Manu N; Meier, Stacey L Colton; Meier, Robert S; Lakshmanan, Ramaswamy

2010-07-01

We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient's comorbid bipolar disorder contributed to the patient's instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method.

Predicting stabilizing treatment outcomes for complex posttraumatic stress disorder and dissociative identity disorder: an expertise-based prognostic model.

PubMed

Baars, Erik W; van der Hart, Onno; Nijenhuis, Ellert R S; Chu, James A; Glas, Gerrit; Draijer, Nel

2011-01-01

The purpose of this study was to develop an expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). We developed a survey in 2 rounds: In the first round we surveyed 42 experienced therapists (22 DID and 20 complex PTSD therapists), and in the second round we surveyed a subset of 22 of the 42 therapists (13 DID and 9 complex PTSD therapists). First, we drew on therapists' knowledge of prognostic factors for stabilization-oriented treatment of complex PTSD and DID. Second, therapists prioritized a list of prognostic factors by estimating the size of each variable's prognostic effect; we clustered these factors according to content and named the clusters. Next, concept mapping methodology and statistical analyses (including principal components analyses) were used to transform individual judgments into weighted group judgments for clusters of items. A prognostic model, based on consensually determined estimates of effect sizes, of 8 clusters containing 51 factors for both complex PTSD and DID was formed. It includes the clusters lack of motivation, lack of healthy relationships, lack of healthy therapeutic relationships, lack of other internal and external resources, serious Axis I comorbidity, serious Axis II comorbidity, poor attachment, and self-destruction. In addition, a set of 5 DID-specific items was constructed. The model is supportive of the current phase-oriented treatment model, emphasizing the strengthening of the therapeutic relationship and the patient's resources in the initial stabilization phase. Further research is needed to test the model's statistical and clinical validity.

Temperament and character traits in patients with conversion disorder and their relations with dissociation.

PubMed

Sarisoy, Gökhan; Kaçar, Ö Mer Faruk; Öztürk, Arif; Yilman, Tuba; Mor, Sema; Özturan, Deniz Deniz; Yazici, Neslihan; Gümüş, Kübra

2015-12-01

The purpose of this study was to investigate temperament and character traits in patients with conversion disorder and the relation of these traits with dissociative symptoms. Sixty patients (60) diagnosed with conversion disorder according to DSM-IV-TR and 60 healthy volunteers were included in the study. All participants' temperament and character traits were determined using Cloninger's Temperament and Character Inventory (TCI). Patients with conversion disorder were divided into two subgroups using the Dissociative Experiences Scale (DES), dissociative (n=30, 50%) and non-dissociative (n=30, 50%). The two conversion disorder subgroups were compared with the control group in terms of temperament and character traits. Correlation analysis was also performed between TCI and DES scores in the entire conversion group. Novelty seeking (NS) scores were lower in both the dissociative and non-dissociative groups compared to the control group. Harm avoidance (HA) scores were higher in the dissociative group than in the control group. Reward dependence (RD) scores were lower in the dissociative group than in the non-dissociative and control group. Self-directedness (SD) scores were lower in the dissociative group than in the control group. Self-transcendence (ST) scores were higher in the dissociative group than in the non-dissociative group. DES scores were negatively correlated with RD and SD scores in the entire conversion group and positively correlated with ST scores. Low NS temperament traits may be associated with conversion disorder. High HA and low RD temperament traits and low SD and high ST character traits may be associated with pathological dissociation in patients with conversion disorder.

Dissociative disorder manifesting for underlying adolescent hemi-parkinsonism: New chronology for old mummies.

PubMed

Jha, Shailesh; Garg, Amit; Khanna, Amit

2015-08-01

Dissociative symptoms can be induced by a variety of conditions that can either coexist or mimic each other in clinical presentation. In coexisting dissociative disorder with medical illness, the causality remains uncertain, but sometime its role as nidus for dissociative symptoms just cannot be ruled out. The origin of "organic dissociative disorder" is undoubtedly found by various authors who demonstrated that a high percentage of patients with dissociative symptoms present with some form of neurological insult before developing the symptom. Herein we report on a case of adolescent onset hemi-parkinsonism with coexisting dissociative disorder. Copyright © 2015 Elsevier B.V. All rights reserved.

High psychiatric comorbidity in adolescents with dissociative disorders.

PubMed

Bozkurt, Hasan; Duzman Mutluer, Tuba; Kose, Cigdem; Zoroglu, Salih

2015-06-01

The aim of this study was to evaluate psychiatric comorbidity rates and patterns in a sample of clinically referred adolescents diagnosed with dissociative disorders (DD) by using a structured interview. All participants completed a comprehensive test battery, which consisted of a questionnaire for sociodemographic data and clinical history, Child Posttraumatic Stress Reaction Index, Childhood Abuse and Neglect Questionnaire and the Adolescent Dissociative Experiences Scale. Diagnosis was made by the Structured Clinical Interview for DSM-IV Dissociative Disorders. Psychiatric comorbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version. A total of 25 adolescent subjects aged 12-18 years participated in the study. Ten adolescents were diagnosed as having dissociative identity disorder and 15 of them were diagnosed as having dissociative disorder-not otherwise specified based on the Structured Clinical Interview for DSM-IV Dissociative Disorders findings. Adolescents with dissociative identity disorder were found to have higher scores on the Adolescent Dissociative Experiences Scale and Child Posttraumatic Stress Reaction Index than the dissociative disorder-not otherwise specified group. Sexual and physical abuses were also found to be among the main traumatic events. Incest was reported in six cases of the study sample. All subjects had at least one comorbid psychiatric disorder. The most common psychiatric diagnoses were major depressive disorder (n = 25; 100%) and post-traumatic stress disorder (n = 22; 88%). High psychiatric comorbidity rates were found in adolescents diagnosed with DD. A prevalent history of abuse and traumatic events was represented. Clinicians should be aware of the impacts of DD on adolescents' mental health. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Somatoform and psychoform dissociation among women with orgasmic and sexual pain disorders.

PubMed

Farina, Benedetto; Mazzotti, Eva; Pasquini, Paolo; Mantione, Maria Giuseppina

2011-01-01

Since the 20th century, psychogenic female sexual dysfunctions (FSD), like some somatoform and conversion disorders, have been considered an expression of somatoform dissociation. Several studies have reported dissociative symptoms in different somatoform and conversion disorders, but limited data are available on dissociation among patients with FSD. The aim of this study was to assess somatoform and psychoform dissociation among patients with women's orgasmic disorder, dyspareunia, and vaginismus. A battery of self-administered questionnaires (Somatoform Dissociation Questionnaire, Dissociative Experiences Scale, Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised) was given to 200 gynecological outpatients to assess psychoform and somatoform dissociation and their association with FSD. A strong association between somatoform dissociation and FSD was observed (adjusted odds ratio [OR] = 5.39, 95% confidence interval [CI] = 1.15-25.32), the association between somatoform and psychoform dissociation being estimated by an adjusted OR of 4.83 (95% CI = 1.17-19.91). Our results are compatible with the idea that some forms of FSD could be regarded as somatoform dissociative disorders.

Dissociative disorders in acute psychiatric inpatients in Taiwan.

PubMed

Chiu, Chui-De; Meg Tseng, Mei-Chih; Chien, Yi-Ling; Liao, Shih-Cheng; Liu, Chih-Min; Yeh, Yei-Yu; Hwu, Hai-Gwo; Ross, Colin A

2017-04-01

Dissociative disorders have been documented to be common psychiatric disorders which can be detected reliably with standardized diagnostic instruments in North American and European psychiatric inpatients and outpatients (20.6% and 18.4%, respectively). However, there are concerns about their cross-cultural manifestations as an apparently low prevalence rate has been reported in East Asian inpatients and outpatients (1.7% and 4.9%, respectively). It is unknown whether the clinical profile of dissociative disorders in terms of their core symptomatic clusters, associated comorbid disorders, and environmental risk factors that has emerged in western clinical populations can also be found in non-western clinical populations. A standardized structured interview for DSM-IV dissociative disorders, post-traumatic stress disorder, and a history of interpersonal victimization was administered in a sample of Taiwanese acute psychiatric inpatients. Our results showed that 19.5% of our participants met criteria for a DSM-IV dissociative disorder, mostly dissociative disorder not otherwise specified. More importantly, the western clinical profile of dissociative disorders also characterized our patients, including a poly-symptomatic presentation and a history of interpersonal trauma in both childhood and adulthood. Our results lend support to the conclusion that cross-cultural manifestations of dissociative pathology in East Asia are similar to those in North America and Europe. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Adapting Dialectical Behavior Therapy for the Treatment of Dissociative Identity Disorder.

PubMed

Foote, Brad; Van Orden, Kim

2016-12-31

Dialectical Behavior Therapy (DBT), created by Marsha Linehan, has been shown to be an effective therapy for the treatment of borderline personality disorder (BPD) and for suicidal and self-harming behavior. Dissociative identity disorder (DID) is a complex post-traumatic disorder which is highly comorbid with BPD, shares a number of clinical features with BPD, and which like BPD features a high degree of suicidality. The DID treatment literature emphasizes the importance of a staged approach, beginning with the creation of a safe therapeutic frame prior to addressing traumatic material; DBT is also a staged treatment, in which behavioral and safety issues are addressed in Stage 1, and trauma work reserved for Stage 2. The authors describe adapting DBT, and especially its techniques for Stage 1 safety work, for work with DID patients. Basic theoretical principles are described and illustrated with a case example.

Adapting Dialectical Behavior Therapy for the Treatment of Dissociative Identity Disorder

PubMed Central

Foote, Brad; Van Orden, Kim

2017-01-01

Dialectical Behavior Therapy, created by Marsha Linehan, has been shown to be an effective therapy for the treatment of borderline personality disorder (BPD) and for suicidal and self-harming behavior. Dissociative identity disorder (DID) is a complex post-traumatic disorder which is highly comorbid with BPD, shares a number of clinical features with BPD, and which like BPD features a high degree of suicidality. The DID treatment literature emphasizes the importance of a staged approach, beginning with the creation of a safe therapeutic frame prior to addressing traumatic material; DBT is also a staged treatment, where behavioral and safety issues are addressed in Stage 1 and trauma work reserved for Stage 2. The authors describe adapting DBT, and especially its techniques for Stage 1 safety work, for work with DID patients. Basic theoretical principles are described and illustrated with a case example. PMID:28068498

[Translating Hysteria: PTSD dissociative subtype].

PubMed

Levy Yeyati, Elena

2016-03-01

To address the symptoms of depersonalization and derealization a specific dissociative subtype of posttraumatic stress disorder has been included in DSM-5. Depersonalization and derealization have been defined as acute and chronic symptoms of dissociative disorders since DSM-III. Dissociative disorders with chronic features are often diagnosed in North America, Canada and other European countries, but this is not the case in Argentina. Dissociative disorders have clinical and historical features that are strongly connected with hysteria. The latter is included in ICD-10 within the guidelines for diagnoses of dissociative disorders. This would be one of the reasons for not using dissociative disorders with chronic presentations of symptoms like depersonalization and derealization in countries other than North America or Canada: instead hysteria keeps on been used. The relation between trauma, dissociation and hysteria has been explained in different ways depending on the underlying theory (i.e. Janet's or Freud's). Janet's conceptualizations have had decisive influence in DSM formulations in chronic forms of dissociative disorders. Janet's and Freud's theories lead to different consequences on psychotherapy: hypnosis or psychoanalysis. The aim of this article is to show that the authors of PTSD dissociative subtype are in search of a cross-cultural validity of the construct which might be able to exert a more global influence.

Frontal and occipital perfusion changes in dissociative identity disorder.

PubMed

Sar, Vedat; Unal, Seher N; Ozturk, Erdinc

2007-12-15

The aim of the study was to investigate if there were any characteristics of regional cerebral blood flow (rCBF) in dissociative identity disorder. Twenty-one drug-free patients with dissociative identity disorder and nine healthy volunteers participated in the study. In addition to a clinical evaluation, dissociative psychopathology was assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders, the Dissociative Experiences Scale and the Clinician-Administered Dissociative States Scale. A semi-structured interview for borderline personality disorder, the Hamilton Depression Rating Scale, and the Childhood Trauma Questionnaire were also administered to all patients. Normal controls had to be without a history of childhood trauma and without any depressive or dissociative disorder. Regional cerebral blood flow (rCBF) was studied with single photon emission computed tomography (SPECT) with Tc99m-hexamethylpropylenamine (HMPAO) as a tracer. Compared with findings in the control group, the rCBF ratio was decreased among patients with dissociative identity disorder in the orbitofrontal region bilaterally. It was increased in median and superior frontal regions and occipital regions bilaterally. There was no significant correlation between rCBF ratios of the regions of interest and any of the psychopathology scale scores. An explanation for the neurophysiology of dissociative psychopathology has to invoke a comprehensive model of interaction between anterior and posterior brain regions.

The association of posttraumatic stress disorder, complex posttraumatic stress disorder, and borderline personality disorder from a network analytical perspective.

PubMed

Knefel, Matthias; Tran, Ulrich S; Lueger-Schuster, Brigitte

2016-10-01

Posttraumatic Stress Disorder (PTSD), Complex PTSD, and Borderline Personality Disorder (BPD) share etiological risk factors and an overlapping set of associated symptoms. Since the ICD-11 proposal for trauma-related disorders, the relationship of these disorders has to be clarified. A novel approach to psychopathology, network analysis, allows for a detailed analysis of comorbidity on symptom level. Symptoms were assessed in adult survivors of childhood abuse (N=219) using the newly developed ICD-11 Trauma-Questionnaire and the SCID-II. The psychopathological network was analyzed using the network approach. PTSD and Complex PTSD symptoms were strongly connected within disorders and to a lesser degree between disorders. Symptoms of BPD were weakly connected to others. Re-experiencing and dissociation were the most central symptoms. Mental disorders are no discrete entities, clear boundaries are unlikely to be found. The psychopathological network revealed central symptoms that might be important targets for specific first interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Hippocampal and Amygdalar Volumes in Dissociative Identity Disorder

PubMed Central

Vermetten, Eric; Schmahl, Christian; Lindner, Sanneke; Loewenstein, Richard J.; Bremner, J. Douglas

2011-01-01

Objective Smaller hippocampal volume has been reported in several stress-related psychiatric disorders, including posttraumatic stress disorder (PTSD), borderline personality disorder with early abuse, and depression with early abuse. Patients with borderline personality disorder and early abuse have also been found to have smaller amygdalar volume. The authors examined hippocampal and amygdalar volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma. Method The authors used magnetic resonance imaging to measure the volumes of the hippocampus and amygdala in 15 female patients with dissociative identity disorder and 23 female subjects without dissociative identity disorder or any other psychiatric disorder. The volumetric measurements for the two groups were compared. Results Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller in the patients with dissociative identity disorder, compared to the healthy subjects. The ratio of hippocampal volume to amygdalar volume was significantly different between groups. Conclusions The findings are consistent with the presence of smaller hippocampal and amygdalar volumes in patients with dissociative identity disorder, compared with healthy subjects. PMID:16585437

Hippocampal and amygdalar volumes in dissociative identity disorder.

PubMed

Vermetten, Eric; Schmahl, Christian; Lindner, Sanneke; Loewenstein, Richard J; Bremner, J Douglas

2006-04-01

Smaller hippocampal volume has been reported in several stress-related psychiatric disorders, including posttraumatic stress disorder (PTSD), borderline personality disorder with early abuse, and depression with early abuse. Patients with borderline personality disorder and early abuse have also been found to have smaller amygdalar volume. The authors examined hippocampal and amygdalar volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma. The authors used magnetic resonance imaging to measure the volumes of the hippocampus and amygdala in 15 female patients with dissociative identity disorder and 23 female subjects without dissociative identity disorder or any other psychiatric disorder. The volumetric measurements for the two groups were compared. Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller in the patients with dissociative identity disorder, compared to the healthy subjects. The ratio of hippocampal volume to amygdalar volume was significantly different between groups. The findings are consistent with the presence of smaller hippocampal and amygdalar volumes in patients with dissociative identity disorder, compared with healthy subjects.

The Dissociative Subtype of Posttraumatic Stress Disorder: Unique Resting-State Functional Connectivity of Basolateral and Centromedial Amygdala Complexes

PubMed Central

Nicholson, Andrew A; Densmore, Maria; Frewen, Paul A; Théberge, Jean; Neufeld, Richard WJ; McKinnon, Margaret C; Lanius, Ruth A

2015-01-01

Previous studies point towards differential connectivity patterns among basolateral (BLA) and centromedial (CMA) amygdala regions in patients with posttraumatic stress disorder (PTSD) as compared with controls. Here we describe the first study to compare directly connectivity patterns of the BLA and CMA complexes between PTSD patients with and without the dissociative subtype (PTSD+DS and PTSD−DS, respectively). Amygdala connectivity to regulatory prefrontal regions and parietal regions involved in consciousness and proprioception were expected to differ between these two groups based on differential limbic regulation and behavioral symptoms. PTSD patients (n=49) with (n=13) and without (n=36) the dissociative subtype and age-matched healthy controls (n=40) underwent resting-state fMRI. Bilateral BLA and CMA connectivity patterns were compared using a seed-based approach via SPM Anatomy Toolbox. Among patients with PTSD, the PTSD+DS group exhibited greater amygdala functional connectivity to prefrontal regions involved in emotion regulation (bilateral BLA and left CMA to the middle frontal gyrus and bilateral CMA to the medial frontal gyrus) as compared with the PTSD−DS group. In addition, the PTSD+DS group showed greater amygdala connectivity to regions involved in consciousness, awareness, and proprioception—implicated in depersonalization and derealization (left BLA to superior parietal lobe and cerebellar culmen; left CMA to dorsal posterior cingulate and precuneus). Differences in amygdala complex connectivity to specific brain regions parallel the unique symptom profiles of the PTSD subgroups and point towards unique biological markers of the dissociative subtype of PTSD. PMID:25790021

Dissociative Identity Disorder

PubMed Central

2009-01-01

A brief description of the controversies surrounding the diagnosis of dissociative identity disorder is presented, followed by a discussion of the proposed similarities and differences between dissociative identity disorder and borderline personality disorder. The phenomenon of autohypnosis in the context of early childhood sexual trauma and disordered attachment is discussed, as is the meaning of alters or alternate personalities. The author describes recent neurosciences research that may relate the symptoms of dissociative identity disorder to demonstrable disordered attention and memory processes. A clinical description of a typical patient presentation is included, plus some recommendations for approaches to treatment. PMID:19724751

The Parenting Experiences of Mothers with Dissociative Disorders.

ERIC Educational Resources Information Center

Benjamin, Lynn R.; Benjamin, Robert; Rind, Bruce

1998-01-01

Presents a qualitative analysis of the experience of parenting of mothers with dissociative disorders. Using the mothers' words, describes how the five symptom areas of dissociation impeded their parenting efforts. Discusses the necessity of addressing parenting in the treatment of client-mothers with dissociative disorders. (Author/MKA)

Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder.

PubMed

Lewis, D O; Yeager, C A; Swica, Y; Pincus, J H; Lewis, M

1997-12-01

The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder. This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively. Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases. This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.

Unique insula subregion resting-state functional connectivity with amygdala complexes in posttraumatic stress disorder and its dissociative subtype.

PubMed

Nicholson, Andrew A; Sapru, Iman; Densmore, Maria; Frewen, Paul A; Neufeld, Richard W J; Théberge, Jean; McKinnon, Margaret C; Lanius, Ruth A

2016-04-30

The insula and amygdala are implicated in the pathophysiology of posttraumatic stress disorder (PTSD), where both have been shown to be hyper/hypoactive in non-dissociative (PTSD-DS) and dissociative subtype (PTSD+DS) PTSD patients, respectively, during symptom provocation. However, the functional connectivity between individual insula subregions and the amygdala has not been investigated in persons with PTSD, with or without the dissociative subtype. We examined insula subregion (anterior, mid, and posterior) functional connectivity with the bilateral amygdala using a region-of-interest seed-based approach via PickAtlas and SPM8. Resting-state fMRI was conducted with (n=61) PTSD patients (n=44 PTSD-DS; n=17 PTSD+DS), and (n=40) age-matched healthy controls. When compared to controls, the PTSD-DS group displayed increased insula connectivity (bilateral anterior, bilateral mid, and left posterior) to basolateral amygdala clusters in both hemispheres, and the PTSD+DS group displayed increased insula connectivity (bilateral anterior, left mid, and left posterior) to the left basolateral amygdala complex. Moreover, as compared to PTSD-DS, increased insula subregion connectivity (bilateral anterior, left mid, and right posterior) to the left basolateral amygdala was found in PTSD+DS. Depersonalization/derealization symptoms and PTSD symptom severity correlated with insula subregion connectivity to the basolateral amygdala within PTSD patients. This study is an important first step in elucidating patterns of neural connectivity associated with unique symptoms of arousal/interoception, emotional processing, and awareness of bodily states, in PTSD and its dissociative subtype. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Dissociative disorders and dissociative symptoms among veterans of the Iraq-Iran war suffering from chronic post-traumatic disorder.

PubMed

Nejad, Alireza G; Farahati, Hamid

2007-10-01

To evaluate any dissociative disorders in patients with post traumatic stress disorder (PTSD), and find any relationship between dissociation and related variables in these patients. A case controlled study carried out among 130 male patients with PTSD, and 130 matched individuals from the normal population. The study was carried out between January and September 2005, at Beheshti Psychiatric Hospital, Kerman, Iran, Demographic data and history of childhood physical abuse and self-harm in both groups were recorded. The severity of PTSD was measured by Davidson PTSD scale in the study group. Dissociative symptoms were evaluated with the dissociative experience scale (DES). For evaluating dissociative disorders, the dissociative disorder interview schedule (DDIS) was used. Data were analyzed by SPSS software. The mean age (+/- SD) of veterans was 41.46 (+/-5.09) years, and the mean age of going to the combat area was 29.4 (+/-5.015). The mean duration of involvement in combat was 27.8 (+/-23.44) months. The mean DES score in the study group was 26.01 (+/-12.31) and was 9.58 (+/-7.23) in the control group (F=1.171, p<0.0001). The mean score (+/-SD) of Davidson PTSD scale was 54+/-96 in the study group. The most prevalent dissociative disorder in the study group was psychogenic amnesia. Many veterans with the impression of chronic PTSD may have an additional diagnosis of dissociative disorders.

Tracking scientific interest in the dissociative disorders: a study of scientific publication output 1984-2003.

PubMed

Pope, Harrison G; Barry, Steven; Bodkin, Alexander; Hudson, James I

2006-01-01

We attempted to track scientific interest in dissociative amnesia and dissociative identity disorder by estimating the annual output of publications regarding these entities over the last 20 years. Using a standard medical index, PsycINFO, we counted the number of indexed publications involving dissociative amnesia and dissociative identity disorder listed for each year. We then compared these rates with those of well-established diagnoses such as anorexia nervosa, alcohol abuse, and schizophrenia. We also systematically reviewed all publications involving dissociative amnesia that appeared in 2003. Annual publications involving dissociative amnesia and dissociative identity disorder rose from low levels in the 1980's to a sharp peak in the mid 1990's, followed by an equally sharp decline to only about one quarter of their peak levels by 2002 and 2003. In contrast, all of the 25 comparison diagnoses in our survey showed constant or steadily rising publication rates; none showed the 'bubble' pattern of the dissociative disorders. Of the 34 papers involving dissociative amnesia identified by PsycINFO for 2003, 10 (32%) appeared skeptical of the validity of dissociative amnesia and/or recovered-memory therapy. Despite a detailed search using multiple medical indices and search terms, we could find only 13 explicit cases of individuals with dissociative amnesia worldwide in the 2003 literature. Dissociative amnesia and dissociative identity disorder have not generated consistent scientific interest over the years, but instead apparently enjoyed a brief period of fashion that now has waned. Overall, our observations suggest that these diagnostic entities presently do not command widespread scientific acceptance. Copyright 2006 S. Karger AG, Basel.

Errors of logic and scholarship concerning dissociative identity disorder.

PubMed

Ross, Colin A

2009-01-01

The author reviewed a two-part critique of dissociative identity disorder published in the Canadian Journal of Psychiatry. The two papers contain errors of logic and scholarship. Contrary to the conclusions in the critique, dissociative identity disorder has established diagnostic reliability and concurrent validity, the trauma histories of affected individuals can be corroborated, and the existing prospective treatment outcome literature demonstrates improvement in individuals receiving psychotherapy for the disorder. The available evidence supports the inclusion of dissociative identity disorder in future editions of the Diagnostic and Statistical Manual of Mental Disorders.

Dissociative identity disorder: a controversial diagnosis.

PubMed

Gillig, Paulette Marie

2009-03-01

A brief description of the controversies surrounding the diagnosis of dissociative identity disorder is presented, followed by a discussion of the proposed similarities and differences between dissociative identity disorder and borderline personality disorder. The phenomenon of autohypnosis in the context of early childhood sexual trauma and disordered attachment is discussed, as is the meaning of alters or alternate personalities. The author describes recent neurosciences research that may relate the symptoms of dissociative identity disorder to demonstrable disordered attention and memory processes. A clinical description of a typical patient presentation is included, plus some recommendations for approaches to treatment.

Trauma-related pathological dissociation in a case with cerebral palsy.

PubMed

Fung, Hong Wang

2016-01-01

This article provides a case report of a Chinese-Cantonese female with both cerebral palsy and dissociative identity disorder. To my knowledge, this is the first report of a case with dissociative identity disorder from Hong Kong, as well as the first report of a case with both dissociative identity disorder and cerebral palsy in the literature. Large-sample studies should be undertaken in the future to investigate the prevalence of dissociative disorders in a variety of populations in Hong Kong, including individuals with diagnosed brain diseases.

Intimate Partner Violence Among Patients With Dissociative Disorders.

PubMed

Webermann, Aliya R; Brand, Bethany L; Kumar, Shaina A

2017-12-01

Childhood trauma is common among survivors and perpetrators of intimate partner violence (IPV). Although symptoms of posttraumatic stress disorder (PTSD) and dissociative disorders (DDs) are predictors of IPV victimization and perpetration, few studies explore IPV among those with DDs. The present study examined IPV and symptoms as predictors among participants in the Treatment of Patients With Dissociative Disorders (TOP DD) Network study, an educational intervention for individuals with DDs and their clinicians. Both clinicians and patients reported on patients' history of physical, emotional, and sexual IPV as both victims and perpetrators. Patients self-reported dissociative, posttraumatic (PTSD), and emotion dysregulation symptoms, as well as IPV-specific dissociative symptoms. According to patients and clinicians, patients were frequently victims of IPV, most commonly emotional IPV. Dissociative symptoms predicted IPV exposure, whereas dissociative and emotion dysregulation symptoms predicted IPV-specific dissociative symptoms.

Clandestine psychopathology: unrecognized dissociative disorders in inpatient psychiatry.

PubMed

Ginzburg, Karni; Somer, Eli; Tamarkin, Gali; Kramer, Lilach

2010-05-01

Surveys among Israeli mental health professionals found that almost half of them doubt the validity of dissociative disorders (DD) and have no experience in either diagnosing or treating DD patients. These findings, in line with arguments that DDs are socially construed North American phenomena, call for the need to investigate it in Israel. Eighty-one psychiatric inpatients were screened for dissociative pathology. Participants categorized as having low levels of dissociation (n = 26) and those demonstrating high levels of dissociation (n = 22) were asked to participate in a Structured Clinical Interview for the DSM-Dissociative Disorders-Revised. One-quarter of all participants were identified as having probable dissociative psychopathology. Based on the Structured Clinical Interview for the DSM-Dissociative Disorders-Revised, estimates of DD range between 12 and 21%. None of the participants had any indication of a DD diagnosis in their medical records. Diagnosis of personality disorder and psychiatric comorbidity were related to the likelihood of a DD diagnosis and its severity.

Testing the diagnosis of dissociative identity disorder through measures of dissociation, absorption, hypnotizability and PTSD: a Norwegian pilot study.

PubMed

Dale, Karl Yngvar; Berg, Renate; Elden, Ake; Ødegård, Atle; Holte, Arne

2009-01-01

A total of 14 women meeting criteria for dissociative identity disorder (DID) based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]) were compared to a group of women (n = 10) with other dissociative diagnoses and a group of normal controls (n = 14) with regard to dissociativity, absorption, trauma related symptoms and hypnotizability. Both of the clinical groups reported histories of childhood trauma and attained high PTSD scores. The DID group differed significantly from the group with other dissociative diagnoses and the non-diagnosed comparison group with regard to hypnotizability, the variety of dissociative symptomatology, and the magnitude of dissociative symptomatology. However, no significant differences between the two clinical groups were detected with regard to absorption, general dissociative level, or symptoms related to traumatic stress. Results support the notion that DID can be regarded as a clinical entity which is separable from other dissociative disorders. Results also indicated that hypnotizability is the most important clinical feature of DID.

Dissociation, childhood trauma, and ataque de nervios among Puerto Rican psychiatric outpatients.

PubMed

Lewis-Fernández, Roberto; Garrido-Castillo, Pedro; Bennasar, Mari Carmen; Parrilla, Elsie M; Laria, Amaro J; Ma, Guoguang; Petkova, Eva

2002-09-01

This study examined the relationships of dissociation and childhood trauma with ataque de nervios. Forty Puerto Rican psychiatric outpatients were evaluated for frequency of ataque de nervios, dissociative symptoms, exposure to trauma, and mood and anxiety psychopathology. Blind conditions were maintained across assessments. Data for 29 female patients were analyzed. Among these 29 patients, clinician-rated dissociative symptoms increased with frequency of ataque de nervios. Dissociative Experiences Scale scores and diagnoses of panic disorder and dissociative disorders were also associated with ataque frequency, before corrections were made for multiple comparisons. The rate of childhood trauma was uniformly high among the patients and showed no relationship to dissociative symptoms and disorder or number of ataques. Frequent ataques de nervios may, in part, be a marker for psychiatric disorders characterized by dissociative symptoms. Childhood trauma per se did not account for ataque status in this group of female outpatients.

Dissociation and symptoms of culture-bound syndromes in North America: a preliminary study.

PubMed

Ross, Colin A; Schroeder, Elizabeth; Ness, Laura

2013-01-01

The aim of this study was to determine whether classical culture-bound syndromes occur among psychiatric inpatients with dissociative disorders in North America. The Dissociative Trance Disorder Interview Schedule, the Dissociative Experiences Scale, and the Dissociative Disorders Interview Schedule were administered to 100 predominantly Caucasian, American, English-speaking trauma program inpatients at a hospital in the United States. The participants reported high rates of childhood physical and/or sexual abuse (87%), dissociative disorders (73%), and membership in the dissociative taxon (78%). They also reported a wide range of possession experiences and exorcism rituals, as well as the classical culture-bound syndromes of latah, bebainan, amok, and pibloktoq. Our data are consistent with the view that possession and classical culture-bound syndromes are predominantly dissociative in nature and not really culture-bound from the perspective of Caucasian, English-speaking America.

Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified.

PubMed

Rodewald, Frauke; Wilhelm-Göling, Claudia; Emrich, Hinderk M; Reddemann, Luise; Gast, Ursula

2011-02-01

The aim of this study was to investigate axis-I comorbidity in patients with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). Using the Diagnostic Interview for Psychiatric Disorders, results from patients with DID (n = 44) and DDNOS (n = 22) were compared with those of patients with posttraumatic stress disorder (PTSD) (n = 13), other anxiety disorders (n = 14), depression (n = 17), and nonclinical controls (n = 30). No comorbid disorders were found in nonclinical controls. The average number of comorbid disorders in patients with depression or anxiety was 0 to 2. Patients with dissociative disorders averagely suffered from 5 comorbid disorders. The most prevalent comorbidity in DDNOS and DID was PTSD. Comorbidity profiles of patients with DID and DDNOS were very similar to those in PTSD (high prevalence of anxiety, somatoform disorders, and depression), but differed significantly from those of patients with depression and anxiety disorders. These findings confirm the hypothesis that PTSD, DID, and DDNOS are phenomenologically related syndromes that should be summarized within a new diagnostic category.

DSM-5's posttraumatic stress disorder with dissociative symptoms: challenges and future directions.

PubMed

Dorahy, Martin J; van der Hart, Onno

2015-01-01

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, formally recognizes a dissociative subtype of posttraumatic stress disorder (PTSD; PTSD with dissociative symptoms). This nomenclative move will boost empirical and theoretical efforts to further understand the links between dissociation, trauma, and PTSD. This article examines the empirical literature showing that patients with PTSD can be divided into 2 different groups based on their neurobiology, psychological symptom profile, history of exposure to early relational trauma, and depersonalization/derealization symptoms. It then explores the conceptual and empirical challenges of conceiving 1 of these types as reflecting a "dissociative" type of PTSD. First, this classification is based on the presence of a limited subset of dissociative symptoms (i.e., depersonalization, derealization). This sets aside an array of positive and negative psychoform and somatoform dissociative symptoms that may be related to PTSD. Second, empirical evidence suggests heightened dissociation in PTSD compared to many other disorders, indicating that dissociation is relevant to PTSD more broadly rather than simply to the so-called dissociative subtype. This article sets out important issues to be examined in the future study of dissociation in PTSD, which needs to be informed by solid conceptual understandings of dissociation.

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

PubMed

Vogel, Matthias; Meier, Johanna; Grönke, Stephanie; Waage, Marco; Schneider, Wolfgang; Freyberger, Harald Jürgen; Klauer, Thomas

2011-08-30

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. Copyright © 2011 Elsevier Ltd. All rights reserved.

Single and Multiple Clinical Syndromes in Incarcerated Offenders: Associations With Dissociative Experiences and Emotionality

PubMed Central

Garofalo, Carlo; Velotti, Patrizia; Crocamo, Cristina; Carrà, Giuseppe

2017-01-01

The present study examined the prevalence and correlates of clinical syndromes in a large group (N = 438) of incarcerated violent offenders, looking at differences between inmates with one and those with more than one clinical syndromes. More than a half of the sample (57%) reported clinically relevant symptoms for at least one clinical syndrome (n = 252), and the majority of them (38%) reported more syndromes in comorbidity (n = 169). Increased severity of clinical conditions (none, one, more than one syndrome) corresponded with significantly greater levels of personality disorder traits, psychological symptoms, dissociation, and negative emotionality, with large effect sizes. After controlling for co-occurrence of personality disorder traits and other symptoms, the presence of more than one comorbid syndrome significantly predicted unique variance in dissociation (positively) and positive emotionality (negatively). The presence of one clinical syndrome significantly and positively predicted negative emotionality. Findings support the possibility that the complexity, and not just the presence, of psychopathology could identify different groups of inmates. PMID:27913716

Single and Multiple Clinical Syndromes in Incarcerated Offenders: Associations With Dissociative Experiences and Emotionality.

PubMed

Garofalo, Carlo; Velotti, Patrizia; Crocamo, Cristina; Carrà, Giuseppe

2018-04-01

The present study examined the prevalence and correlates of clinical syndromes in a large group ( N = 438) of incarcerated violent offenders, looking at differences between inmates with one and those with more than one clinical syndromes. More than a half of the sample (57%) reported clinically relevant symptoms for at least one clinical syndrome ( n = 252), and the majority of them (38%) reported more syndromes in comorbidity ( n = 169). Increased severity of clinical conditions (none, one, more than one syndrome) corresponded with significantly greater levels of personality disorder traits, psychological symptoms, dissociation, and negative emotionality, with large effect sizes. After controlling for co-occurrence of personality disorder traits and other symptoms, the presence of more than one comorbid syndrome significantly predicted unique variance in dissociation (positively) and positive emotionality (negatively). The presence of one clinical syndrome significantly and positively predicted negative emotionality. Findings support the possibility that the complexity, and not just the presence, of psychopathology could identify different groups of inmates.

[Dispute over the multiple personality disorder: theoretical or practical dilemma?].

PubMed

Stankiewicz, Sylwia; Golczyńska, Maria

2006-01-01

Dissociative identity disorder (DID) could also be referred to as multiple personality disorder (MPD). Due to rare occurrence and difficulty in its' identification it is infrequently diagnosed in Poland. The indicated disorder has been portrayed by the authors throughout the historical context, referring to initial 18th century's references concerning dissociation. A typical dissociatively disordered person has been characterized along with his individual personality categories such as: original personality, altered personality, host and personality fragment. Moreover various diagnosis criterions of DID have been introduced. DID has also been differentiated with other disorders: PTSD (post-traumatic stress disorder) and BPD (borderline personality disorder). A hypothesis has been set up, stating that DID is directly correlated with the trauma experienced during childhood, while PTSD is linked with traumatic lived-through events in the later period of ones' life. The most contemporary and frequently used research tools for DID have been indicated: dissociative experience scale (DES) and somatoform dissociation questionnaire (SDQ-20). Based upon the known literature, the authors have presented treatment methods such as hypnotherapy and recorded therapy sessions. It is the view of the authors that the switching in dissociative identity disorder is of adaptive character (it occurrs depending upon adaptive needs).

Brain functional integration: an epidemiologic study on stress-producing dissociative phenomena.

PubMed

Sperandeo, Raffaele; Monda, Vincenzo; Messina, Giovanni; Carotenuto, Marco; Maldonato, Nelson Mauro; Moretto, Enrico; Leone, Elena; De Luca, Vincenzo; Monda, Marcellino; Messina, Antonietta

2018-01-01

Dissociative phenomena are common among psychiatric patients; the presence of these symptoms can worsen the prognosis, increasing the severity of their clinical conditions and exposing them to increased risk of suicidal behavior. Personality disorders as long duration stressful experiences may support the development of dissociative phenomena. In 933 psychiatric outpatients consecutively recruited, presence of dissociative phenomena was identified with the Dissociative Experience Scale (DES). Dissociative phenomena were significantly more severe in the group of people with mental disorders and/or personality disorders. All psychopathologic traits detected with the symptom checklist-90-revised had a significant correlation with the total score on the DES. Using total DES score as the dependent variable, a linear regression model was constructed. Mental and personality disorders which were associated with greater severity of dissociative phenomena on analysis of variance were included as predictors; scores from the nine scales of symptom checklist-90-revised, significantly correlated to total DES score, were used as covariates. The model consisted of seven explanatory variables (four factors and three covariates) explaining 82% of variance. The four significant factors were the presence of borderline and narcissistic personality disorder, substance abuse disorders and psychotic disorders. Significant covariates were psychopathologic traits of anger, psychoticism and obsessiveness. This study, confirming Janet's theory, explains that, mental disorders and psychopathologic experiences of patients can configure the chronic stress condition that produces functional damage to the adaptive executive system. The symptoms of dissociative depersonalization/derealization and dissociative amnesia can be explained, in large part, through their current and previous psychopathologic experiences.

Brain functional integration: an epidemiologic study on stress-producing dissociative phenomena

PubMed Central

Messina, Giovanni; Carotenuto, Marco; Maldonato, Nelson Mauro; Moretto, Enrico; Leone, Elena; De Luca, Vincenzo; Monda, Marcellino; Messina, Antonietta

2018-01-01

Dissociative phenomena are common among psychiatric patients; the presence of these symptoms can worsen the prognosis, increasing the severity of their clinical conditions and exposing them to increased risk of suicidal behavior. Personality disorders as long duration stressful experiences may support the development of dissociative phenomena. In 933 psychiatric outpatients consecutively recruited, presence of dissociative phenomena was identified with the Dissociative Experience Scale (DES). Dissociative phenomena were significantly more severe in the group of people with mental disorders and/or personality disorders. All psychopathologic traits detected with the symptom checklist-90-revised had a significant correlation with the total score on the DES. Using total DES score as the dependent variable, a linear regression model was constructed. Mental and personality disorders which were associated with greater severity of dissociative phenomena on analysis of variance were included as predictors; scores from the nine scales of symptom checklist-90-revised, significantly correlated to total DES score, were used as covariates. The model consisted of seven explanatory variables (four factors and three covariates) explaining 82% of variance. The four significant factors were the presence of borderline and narcissistic personality disorder, substance abuse disorders and psychotic disorders. Significant covariates were psychopathologic traits of anger, psychoticism and obsessiveness. This study, confirming Janet’s theory, explains that, mental disorders and psychopathologic experiences of patients can configure the chronic stress condition that produces functional damage to the adaptive executive system. The symptoms of dissociative depersonalization/derealization and dissociative amnesia can be explained, in large part, through their current and previous psychopathologic experiences. PMID:29296086

[Inpatient Treatment of Complex PTSD Following Childhood Abuse: Effectiveness and Predictors of Treatment Outcome].

PubMed

Kratzer, Leonhard; Heinz, Peter; Schennach, Rebecca; Schiepek, Günter Karl; Padberg, Frank; Jobst, Andrea

2018-05-30

There is a lack of studies investigating the effectiveness of inpatient trauma-focused psychotherapy of complex post-traumatic stress disorder. The first aim of this retrospective investigation was to analyze the course of PTSD. Second, possible predictors of treatment response were investigated. 150 inpatients of Clinic St. Irmingard with complex PTSD following childhood physical and childhood sexual abuse were assessed regarding childhood abuse, PTSD symptomatology, mindfulness, dissociation and general psychopathology. Differences in pre and post scores were analyzed using regression analyses. A classification tree was used to identify predictors of response. The significant reduction of PTSD symptoms corresponded to a large effect (d=1.8) and a reponse rate of 52% according to the reliable change index (p<0.05). Effect sizes for other symptoms were medium to large (0.5

The mirror has two faces: dissociative identity disorder and the defence of pathological criminal incapacity--a South African criminal law perspective.

PubMed

Stevens, Philip

2013-03-01

Dissociative identity disorder poses numerous medico legal issues whenever the insanity defence emerges. Within the context of the South African criminal law, the impact of dissociative identity disorder on criminal responsibility has only been addressed very briefly in one decided case. Various questions arise as to the impact that the distinctive diagnostic features of dissociative identity disorder could possibly have on the defence of pathological criminal incapacity, or better known as the insanity defence, within the ambit of the South African criminal law. In this contribution the author reflects on the mental disorder known as dissociative identity disorder or multiple personality disorder, against the backdrop of the defence of pathological criminal incapacity. Reflections are also provided pertaining to the various medico legal issues at stake whenever this defence has to be adjudicated upon.

Treatment of trauma- and abuse-related dissociative symptom disorders in children and adolescents.

PubMed

Weber, Scott

2009-02-01

Dissociation is believed to be one of the most common underlying psychological processes among children and adolescents receiving mental health treatment, but most of the dissemination of information about dissociation has occurred among psychiatrists and psychologists. Modes of treatment for dissociation as it affects children and adolescents are described. Current research and practice scholarly articles on treatment of children and adolescents for dissociation and dissociative symptom disorders were accessed and critically reviewed. Prognosis in children and adolescents can vary widely among patients and between the specific types of dissociation disorder; however, expert clinicians and researchers agree that early, intense treatment offers the greatest possibility of full recovery.

Hypnotizability in acute stress disorder.

PubMed

Bryant, R A; Guthrie, R M; Moulds, M L

2001-04-01

This study investigated the relationship between acute dissociative reactions to trauma and hypnotizability. Acutely traumatized patients (N=61) with acute stress disorder, subclinical acute stress disorder (no dissociative symptoms), and no acute stress disorder were administered the Stanford Hypnotic Clinical Scale within 4 weeks of their trauma. Although patients with acute stress disorder and patients with subclinical acute stress disorder displayed comparable levels of nondissociative psychopathology, acute stress disorder patients had higher levels of hypnotizability and were more likely to display reversible posthypnotic amnesia than both patients with subclinical acute stress disorder and patients with no acute stress disorder. The findings may be interpreted in light of a diathesis-stress process mediating trauma-related dissociation. People who develop acute stress disorder in response to traumatic experience may have a stronger ability to experience dissociative phenomena than people who develop subclinical acute stress disorder or no acute stress disorder.

Dissociation and psychosis in dissociative identity disorder and schizophrenia.

PubMed

Laddis, Andreas; Dell, Paul F

2012-01-01

Dissociative symptoms, first-rank symptoms of schizophrenia, and delusions were assessed in 40 schizophrenia patients and 40 dissociative identity disorder (DID) patients with the Multidimensional Inventory of Dissociation (MID). Schizophrenia patients were diagnosed with the Structured Clinical Interview for the DSM-IV Axis I Disorders; DID patients were diagnosed with the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised. DID patients obtained significantly (a) higher dissociation scores; (b) higher passive-influence scores (first-rank symptoms); and (c) higher scores on scales that measure child voices, angry voices, persecutory voices, voices arguing, and voices commenting. Schizophrenia patients obtained significantly higher delusion scores than did DID patients. What is odd is that the dissociation scores of schizophrenia patients were unrelated to their reports of childhood maltreatment. Multiple regression analyses indicated that 81% of the variance in DID patients' dissociation scores was predicted by the MID's Ego-Alien Experiences Scale, whereas 92% of the variance in schizophrenia patients' dissociation scores was predicted by the MID's Voices Scale. We propose that schizophrenia patients' responses to the MID do not index the same pathology as do the responses of DID patients. We argue that neither phenomenological definitions of dissociation nor the current generation of dissociation instruments (which are uniformly phenomenological in nature) can distinguish between the dissociative phenomena of DID and what we suspect are just the dissociation-like phenomena of schizophrenia.

Dissociative symptoms in female patients with mood and anxiety disorders: a psychopathological and temperamental investigation.

PubMed

Bersani, G; Moscariello, M A; Bersani, F S; Colletti, C; Anastasia, A; Prinzivalli, E; Valeriani, G; Salviati, M

2014-01-01

Dissociative symptoms are frequent among psychiatric patients and may considerably affect patients' psychopathological condition and treatment outcomes. The objectives of the study are to assess the presence of dissociative symptoms in female patients with mood and anxiety disorders, to investigate their correlation with the clinical severity of the disorders and to investigate those personality traits that are more frequent in patients with high levels of dissociation. 50 Caucasian females were enrolled in the study. Patients were assessed through the Self-Report Symptom Check-List, the Dissociative Experiences Scale (DES) and rating scales for Depression and Anxiety. The mean DES score in the overall sample was 16.6. 32% of patients had a DES score > 20. Depressive symptoms positively correlated with the DES total scores. Dissociator patients presented some significantly different temperamental characteristics in comparison with non dissociator patients. Dissociative symptoms are highly present in patients with mood and anxiety disorders and correlate with the severity of depressive symptoms. Specific personality traits more frequently observed in dissociator people may represent predisposing factors; their early identification could be clinically relevant.

Mirror writing and a dissociative identity disorder.

PubMed

Le, Catherine; Smith, Joyce; Cohen, Lewis

2009-01-01

Individuals with dissociative identity disorder (DID) have been known to show varied skills and talents as they change from one dissociative state to another. For example, case reports have described people who have changed their handedness or have spoken foreign languages during their dissociative states. During an interview with a patient with DID, a surprising talent emerged when she wrote a sentence for the Folstein Mini-Mental State Exam-mirror writing. It is not known whether her mirror writing had a deeper level of meaning; however, it does emphasize the idiosyncratic nature of dissociative identity disorder.

Errors of Logic and Scholarship Concerning Dissociative Identity Disorder

ERIC Educational Resources Information Center

Ross, Colin A.

2009-01-01

The author reviewed a two-part critique of dissociative identity disorder published in the "Canadian Journal of Psychiatry". The two papers contain errors of logic and scholarship. Contrary to the conclusions in the critique, dissociative identity disorder has established diagnostic reliability and concurrent validity, the trauma histories of…

Relationships of dissociative disorders and personality traits in opium addicts on methadone treatment.

PubMed

Ghafarinezhad, Alireza; Rajabizadeh, Ghodratollah; Shahriari, Vahid

2013-01-01

Drug abuse is a major public health problem. Some believe that when dissociation fails to defend against emotional, physical, or sexual trauma, the person will find relief from unpleasant thoughts and emotions in opium use. On the other hand, personality disorders are considered as important predictors of treatment outcomes in drug abusers. Due to lack of adequate research in this regard, we evaluated dissociative disorders and personality traits of opium addicts on methadone treatment. This cross-sectional analytic study included 111 non-psychotic subjects on methadone treatment (case group) and 69 non-addicts (control group). After recording demographic characteristics, Dissociative Experiences Scale (DES) and Millon Multiaxial Inventory III were applied to assess dissociative symptoms and clinical personality patterns of all participants. Dissociative symptoms were significantly more common in the case group than in the control group (P = 0.044). While hysterionic personality disorder was more frequent in the control group (P = 0.008), sadistic, antisocial, and schizotypal personality disorders were significantly more common in the case group (P = 0.008, 0.002, and 0.023, respectively). We found relations between history of drug dependence, dissociative symptoms, and personality disorders. Therefore, the mentioned disorders need to be kept in mind while planning addiction treatment modalities and identifying high risk groups.

Dissociative disorders among adults in the community, impaired functioning, and axis I and II comorbidity.

PubMed

Johnson, Jeffrey G; Cohen, Patricia; Kasen, Stephanie; Brook, Judith S

2006-03-01

To investigate the association of dissociative disorder (DD) with impaired functioning and co-occurring Axis I and personality disorders among adults in the community. Psychiatric interviews were administered to a sample of 658 adult participants in the Children in the Community Study, a community-based longitudinal study. Depersonalization disorder (prevalence: 0.8%), dissociative amnesia (prevalence: 1.8%), dissociative identity disorder (prevalence: 1.5%), and dissociative disorder not otherwise specified (prevalence: 4.4%), evident within the past year, were each associated with impaired functioning, as assessed by the clinician-administered Global Assessment of Functioning Scale. These associations remained significant after controlling for age, sex, and co-occurring disorders. Individuals with anxiety, mood, and personality disorders were significantly more likely than individuals without these disorders were to have DD, after the covariates were controlled. Individuals with Cluster A (DD prevalence: 58%), B (DD prevalence: 68%), and C (DD prevalence: 37%) personality disorders were substantially more likely than those without personality disorders were to have DD. DD is associated with clinically significant impairment among adults in the community. DD may be particularly prevalent among individuals with personality disorders.

Dissociative Amnesia and DSM-IV-TR Cluster C Personality Traits.

PubMed

Leong, Stephanie; Waits, Wendi; Diebold, Carroll

2006-01-01

Dissociative amnesia is a disorder characterized by retrospectively reported memory gaps. These gaps involve an inability to recall personal information, usually of a traumatic or stressful nature. Dissociative amnesia most commonly occurs in the presence of other psychiatric conditions, particularly personality disorders. In the literature and in clinical practice, it is often associated with DSM-IV-TR Cluster B personality disorders. However, there is evidence to suggest that dissociative amnesia may be more likely to occur among individuals with Cluster C personality disorders. Presented here is a discussion of the types of memory loss, two cases of dissociative amnesia occurring in patients with Cluster C psychopathology, and a focused literature review.

Dissociative Amnesia and DSM-IV-TR Cluster C Personality Traits

PubMed Central

Waits, Wendi; Diebold, Carroll

2006-01-01

Dissociative amnesia is a disorder characterized by retrospectively reported memory gaps. These gaps involve an inability to recall personal information, usually of a traumatic or stressful nature. Dissociative amnesia most commonly occurs in the presence of other psychiatric conditions, particularly personality disorders. In the literature and in clinical practice, it is often associated with DSM-IV-TR Cluster B personality disorders. However, there is evidence to suggest that dissociative amnesia may be more likely to occur among individuals with Cluster C personality disorders. Presented here is a discussion of the types of memory loss, two cases of dissociative amnesia occurring in patients with Cluster C psychopathology, and a focused literature review. PMID:21103150

Peas, please: a case report and neuroscientific review of dissociative amnesia and fugue.

PubMed

MacDonald, Kai; MacDonald, Tina

2009-01-01

Dissociative amnesia that encompasses one's entire life and identity is a rare disorder, as is dissociative fugue. In evaluating such cases, a dichotomy is often invoked between functional and organic etiologies. However, this dichotomy suffers from both conceptual and ethical flaws. Conceptually, putative brain-based, organic etiologies for many dissociative disorders-including dissociative amnesia-exist. Ethically, such dichotomies may result in dismissive care for patients with distress-based disorders like dissociative amnesia. In support of humane, neurobiologically informed treatment of patients with dissociative amnesia, we present excerpts from 2 post-event interviews with a patient who suffered and recovered from an episode of dissociative amnesia and fugue. Following this, we review current neurobiological models of dissociative amnesia that undermine the dichotomy of functional versus organic, and suggest that the crucial distinction in such cases is between a patient's willful, conscious deceit and processes that occur without conscious intent.

MULTIPLE PERSONALITY DISORDER FOLLOWING CONVERSION AND DISSOCIATIVE DISORDER NOS : A CASE REPORT

PubMed Central

Jhingan, Harsh Prem; Aggarwal, Neeruj; Saxena, Shekhar; Gupta, Dhanesh K.

2000-01-01

A case progressing from symptoms of conversion disorder to dissociative disorder and then to multiple personality disorder as per DSM-III-R criteria is being reported. The clinical implications are discussed. PMID:21407917

Development, Reliability, and Validity of a Child Dissociation Scale.

ERIC Educational Resources Information Center

Putnam, Frank W.; And Others

1993-01-01

Evaluation of the Child Dissociative Checklist found it to be a reliable and valid observer report measure of dissociation in children, including sexually abused girls and children with dissociative disorder and with multiple personality disorder. The checklist, which is appended, is intended as a clinical screening instrument and research measure…

Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence

PubMed Central

Jans, Thomas; Schneck-Seif, Stefanie; Weigand, Tobias; Schneider, Wolfgang; Ellgring, Heiner; Wewetzer, Christoph; Warnke, Andreas

2008-01-01

Background In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. The aim of this follow-up study is to bridge this gap to some extent describing the long-term outcome of juvenile dissociative disorder in a clinical sample. To our knowledge there is no comparable other long-term follow-up study which is based on a case definition according to actual classification systems using standardized interviews for individual assessment of the patients at the time of follow-up. Methods The total study group was made up of all patients treated for dissociative disorder at our department for child and adolescent psychiatry between 1983 and 1992 (N = 62). Two of these former patients committed suicide during the follow-up period (3%). We got information on the clinical course of 27 former patients (44%). 17 out of these 27 former patients were female (63%). The mean age of onset of dissociative disorder was11.7 years and the mean follow-up time was 12.4 years. Most of the patients were reassessed personally (n = 23) at a mean age of 24.8 years using structured interviews covering dissociative disorders, other Axis I disorders and personality disorders (Heidelberg Dissociation Inventory HDI; Expert System for Diagnosing Mental Disorders, DIA-X; Structured Clinical Interview for DSM-IV, SCID-II). Social adjustment was assessed by a semi-structured interview and by patient self report (Social Adjustment Scale – Self Report, SAS-SR). Psychosocial outcome variables were additionally assessed in 36 healthy controls (67% female, mean age = 22.9 years). Results At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. A total of 56.5% presented with an Axis I disorder (especially anxiety, dissociative and somatoform disorders). Personality disorders were seen in 47.8% (especially borderline, obsessive-compulsive and negativistic personality disorders). More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood. Conclusion Treatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. Limitations of the study refer to the small sample size and the low rate of former patients taking part in the follow-up investigation. PMID:18651951

Epilepsy, Mental Health Disorder, or Both?

PubMed Central

Beletsky, Vadim; Mirsattari, Seyed M.

2012-01-01

Temporal lobe epilepsy (TLE), a subset of the seizure disorder family, represents a complex neuropsychiatric illness, where the neurological presentation may be complemented by varying severity of affective, behavioral, psychotic, or personality abnormalities, which, in turn, may not only lead to misdiagnosis, but also affect the management. This paper outlines a spectrum of mental health presentations, including psychosis, mood, anxiety, panic, and dissociative states, associated with epilepsy that make the correct diagnosis a challenge. PMID:22934158

A Systematic Chart Review of Inpatient Population with Childhood Dissociative Disorder

ERIC Educational Resources Information Center

Prabhuswamy, Mukesh; Jairam, Rajeev; Srinath, Shoba; Girimaji, Satish; Seshadri, Shekhar P.

2006-01-01

Objective: To study the socio-demographic factors, clinical characteristics, and long-term outcome of dissociative disorders in inpatient children and adolescents. Methods: Chart data of forty-four subjects (8-15 years) with a diagnosis of dissociative disorder admitted to a specialist Child and Adolescent Psychiatry (CAP) unit between September…

The Association Between Peritraumatic Dissociation and PTSD Symptoms: The Mediating Role of Negative Beliefs About the Self.

PubMed

Thompson-Hollands, Johanna; Jun, Janie J; Sloan, Denise M

2017-04-01

Peritraumatic dissociation, a term used to describe a complex array of reactions to trauma, including depersonalization, derealization, and emotional numbness, has been associated with posttraumatic stress disorder (PTSD) symptoms across a number of studies. Cognitive theory suggests that interpretations of traumatic events and reactions underlie the persistence of PTSD. The present study examined the associations among peritraumatic dissociation, posttraumatic cognitions, and PTSD symptoms in a group of trauma-exposed adults (N = 169). Results indicated that, after accounting for overall symptom severity and current dissociative tendencies, peritraumatic dissociation was significantly predictive of negative beliefs about the self (R 2 = .06, p < .001). Other categories of maladaptive posttraumatic cognitions did not show a similar relationship (R 2 = .01 to .02, nonsignificant). Negative thoughts about the self partially mediated the association between peritraumatic dissociation and PTSD severity (completely standardized indirect effect = .25). These findings lend support to cognitive theories of PTSD and point to an important area for clinical intervention. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Psychophysiology of dissociated consciousness.

PubMed

Bob, Petr

2014-01-01

Recent study of consciousness provides an evidence that there is a limit of consciousness, which presents a barrier between conscious and unconscious processes. This barrier likely is specifically manifested as a disturbance of neural mechanisms of consciousness that through distributed brain processing, attentional mechanisms and memory processes enable to constitute integrative conscious experience. According to recent findings a level of conscious integration may change during certain conditions related to experimental cognitive manipulations, hypnosis, or stressful experiences that can lead to dissociation of consciousness. In psychopathological research the term dissociation was proposed by Pierre Janet for explanation of processes related to splitting of consciousness due to traumatic events or during hypnosis. According to several recent findings dissociation of consciousness likely is related to deficits in global distribution of information and may lead to heightened levels of "neural complexity" that reflects brain integration or differentiation based on numbers of independent neural processes in the brain that may be specifically related to various mental disorders.

Dissociative Identity Disorders in Korea: Two Recent Cases.

PubMed

Kim, Ilbin; Kim, Daeho; Jung, Hyun-Jin

2016-03-01

Although dissociative identity disorder (DID), the most severe of the dissociative disorders, has retained its own diagnostic entity since its introduction in the DSM-III, cases of DID are rarely seen in South and East Asia, likely due to the higher prevalence of possession disorder. We report two patients with DID who were recently admitted to our inpatient psychiatric unit and demonstrated distinct transitions to several identities. Their diagnoses were confirmed through a structured interview for dissociative disorders and possible differential diagnoses were ruled out by psychological, neuroimaging, and laboratory tests. The rapid transition to a Westernized, individualized society along with an increase in child abuse, might contribute to an increase in DID, previously under-diagnosed in this region.

Cognitive abuse within the incestuous family as a factor in the development of dissociative identity disorder.

PubMed

Reed-Gavish, Maya

2013-01-01

The polarized nature of the ongoing controversies surrounding the genesis and validity of dissociative identity disorder pit advocates who see and work with dissociative identity disorder sufferers against skeptics who claim it to be an artificial iatrogenically produced phenomenon. This paper suggests that such a dichotomy is unwarranted and that, in fact, both sides of the argument have merit. A short description of the controversy that rages among professionals is followed by a personal-experiential review of the development of dissociative identities in the author. Using sociocognitive conceptualizations and describing the iatrogenic intrafamilial processes that led to the "choice" of dissociation as a strategy for coping with a traumatic reality, this paper shows how both sides of the conflict complement each other and suggests a new way of understanding the developmental pathway of dissociative identity disorder.

Neural Dissociation of Phonological and Visual Attention Span Disorders in Developmental Dyslexia: fMRI Evidence from Two Case Reports

ERIC Educational Resources Information Center

Peyrin, C.; Lallier, M.; Demonet, J. F.; Pernet, C.; Baciu, M.; Le Bas, J. F.; Valdois, S.

2012-01-01

A dissociation between phonological and visual attention (VA) span disorders has been reported in dyslexic children. This study investigates whether this cognitively-based dissociation has a neurobiological counterpart through the investigation of two cases of developmental dyslexia. LL showed a phonological disorder but preserved VA span whereas…

Cognitive Abuse within the Incestuous Family as a Factor in the Development of Dissociative Identity Disorder

ERIC Educational Resources Information Center

Reed-Gavish, Maya

2013-01-01

The polarized nature of the ongoing controversies surrounding the genesis and validity of dissociative identity disorder pit advocates who see and work with dissociative identity disorder sufferers against skeptics who claim it to be an artificial iatrogenically produced phenomenon. This paper suggests that such a dichotomy is unwarranted and…

Symptom patterns in dissociative identity disorder patients and the general population.

PubMed

Ross, Colin A; Ness, Laura

2010-01-01

The authors used the Dissociative Disorders Interview Schedule to compare structured interview symptom patterns in a general population sample (N= 502) and a sample of patients with clinical diagnoses of dissociative identity disorder (N= 303). Based on the Trauma Model, the authors predicted that the patterns would be similar in the 2 samples and that symptom scores would be higher in participants reporting childhood sexual abuse in both samples. They predicted that symptom scores would be higher among women with dissociative identity disorder reporting sexual abuse than among women in the general population reporting sexual abuse, with the clinical sample reporting more severe abuse. These predictions were supported by the data. The authors conclude that symptom patterns in dissociative identity disorder are typical of the normal human response to severe, chronic childhood trauma and have ecological validity for the human race in general.

Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both-A multi-center study.

PubMed

Schäfer, Ingo; Langeland, Willemien; Hissbach, Johanna; Luedecke, Christel; Ohlmeier, Martin D; Chodzinski, Claudia; Kemper, Ulrich; Keiper, Peter; Wedekind, Dirk; Havemann-Reinecke, Ursula; Teunissen, Sybille; Weirich, Steffen; Driessen, Martin

2010-06-01

The aims of this study were to examine the level of dissociative symptoms in patients with different substance related disorders (alcohol dependence, drug dependence, and combined alcohol and drug dependence), and to investigate the influence of potentially traumatic events in childhood, age, gender, and posttraumatic stress disorder on the relationship between dissociative symptoms and type of substance abuse. Of the 459 participants (59.7% male) 182 (39.7%) were alcohol-dependent (A), 154 (33.6%) were drug-dependent (D), and 123 (26.8%) were dependent on both, alcohol and drugs (AD) based on the DSM-IV criteria for a current diagnosis. Participants completed the Childhood Trauma Questionnaire (CTQ) and the Dissociative Experiences Scale (DES). The International Diagnostics Checklist (IDCL) was administered to diagnose PTSD. Higher levels of dissociation were observed in patients with drug dependence as compared to patients with mere alcohol dependence (mean DES group A: 9.9+/-8.8; group D: 12.9+/-11.7; group AD: 15.1+/-11.3). However, when severity of potentially traumatic events in childhood, PTSD, age and gender were included in the analysis, the influence of the type of substance abuse did not prove to be statistically significant. The variable most strongly related to dissociative symptoms was severity of potentially traumatic events in childhood, in particular emotional abuse, even after controlling for PTSD and other potential confounders. It seems appropriate to screen SUD patients for dissociative symptoms, especially those with a more complex risk profile including (additional) drug abuse, female gender, younger age and most importantly a history of childhood trauma. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Multiple personality disorder among female inpatients in a state hospital.

PubMed

Latz, T T; Kramer, S I; Hughes, D L

1995-09-01

Professional skepticism and concerns regarding diagnostic reliability hinder research in dissociative disorders and multiple personality disorder. The reported frequency of multiple personality disorder in different psychiatric settings ranges from 2.4% to 35%. The authors conducted a replication study of multiple personality disorder ascertainment in women admitted to a state hospital over a 5.5-month period. Responses to the Dissociative Experiences Scale and to the Dissociative Disorders Interview Schedule were obtained, along with data on length of stay, county of admission referral, admission commitment status, and discharge diagnoses, for 176 female inpatients in a state hospital. Of 421 women representing 483 consecutive admissions, 121 were discharged before they could be assessed for study, 64 were excluded, 60 declined to participate, 176 enrolled in the study, and 175 completed the research procedures. Twenty-one women (12%) met criteria for multiple personality disorder based on the Dissociative Disorders Interview Schedule; these women were significantly younger than the women without multiple personality disorder. Scores on the Dissociative Experiences Scale of the women with multiple personality disorder (mean = 59.5, SD = 19.6) were significantly higher than the scores of women without multiple personality disorder (mean = 22.5, SD = 20.1), but considerable overlap occurred. There was no significant difference between groups in length of stay or admission status. The authors conclude that 1) the wide variability in multiple personality disorder detection is partially due to site-specific ascertainment biases and 2) despite its apparent usefulness for screening purposes, the Dissociative Experiences Scale requires more comprehensive evaluation before it can be applied broadly.

Etiology and clinical course of pseudoseizures. Relationship to trauma, depression, and dissociation.

PubMed

Bowman, E S

1993-01-01

Twenty-seven outpatients with video-EEG-documented pseudoseizures were interviewed by a psychiatrist to determine the historical course of seizures and diagnose the current presence of these DSM-III-R diagnoses: affective disorders (85%), dissociative disorders (85%), and posttraumatic stress disorder (33%). Their mean (26.7) and median (26.9) Dissociative Experiences Scale scores were elevated. Eighty-eight percent of subjects had sustained significant trauma, including sexual abuse/rape (77%) and physical abuse (70%). Four psychodynamic pathways to pseudoseizures were noted. Most commonly, pseudoseizures originated from dissociated personalities or ego states, were expressions of dissociated memories of child abuse, and were triggered by recent stresses or traumas.

The rise and fall of dissociative identity disorder.

PubMed

Paris, Joel

2012-12-01

Dissociative identity disorder (DID), once considered rare, was frequently diagnosed during the 1980s and 1990s, after which interest declined. This is the trajectory of a medical fad. DID was based on poorly conceived theories and used potentially damaging treatment methods. The problem continues, given that the DSM-5 includes DID and accords dissociative disorders a separate chapter in its manual.

[A case of incest with dissociative amnesia and post traumatic stress disorder].

PubMed

Erdinç, Işil Bilgin; Sengül, Ceyhan Balci; Dilbaz, Nesrin; Bozkurt, Songül

2004-01-01

Incest is a kind of sexual abuse that causes serious disorders during childhood and adulthood. In order to overcome the trauma, abuse victims frequently use dissociative defence mechanisms. Post traumatic stress disorder, dissociative disorders, major depression and borderline personality disorder can be seen in the victims of childhood sexual abuse. In this article we present an adolescent who was found and brought to our clinic by the Children's Police Department while she was wandering around aimlessly. She could not remember anything about her identity or personal history. She had no apparent physical disturbances, marks of beating or wounds which could be seen externally. Her physical and neurological examinations were both normal. In her laboratory tests, there was nothing abnormal. No sign of intoxication or infection was detected. EEG and CT were also normal. After the family was found, we learned about the sexual and physical abuse and the patient was diagnosed with dissociative amnesia. The psychometric evaluations also supported our diagnosis. When the dissociation began to disappear, post traumatic stress disorder symptoms became more apparent. After she described her traumatic memories, PTSD symptoms began to recede. Through this case presentation we would like to emphasize the relationship between childhood physical and sexual abuse and dissociative disorders.

Dissociative features in posttraumatic stress disorder: A latent profile analysis.

PubMed

Műllerová, Jana; Hansen, Maj; Contractor, Ateka A; Elhai, Jon D; Armour, Cherie

2016-09-01

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) characterizes the dissociative subtype of posttraumatic stress disorder (PTSD) in terms of the individual meeting the criteria for PTSD and additionally reporting symptoms of depersonalization and/or derealization. The current study aimed to examine whether a dissociative PTSD profile may include alternative features of dissociation and whether it could be differentiated from a nondissociative PTSD profile on certain psychopathologies and demographics. Data from 309 trauma-exposed participants, collected through Amazon Mechanical Turk, were subjected to latent profile analysis. Regression analyses were used to examine the predictors of latent classes. Three discrete profiles named Baseline, PTSD, and Dissociative profile were uncovered. All examined features of dissociation were significantly elevated in the Dissociative profile. Anxiety, male sex, being employed, and having a minority racial background significantly predicted the Dissociative profile relative to the PTSD profile. The study points to the importance of alternative symptoms of dissociation in the dissociative PTSD subtype beyond the symptoms of depersonalization and derealization. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

First reported case of Lorazepam-assisted interview in a young Indian female presenting with dissociative identity disorder and improvement in symptoms after the interview.

PubMed

Mushtaq, Raheel; Shoib, Sheikh; Arif, Tasleem; Shah, Tabindah; Mushtaq, Sahil

2014-01-01

Dissociative identity disorder (DID) is one of the most fascinating disorders in psychiatry. The arduous search to reveal the obscurity of this disorder has led to colossal research in this area over the years. Although drug-assisted interviews are not widely used, they may be beneficial for some patients that do not respond to conventional treatments such as supportive psychotherapy or psychopharmacotherapy. Drug-assisted interviews facilitate recall of memories in promoting integration of dissociative information. We report a case of a 16-year-old female with dissociative identity disorder (DID) that was treated with lorazepam-assisted interview and there was rapid improvement in symptoms after the interview.

First Reported Case of Lorazepam-Assisted Interview in a Young Indian Female Presenting with Dissociative Identity Disorder and Improvement in Symptoms after the Interview

PubMed Central

Mushtaq, Raheel; Arif, Tasleem; Shah, Tabindah; Mushtaq, Sahil

2014-01-01

Dissociative identity disorder (DID) is one of the most fascinating disorders in psychiatry. The arduous search to reveal the obscurity of this disorder has led to colossal research in this area over the years. Although drug-assisted interviews are not widely used, they may be beneficial for some patients that do not respond to conventional treatments such as supportive psychotherapy or psychopharmacotherapy. Drug-assisted interviews facilitate recall of memories in promoting integration of dissociative information. We report a case of a 16-year-old female with dissociative identity disorder (DID) that was treated with lorazepam-assisted interview and there was rapid improvement in symptoms after the interview. PMID:25161793

The relationship of psychological trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-injury and suicidality: a review.

PubMed

Ford, Julian D; Gómez, Jennifer M

2015-01-01

We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.

The Dual Role of Disorder on the Dissociation of Interfacial Charge Transfer Excitons

NASA Astrophysics Data System (ADS)

Shi, Liang; Lee, Chee-Kong; Willard, Adam

In organic-based photovoltaics (OPV), dissociation of neutral photo-excitations (i.e., Frenkel excitons) into free charge carriers requires the excitons to overcome binding energy that can significantly exceed thermal energies. The inability of bound charges to overcome this large binding energy has been implicated as a primary source of efficiency loss in OPVs. Despite the potential impact on the performance of organic solar cells much remains to be understood about the microscopic mechanism of exciton dissociation in OPV materials. Here we explore the role of static molecular disorder in mediating this charge dissociation process. Using a simple lattice model of exciton dynamics we demonstrate that random spatial variations in the energetic landscape can mitigate the effects of the exciton binding energy by lowering the free energy barrier. By considering the competition between this thermodynamic effect and the disorder-induced slowing of dissociation kinetics we demonstrate that exciton dissociation yields are expected to depend non-monotonically on the degree of static disorder. We conclude that a certain amount of molecular-scale disorder is desirable in order to optimize the performance of organic photovoltaic materials.

Dissociative Identity Disorder

ERIC Educational Resources Information Center

Schmidt, Tom

2007-01-01

Few psychological disorders in the Diagnostic Statistical Manual have generated as much controversy as Dissociative Identity Disorder (DID). For the past 35 years diagnoses of DID, previously referred to as Multiple Personality Disorder (MPD), have increased exponentially, causing various psychological researchers and clinicians to question the…

Interplay between binding affinity and kinetics in protein-protein interactions.

PubMed

Cao, Huaiqing; Huang, Yongqi; Liu, Zhirong

2016-07-01

To clarify the interplay between the binding affinity and kinetics of protein-protein interactions, and the possible role of intrinsically disordered proteins in such interactions, molecular simulations were carried out on 20 protein complexes. With bias potential and reweighting techniques, the free energy profiles were obtained under physiological affinities, which showed that the bound-state valley is deep with a barrier height of 12 - 33 RT. From the dependence of the affinity on interface interactions, the entropic contribution to the binding affinity is approximated to be proportional to the interface area. The extracted dissociation rates based on the Arrhenius law correlate reasonably well with the experimental values (Pearson correlation coefficient R = 0.79). For each protein complex, a linear free energy relationship between binding affinity and the dissociation rate was confirmed, but the distribution of the slopes for intrinsically disordered proteins showed no essential difference with that observed for ordered proteins. A comparison with protein folding was also performed. Proteins 2016; 84:920-933. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Dissociative sensibility disorders - A retrospective case series and systematic literature review.

PubMed

Weber, Peter; Erlacher, Rahel

2018-01-01

Dissociative disorders present a huge challenge in clinical settings. In contrast to other dissociative symptoms, dissociative sensibility disorders are rarely focused on. To identify the clinical characteristics and outcomes of dissociative sensibility disorders in children and adolescents, and to review the use of diagnostic procedures. For the review, a literature search used Pubmed, Embase, Web of Science, and PubPsych (to 02/2015) and the reference lists of the studies identified. Screening of titles and abstracts; full-text assessment by two reviewers. The original case series was identified by using the local data register. Two reviewers independently reviewed the data and, if they agreed on the relevance, extracted the data. In the original case series, data were extracted retrospectively from the records. Sixteen studies and seven case reports were identified, including 931 cases with dissociative disorders. In 210 cases the patient suffered either from a single sensibility disorder or predominantly from sensibility disorders. We identified thirteen further cases in our cohort. In both groups there was female predominance; the mean age of manifestation was early adolescence. The timing of admissions was variable. In approximately 50% of cases a premorbid stressful life event could be identified. Over 75% of cases had a good prognosis with complete resolution. Retrospective character of our own data collection, partially missing differentiation between the subgroups of dissociative disorders in the reviewed studies. There is no uniform procedure for diagnostic work-up. The overall short-term prognosis is good. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Dissociative experiences during sexual behavior among a sample of adults living with HIV infection and a history of childhood sexual abuse.

PubMed

Hansen, Nathan B; Brown, Lauren J; Tsatkin, Elizabeth; Zelgowski, Brittany; Nightingale, Vienna

2012-01-01

Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of dissociative experiences during sexual behavior. Predictor variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses of posttraumatic stress disorder (PTSD) and dissociative disorders, rape by an intimate partner, duration of CSA, number of perpetrators of CSA, and current sexual satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, dissociative disorders, rape by an intimate partner, duration of CSA, and number of perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA.

The Dissociative Subtype of Post-traumatic Stress Disorder: Research Update on Clinical and Neurobiological Features.

PubMed

van Huijstee, Jytte; Vermetten, Eric

2017-10-21

Recently, a dissociative subtype of post-traumatic stress disorder (PTSD) has been included in the DSM-5. This review focuses on the clinical and neurobiological features that distinguish the dissociative subtype of PTSD from non-dissociative PTSD. Clinically, the dissociative subtype of PTSD is associated with high PTSD severity, predominance of derealization and depersonalization symptoms, a more significant history of early life trauma, and higher levels of comorbid psychiatric disorders. Furthermore, PTSD patients with dissociative symptoms exhibit different psychophysiological and neural responses to the recall of traumatic memories. While individuals with non-dissociative PTSD exhibit an increased heart rate, decreased activation of prefrontal regions, and increased activation of the amygdala in response to traumatic reminders, individuals with the dissociative subtype of PTSD show an opposite pattern. It has been proposed that dissociation is a regulatory strategy to restrain extreme arousal in PTSD through hyperinhibition of limbic regions. In this research update, promises and pitfalls in current research studies on the dissociative subtype of PTSD are listed. Inclusion of the dissociative subtype of PTSD in the DSM-5 stimulates research on the prevalence, symptomatology, and neurobiology of the dissociative subtype of PTSD and poses a challenge to improve treatment outcome in PTSD patients with dissociative symptoms.

Dissociative symptoms in individuals with gender dysphoria: is the elevated prevalence real?

PubMed

Colizzi, Marco; Costa, Rosalia; Todarello, Orlando

2015-03-30

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. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Early Indicators of Pathological Dissociation in Sexually Abused Children.

ERIC Educational Resources Information Center

McElroy, Linda Provus

1992-01-01

This paper reviews factors in the professional neglect of multiple personality disorder (MPD) and sexual abuse in childhood, as well as recent diagnostic developments in childhood dissociative disorders. The identification of subtle dissociative symptomatology in children is illustrated, and two case examples are presented. (Author)

Dissociative amnesia.

PubMed

Staniloiu, Angelica; Markowitsch, Hans J

2014-08-01

Dissociative amnesia is one of the most enigmatic and controversial psychiatric disorders. In the past two decades, interest in the understanding of its pathophysiology has surged. In this report, we review new data about the epidemiology, neurobiology, and neuroimaging of dissociative amnesia and show how advances in memory research and neurobiology of dissociation inform proposed pathogenetic models of the disorder. Dissociative amnesia is characterised by functional impairment. Additionally, preliminary data suggest that affected people have an increased and possibly underestimated suicide risk. The prevalence of dissociative amnesia differs substantially across countries and populations. Symptoms and disease course also vary, indicating a possibly heterogeneous disorder. The accompanying clinical features differ across cultural groups. Most dissociative amnesias are retrograde, with memory impairments mainly involving the episodic-autobiographical memory domain. Anterograde dissociative amnesia occurring without significant retrograde memory impairments is rare. Functional neuroimaging studies of dissociative amnesia with prevailing retrograde memory impairments show changes in the network that subserves autobiographical memory. At present, no evidence-based treatments are available for dissociative amnesia and no broad framework exists for its rehabilitation. Further research is needed into its neurobiology, course, treatment options, and strategies to improve differential diagnoses. Copyright © 2014 Elsevier Ltd. All rights reserved.

Comparing the symptoms and mechanisms of "dissociation" in dissociative identity disorder and borderline personality disorder.

PubMed

Laddis, Andreas; Dell, Paul F; Korzekwa, Marilyn

2017-01-01

A total of 75 patients were diagnosed with the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised as having dissociative identity disorder (DID), and 100 patients were diagnosed with the Structured Interview for DSM-IV Personality as having borderline personality disorder (BPD). Both groups were administered the Multidimensional Inventory of Dissociation (MID). DID patients had significantly higher MID scores than BPD patients, different distributions of MID scores, and different MID subscale profiles in 3 ranges of MID scores (0-15, 15-30, 30-45). The core MID symptoms-exhibited at all ranges of MID scores-for DID patients (the presence of alters, identity confusion, and memory problems) and BPD patients (flashbacks, identity confusion, and memory problems) were ostensibly similar but were considered to be mostly produced by different underlying processes. Multiple regression analyses showed that the core MID symptoms of DID patients had different predictors than did the core MID symptoms of BPD patients. Alter identities seemed to generate most-but not all-dissociative phenomena in DID patients, whereas only the 24% highest scoring BPD patients (MID ≥45) seemed to manifest alter-driven dissociative experiences. Most BPD dissociative experiences appeared to be due to 5 other mechanisms: (a) BPD-specific, stress-driven, rapid shifts of self-state; (b and c) nondefensive disruptions of the framework of perceptual organization with or without an accompanying BPD-specific, dissociation-like disintegration of affective/neurocognitive functioning; (d) a defensive distancing or detachment from distress (i.e., simple depersonalization); and (e) Allen, Console, and Lewis's (1999) severe absorptive detachment.

[Dissociative identity disorder or schizophrenia?].

PubMed

Tschöke, S; Steinert, T

2010-01-01

We present a case of dissociative identity disorder in which Schneiderian first rank symptoms were present besides of various states of consciousness. Thus the diagnosis of schizophrenia had to be considered. Formally, the symptoms met ICD-10 criteria for schizophrenia. However, taking into account the lack of formal thought disorder and of negative symptoms as well as a typical history of severe and prolonged traumatisation, we did not diagnose a co-morbid schizophrenic disorder. There is good evidence for the existence of psychotic symptoms among patients with dissociative disorders. However, in clinical practice this differential diagnosis is rarely considered.

Calculation of rates of exciton dissociation into hot charge-transfer states in model organic photovoltaic interfaces

NASA Astrophysics Data System (ADS)

Vázquez, Héctor; Troisi, Alessandro

2013-11-01

We investigate the process of exciton dissociation in ordered and disordered model donor/acceptor systems and describe a method to calculate exciton dissociation rates. We consider a one-dimensional system with Frenkel states in the donor material and states where charge transfer has taken place between donor and acceptor. We introduce a Green's function approach to calculate the generation rates of charge-transfer states. For disorder in the Frenkel states we find a clear exponential dependence of charge dissociation rates with exciton-interface distance, with a distance decay constant β that increases linearly with the amount of disorder. Disorder in the parameters that describe (final) charge-transfer states has little effect on the rates. Exciton dissociation invariably leads to partially separated charges. In all cases final states are “hot” charge-transfer states, with electron and hole located far from the interface.

Childhood maltreatment and intimate partner violence in dissociative disorder patients.

PubMed

Webermann, Aliya R; Brand, Bethany L; Chasson, Gregory S

2014-01-01

Childhood maltreatment (CM) is a risk factor for subsequent intimate partner violence (IPV) in adulthood, with high rates of retrospectively reported CM among IPV victims and perpetrators. A theorized mechanism of the link between CM and IPV is dissociation. Dissociation may allow perpetrators of violence to remain emotionally distant from their behavior and minimize empathy toward those they victimize, enabling them to commit acts of violence similar to their own experiences. Indeed, elevated rates of dissociation and dissociative disorders (DD) have been found among IPV survivors and perpetrators. In addition, in pilot studies, DD clinicians have reported high levels of violent behavior among DD patients. The present study investigates IPV among DD patients with Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified, a group with CM rates of 80-95% and severe dissociative symptoms. DD clinicians reported on rates of CM and IPV among 275 DD patients in outpatient treatment. DD patients also completed a self-report measure of dissociation. Analyses assessed the associations between CM typologies and IPV, as well as trait dissociation and IPV. Physical and emotional child abuse were associated with physical IPV, and childhood witnessing of domestic violence (DV) and childhood neglect were associated with emotional IPV. The present study is the first to provide empirical support for a possible CM to adult IPV developmental trajectory among DD patients. Future research is needed to better understand the link between CM and IPV among those with trauma and DD.

Childhood maltreatment and intimate partner violence in dissociative disorder patients

PubMed Central

Webermann, Aliya R.; Brand, Bethany L.; Chasson, Gregory S.

2014-01-01

Background Childhood maltreatment (CM) is a risk factor for subsequent intimate partner violence (IPV) in adulthood, with high rates of retrospectively reported CM among IPV victims and perpetrators. A theorized mechanism of the link between CM and IPV is dissociation. Dissociation may allow perpetrators of violence to remain emotionally distant from their behavior and minimize empathy toward those they victimize, enabling them to commit acts of violence similar to their own experiences. Indeed, elevated rates of dissociation and dissociative disorders (DD) have been found among IPV survivors and perpetrators. In addition, in pilot studies, DD clinicians have reported high levels of violent behavior among DD patients. Objective The present study investigates IPV among DD patients with Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified, a group with CM rates of 80–95% and severe dissociative symptoms. Methods DD clinicians reported on rates of CM and IPV among 275 DD patients in outpatient treatment. DD patients also completed a self-report measure of dissociation. Analyses assessed the associations between CM typologies and IPV, as well as trait dissociation and IPV. Results Physical and emotional child abuse were associated with physical IPV, and childhood witnessing of domestic violence (DV) and childhood neglect were associated with emotional IPV. Conclusions The present study is the first to provide empirical support for a possible CM to adult IPV developmental trajectory among DD patients. Future research is needed to better understand the link between CM and IPV among those with trauma and DD. PMID:25279109

Dissociative Disorders in Children: Behavioral Profiles and Problems.

ERIC Educational Resources Information Center

Putnam, Frank W.

1993-01-01

Clinical research has established a connection between childhood trauma and the development of dissociative disorders in adults. Pathological dissociation produces a range of symptoms and behaviors such as amnesias, rapid shifts in mood and behavior, and auditory and visual hallucinations. Many of these symptoms are misdiagnosed as attention,…

Psychogenic Dissociation in Childhood: The Role of the Counseling Psychologist.

ERIC Educational Resources Information Center

Richardson, Lisa Frey

1998-01-01

Reviews the literature on psychogenic dissociative disorders in children so as to highlight the unique characteristics and needs of this population. Discusses three central ideas, such as the role of the counseling psychologist in the research, assessment and treatment of dissociatively disordered children, and emphasizes contributions counseling…

Egocentric virtual maze learning in adult survivors of childhood abuse with dissociative disorders: evidence from functional magnetic resonance imaging.

PubMed

Weniger, Godehard; Siemerkus, Jakob; Barke, Antonia; Lange, Claudia; Ruhleder, Mirjana; Sachsse, Ulrich; Schmidt-Samoa, Carsten; Dechent, Peter; Irle, Eva

2013-05-30

Present neuroimaging findings suggest two subtypes of trauma response, one characterized predominantly by hyperarousal and intrusions, and the other primarily by dissociative symptoms. The neural underpinnings of these two subtypes need to be better defined. Fourteen women with childhood abuse and the current diagnosis of dissociative amnesia or dissociative identity disorder but without posttraumatic stress disorder (PTSD) and 14 matched healthy comparison subjects underwent functional magnetic resonance imaging (fMRI) while finding their way in a virtual maze. The virtual maze presented a first-person view (egocentric), lacked any topographical landmarks and could be learned only by using egocentric navigation strategies. Participants with dissociative disorders (DD) were not impaired in learning the virtual maze when compared with controls, and showed a similar, although weaker, pattern of activity changes during egocentric learning when compared with controls. Stronger dissociative disorder severity of participants with DD was related to better virtual maze performance, and to stronger activity increase within the cingulate gyrus and the precuneus. Our results add to the present knowledge of preserved attentional and visuospatial mnemonic functioning in individuals with DD. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Experimentally-induced dissociation impairs visual memory.

PubMed

Brewin, Chris R; Mersaditabari, Niloufar

2013-12-01

Dissociation is a phenomenon common in a number of psychological disorders and has been frequently suggested to impair memory for traumatic events. In this study we explored the effects of dissociation on visual memory. A dissociative state was induced experimentally using a mirror-gazing task and its short-term effects on memory performance were investigated. Sixty healthy individuals took part in the experiment. Induced dissociation impaired visual memory performance relative to a control condition; however, the degree of dissociation was not associated with lower memory scores in the experimental group. The results have theoretical and practical implications for individuals who experience frequent dissociative states such as patients with posttraumatic stress disorder (PTSD). Copyright © 2013 Elsevier Inc. All rights reserved.

Dissociative detachment and memory impairment: reversible amnesia or encoding failure?

PubMed

Allen, J G; Console, D A; Lewis, L

1999-01-01

The authors propose that clinicians endeavor to differentiate between reversible and irreversible memory failures in patients with dissociative symptoms who report "memory gaps" and "lost time." The classic dissociative disorders, such as dissociative amnesia and dissociative identity disorder, entail reversible memory failures associated with encoding experience in altered states. The authors propose another realm of memory failures associated with severe dissociative detachment that may preclude the level of encoding of ongoing experience needed to support durable autobiographical memories. They describe how dissociative detachment may be intertwined with neurobiological factors that impair memory, and they spell out the significance of distinguishing reversible and irreversible memory impairment for diagnosis, patient education, psychotherapy, and research.

Relations between Post-traumatic Stress Disorder, Dissociation and Attention-Deficit/Hyperactivity Disorder among Earthquake Survivors

PubMed Central

ÖZDEMİR, Osman; BOYSAN, Murat; GÜZEL ÖZDEMİR, Pınar; YILMAZ, Ekrem

2015-01-01

Introduction There is a burgeoning interest in relations between post-traumatic stress disorder (PTSD) and attention-deficit/hyperactivity disorder (ADHD). Although few studies were conducted, weak evidence was found supporting the hypothesis that ADHD may be a risk factor for the development of PTSD. In addition, there is a paucity of research addressing the relations between dissociation and ADHD. In this study, our aim was to examine the relations between PTSD and ADHD combined with the mediating effect of dissociative psychopathology. Methods The participants were 317 undergraduate students, a greater proportion of whom experienced the 2011 Van earthquake (66%). The participants were administered the Posttraumatic Diagnostic Scale, Dissociative Experiences Scale, Adult ADHD Self-Report Scale, Beck Depression Inventory and Beck Anxiety Inventory. Results We found that ADHD symptoms and dissociation were significantly associated with PTSD. Considering the multivariate relations between ADHD, PTSD and dissociation, significant associations between PTSD and ADHD resulted from symptom overlaps. However, pathological dissociation mediated the relations between PTSD and ADHD. Conclusion We concluded that ADHD comorbidity was not a predominant vulnerability factor for the development of post-traumatic stress response but may be an exacerbating factor after the development of PTSD. PMID:28360719

[Dissociative symptoms in patients with mood and anxiety disorders].

PubMed

Moscariello, Marianna Margherita; Ratti, Flavia; Quartini, Adele; Forcén, Fernando Espí; Munuera, Joaquin Nieto; Bersani, Giuseppe

2010-01-01

The objective of this study was to evaluate the occurrence of dissociative symptoms in outpatients affected by mood or anxiety disorder and their potential implication in general psychopathology and treatment response. The sample was recruited at Italian and Spanish psychiatric outpatient services. The sample consisted in 40 (13 Male, 27 Female) outpatients, 22 Italians (55%) and 18 Spanish (45%). Inclusion criteria were the Axis I diagnosis of any DSM-IV-TR mood or anxiety disorder and Clinical Global Impression/Global Severity Index (CGI) baseline scores > or = 3 and Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A) baseline scores > or = 18. General psychopathology, dissociative symptoms and personality traits were respectively assessed by the self-report symptom inventory Symptom Check-List 90 (SCL-90), the Dissociative Experience Scale (DES) and the Cloninger's Temperament and Character Inventory (TCI). Dissociative symptoms emerged as relatively frequent in mood and anxiety disorders. Globally, depression symptoms seem to correlate positively with the dissociative experiences and the severity of global psychopathology. Dissociative symptoms seem to correlate positively with some personality traits and the severity of global psychopathology and should receive further investigation in clinical practice, as might be a predictor of poor response to conventional drug treatment.

Deconstructing DID.

PubMed

Brenner, I

1999-01-01

The author contends that a psychoanalytically informed approach to the patient with dissociative identity disorder (DID) can be very useful. However, there are difficulties in conceptualizing this condition without extending existing theory or applying in new ways what is already known. It is also difficult to put DID in a proper context relative to all the other disorders known to occur in the human mind. Depending on one's clinical experience, level of skepticism, and appreciation of history, DID may be seen as either: a) the psychological "missing link" that realizes Freud's goal of uniting the psychology of dreams with psychopathology, or b) a fraudulent condition that is wittingly or unwittingly manufactured in the therapist's office or c) a population of disturbed and disturbing patients, once the subject of great scientific interest, which, exiled like a "Lost Tribe," is now back in the fold of legitimacy. The author has had extensive clinical experience with psychic trauma, and bases his own views of DID on three assumptions: 1. that dissociation may be seen as a complex defense; 2. that DID may be thought of as a "lower level dissociative character"; and 3. that there is a unique psychic structure, the "dissociative self" whose function is to create "alter personalities" out of disowned affects, memories, fantasies, and drives. This "dissociative self" must be dissolved in order for integration of "alter personalities" to occur. A clinical vignette is offered to illustrate how he addresses some of the challenges of developing a therapeutic alliance at this end of the dissociative-character-pathology continuum, and how he grapples with the difficulty of integrating clinical phenomena, such as the appearance of "alters," with the psychoanalytic model of the mind.

Gestational and Postnatal Cortisol Profiles of Women With Posttraumatic Stress Disorder and the Dissociative Subtype.

PubMed

Seng, Julia S; Li, Yang; Yang, James J; King, Anthony P; Kane Low, Lisa M; Sperlich, Mickey; Rowe, Heather; Lee, Hyunhwa; Muzik, Maria; Ford, Julian D; Liberzon, Israel

2018-01-01

To test the hypothesis that women with posttraumatic stress disorder (PTSD) have greater salivary cortisol levels across the diurnal curve and throughout gestation, birth, and the postpartum period than women who do not have PTSD. Prospective, longitudinal, biobehavioral cohort study. Prenatal clinics at academic health centers in the Midwest region of the United States. Women expecting their first infants who fit with one of four cohorts: a nonexposed control group, a trauma-exposed control group, a group with PTSD, and a group with the dissociative subtype of PTSD. In the first half of pregnancy, 395 women provided three salivary cortisol specimens on a single day for diurnal data. A subsample of 111 women provided three salivary cortisol specimens per day, 12 times, from early pregnancy to 6 weeks postpartum for longitudinal data. Trauma history, PTSD, and dissociative symptoms were measured via standardized telephone diagnostic interviews with the use of validated epidemiologic measures. Generalized estimating equations were used to determine group differences. Generalized estimating equations showed that women with the dissociative subtype of PTSD had the highest and flattest gestational cortisol level curves. The difference was greatest in early pregnancy, when participants in the dissociative subtype group had cortisol levels 8 times greater in the afternoon and 10 times greater at bedtime than those in the nonexposed control group. Women with the dissociative subtype of PTSD, a complex form associated with a history of childhood maltreatment, may have toxic levels of cortisol that contribute to intergenerational patterns of adverse health outcomes. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

An outpatient clinical study of dissociative disorder not otherwise specified.

PubMed

Yanartaş, Ömer; Özmen, Hülya Akar; Citak, Serhat; Zincir, Selma Bozkurt; Sünbül, Esra Aydin

2014-05-01

The relatively high prevalence of the diagnosis of dissociative disorder not otherwise specified is frequently considered to be disproportionate. The disproportionate rate of this diagnosis is thought to be related to nosologic and/or diagnostic issues in dissociative identity disorder. We sought to investigate and compare the symptom patterns of these two clinical entities. We conducted a cross-sectional study involving 1314 participants who were screened with the Dissociative Experience Scale (DES) and the Somatoform Dissociation Questionnaire (SDQ). Of the participants, 272 who scored above the cut-off points for the screening questionnaires (DES score>30 and/or SDQ score>40 points) were invited to complete a structured interview using the Dissociative Disorders Interview Schedule (DDIS); of this subsample, only 190 participants agreed to participate in the second phase of the study. The mean score for the DES was 18.55±17.23, and the mean score for the SDQ was 30.19±13.32. Of the 190 participants, 167 patients were diagnosed as having a dissociative disorder (87.8%). We found that DD-NOS was the most prevalent category of dissociative disorder. There was a significantly larger percentage of patients in the DID group than in the DD-NOS group according to secondary features of DID and Schneiderian symptoms. The secondary features of DID and Schneiderian symptoms appeared to be more specific for DID, while no differences were detected between DID and DD-NOS based on most of the items on the SCL 90R. Further longitudinal studies are needed to determine the features that are similar and dissimilar between DD-NOS and DID. Copyright © 2014 Elsevier Inc. All rights reserved.

Does phasic trauma treatment make patients with dissociative identity disorder treatment more dissociative?

PubMed

Brand, Bethany; Loewenstein, Richard J

2014-01-01

Proponents of the iatrogenic model of the etiology of dissociative identity disorder (DID) have expressed concern that treatment focused on direct engagement and interaction with dissociated self-states harms DID patients. However, empirical data have shown that this type of DID treatment is beneficial. Analyzing data from the prospective Treatment of Patients With Dissociative Disorders (TOP DD) Study, we test empirically whether DID treatment is associated with clinically adverse manifestations of dissociated self-states: acting so differently that one feels like different people, hearing voices, and dissociative amnesia. We show that, over the course of the study, there were significant decreases in feeling like different people and hearing voices. These results indicate that this form of DID treatment does not lead to symptomatic worsening in these dimensions, as predicted by the iatrogenic model. Indeed, treatment provided by TOP DD therapists reduced, rather than increased, the extent to which patients experienced manifestations of pathological dissociation. Because severe symptomatology and impairment are associated with DID, iatrogenic harm may come from depriving DID patients of treatment that targets DID symptomatology.

Dissociation From a Cross-Cultural Perspective: Implications of Studies in Brazil.

PubMed

Maraldi, Everton de Oliveira; Krippner, Stanley; Barros, Maria Cristina Monteiro; Cunha, Alexandre

2017-07-01

A major issue in the study of dissociation concerns the cross-cultural validity of definitions and measurements used to identify and classify dissociative disorders. There is also extensive debate on the etiological factors underlying dissociative experiences. Cross-cultural research is essential to elucidate these issues, particularly regarding evidence obtained from countries in which the study of dissociation is still in its infancy. The aim of this article was to discuss Brazilian research on the topic of dissociation, highlighting its contributions for the understanding of dissociative experiences in nonclinical populations and for the validity and relevance of dissociative disorders in the contexts of psychiatry, psychology, and psychotherapy. We also consider the ways in which dissociative experiences are assimilated by Brazilian culture and religious expressions, and the implications of Brazilian studies for the sociocultural investigation of dissociation. We conclude by addressing the limitations of these studies and potential areas for future research.

Traumatic dissociation as a predictor of posttraumatic stress disorder in South African female rape survivors.

PubMed

Nöthling, Jani; Lammers, Kees; Martin, Lindi; Seedat, Soraya

2015-04-01

Women survivors of rape are at an increased risk for posttraumatic stress disorder (PTSD). Traumatic dissociation has been identified as a precursor of PTSD. This study assessed the predictive potential of traumatic dissociation in PTSD and depression development.The study followed a longitudinal, prospective design. Ninety-seven female rape survivors were recruited from 2 clinics in Cape Town, South Africa. Clinical interviews and symptom status assessments of the participants were completed to measure dissociation, childhood traumas, resilience, depression, and PTSD.Traumatic dissociation was a significant predictor of PTSD and depression. The linear combination of prior dissociation, current dissociation, and resilience significantly explained 20.7% of the variance in PTSD. Dissociation mediated the relationship between resilience and PTSD.As traumatic dissociation significantly predicts PTSD, its early identification and management may reduce the risk of developing PTSD. Interventions focused on promoting resilience may also be successful in reducing the risk of dissociation following rape.

Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in DSM-5 and ICD-11: Clinical and Behavioral Correlates.

PubMed

Hyland, Philip; Shevlin, Mark; Fyvie, Claire; Karatzias, Thanos

2018-04-01

The American Psychiatric Association and the World Health Organization provide distinct trauma-based diagnoses in the fifth edition of the Diagnostic and Statistical Manual (DSM-5), and the forthcoming 11th version of the International Classification of Diseases (ICD-11), respectively. The DSM-5 conceptualizes posttraumatic stress disorder (PTSD) as a single, broad diagnosis, whereas the ICD-11 proposes two "sibling" disorders: PTSD and complex PTSD (CPTSD). The objectives of the current study were to: (a) compare prevalence rates of PTSD/CPTSD based on each diagnostic system; (b) identify clinical and behavioral variables that distinguish ICD-11 CPTSD and PTSD diagnoses; and (c) examine the diagnostic associations for ICD-11 CPTSD and DSM-5 PTSD. Participants in a predominately female clinical sample (N = 106) completed self-report scales to measure ICD-11 PTSD and CPTSD, DSM-5 PTSD, and depression, anxiety, borderline personality disorder, dissociation, destructive behaviors, and suicidal ideation and self-harm. Significantly more people were diagnosed with PTSD according to the DSM-5 criteria (90.4%) compared to those diagnosed with PTSD and CPTSD according to the ICD-11 guidelines (79.8%). An ICD-11 CPTSD diagnosis was distinguished from an ICD-11 PTSD diagnosis by higher levels of dissociation (d = 1.01), depression (d = 0.63), and borderline personality disorder (d = 0.55). Diagnostic associations with depression, anxiety, and suicidal ideation and self-harm were higher for ICD-11 CPTSD compared to DSM-5 PTSD (by 10.7%, 4.0%, and 7.0%, respectively). These results have implications for differential diagnosis and for the development of targeted treatments for CPTSD. Copyright © 2018 International Society for Traumatic Stress Studies.

Self-Destructive Behavior in People with Dissociative Disorders.

ERIC Educational Resources Information Center

Saxe, Glenn N.; Chawla, Neharika; Van der Kolk, Bessel

2002-01-01

Study assesses self-destructive behavior in a group of inpatients who have dissociative disorders compared to those who report few dissociative symptoms. Results reveal that these patients more frequently engage in self-destructive behaviors, use more methods of self-injury, and begin to injure themselves at an earlier age then patients who do not…

Owning the past, claiming the present: perspectives on the treatment of dissociative patients.

PubMed

Middleton, Warwick

2005-03-01

From the early 1990s there has been a growing awareness in Australia of dissociative processes and dissociative disorders. The objective in this paper is to provide a selective overview of the context and process of treatment based on the substantive dissociative disorders literature, ongoing clinical experience and research, and over 8 years as director of a trauma and dissociation unit at Belmont Hospital, Brisbane. The construct of individual selfhood is of direct relevance in illustrating the psychological damage sustained by patients who have relied on dissociative defences to survive, and in highlighting issues and areas that are a particular focus of informed treatment.

Dissociative subtype of DSM-5 posttraumatic stress disorder in U.S. veterans.

PubMed

Tsai, Jack; Armour, Cherie; Southwick, Steven M; Pietrzak, Robert H

2015-01-01

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) formally introduced a dissociative subtype of posttraumatic stress disorder (PTSD). This study examined the proportion of U.S. veterans with DSM-5 PTSD that report dissociative symptoms; and compared veterans with PTSD with and without the dissociative subtype and trauma-exposed controls on sociodemographics, clinical characteristics, and quality of life. Multivariable analyses were conducted on a nationally representative sample of 1484 veterans from the National Health and Resilience in Veterans Study (second baseline survey conducted September-October, 2013). Of the 12.0% and 5.2% of veterans who screened positive for lifetime and past-month DSM-5 PTSD, 19.2% and 16.1% screened positive for the dissociative subtype, respectively. Among veterans with PTSD, those with the dissociative subtype reported more severe PTSD symptoms, comorbid depressive and anxiety symptoms, alcohol use problems, and hostility than those without the dissociative subtype. Adjusting for PTSD symptom severity, those with the dissociative subtype continued to report more depression and alcohol use problems. These results underscore the importance of assessing, monitoring, and treating the considerable proportion of veterans with PTSD and dissociative symptoms. Published by Elsevier Ltd.

Dissociative identity disorder and schizophrenia: differential diagnosis and theoretical issues.

PubMed

Foote, Brad; Park, Jane

2008-06-01

Schizophrenia and dissociative identity disorder (DID) are typically thought of as unrelated syndromes--a genetically based psychotic disorder versus a trauma-based dissociative disorder--and are categorized as such by the DSM-IV. However, substantial data exist to document the elevated occurrence of psychotic symptoms in DID; awareness of these features is necessary to prevent diagnostic confusion. Recent research has also pointed out that schizophrenia and DID overlap not only in psychotic symptoms but also in terms of traumatic antecedents, leading to a number of suggestions for revision of our clinical, theoretical, and nosologic understanding of the relationship between these two disorders.

Anomalous maximum and minimum for the dissociation of a geminate pair in energetically disordered media

NASA Astrophysics Data System (ADS)

Govatski, J. A.; da Luz, M. G. E.; Koehler, M.

2015-01-01

We study the geminated pair dissociation probability φ as function of applied electric field and temperature in energetically disordered nD media. Regardless nD, for certain parameters regions φ versus the disorder degree (σ) displays anomalous minimum (maximum) at low (moderate) fields. This behavior is compatible with a transport energy which reaches a maximum and then decreases to negative values as σ increases. Our results explain the temperature dependence of the persistent photoconductivity in C60 single crystals going through order-disorder transitions. They also indicate how an energetic disorder spatial variation may contribute to higher exciton dissociation in multicomponent donor/acceptor systems.

Experiences of possession and paranormal phenomena among women in the general population: are they related to traumatic stress and dissociation?

PubMed

Sar, Vedat; Alioğlu, Firdevs; Akyüz, Gamze

2014-01-01

This study sought to determine the prevalence of experiences of possession and paranormal phenomena (PNP) in the general population and their possible relations to each other and to traumatic stress and dissociation. The study was conducted on a representative female sample recruited from a town in central eastern Turkey. The Dissociative Disorders Interview Schedule, the posttraumatic stress disorder (PTSD) and borderline personality disorder sections of the Structured Clinical Interviews for DSM-IV Axis-I and Personality Disorders, and the Childhood Abuse and Neglect Questionnaire were administered to 628 women. Of these, 127 (20.2%) women reported at least 1 type of PNP and 13 (2.1%) women reported possession. Women with a dissociative disorder reported all types of possession and PNP (except telepathy) more frequently than those without. Whereas women with a trauma history in childhood and adulthood or PTSD reported possession more frequently than those without, PNP were associated with childhood trauma only. Factor analysis yielded 4 dimensions: possession by and/or contact with nonhuman entities, extrasensory communications, possession by a human entity, and precognition. These factors correlated with number of secondary features of dissociative identity disorder and Schneiderian symptoms. Latent class analysis identified 3 groups. The most traumatized group, with predominantly dissociative and trauma-related disorders, had the highest scores on all factors. Notwithstanding their presence in healthy individuals, possession and PNP were associated with trauma and dissociation in a subgroup of affected participants. Both types of experience seem to be normal human capacities of experiencing that may be involved in response to traumatic stress. Given the small numbers, this study should be considered preliminary.

Dissociation in virtual reality: depersonalization and derealization

NASA Astrophysics Data System (ADS)

Garvey, Gregory P.

2010-01-01

This paper looks at virtual worlds such as Second Life7 (SL) as possible incubators of dissociation disorders as classified by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition3 (also known as the DSM-IV). Depersonalization is where "a person feels that he or she has changed in some way or is somehow unreal." Derealization when "the same beliefs are held about one's surroundings." Dissociative Identity Disorder (DID), previously known as multiple personality disorder fits users of Second Life who adopt "in-world" avatars and in effect, enact multiple distinct identities or personalities (known as alter egos or alters). Select questions from the Structured Clinical Interview for Depersonalization (SCI-DER)8 will be discussed as they might apply to the user's experience in Second Life. Finally I would like to consider the hypothesis that rather than a pathological disorder, dissociation is a normal response to the "artificial reality" of Second Life.

Dissociative complexity: Antecedents and clinical correlates of a new construct.

PubMed

Briere, John; Dietrich, Anne; Semple, Randye J

2016-09-01

To the extent that dissociation is a multidimensional phenomenon, and given a growing literature on complex posttraumatic outcomes, we hypothesized a new construct: dissociative complexity (DC). DC is defined as the tendency to simultaneously endorse multiple, relatively independent dissociative dimensions into their clinical ranges, and therefore represents the overall breadth or complexity of an individual's dissociative response. DC was evaluated in general population and prison participants using the Multiscale Dissociation Inventory (MDI; Briere, 2002). DC was higher among prisoners and women, and, as hypothesized, was associated with cumulative trauma and serious comorbidities (suicidality and substance abuse), even when controlling for generally elevated dissociation. DC appears to be a meaningful clinical construct that is phenomenologically and empirically different from a unidimensional index of dissociative severity. DC may serve as a clinical marker for multiple trauma exposures, complex dissociative outcomes, and risk of problematic comorbidities. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Psychopathy/antisocial personality disorder conundrum.

PubMed

Ogloff, James R P

2006-01-01

Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those with antisocial or dissocial personality disorder.

Differences in trauma history and psychopathology between PTSD patients with and without co-occurring dissociative disorders

PubMed Central

Wabnitz, Pascal; Gast, Ursula; Catani, Claudia

2013-01-01

Background The interplay between different types of potentially traumatizing events, posttraumatic symptoms, and the pathogenesis of PTSD or major dissociative disorders (DD) has been extensively studied during the last decade. However, the phenomenology and nosological classification of posttraumatic disorders is currently under debate. The current study was conducted to investigate differences between PTSD patients with and without co-occurring major DD with regard to general psychopathology, trauma history, and trauma-specific symptoms. Methods Twenty-four inpatients were administered the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Mini-Structured Clinical Interview for DSM-IV Dissociative Disorders (MINI-SKID-D) to assess DD and PTSD. Additionally, participants completed questionnaires to assess general psychopathology and health status. Results Symptom profiles and axis I comorbidity were similar in all patients. Traumatic experiences did not differ between the two groups, with both reporting high levels of childhood trauma. Only trauma-specific avoidance behavior and dissociative symptoms differed between groups. Conclusion Results support the view that PTSD and DD are affiliated disorders that could be classified within the same diagnostic category. Our results accord with a typological model of dissociation in which profound forms of dissociation are specific to DD and are accompanied with higher levels of trauma-specific avoidance in DD patients. PMID:24298325

Differences in trauma history and psychopathology between PTSD patients with and without co-occurring dissociative disorders.

PubMed

Wabnitz, Pascal; Gast, Ursula; Catani, Claudia

2013-01-01

The interplay between different types of potentially traumatizing events, posttraumatic symptoms, and the pathogenesis of PTSD or major dissociative disorders (DD) has been extensively studied during the last decade. However, the phenomenology and nosological classification of posttraumatic disorders is currently under debate. The current study was conducted to investigate differences between PTSD patients with and without co-occurring major DD with regard to general psychopathology, trauma history, and trauma-specific symptoms. Twenty-four inpatients were administered the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Mini-Structured Clinical Interview for DSM-IV Dissociative Disorders (MINI-SKID-D) to assess DD and PTSD. Additionally, participants completed questionnaires to assess general psychopathology and health status. Symptom profiles and axis I comorbidity were similar in all patients. Traumatic experiences did not differ between the two groups, with both reporting high levels of childhood trauma. Only trauma-specific avoidance behavior and dissociative symptoms differed between groups. Results support the view that PTSD and DD are affiliated disorders that could be classified within the same diagnostic category. Our results accord with a typological model of dissociation in which profound forms of dissociation are specific to DD and are accompanied with higher levels of trauma-specific avoidance in DD patients.

Dissociation and Memory Fragmentation in Posttraumatic Stress Disorder: An Evaluation of the Dissociative Encoding Hypothesis

PubMed Central

Bedard-Gilligan, Michele; Zoellner, Lori A.

2012-01-01

Several prominent theories of posttraumatic stress disorder (PTSD) posit that peritraumatic dissociation results in insufficient encoding of the trauma memory and that persistent dissociation prevents memory elaboration, resulting in memory fragmentation and PTSD. In this review, we summarize the empirical literature on peritraumatic and trait dissociation and trauma narrative fragmentation as measured by meta-memory and rater/objective coding. Across 16 studies to date, the association between dissociation and fragmentation was most prominent when examining peritraumatic dissociation and patient's own ratings of memory fragmentation. This relationship did not hold when examining trait dissociation or rater-coded or computer-generated measures of fragmentation. Thus, initial evidence points more toward a strong self-reported association between constructs that is not supported on more objective fragmentation coding. Measurement overlap, construct ambiguity, and exclusion of potential confounds may underlie lack of a strong association between dissociation and objective-rated fragmentation. PMID:22348400

Personality features, dissociation, self-stigma, hope, and the complex treatment of depressive disorder

PubMed Central

Prasko, Jan; Ociskova, Marie; Grambal, Ales; Sigmundova, Zuzana; Kasalova, Petra; Marackova, Marketa; Holubova, Michaela; Vrbova, Kristyna; Latalova, Klara; Slepecky, Milos

2016-01-01

Objective Identifying the predictors of response to psychiatric and psychotherapeutic treatments may be useful for increasing treatment efficacy in pharmacoresistant depressive patients. The goal of this study was to examine the influence of dissociation, hope, personality trait, and selected demographic factors in treatment response of this group of patients. Methods Pharmacoresistant depressive inpatients were enrolled in the study. All patients completed Clinical Global Impression – both objective and subjective form (CGI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) at baseline and after 6 weeks of combined pharmacotherapy and psychotherapy (group cognitive-behavioral or group psychodynamic) treatment as an outcome measures. The Internalized Stigma of Mental Illness Scale (ISMI), Dissociative Experience Scale (DES), Adult Dispositional Hope Scale (ADHS), and Temperament and Character Inventory (TCI-R) were completed at the start of the treatment with the intention to find the predictors of treatment efficacy. Results The study included 72 patients who were hospitalized for the pharmacoresistant major depression; 63 of them completed the study. The mean scores of BDI-II, BAI, subjCGI, and objCGI significantly decreased during the treatment. BDI-II relative change statistically significantly correlated with the total ISMI score, Discrimination Experience (ISMI subscale), and Harm Avoidance (TCI-R personality trait). According to stepwise regression, the strongest factors connected to BDI-II relative change were the duration of the disorder and Discrimination Experience (domain of ISMI). ObjCGI relative change significantly correlated with the level of dissociation (DES), the total ISMI score, hope in ADHS total score, and Self-Directedness (TCI-R). According to stepwise regression, the strongest factor connected to objCGI relative change was Discrimination Experience (domain of ISMI). The existence of comorbid personality disorder did not influence the treatment response. Conclusion According to the results of the present study, patients with pharmacoresistant depressive disorders, who have had more experience with discrimination because of their mental struggles, showed a poorer response to treatment. PMID:27785031

Does dissociation offer a useful explanation for psychopathology?

PubMed

Jureidini, Jon

2004-01-01

Dissociation is often conceptualised as an altered state of consciousness, a trance-like state in which normal barriers between conscious and unconscious memories, desires and beliefs break down and other amnestic barriers emerge. This review explores whether it is likely that there is a neurophysiology of pathological dissociative processes that will elucidate management. A critical reading of current research, sourced through Medline and Psychinfo searches from 1990 to 2002, using subject headings: dissociative disorders, hypnosis and stress disorder (post-traumatic), as well as keywords: dissociation, hypnosis and trance. Current knowledge does not support the notion of dissociation as a discrete brain state or process. Psychiatric and neurophysiological research and theory development are better directed towards individual components that contribute to dissociative experience. Copyright (c) 2004 S. Karger AG, Basel.

Traumatic Dissociation as a Predictor of Posttraumatic Stress Disorder in South African Female Rape Survivors

PubMed Central

Nöthling, Jani; Lammers, Kees; Martin, Lindi; Seedat, Soraya

2015-01-01

Abstract Women survivors of rape are at an increased risk for posttraumatic stress disorder (PTSD). Traumatic dissociation has been identified as a precursor of PTSD. This study assessed the predictive potential of traumatic dissociation in PTSD and depression development. The study followed a longitudinal, prospective design. Ninety-seven female rape survivors were recruited from 2 clinics in Cape Town, South Africa. Clinical interviews and symptom status assessments of the participants were completed to measure dissociation, childhood traumas, resilience, depression, and PTSD. Traumatic dissociation was a significant predictor of PTSD and depression. The linear combination of prior dissociation, current dissociation, and resilience significantly explained 20.7% of the variance in PTSD. Dissociation mediated the relationship between resilience and PTSD. As traumatic dissociation significantly predicts PTSD, its early identification and management may reduce the risk of developing PTSD. Interventions focused on promoting resilience may also be successful in reducing the risk of dissociation following rape. PMID:25906104

Concerns and Issues in Treating Children of Parents Diagnosed with Dissociative Identity Disorder.

ERIC Educational Resources Information Center

Boat, Barbara W.; Peterson, Gary

1997-01-01

Describes reasons why therapists may hesitate to address the needs of children when treating parents with Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder). Summarizes the literature supporting assessment of these children, relates clinical observations on the potential impact of DID on children, and suggests…

Personality assessment inventory profile and predictors of elevations among dissociative disorder patients.

PubMed

Stadnik, Ryan D; Brand, Bethany; Savoca, Angela

2013-01-01

Assessing patients with dissociative disorders (DD) using personality tests is difficult. On the Minnesota Multiphasic Personality Inventory-2 ( J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989 ), DD patients often obtain elevations on multiple clinical scales as well as on validity scales that were thought to indicate exaggeration yet have been shown to be elevated among traumatized individuals, including those with DD. No research has been conducted to determine how DD patients score on the Personality Assessment Inventory (PAI; L. C. Morey, 1991 ), which includes the symptom exaggeration scale Negative Impression (NIM) and the malingering scales Malingering Index (MAL) and Rogers Discriminant Function (RDF). The goals of this study were to document the PAI profile of dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) patients and to determine how the validity and Schizophrenia scales are related to other PAI scales as well as dissociation. A total of 42 inpatients with DID or DDNOS were assessed on the PAI as well as the Dissociative Experiences Scale-II. The DID/DDNOS patients were elevated on many PAI scales, including NIM and, to a lesser extent, MAL, but not RDF. Dissociation scores significantly and uniquely predicted NIM scores above and beyond Depression and Borderline Features. In addition, after we controlled for MAL and RDF, dissociation was positively associated with NIM. In contrast, after we controlled for the other 2 scales, dissociation was not related to MAL and was negatively related to RDF, indicating that RDF and, to a lesser extent, MAL are better correlates of feigning in DD patients than NIM.

[Dissociative phenomena in a sample of outpatients].

PubMed

Cantone, Daniela; Sperandeo, Raffaele; Maldonato, Mauro Nelson; Cozzolino, Pasquale; Perris, Francesco

2012-01-01

The study describes the frequency and the quality of dissociative phenomena and their relationship with axis I disorders and the psychopathological severity in outpatients. The sample (N=383) was subjected to MINI diagnostic interview and self-assessment scales DES and SCL-90. The data were analysed using SPSS. The 11,0% of subjects has a score ≥20 on DES. The 5,2% has no dissociative symptoms. The absorption images is the most frequent dissociative phenomenon, the less common is the dissociation amnesia. A relationship between dissociative phenomena and conditions unemployment, marital separation and single parties and an inverse relationship with age founded. Dissociative phenomena are more frequent in participants who have been diagnosed at least one axis I disorder and their severity is positively correlated with the number of diagnosed diseases and scores to the General Symptomatic Index. Our results point towards the existence of three types of dissociative experiences. The first type, represented by the factor absorption/imaginative involvement, is expressed along a continuum from normal to pathological; a second type, represented by the factor depersonalization/derealization, occurs in a significantly more intense and specific among subjects with axis I disorders; the latest manifestation dissociative, described by the dissociation amnesia, seems to have a predominantly typological feature that qualifies it as an experience not commonly distributed in the general population. The identifying of dissociative symptoms is necessary for the psychopathologic evaluation and to improve the effectiveness of treatment programs.

[Childhood traumatization, dissociation and nonsuicidal self-injurious behavior in borderline personality disorder].

PubMed

Merza, Katalin; Harmatta, János; Papp, Gábor; Kuritárné Szabó, Ildikó

2017-05-01

Childhood traumatization plays a significant role in the etiology of borderline personality disorder. Studies found a significant association between childhood traumatization, dissociation, and nonsuicidal self-injurious behavior. The aim of our study was to assess dissociation and nonsuicidal self-injury among borderline inpatients and to reveal the association between childhood traumatization, dissociation, and self-injurious behavior. The sample consisted of 80 borderline inpatients and 73 depressed control patients. Childhood traumatization, dissociation and self-injurious behavior were assessed by questionnaires. Borderline patients reported severe and multiplex childhood traumatization. Cumulative trauma score and sexual abuse were the strongest predictors of dissociation. Furthermore, we have found that cumulative trauma score and dissociation were highly predictive of self-injurious behavior. Our results suggest that self-injurious behavior and dissociation in borderline patients can be regarded as indicators of childhood traumatization. Orv Hetil. 2017; 158(19): 740-747.

A Non-linear Predictive Model of Borderline Personality Disorder Based on Multilayer Perceptron.

PubMed

Maldonato, Nelson M; Sperandeo, Raffaele; Moretto, Enrico; Dell'Orco, Silvia

2018-01-01

Borderline Personality Disorder is a serious mental disease, classified in Cluster B of DSM IV-TR personality disorders. People with this syndrome presents an anamnesis of traumatic experiences and shows dissociative symptoms. Since not all subjects who have been victims of trauma develop a Borderline Personality Disorder, the emergence of this serious disease seems to have the fragility of character as a predisposing condition. Infect, numerous studies show that subjects positive for diagnosis of Borderline Personality Disorder had scores extremely high or extremely low to some temperamental dimensions (harm Avoidance and reward dependence) and character dimensions (cooperativeness and self directedness). In a sample of 602 subjects, who have had consecutive access to an Outpatient Mental Health Service, it was evaluated the presence of Borderline Personality Disorder using the semi-structured interview for the DSM IV-TR personality disorders. In this population we assessed the presence of dissociative symptoms with the Dissociative Experiences Scale and the personality traits with the Temperament and Character Inventory developed by Cloninger. To assess the weight and the predictive value of these psychopathological dimensions in relation to the Borderline Personality Disorder diagnosis, a neural network statistical model called "multilayer perceptron," was implemented. This model was developed with a dichotomous dependent variable, consisting in the presence or absence of the diagnosis of borderline personality disorder and with five covariates. The first one is the taxonomic subscale of dissociative experience scale, the others are temperamental and characterial traits: Novelty-Seeking, Harm-Avoidance, Self-Directedness and Cooperativeness. The statistical model, that results satisfactory, showed a significance capacity (89%) to predict the presence of borderline personality disorder. Furthermore, the dissociative symptoms seem to have a greater influence than the character traits in the borderline personality disorder e disease. In conclusion, the results seem to indicate that to borderline personality disorder development, contribute both psychic factors, such as temperament and character traits, and environmental factors, such as traumatic events capable of producing dissociative symptoms. These factors interact in a nonlinear way in producing maladaptive behaviors typical of this disorder.

The wreathing protocol: the imbrication of hypnosis and EMDR in the treatment of dissociative identity disorder and other dissociative responses. Eye Movement Desensitization Reprocessing.

PubMed

Fine, C G; Berkowitz, A S

2001-01-01

Dissociative Identity Disorder (DID), a chronic childhood onset posttraumatic stress disorder, is currently recognized as a treatable condition. It is considered the paradigmatic dissociative condition and carries with it extreme posttraumatic symptomatology. Therapists skilled in the treatment of DID are typically fluent in the uses of hypnosis for stabilization, affect management, building a safe place and grounding to name of few. EMDR, which has come to the forefront of clinical awareness in the last ten years, seems aptly suited for the treatment of trauma, but can be destabilizing. This paper proposes a protocol, called Wreathing Protocol, for the imbricated use of EMDR and hypnosis in the treatment of not only DID (though this will be the primary focus of the paper), but also Dissociative Disorder Not Otherwise Specified (DDNOS) and chronic Posttraumatic Stress Disorder (PTSD). This protocol is useful to advanced clinicians skilled in both modalities independently. The sequential steps of the Wreathing Protocol will be described and illustrated by a clinical vignette on DID. The clinical implications of the use of the Wreathing Protocol will be discussed in DID as well as the chronic post traumatic spectrum.

Convergent paradigms for visual neuroscience and dissociative identity disorder.

PubMed

Manning, Mark L; Manning, Rana L

2009-01-01

Although dissociative identity disorder, a condition in which multiple individuals appear to inhabit a single body, is a recognized psychiatric disorder, patients may yet encounter health professionals who declare that they simply "do not believe in multiple personalities." This article explores the proposal that resistance to the disorder represents a failure to apply an appropriate paradigm from which the disorder should be interpreted. Trauma and sociocognitive explanations of dissociative identity disorder are contrasted. The trauma hypothesis is further differentiated into paradigms in which trauma affects a defense mechanism, and one in which trauma serves to inhibit the normal integration sequence of parallel processes of the self in childhood. This latter paradigm is shown to be broadly consistent with current models of cortical processing in another system, the cortical visual system.

Dissociative disorder due to Graves' hyperthyroidism: a case report.

PubMed

Mizutani, Kaoru; Nishimura, Katsuji; Ichihara, Atsuhiro; Ishigooka, Jun

2014-01-01

We report the case of a 20-year-old Japanese woman with no psychiatric history with apparent dissociative symptoms. These consisted of amnesia for episodes of shoplifting behaviors and a suicide attempt, developing together with an exacerbation of Graves' hyperthyroidism. Patients with Graves' disease frequently manifest various psychiatric disorders; however, very few reports have described dissociative disorder due to this disease. Along with other possible causes, for example, encephalopathy associated with autoimmune thyroid disease, clinicians should be aware of this possibility. Copyright © 2014 Elsevier Inc. All rights reserved.

Neural dissociation of phonological and visual attention span disorders in developmental dyslexia: FMRI evidence from two case reports.

PubMed

Peyrin, C; Lallier, M; Démonet, J F; Pernet, C; Baciu, M; Le Bas, J F; Valdois, S

2012-03-01

A dissociation between phonological and visual attention (VA) span disorders has been reported in dyslexic children. This study investigates whether this cognitively-based dissociation has a neurobiological counterpart through the investigation of two cases of developmental dyslexia. LL showed a phonological disorder but preserved VA span whereas FG exhibited the reverse pattern. During a phonological rhyme judgement task, LL showed decreased activation of the left inferior frontal gyrus whereas this region was activated at the level of the controls in FG. Conversely, during a visual categorization task, FG demonstrated decreased activation of the parietal lobules whereas these regions were activated in LL as in the controls. These contrasted patterns of brain activation thus mirror the cognitive disorders' dissociation. These findings provide the first evidence for an association between distinct brain mechanisms and distinct cognitive deficits in developmental dyslexia, emphasizing the importance of taking into account the heterogeneity of the reading disorder. Copyright © 2012 Elsevier Inc. All rights reserved.

The Role of Double Dissociation Studies in the Search for Candidate Endophenotypes for the Comorbidity of Attention Deficit Hyperactivity Disorder and Reading Disability

ERIC Educational Resources Information Center

de Jong, Christien G. W.; Oosterlaan, Jaap; Sergeant, Joseph A.

2006-01-01

The neuropsychological underpinnings of Attention Deficit Hyperactivity Disorder (ADHD) and Reading Disability (RD) and their comorbidity may be studied usefully with the double dissociation design. The results of studies using the double dissociation method may be linked to the search for an endophenotype of ADHD and RD and their comorbidity.…

A Brief Screening Instrument for Emotionally Unstable and Dissocial Personality Disorder in Male Offenders with Intellectual Disabilities

ERIC Educational Resources Information Center

Taylor, John L.; Novaco, Raymond W.

2013-01-01

Personality disorder is prevalent among offenders with intellectual disabilities (ID), and it is associated with their risk for violence and recurrent offending behaviour. A new staff-rated instrument, the Personality Disorder Characteristics Checklist (PDCC), designed to screen for ICD-10 dissocial and emotionally unstable personality…

Sexual Abuse and the Problem of Embodiment.

ERIC Educational Resources Information Center

Young, Leslie

1992-01-01

Potential long-term effects of the trauma of severe sexual abuse on a child's sense of living in his/her body and in the world are explored. Trauma and dissociation are analyzed and linked to a posttraumatic sense of personal identity. Then dissociation, multiple personality disorder, eating disorders, somatization disorder, self-mutilation, and…

Raman and Brillouin scattering of LiClO4 complexed in poly(propylene-glycol)

NASA Astrophysics Data System (ADS)

Schantz, S.; Torell, L. M.; Stevens, J. R.

1988-08-01

Raman spectra of LiClO4 complexed in poly(propylene-glycol) (PPG) have been obtained for concentrations of the monomer to salt ratio (ether oxygen):Li in the range 30:1-5:1. Splitting of the symmetric stretching mode of the ClO4- anion was observed with an intensity profile that varied with salt concentration. This phenomenon indicates a changing environment about the anion. A two-component band analysis leads to the identification of dissociated ions on one hand and solvent-separated ion pairs on the other. The concentration of ion pairs is relatively low compared to that of the dissociated ions, which are predominant for all concentrations. Despite the observed increase in the absolute number of dissociated ions at higher salt concentration, the electrical conductivity is reported to decrease in the same range. This indicates that the number of ``free'' charge carriers is of less importance for the conductivity than the mobility, which is damped in this concentration range. Frequency shifts of the disordered longitudinal-acoustic mode and increased hypersonic velocities, measured with Raman and Brillouin scattering techniques, respectively, indicate increased stiffness of the polymer matrix for increasing salt concentration, which probably results in decreased ion mobility.

Dissociative Experiences and Disorders among Women Who Identify Themselves as Sexual Abuse Survivors.

ERIC Educational Resources Information Center

Anderson, Geri; And Others

1993-01-01

Interviews with 51 female sexual abuse survivors revealed that over half had a diagnosis of multiple personality disorder, and the vast majority had extensive dissociative symptomatology and related features. (Author/JDD)

Psychological Dissection of Patients Having Dissociative Disorder: A Cross-sectional Study

PubMed Central

Reddy, Lohit Somashekar; Patil, N. M.; Nayak, Raghavendra B.; Chate, Sameeran S.; Ansari, Saba

2018-01-01

Background: Patients present with dissociative disorders as a decompensation to underlying stressful situation. It is clinically important to evaluate the presence, type, and temporal relation of the stressors resulting in dissociation. Further knowing the sociodemographic and psychological profile of the dissociative patient helps in better management. Materials and Methods: The study included 55 dissociative patients aged between 5 to 45 years. Psychiatric diagnosis was made using ICD-10 DCR. Psychosocial stressors and stressful life events were assessed using presumptive stressful life events scale/life events scale for Indian children and clinical interview. Personality and temperament traits were assessed using medico psychological questionnaire and temperament measurement schedule, respectively. Intelligence quotient (IQ) was assessed using standard progressive matrices and colored progressive matrices. Statistical analysis was done using Epi Info 7 software. Results: All patients had significant psychosocial stressors preceding dissociation. Precipitating factor with temporal association was observed in only 83.64%. Family disharmony (41.82%) followed by education-related problems (29.09%) was the most common psychosocial stressors. 61.82% of the dissociative patients had psychiatric comorbidity. Mean IQ of study sample was 92.47. Dissociative children had high emotionality and energy levels but low sociability, rhythmicity, and distractibility. 50% of the adults were neurotic and had emotionally unstable personality. Conclusion: Dissociative disorders are commonly seen in females, adolescents, and in those from lower socioeconomic status and rural areas. They are always preceded by psychosocial stressors. Most of them have comorbid psychiatric disorders such as depression and anxiety. Neuroticism and emotionally unstable personality traits are common in adult patients while temperamental traits such as low sociability, low rhythmicity, low distractibility, high emotionality, and high energy levels are common in children. PMID:29403129

Psychological Dissection of Patients Having Dissociative Disorder: A Cross-sectional Study.

PubMed

Reddy, Lohit Somashekar; Patil, N M; Nayak, Raghavendra B; Chate, Sameeran S; Ansari, Saba

2018-01-01

Patients present with dissociative disorders as a decompensation to underlying stressful situation. It is clinically important to evaluate the presence, type, and temporal relation of the stressors resulting in dissociation. Further knowing the sociodemographic and psychological profile of the dissociative patient helps in better management. The study included 55 dissociative patients aged between 5 to 45 years. Psychiatric diagnosis was made using ICD-10 DCR. Psychosocial stressors and stressful life events were assessed using presumptive stressful life events scale/life events scale for Indian children and clinical interview. Personality and temperament traits were assessed using medico psychological questionnaire and temperament measurement schedule, respectively. Intelligence quotient (IQ) was assessed using standard progressive matrices and colored progressive matrices. Statistical analysis was done using Epi Info 7 software. All patients had significant psychosocial stressors preceding dissociation. Precipitating factor with temporal association was observed in only 83.64%. Family disharmony (41.82%) followed by education-related problems (29.09%) was the most common psychosocial stressors. 61.82% of the dissociative patients had psychiatric comorbidity. Mean IQ of study sample was 92.47. Dissociative children had high emotionality and energy levels but low sociability, rhythmicity, and distractibility. 50% of the adults were neurotic and had emotionally unstable personality. Dissociative disorders are commonly seen in females, adolescents, and in those from lower socioeconomic status and rural areas. They are always preceded by psychosocial stressors. Most of them have comorbid psychiatric disorders such as depression and anxiety. Neuroticism and emotionally unstable personality traits are common in adult patients while temperamental traits such as low sociability, low rhythmicity, low distractibility, high emotionality, and high energy levels are common in children.

Unique and Overlapping Symptoms in Schizophrenia Spectrum and Dissociative Disorders in Relation to Models of Psychopathology: A Systematic Review

PubMed Central

Renard, Selwyn B.; Huntjens, Rafaele J. C.; Lysaker, Paul H.; Moskowitz, Andrew; Aleman, André; Pijnenborg, Gerdina H. M.

2017-01-01

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. PMID:27209638

Dissociative Disorders

MedlinePlus

... use disorders Depression and anxiety disorders Post-traumatic stress disorder Personality disorders Sleep disorders, including nightmares, insomnia and sleepwalking Eating disorders Physical symptoms such as ...

Assessing the existence of dissociative PTSD in sub-acute patients of whiplash.

PubMed

Hansen, Maj; Hyland, Philip; Armour, Cherie; Andersen, Tonny E

2018-03-16

Numerous studies investigating dissociative posttraumatic stress disorder (D-PTSD) have emerged. However, there is a lack of studies investigating D-PTSD following a wider range of traumatic exposure. Thus, the present study investigates D-PTSD using latent class analysis (LCA) in sub-acute patients of whiplash and associated risk factors. The results of LCA showed a three-class solution primarily distributed according to posttraumatic stress disorder (PTSD) symptom severity and thus no indication of D-PTSD. Dissociative symptoms, psychological distress (i.e. anxiety/depression), and pain severity significantly predicted PTSD severity. Combined, the results support the component model of dissociation and PTSD, while still stressing the importance of dissociative symptoms when planning treatment for PTSD.

Dissociative Experience and Cultural Neuroscience: Narrative, Metaphor and Mechanism

PubMed Central

Kirmayer, Laurence J.

2016-01-01

Approaches to trance and possession in anthropology have tended to use outmoded models drawn from psychodynamic theory or treated such dissociative phenomena as purely discursive processes of attributing action and experience to agencies other than the self. Within psychology and psychiatry, understanding of dissociative disorders has been hindered by polemical “either/or” arguments: either dissociative disorders are real, spontaneous alterations in brain states that reflect basic neurobiological phenomena, or they are imaginary, socially constructed role performances dictated by interpersonal expectations, power dynamics and cultural scripts. In this paper, we outline an approach to dissociative phenomena, including trance, possession and spiritual and healing practices, that integrates the neuropsychological notions of underlying mechanism with sociocultural processes of the narrative construction and social presentation of the self. This integrative model, grounded in a cultural neuroscience, can advance ethnographic studies of dissociation and inform clinical approaches to dissociation through careful consideration of the impact of social context. PMID:18213511

Dissociative experience and cultural neuroscience: narrative, metaphor and mechanism.

PubMed

Seligman, Rebecca; Kirmayer, Laurence J

2008-03-01

Approaches to trance and possession in anthropology have tended to use outmoded models drawn from psychodynamic theory or treated such dissociative phenomena as purely discursive processes of attributing action and experience to agencies other than the self. Within psychology and psychiatry, understanding of dissociative disorders has been hindered by polemical "either/or" arguments: either dissociative disorders are real, spontaneous alterations in brain states that reflect basic neurobiological phenomena, or they are imaginary, socially constructed role performances dictated by interpersonal expectations, power dynamics and cultural scripts. In this paper, we outline an approach to dissociative phenomena, including trance, possession and spiritual and healing practices, that integrates the neuropsychological notions of underlying mechanism with sociocultural processes of the narrative construction and social presentation of the self. This integrative model, grounded in a cultural neuroscience, can advance ethnographic studies of dissociation and inform clinical approaches to dissociation through careful consideration of the impact of social context.

The Contribution of Art Therapy to the Dissociative Disorders.

ERIC Educational Resources Information Center

Murphy, Patricia S.

1994-01-01

Explored concepts of brain hemispheric lateralization and distinct right brain functioning in extensive dissociation by administering Dissociative Experiences Scale to 114 engineering students and 92 university drawing students. Chi-square calculation found differences in dissociative scoring levels between groups that approached significance at…

Dissociation is associated with emotional maltreatment in a sample of traumatized women with a history of child abuse.

PubMed

Haferkamp, Lisa; Bebermeier, Anke; Möllering, Andrea; Neuner, Frank

2015-01-01

Theories of dissociation emphasize that symptoms of dissociation are correlated with traumatic events. Although the association of dissociative symptoms and retrospective reports of child abuse with a focus on mainly sexual and physical abuse has been well documented, investigation of the contribution of emotional or psychological types of maltreatment to the prediction of dissociation has been neglected to a great extent. The aim of this study was to determine the differential impact of different types of maltreatment on dissociative symptoms in a sample of 203 female residential patients treated for posttraumatic stress disorder linked to child maltreatment. Moreover, it was examined whether the link between dissociation and child maltreatment is direct or indirect. Subjects completed questionnaires on child maltreatment, posttraumatic stress, and dissociative symptoms. Although all types of maltreatment were related to dissociative symptoms, emotional abuse was the strongest and most direct predictor of dissociation in multivariate hierarchical analyses with the influence of other trauma types being confounded by emotional abuse. This study highlights the importance of emotional types of maltreatment for the genesis of dissociative symptoms in patients with posttraumatic stress disorder.

[Persistent Perpetrator Contact in a Patient with Dissociative Identity Disorder].

PubMed

Tschöke, Stefan; Eisele, Frank; Steinert, Tilman

2016-05-01

The case of a young woman with still ongoing incest and forced prostitution is presented. The criteria for a dissociative identity disorder (DID) were met. Due to persistent contact to the perpetrator she was repeatedly revictimized. Based on the model of trauma-related dissociation we discuss to what extent she was capable of self-determined decision making as well as therapeutic consequences resulting therefrom. © Georg Thieme Verlag KG Stuttgart · New York.

Dissociative Mothers' Subjective Experience of Parenting.

ERIC Educational Resources Information Center

Benjamin, Lynn R.; And Others

1996-01-01

A study of 54 mothers with a dissociative disorder, 20 mothers with other mental problems, and 20 normal mothers investigated what effect, if any, dissociation had on parenting. When tested on the Subjective Experiences of Parenting Scale, mothers with dissociation presented significantly more negative parenting behavior and attitudes. (CR)

[Minimal emotional dysfunction and first impression formation in personality disorders].

PubMed

Linden, M; Vilain, M

2011-01-01

"Minimal cerebral dysfunctions" are isolated impairments of basic mental functions, which are elements of complex functions like speech. The best described are cognitive dysfunctions such as reading and writing problems, dyscalculia, attention deficits, but also motor dysfunctions such as problems with articulation, hyperactivity or impulsivity. Personality disorders can be characterized by isolated emotional dysfunctions in relation to emotional adequacy, intensity and responsivity. For example, paranoid personality disorders can be characterized by continuous and inadequate distrust, as a disorder of emotional adequacy. Schizoid personality disorders can be characterized by low expressive emotionality, as a disorder of effect intensity, or dissocial personality disorders can be characterized by emotional non-responsivity. Minimal emotional dysfunctions cause interactional misunderstandings because of the psychology of "first impression formation". Studies have shown that in 100 ms persons build up complex and lasting emotional judgements about other persons. Therefore, minimal emotional dysfunctions result in interactional problems and adjustment disorders and in corresponding cognitive schemata.From the concept of minimal emotional dysfunctions specific psychotherapeutic interventions in respect to the patient-therapist relationship, the diagnostic process, the clarification of emotions and reality testing, and especially an understanding of personality disorders as impairment and "selection, optimization, and compensation" as a way of coping can be derived.

Dissociative seizures--a critical review and perspective.

PubMed

Schmutz, Matthias

2013-12-01

Dissociative seizures are commonly recognized as both a challenging and a poorly understood condition. Though research and publication activity is high, advances in knowledge and insight seem only moderate in recent years. This review focuses on some relevant problematic issues, which might account for a still unsatisfactory research state. A general tendency to deal with dissociative seizures as an assumed disorder in its own nosological right and not as a sole symptom of an underlying psychiatric disorder is most likely one of the major roots of the problem. Unfavorable impacts of this confusion pertaining to clinical management, therapy, and outcome of dissociative seizures are discussed. An alternative point of view, based on the immanent psychiatric and psychodynamic roots of dissociative seizures, is considered. © 2013.

Trauma-related dissociative (conversion) disorders in children and adolescents--an overview of assessment tools and treatment principles.

PubMed

Diseth, Trond H; Christie, Helen J

2005-01-01

A high proportion of patients in child and adolescent psychiatry with significant dissociative symptomatology after early childhood traumatization may go undiagnosed, be wrongly diagnosed and/or inappropriately treated. The diagnostics and treatment of dissociative disorders have been limited by lack of comprehensive, reliable and valid instruments and the ongoing polarization and fierce controversy regarding treatment. However, recent neurobiological findings of neurochemical, functional and structural cerebral consequences of early stressful childhood experiences point out a need for active, early and effective identification and treatment interventions. We present an update on assessment tools available in the Nordic countries, and an overview of different appropriate therapeutic intervention models for children and adolescents. A systematic overview of studies of dissociation in children and adolescent published over the last decade disclosed a total of 1019 references. The 465 papers describing aspects of assessment tools and/or treatment were studied in detail. Reliable and valid screening questionnaires and diagnostic interviews for children and adolescents now allow for effective early identification of dissociative disorders. A combination of individual psychotherapy, pharmacotherapy and family therapy are often required to handle dissociative disorders in children and adolescents. Cognitive-behavioural therapy, hypnotherapy, Eye-Movement Desensitization-Reprocessing (EMDR), psychodynamic therapy and an integrated approach are the main described psychotherapeutic approaches, but treatment of dissociation in children and adolescent does not require allegiance to any one particular treatment model. However, achievement of physical safety by providing a safe environment is a primary goal that supersedes any other therapeutic work. Assessments tools are now available, and appropriate therapeutic intervention models may hopefully contribute to reduce the risk of wrong diagnoses and inappropriate treatment of dissociative symptomatology in children and adolescents. However, controlled clinical trials of the various interventions and longitudinal outcome studies are needed.

A latent class analysis of dissociation and posttraumatic stress disorder: evidence for a dissociative subtype.

PubMed

Wolf, Erika J; Miller, Mark W; Reardon, Annemarie F; Ryabchenko, Karen A; Castillo, Diane; Freund, Rachel

2012-07-01

The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosologic importance. To examine evidence for a dissociative subtype of PTSD and to examine its association with different types of trauma. A latent profile analysis of cross-sectional data from structured clinical interviews indexing DSM-IV symptoms of current PTSD and dissociation. The VA Boston Healthcare System and the New Mexico VA Health Care System. A total of 492 veterans and their intimate partners, all of whom had a history of trauma. Participants reported exposure to a variety of traumatic events, including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents, and natural disasters, with most participants reporting exposure to multiple types of traumatic events. Forty-two percent of the sample met the criteria for a current diagnosis of PTSD. Item-level scores on the Clinician-Administered PTSD Scale. A latent profile analysis suggested a 3-class solution: a low PTSD severity subgroup, a high PTSD severity subgroup characterized by elevations across the 17 core symptoms of the disorder, and a small but distinctly dissociative subgroup that composed 12% of individuals with a current diagnosis of PTSD. The latter group was characterized by severe PTSD symptoms combined with marked elevations on items assessing flashbacks, derealization, and depersonalization. Individuals in this subgroup also endorsed greater exposure to childhood and adult sexual trauma compared with the other 2 groups, suggesting a possible etiologic link with the experience of repeated sexual trauma. These results support the subtype hypothesis of the association between PTSD and dissociation and suggest that dissociation is a highly salient facet of posttraumatic psychopathology in a subset of individuals with the disorder.

Empirical testing of criteria for dissociative schizophrenia.

PubMed

Laferrière-Simard, Marie-Christine; Lecomte, Tania; Ahoundova, Lola

2014-01-01

This study examined the validity of dissociative schizophrenia diagnostic criteria. In the first phase, 50 participants with a psychotic disorder were administered the Dissociative Experiences Scale and the Childhood Trauma Questionnaire to identify those with dissociative characteristics. In the second phase, we selected those who had a score of 15 or above on the Dissociative Experiences Scale. Fifteen of these participants were evaluated thoroughly with the Structured Clinical Interview for DSM-IV Axis I, Structured Clinical Interview for DSM-IV Axis II, and Structured Clinical Interview for DSM-IV Dissociative Disorders to determine whether they met the criteria for dissociative schizophrenia and to generate a clinical description. Our results indicated that 24% of the individuals we tested met these criteria. We propose making mandatory 1 of the 3 dissociative symptoms of the criteria to eliminate people with only nonspecific symptoms (e.g., extensive comorbidity). According to this modified criterion, 14% of our sample would receive a diagnosis of dissociative schizophrenia. However, a more comprehensive look at the clinical picture begs the question of whether dissociative schizophrenia is truly present in every person meeting the criteria. We discuss the relevance of creating a new schizophrenia subtype and offer recommendations for clinicians.

Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness.

PubMed

Mauritz, Maria W; Goossens, Peter J J; Draijer, Nel; van Achterberg, Theo

2013-01-01

Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. We conducted a systematic review of four databases (1980-2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25-72%), sexual abuse 37% (range 24-49%), and posttraumatic stress disorder (PTSD) 30% (range 20-47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.

Abnormal Hippocampal Morphology in Dissociative Identity Disorder and Posttraumatic Stress Disorder Correlates with Childhood Trauma and Dissociative Symptoms

PubMed Central

Chalavi, Sima; Vissia, Eline M.; Giesen, Mechteld E.; Nijenhuis, Ellert R.S.; Draijer, Nel; Cole, James H.; Dazzan, Paola; Pariante, Carmine M.; Madsen, Sarah K.; Rajagopalan, Priya; Thompson, Paul M.; Toga, Arthur W.; Veltman, Dick J.; Reinders, Antje A.T.S.

2015-01-01

Smaller hippocampal volume has been reported in individuals with posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID), but the regional specificity of hippocampal volume reductions and the association with severity of dissociative symptoms and/or childhood traumatization are still unclear. Brain structural MRI scans were analyzed for 33 outpatients (17 with DID and 16 with PTSD only) and 28 healthy controls (HC), all matched for age, sex, and education. DID patients met criteria for PTSD (PTSD-DID). Hippocampal global and subfield volumes and shape measurements were extracted. We found that global hippocampal volume was significantly smaller in all 33 patients (left: 6.75%; right: 8.33%) compared to HC. PTSD-DID (left: 10.19%; right: 11.37%) and PTSD-only with a history of childhood traumatization (left: 7.11%; right: 7.31%) had significantly smaller global hippocampal volume relative to HC. PTSD-DID had abnormal shape and significantly smaller volume in the CA2-3, CA4-DG and (pre)subiculum compared to HC. In the patient groups, smaller global and subfield hippocampal volumes significantly correlated with higher severity of childhood traumatization and dissociative symptoms. These findings support a childhood trauma-related etiology for abnormal hippocampal morphology in both PTSD and DID and can further the understanding of neurobiological mechanisms involved in these disorders. PMID:25545784

Abnormal hippocampal morphology in dissociative identity disorder and post-traumatic stress disorder correlates with childhood trauma and dissociative symptoms.

PubMed

Chalavi, Sima; Vissia, Eline M; Giesen, Mechteld E; Nijenhuis, Ellert R S; Draijer, Nel; Cole, James H; Dazzan, Paola; Pariante, Carmine M; Madsen, Sarah K; Rajagopalan, Priya; Thompson, Paul M; Toga, Arthur W; Veltman, Dick J; Reinders, Antje A T S

2015-05-01

Smaller hippocampal volume has been reported in individuals with post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID), but the regional specificity of hippocampal volume reductions and the association with severity of dissociative symptoms and/or childhood traumatization are still unclear. Brain structural magnetic resonance imaging scans were analyzed for 33 outpatients (17 with DID and 16 with PTSD only) and 28 healthy controls (HC), all matched for age, sex, and education. DID patients met criteria for PTSD (PTSD-DID). Hippocampal global and subfield volumes and shape measurements were extracted. We found that global hippocampal volume was significantly smaller in all 33 patients (left: 6.75%; right: 8.33%) compared with HC. PTSD-DID (left: 10.19%; right: 11.37%) and PTSD-only with a history of childhood traumatization (left: 7.11%; right: 7.31%) had significantly smaller global hippocampal volume relative to HC. PTSD-DID had abnormal shape and significantly smaller volume in the CA2-3, CA4-DG and (pre)subiculum compared with HC. In the patient groups, smaller global and subfield hippocampal volumes significantly correlated with higher severity of childhood traumatization and dissociative symptoms. These findings support a childhood trauma-related etiology for abnormal hippocampal morphology in both PTSD and DID and can further the understanding of neurobiological mechanisms involved in these disorders. © 2014 Wiley Periodicals, Inc.

Effectiveness of trauma-focused treatment for patients with psychosis with and without the dissociative subtype of post-traumatic stress disorder.

PubMed

van Minnen, A; van der Vleugel, B M; van den Berg, D P G; de Bont, P A J M; de Roos, C; van der Gaag, M; de Jongh, A

2016-10-01

This study presents secondary analyses of a recently published trial in which post-traumatic stress disorder (PTSD) patients with psychosis (n = 108) underwent 8 sessions of trauma-focused treatment, either prolonged exposure (PE) or eye movement desensitisation and reprocessing (EMDR) therapy. 24.1% fulfilled the criteria for the dissociative subtype, a newly introduced PTSD subtype in DSM-5. Treatment outcome was compared for patients with and without the dissociative subtype of PTSD. Patients with the dissociative subtype of PTSD showed large reductions in clinician-administered PTSD scale (CAPS) score, comparable with patients without the dissociative subtype of PTSD. It is concluded that even in a population with severe mental illness, patients with the dissociative subtype of PTSD do benefit from trauma-focused treatments without a pre-phase of emotion regulation skill training and should not be excluded from these treatments. © The Royal College of Psychiatrists 2016.

Relations between childhood traumatic experiences, dissociation, and cognitive models in obsessive compulsive disorder.

PubMed

Selvi, Yavuz; Besiroglu, Lutfullah; Aydin, Adem; Gulec, Mustafa; Atli, Abdullah; Boysan, Murat; Celik, Cihat

2012-03-01

Previous studies have indicated that obsessive compulsive disorder (OCD) is associated with childhood traumatic experiences and higher levels of dissociation. Dissociative tendency may arise when individual attempt to incorporate adverse experiences into cognitive schema. We investigated the possible links among childhood trauma, dissociation, and cognitive processes. We evaluated 95 patients with OCD using the Beck Depression Inventory (BDI), Thought-Action Fusion Scale (TAFS), Metacognitions Questionnaire (MCQ-30), White Bear Suppression Inventory (WBSI), Dissociative Experiences Scale (DES), and Childhood Trauma Questionnaire (CTQ-28). The CTQ-28 total scores were not associated with Y-BOCS total, Y-BOCS insight, BDI, TAFS, MCQ-30, and WBSI scores. The TAFS Total, MCQ-30, WBSI, and BDI scores were significantly associated with DES scores. Regression analysis revealed that MCQ-30 and WBSI scores significantly predicted the DES scores. These results suggest that in spite of pathological connotation of dissociative experiences, dissociation may primarily constitute a cognitive trait which is strongly associated with cognitive processes.

[Dissociative disorders: from Janet to DSM-IV].

PubMed

Nakatani, Y

2000-01-01

I reviewed the literature on dissociation and dissociative disorders from Pierre Janet to DSM-IV, and examined the current trends in research. Janet's theory on hysteria is multifaceted, and is based on three psychological models. Based on a hierarchical model, Janet related hysteric symptoms to the activities within the lower strata of mental hierarchy (automatisms psychologiques), which were demonstrably shown in somnambulism. A second model was based on the concept of a psychological system, which was hypothetically composed of ideas, images, feelings, sensations, and movements. According to this model, dissociation of psychological functions was fundamental to the mechanism of hysteria: loss of integration was thought to engender fixed ideas (ideas fixes) and to lead to the development of a system totally isolated from the whole personality system. Janet also attempted to explain various mental disorders using an economic model. He referred to a loss of equilibration between psychological force and psychological tension. Thus, an unexpected emotional experience was conceived to cause a consumption of reserved psychological force, which was in turn followed by exhaustion associated with hysteric symptoms. Whereas most current researchers regard Janet as the first to study psychological trauma as a principal cause of dissociation, I feel it is important to note that he also emphasized the role of stigmata, i.e., permanent traits of hysteric patients, which were represented as a suggestibility and a tendency toward a narrowing of the consciousness field. Discussion about dissociation and its relation to trauma all but disappeared after Janet. However, during the Second World War and post-war period, some psychiatrists began to pay attention to two emerging phenomena: a high incidence of dissociative symptoms such as fugue and amnesia among combatants, and traumatic neurosis frequently observed among ex-inmates of concentration camps. In the 1970s, interest in dissociation and trauma was revived in different areas: the feminism movement was linked with concerns about child sexual abuse, public curiosity about multiple personalities was heightened by novels and movies, and recognition of posttraumatic stress disorder (PTSD) among Vietnam War veterans. In 1980, dissociative disorders were finally adopted as a diagnostic category in the official nomenclature of DSM-III. Although current research on dissociation is being carried out in various fields, two basic assumptions, reflected in the definition of DSM-IV, can be made. One is the "trauma-genic hypothesis," and the other is the great importance attached to multiple personality disorder (MPD). According to the predominantly held view, dissociation represents a reaction to early traumatic experience, especially sexual and physical abuse in childhood. In contrast, some authors argue that the causality of childhood traumatic experience has not been empirically confirmed, and other factors such as the influence of the environment and the predisposition of patients should be taken into consideration. MPD, which was originally described as an unusual phenomenon in classical literature, is currently thought to be a common type of dissociation. However, the reported rapid increase in the number of MPD patients in North America may be partially due to over-diagnosis and inclusion of iatrogenic cases. Significance is also given to MPD in respect to classification of dissociative phenomena. According to the widely held scheme of a "dissociative continuum," which ranges from normal experiences such as daydreams to pathological states, MPD is placed at the extreme end of the continuum. Furthermore, most researchers tend to classify MPD as the severest dissociative disorder due to chronic trauma. On this point, there seems to be confusion about "extremity" and "severity" of MPD. I conclude that the trauma-genic hypothesis of dissociation and the overemphasis placed on MPD should be reexamin

A general mechanism for competitor-induced dissociation of molecular complexes

PubMed Central

Paramanathan, Thayaparan; Reeves, Daniel; Friedman, Larry J.; Kondev, Jane; Gelles, Jeff

2014-01-01

The kinetic stability of non-covalent macromolecular complexes controls many biological phenomena. Here we find that physical models of complex dissociation predict that competitor molecules will in general accelerate the breakdown of isolated bimolecular complexes by occluding rapid rebinding of the two binding partners. This prediction is largely independent of molecular details. We confirm the prediction with single-molecule fluorescence experiments on a well-characterized DNA strand dissociation reaction. Contrary to common assumptions, competitor–induced acceleration of dissociation can occur in biologically relevant competitor concentration ranges and does not necessarily implyternary association of competitor with the bimolecular complex. Thus, occlusion of complex rebinding may play a significant role in a variety of biomolecular processes. The results also show that single-molecule colocalization experiments can accurately measure dissociation rates despite their limited spatio temporal resolution. PMID:25342513

Culture and conversion disorder: implications for DSM-5.

PubMed

Brown, Richard J; Lewis-Fernández, Roberto

2011-01-01

The diagnostic criteria and related features of conversion disorder are under revision for DSM-5, including the requirement that psychological factors accompany the symptoms or deficits in question (Criterion B) and whether conversion disorder should be re-labeled as a dissociative, rather than a somatoform, condition. We examined the cross-cultural evidence on the prevalence, characteristics, and associated features of pseudoneurological symptoms more generally, and conversion disorder in particular, in order to inform the ongoing re-evaluation of the conversion disorder category. We also examined the relationship between these constructs and dissociative symptoms and disorders across cultural groups. Searches were conducted of the mental health literature, particularly since 1994, regarding culture, race, or ethnicity factors related to conversion disorder. Many proposed DSM-5 revisions were supported, such as the elimination of Criterion B. We also found cross-cultural variability in predominant symptoms, disorder prevalence, and relationship with cultural syndromes. Additional information that may contribute to DSM-5 includes the elevated rates across cultures of traumatic exposure and psychiatric comorbidity in conversion disorder. Cross-culturally, conversion disorder is associated strongly with both dissociative and somatoform presentations, revealing no clear basis on which to locate the disorder in DSM-5. Careful consideration should be given to the possible alternatives.

Cognitive behavioral hypnotherapy for dissociative disorders.

PubMed

Fine, Catherine G

2012-04-01

Dissociative disorders (DD) prevail as sequelae to overwhelming experiences in childhood. These readily formed post-traumatic responses and trance states develop in high hypnotizable subjects whose dysregulations become organized into ego states. A cognitive behavioral hypnotherapeutic treatment model will effectively contain, explore, metabolize, and resolve these life-endangering conditions. This article will detail the cognitive hypnotic world of DD patients, the relational spaces of the ego states, and the triphasic treatment mode to successfully resolve the dissociative pathology. Structured and phase appropriate hypnotic interventions will be described.

Dissociative Identity Disorder in Felonious Offenders: Two Case Studies.

ERIC Educational Resources Information Center

Culiner, Ty

1997-01-01

Describes the case studies of two inmates detained in a maximum security prison having been diagnosed with Dissociative Identity Disorder and receiving individual therapy. Although treatment is ongoing, mid-treatment progress indicates the treatment is successful and the prognosis is excellent. Accentuates the practicality and rewards of working…

Patients Reporting Ritual Abuse in Childhood: A Clinical Syndrome. Report of 37 Cases.

ERIC Educational Resources Information Center

Young, Walter C.; And Others

1991-01-01

Thirty-seven adult dissociative disorder patients who reported ritual abuse in childhood by satanic cults are described. A clinical syndrome is presented that includes dissociative states with satanic overtones, posttraumatic stress disorder, survivor guilt, unusual fears, and substance abuse. Questions concerning reliability, credibility, and…

Three cases of dissociative identity disorder and co-occurring borderline personality disorder treated with dynamic deconstructive psychotherapy.

PubMed

Chlebowski, Susan M; Gregory, Robert J

2012-01-01

Dissociative Identity Disorder (DID) is an under-researched entity and there are no clinical trials employing manual-based therapies and validated outcome measures. There is evidence that borderline personality disorder (BPD) commonly co-occurs with DID and can worsen its course. The authors report three cases of DID with co-occurring BPD that we successfully treated with a manual-based treatment, Dynamic Deconstructive Psychotherapy (DDP). Each of the three clients achieved a 34% to 79% reduction in their Dissociative Experiences Scale scores within 12 months of initiating therapy. Dynamic Deconstructive Psychotherapy was developed for treatment refractory BPD and differs in some respects from expert consensus treatment of DID. It may be a promising modality for DID complicated by co-occurring BPD.

Possession experiences in dissociative identity disorder: a preliminary study.

PubMed

Ross, Colin A

2011-01-01

Dissociative trance disorder, which includes possession experiences, was introduced as a provisional diagnosis requiring further study in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Consideration is now being given to including possession experiences within dissociative identity disorder (DID) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), which is due to be published in 2013. In order to provide empirical data relevant to the relationship between DID and possession states, I analyzed data on the prevalence of trance, possession states, sleepwalking, and paranormal experiences in 3 large samples: patients with DID from North America; psychiatric outpatients from Shanghai, China; and a general population sample from Winnipeg, Canada. Trance, sleepwalking, paranormal, and possession experiences were much more common in the DID patients than in the 2 comparison samples. The study is preliminary and exploratory in nature because the samples were not matched in any way.

The Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) Among Adolescents: Co-Occurring PTSD, Depersonalization/Derealization, and Other Dissociation Symptoms.

PubMed

Choi, Kristen R; Seng, Julia S; Briggs, Ernestine C; Munro-Kramer, Michelle L; Graham-Bermann, Sandra A; Lee, Robert C; Ford, Julian D

2017-12-01

The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by evaluating evidence for the depersonalization/derealization dissociative subtype of PTSD as defined by the DSM-5 and then examining a broader set of dissociation symptoms. A sample of treatment-seeking, trauma-exposed adolescents 12 to 16 years old (N = 3,081) from the National Child Traumatic Stress Network Core Data Set was used to meet the study objectives. Two models of PTSD/dissociation co-occurrence were estimated using latent class analysis, one with 2 dissociation symptoms and the other with 10 dissociation symptoms. After model selection, groups within each model were compared on demographics, trauma characteristics, and psychopathology. Model A, the depersonalization/derealization model, had 5 classes: dissociative subtype/high PTSD; high PTSD; anxious arousal; dysphoric arousal; and a low symptom/reference class. Model B, the expanded dissociation model, identified an additional class characterized by dissociative amnesia and detached arousal. These 2 models provide new information about the specific ways PTSD and dissociation co-occur and illuminate some differences between adult and adolescent trauma symptom expression. A dissociative subtype of PTSD can be distinguished from PTSD alone in adolescents, but assessing a wider range of dissociative symptoms is needed to fully characterize adolescent traumatic stress responses. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

The Influence of the Dissociative Subtype of Posttraumatic Stress Disorder on Treatment Efficacy in Female Veterans and Active Duty Service Members

PubMed Central

Wolf, Erika J.; Lunney, Carole A.; Schnurr, Paula P.

2016-01-01

Objective A dissociative subtype of posttraumatic stress disorder (PTSD) was recently added to the Diagnostic and Statistical Manual-5 (American Psychiatric Association, 2013) and is thought to be associated with poor PTSD treatment response. Method We used latent growth curve modeling to examine data from a randomized controlled trial of Prolonged Exposure and Present-Centered Therapy for PTSD in a sample of 284 female veterans and active duty service members with PTSD to test the association between the dissociative subtype and treatment response. Results Individuals with the dissociative subtype (defined using latent profile analysis) had a flatter slope (p = .008) compared to those with high PTSD symptoms and no dissociation such that the former group showed, on average, a 9.75 (95% CI = -16.94 to -2.57) lesser decrease in PTSD severity scores on the Clinician Administered PTSD Scale (Blake et al., 1995) over the course of the trial. However, this effect was small in magnitude. Dissociative symptoms decreased markedly among those with the subtype, though neither treatment explicitly addressed such symptoms. There were no differences as a function of treatment type. Conclusions Results raise doubt about the common clinical perception that exposure therapy is not effective or appropriate for individuals who have PTSD and dissociation and provide empirical support for the use of exposure treatment for individuals with the dissociative subtype of PTSD. Public Health Significance . This study found that female veterans and active duty service members with the dissociative subtype of posttraumatic stress disorder (PTSD) did not respond as well to PTSD treatment with Prolonged Exposure or Present-Centered Therapy as did those without the subtype. However, both PTSD and dissociation symptoms did improve markedly in the dissociative group, suggesting that the dissociative subtype is not a contraindication for the use of empirically supported treatments for PTSD. PMID:26167946

The influence of the dissociative subtype of posttraumatic stress disorder on treatment efficacy in female veterans and active duty service members.

PubMed

Wolf, Erika J; Lunney, Carole A; Schnurr, Paula P

2016-01-01

A dissociative subtype of posttraumatic stress disorder (PTSD) was recently added to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013) and is thought to be associated with poor PTSD treatment response. We used latent growth curve modeling to examine data from a randomized controlled trial of prolonged exposure and present-centered therapy for PTSD in a sample of 284 female veterans and active duty service members with PTSD to test the association between the dissociative subtype and treatment response. Individuals with the dissociative subtype (defined using latent profile analysis) had a flatter slope (p = .008) compared with those with high PTSD symptoms and no dissociation, such that the former group showed, on average, a 9.75 (95% confidence interval [-16.94, -2.57]) lesser decrease in PTSD severity scores on the Clinician Administered PTSD Scale (Blake et al., 1995) over the course of the trial. However, this effect was small in magnitude. Dissociative symptoms decreased markedly among those with the subtype, though neither treatment explicitly addressed such symptoms. There were no differences as a function of treatment type. Results raise doubt about the common clinical perception that exposure therapy is not effective or appropriate for individuals who have PTSD and dissociation, and provide empirical support for the use of exposure treatment for individuals with the dissociative subtype of PTSD. (c) 2015 APA, all rights reserved).

Dissociative Experiences during Sexual Behavior among a Sample of Adults Living with HIV Infection and a History of Childhood Sexual Abuse

PubMed Central

Hansen, Nathan B.; Brown, Lauren J.; Tsatkin, Elizabeth; Zelgowski, Brittany; Nightingale, Vienna

2012-01-01

Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of Dissociative Experiences during Sexual Behavior. Predictor variables included DSM-IV-TR diagnoses of PTSD and Dissociative Disorders, Rape by an Intimate Partner, Duration of CSA, Number of Perpetrators of CSA, and Current Sexual Satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, Dissociative Disorders, Rape by an Intimate Partner, Duration of CSA, and Number of Perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA. PMID:22545567

Dissociative symptoms and sleep parameters--an all-night polysomnography study in patients with insomnia.

PubMed

Van Der Kloet, Dalena; Giesbrecht, Timo; Franck, Erik; Van Gastel, Ann; De Volder, Ilse; Van Den Eede, Filip; Verschuere, Bruno; Merckelbach, Harald

2013-08-01

Dissociative disorders encompass a range of symptoms varying from severe absent-mindedness and memory problems to confusion about one's own identity. Recent studies suggest that these symptoms may be the by-products of a labile sleep-wake cycle. In the current study, we explored this issue in patients suffering from insomnia (N=46). We investigated whether these patients have raised levels of dissociative symptoms and whether these are related to objective sleep parameters. Patients stayed for at least one night in a specialized sleep clinic, while sleep EEG data were obtained. In addition, they completed self-report measures on dissociative symptoms, psychological problems, and sleep characteristics. Dissociative symptom levels were elevated in patients suffering from insomnia, and were correlated with unusual sleep experiences and poor sleep quality. Longer REM sleep periods and less time spent awake during the night were predictive of dissociation. This is the first study to show that insomnia patients have raised dissociative symptom levels and that their dissociative symptoms are related to objective EEG parameters. These findings are important because they may inspire sleep-related treatment methods for dissociative disorders. Copyright © 2013 Elsevier Inc. All rights reserved.

Reducing the cost of dissociative identity disorder: Measuring the effectiveness of specialized treatment by frequency of contacts with mental health services.

PubMed

Lloyd, Mike

2016-01-01

It is important to understand and record the impact of therapy on severe mental health conditions through the use of clinical assessment measures. In this article, I propose to extend outcome evaluation by measuring service use and cost prior to and during the commencement of psychological therapy over a period of 4 years for 2 people diagnosed with dissociative identity disorder. The treatment was provided within an outpatient setting in a U.K. National Health Service hospital trust following therapeutic guidelines set out by the International Society for the Study of Trauma and Dissociation. Results show that service use in both inpatient and out-of-hours crisis services reduced as the 2 people received therapy over the 4-year time period. Based on these 2 cases, it appears to be cost effective to provide specialized therapy for dissociative identity disorder in outpatient settings.

Inter-Identity Autobiographical Amnesia in Patients with Dissociative Identity Disorder

PubMed Central

Huntjens, Rafaële J. C.; Verschuere, Bruno; McNally, Richard J.

2012-01-01

Background A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder) is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive of dissociative amnesia. The aim of the current study was to objectively assess transfer of autobiographical information between identities in a larger sample of DID patients. Methods Using a concealed information task, we assessed recognition of autobiographical details in an amnesic identity. Eleven DID patients, 27 normal controls, and 23 controls simulating DID participated. Controls and simulators were matched to patients on age, education level, and type of autobiographical memory tested. Findings Although patients subjectively reported amnesia for the autobiographical details included in the task, the results indicated transfer of information between identities. Conclusion The results call for a revision of the DID definition. The amnesia criterion should be modified to emphasize its subjective nature. PMID:22815769

Inter-identity autobiographical amnesia in patients with dissociative identity disorder.

PubMed

Huntjens, Rafaële J C; Verschuere, Bruno; McNally, Richard J

2012-01-01

A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder) is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive of dissociative amnesia. The aim of the current study was to objectively assess transfer of autobiographical information between identities in a larger sample of DID patients. Using a concealed information task, we assessed recognition of autobiographical details in an amnesic identity. Eleven DID patients, 27 normal controls, and 23 controls simulating DID participated. Controls and simulators were matched to patients on age, education level, and type of autobiographical memory tested. Although patients subjectively reported amnesia for the autobiographical details included in the task, the results indicated transfer of information between identities. The results call for a revision of the DID definition. The amnesia criterion should be modified to emphasize its subjective nature.

Surface Induced Dissociation Yields Quaternary Substructure of Refractory Noncovalent Phosphorylase B and Glutamate Dehydrogenase Complexes

NASA Astrophysics Data System (ADS)

Ma, Xin; Zhou, Mowei; Wysocki, Vicki H.

2014-03-01

Ion mobility (IM) and tandem mass spectrometry (MS/MS) coupled with native MS are useful for studying noncovalent protein complexes. Collision induced dissociation (CID) is the most common MS/MS dissociation method. However, some protein complexes, including glycogen phosphorylase B kinase (PHB) and L-glutamate dehydrogenase (GDH) examined in this study, are resistant to dissociation by CID at the maximum collision energy available in the instrument. Surface induced dissociation (SID) was applied to dissociate the two refractory protein complexes. Different charge state precursor ions of the two complexes were examined by CID and SID. The PHB dimer was successfully dissociated to monomers and the GDH hexamer formed trimeric subcomplexes that are informative of its quaternary structure. The unfolding of the precursor and the percentages of the distinct products suggest that the dissociation pathways vary for different charge states. The precursors at lower charge states (+21 for PHB dimer and +27 for GDH hexamer) produce a higher percentage of folded fragments and dissociate more symmetrically than the precusors at higher charge states (+29 for PHB dimer and +39 for GDH hexamer). The precursors at lower charge state may be more native-like than the higher charge state because a higher percentage of folded fragments and a lower percentage of highly charged unfolded fragments are detected. The combination of SID and charge reduction is shown to be a powerful tool for quaternary structure analysis of refractory noncovalent protein complexes, as illustrated by the data for PHB dimer and GDH hexamer.

Dissociative trance and spirit possession: Challenges for cultures in transition.

PubMed

Bhavsar, Vishal; Ventriglio, Antonio; Bhugra, Dinesh

2016-12-01

The cross-cultural validity of dissociative possession and trance disorders is a matter of some debate, limiting research and meaningful interpretation of prevalence data. Intimate to these concerns is the status of spirit possession categories studied in the social sciences, particularly anthropology. These two categories are phenomenologically related and display similar epidemiological associations. In India, dissociative and conversion disorders are fairly common in clinical settings. There is no doubt that there are true cultural variations in possession and trance disorders. A new framework may enable clinicians to better understand possession states and spirit possession. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

Unique and Overlapping Symptoms in Schizophrenia Spectrum and Dissociative Disorders in Relation to Models of Psychopathology: A Systematic Review.

PubMed

Renard, Selwyn B; Huntjens, Rafaele J C; Lysaker, Paul H; Moskowitz, Andrew; Aleman, André; Pijnenborg, Gerdina H M

2017-01-01

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. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Dissociative seizures: a challenge for neurologists and psychotherapists.

PubMed

Fritzsche, Kurt; Baumann, Kathrin; Götz-Trabert, Katrin; Schulze-Bonhage, Andreas

2013-04-01

The prevalence of dissociative seizures is between 2 and 33 sufferers per 100,000 persons. 70% of sufferers are women. Dissociative seizures markedly impair quality of life. Their close superficial resemblance to epileptic seizures makes them hard to diagnose. Selective literature search in PubMed and PsycINFO. Persons with dissociative seizures constitute a mixed group with a wide variety of predisposing, precipitating, and maintaining factors. Some 90% have comorbid psychiatric disorders such as depression, anxiety, somatoform disorders, personality disorders, or post-traumatic stress disorder. Video-EEG monitoring enables highly reliable diagnosis. Psychotherapy is considered the treatment of first choice; in prospective studies, it has been found to lower the frequency of dissociative seizures by at least 50%, or to eliminate them completely, in 50% to 80% of patients. An individually tailored combination of behavioral therapeutic, imagery-based, and psychodynamic approaches seems reasonable. For the treatment of psychiatric comorbidities, psychotherapy is indicated, in combination with psychoactive drugs if necessary. Before any treatment is provided, the diagnosis should be communicated to the patient in an appropriate way, ideally by both the neurologist and the psychotherapist, so that the patient can develop an alternative disease model. When the diagnosis of dissociative seizures has been made, psychotherapy is indicated, possibly in combination with psychoactive medication, in the setting of long-term treatment provided in collaboration by the neurologist, psychiatrist, psychotherapist, and family physician. Further randomized trials are needed to determine which treatments are best for which subgroups of patients.

Dissociation kinetics of Fe(III)- and Al(III)-natural organic matter complexes at pH 6.0 and 8.0 and 25 °C

NASA Astrophysics Data System (ADS)

Jones, Adele M.; Pham, A. Ninh; Collins, Richard N.; Waite, T. David

2009-05-01

The rate at which iron- and aluminium-natural organic matter (NOM) complexes dissociate plays a critical role in the transport of these elements given the readiness with which they hydrolyse and precipitate. Despite this, there have only been a few reliable studies on the dissociation kinetics of these complexes suggesting half-times of some hours for the dissociation of Fe(III) and Al(III) from a strongly binding component of NOM. First-order dissociation rate constants are re-evaluated here at pH 6.0 and 8.0 and 25 °C using both cation exchange resin and competing ligand methods for Fe(III) and a cation exchange resin method only for Al(III) complexes. Both methods provide similar results at a particular pH with a two-ligand model accounting satisfactorily for the dissociation kinetics results obtained. For Fe(III), half-times on the order of 6-7 h were obtained for dissociation of the strong component and 4-5 min for dissociation of the weak component. For aluminium, the half-times were on the order of 1.5 h and 1-2 min for the strong and weak components, respectively. Overall, Fe(III) complexes with NOM are more stable than analogous complexes with Al(III), implying Fe(III) may be transported further from its source upon dilution and dispersion.

Partial mediator role of physical abuse on the relationship between attention-deficit/hyperactivity disorder symptoms and severity of dissociative experiences in a sample of inpatients with alcohol use disorder

PubMed Central

Evren, Cuneyt; Umut, Gokhan; Bozkurt, Muge; Can, Yesim; Evren, Bilge; Agachanli, Ruken

2017-01-01

Aim: This study aimed to evaluate the relationship of attention-deficit/hyperactivity disorder (ADHD) symptoms with dissociative experiences, and the mediator role of childhood traumas on this relationship, while controlling the effect of depression in alcohol use disorder (AUD). Settings and Design: It was a hospital-based, cross-sectional study. Materials and Methods: One hundred and ninety inpatients with AUD were evaluated with the Beck Depression Inventory, the Adult ADHD Self-Report Scale (ASRS), Childhood Trauma Qestionnaire, and Dissociative Experiences Scale (DES). Statistical Analysis: One-way ANOVA, Chi-squared test, and hierarchical linear regression model were performed. Results: The ratio of those who receive 10 points or less from DES was 26.8%, those who receive points between 11 and 30 was 45.3%, and those who receive more than 30 points was 27.9%. The latter group that was considered as a group with high risk of dissociative disorder had higher scores from depression, childhood trauma, and ADHD scores than the other groups. Rate of those with high probability of ADHD was higher among this group. ASRS total score and inattentive subscale scores were moderately (r = 0.552 and r = 0.547, respectively) and hyperactive/impulsive subscale was mildly (r = 0.430) correlated with DES score. Severity of ADHD was related with the severity of dissociative symptoms, and physical abuse had partial mediator effect on this relationship, even after controlling the depressive symptoms. Conclusions: These findings demonstrate that the presence of severe IN symptoms is an important factor related with dissociative tendency in AUD population with a history of physical abuse. PMID:29085089

Partial mediator role of physical abuse on the relationship between attention-deficit/hyperactivity disorder symptoms and severity of dissociative experiences in a sample of inpatients with alcohol use disorder.

PubMed

Evren, Cuneyt; Umut, Gokhan; Bozkurt, Muge; Can, Yesim; Evren, Bilge; Agachanli, Ruken

2017-01-01

This study aimed to evaluate the relationship of attention-deficit/hyperactivity disorder (ADHD) symptoms with dissociative experiences, and the mediator role of childhood traumas on this relationship, while controlling the effect of depression in alcohol use disorder (AUD). It was a hospital-based, cross-sectional study. One hundred and ninety inpatients with AUD were evaluated with the Beck Depression Inventory, the Adult ADHD Self-Report Scale (ASRS), Childhood Trauma Qestionnaire, and Dissociative Experiences Scale (DES). One-way ANOVA, Chi-squared test, and hierarchical linear regression model were performed. The ratio of those who receive 10 points or less from DES was 26.8%, those who receive points between 11 and 30 was 45.3%, and those who receive more than 30 points was 27.9%. The latter group that was considered as a group with high risk of dissociative disorder had higher scores from depression, childhood trauma, and ADHD scores than the other groups. Rate of those with high probability of ADHD was higher among this group. ASRS total score and inattentive subscale scores were moderately ( r = 0.552 and r = 0.547, respectively) and hyperactive/impulsive subscale was mildly ( r = 0.430) correlated with DES score. Severity of ADHD was related with the severity of dissociative symptoms, and physical abuse had partial mediator effect on this relationship, even after controlling the depressive symptoms. These findings demonstrate that the presence of severe IN symptoms is an important factor related with dissociative tendency in AUD population with a history of physical abuse.

Childhood trauma and dissociation in women with pseudoseizure-type conversion disorder.

PubMed

Ozcetin, Adnan; Belli, Hasan; Ertem, Umit; Bahcebasi, Talat; Ataoglu, Ahmet; Canan, Fatih

2009-11-01

Conversion disorder is thought to be associated with psychological factors because of the presence of conflict and other stressors prior to the condition. The aim of this study is to compare adult patients with pseudoseizure-type conversion disorder with healthy control group in terms of childhood trauma, dissociative disorder and family history of psychiatric disorders. 56 female patients were admitted to the general psychiatry hospital outpatient clinic between January and July 2005. All patients had a negative experience about their families just before having the conversion. Diagnosis was made according to the DSM-IV criteria. A control group consisting of similar patient demographics of the disease group has been selected. Socio-demographic information forms, the Childhood Trauma Questionnaire (CTQ) and Dissociation Questionnaire (DIS-Q), were completed on the patients. CTQ total (t=12.12, P<0.001) and subscales, emotional abuse and emotional neglect (EA-EN) (t=12.74, P<0.001), physical abuse (PA) (t=10.05, P<0.001), and sexual abuse (SA) (t=7.69, P<0.001) were significantly high in the conversion group. DIS-Q mean points were statistically higher in the conversion group (t=11.05, P<0.001). The findings suggest that pseudoseizures (conversion disorder) should be included within dissociative disorders in DSM system as in ICD. It is usually uncommon for the patient to tell about childhood trauma without being specially questioned about this issue. Thus, it would be helpful to uncover these experiences by using related scales in conversion disorder patients.

Effectiveness of paliperidone depot injection in seriously violent men with comorbid schizophrenia and dissocial personality disorder in a UK high-security hospital.

PubMed

Mortlock, Anna-Marie; Larkin, Fintan; Ross, Callum C; Gupta, Nitin; Sengupta, Samrat; Das, Mrigendra

2017-05-01

High-security hospital patients are often complex in presentation and are characterized by treatment resistance, medication nonadherence and history of violence. Paliperidone is licensed both as an oral and depot antipsychotic medication in the treatment of schizophrenia. Clinical trials have shown that paliperidone depot is well tolerated with similar efficacy to risperidone depot but with additional practical advantages. Whilst data exist for the effectiveness of paliperidone palmitate (PP), there are no studies involving patients in forensic settings or those with comorbid personality disorder. Our aim was to evaluate the effectiveness of PP on violence, aggression and personality disorder symptoms. This project was a retrospective service evaluation involving 11 patients, carried out in a high-security hospital. A combination of patient records and interviews with the treating consultant psychiatrist were used to ascertain a Clinical Global Impression (CGI) score, the effect of PP on specific personality disorder symptom domains (cognitive-perceptual, impulsive-behavioural dyscontrol and affective dysregulation) and incidents of violence and aggression. Engagement with occupational and psychological therapies was also evaluated. Metabolic parameters were reviewed. A total of 6 out of 11 patients continued on PP, most of whom had schizophrenia and dissocial personality disorder with histories of violence. All showed improvement in the CGI score with associated benefits in the three personality symptom domains. Overall, two patients demonstrated a reduction in the risk of violence. There was improvement in engagement with occupational therapy and psychological work. No significant effects on metabolic parameters were noted although hyperprolactinaemia, albeit asymptomatic, was consistently recorded. This pragmatic service evaluation of a small but complex patient group demonstrated, for the first time, that PP was effective in reducing violence as well as improving personality pathology across all dimensions: a finding which could have significant implications for management of such high-security patients.

Relationships between Trauma, Posttraumatic Stress Disorder Symptoms, Dissociative Symptoms, and Lifetime Heroin Use among Individuals Who Abuse Substances in Residential Treatment

ERIC Educational Resources Information Center

Horton, E. Gail; Diaz, Naelys; Peluso, Paul R.; Mullaney, Donald; Weiner, Michael; McIlveen, John W.

2009-01-01

This study explored the relationships between trauma, posttraumatic stress disorder symptoms, dissociation, and lifetime heroin use among inpatient clients who abused substances. Results indicate important implications for practice and directions for future research. (Contains 1 figure and 1 table.)

Dissociative identity disorder and the process of couple therapy.

PubMed

Macintosh, Heather B

2013-01-01

Couple therapy in the context of dissociative identity disorder (DID) has been neglected as an area of exploration and development in the couple therapy and trauma literature. What little discussion exists focuses primarily on couple therapy as an adjunct to individual therapy rather than as a primary treatment for couple distress and trauma. Couple therapy researchers have begun to develop adaptations to provide effective support to couples dealing with the impact of childhood trauma in their relationships, but little attention has been paid to the specific and complex needs of DID patients in couple therapy (H. B. MacIntosh & S. Johnson, 2008 ). This review and case presentation explores the case of "Lisa," a woman diagnosed with DID, and "Don," her partner, and illustrates the themes of learning to communicate, handling conflicting needs, responding to child alters, and addressing sexuality and education through their therapy process. It is the hope of the author that this discussion will renew interest in the field of couple therapy in the context of DID, with the eventual goal of developing an empirically testable model of treatment for couples.

Dissociation in Posttraumatic Stress Disorder: Evidence from the World Mental Health Surveys

PubMed Central

Stein, Dan J.; Koenen, Karestan C.; Friedman, Matthew J.; Hill, Eric; McLaughlin, Katie A.; Petukhova, Maria; Ruscio, Ayelet Meron; Shahly, Victoria; Spiegel, David; Borges, Guilherme; Bunting, Brendan; Caldas-de-Almeida, Jose Miguel; de Girolamo, Giovanni; Demyttenaere, Koen; Florescu, Silvia; Haro, Josep Maria; Karam, Elie G.; Kovess-Masfety, Viviane; Lee, Sing; Matschinger, Herbert; Mladenova, Maya; Posada-Villa, Jose; Tachimori, Hisateru; Viana, Maria Carmen; Kessler, Ronald C.

2012-01-01

Background Although the proposal for a dissociative subtype of posttraumatic stress disorder (PTSD) in DSM-5 is supported by considerable clinical and neurobiological evidence, this evidence comes mostly from referred samples in Western countries. Cross-national population epidemiologic surveys were analyzed to evaluate generalizability of the subtype in more diverse samples. Methods Interviews were administered to 25,018 respondents in 16 countries in the World Health Organization World Mental Health Surveys. The Composite International Diagnostic Interview was used to assess 12-month DSM-IV PTSD and other common DSM-IV disorders. Items from a checklist of past-month nonspecific psychological distress were used to assess dissociative symptoms of depersonalization and derealization. Differences between PTSD with and without these dissociative symptoms were examined across a variety of domains, including index trauma characteristics, prior trauma history, childhood adversity, sociodemographic characteristics, psychiatric comorbidity, functional impairment, and treatment seeking. Results Dissociative symptoms were present in 14.4% of respondents with 12-month DSM-IV/Composite International Diagnostic Interview PTSD and did not differ between high and low/middle income countries. Symptoms of dissociation in PTSD were associated with high counts of re-experiencing symptoms and net of these symptom counts with male sex, childhood onset of PTSD, high exposure to prior (to the onset of PTSD) traumatic events and childhood adversities, prior histories of separation anxiety disorder and specific phobia, severe role impairment, and suicidality. Conclusion These results provide community epidemiologic data documenting the value of the dissociative subtype in distinguishing a meaningful proportion of severe and impairing cases of PTSD that have distinct correlates across a diverse set of countries. PMID:23059051

Memories of attachment hamper EEG cortical connectivity in dissociative patients.

PubMed

Farina, Benedetto; Speranza, Anna Maria; Dittoni, Serena; Gnoni, Valentina; Trentini, Cristina; Vergano, Carola Maggiora; Liotti, Giovanni; Brunetti, Riccardo; Testani, Elisa; Della Marca, Giacomo

2014-08-01

In this study, we evaluated cortical connectivity modifications by electroencephalography (EEG) lagged coherence analysis, in subjects with dissociative disorders and in controls, after retrieval of attachment memories. We asked thirteen patients with dissociative disorders and thirteen age- and sex-matched healthy controls to retrieve personal attachment-related autobiographical memories through adult attachment interviews (AAI). EEG was recorded in the closed eyes resting state before and after the AAI. EEG lagged coherence before and after AAI was compared in all subjects. In the control group, memories of attachment promoted a widespread increase in EEG connectivity, in particular in the high-frequency EEG bands. Compared to controls, dissociative patients did not show an increase in EEG connectivity after the AAI. Conclusions: These results shed light on the neurophysiology of the disintegrative effect of retrieval of traumatic attachment memories in dissociative patients.

Self-Reported Sleep Disturbances in Patients with Dissociative Identity Disorder and Post-Traumatic Stress Disorder and How They Relate to Cognitive Failures and Fantasy Proneness

PubMed Central

van Heugten – van der Kloet, Dalena; Huntjens, Rafaele; Giesbrecht, Timo; Merckelbach, Harald

2014-01-01

Sleep disturbances, fantasy proneness, cognitive failures, and dissociative symptoms are related to each other. However, the co-occurrence of these phenomena has been primarily studied in non-clinical samples. We investigated the correlations between these phenomena in dissociative identity disorder (DID) patients, post-traumatic stress disorder (PTSD) patients, and healthy controls. Both patient groups reported more sleep problems and lower sleep quality and displayed higher levels of fantasy proneness and cognitive failures than controls. However, the two patient groups did not differ with regard to these variables. Moreover, a higher level of unusual sleep experiences tended to predict participants belonging to the DID group, while specifically a lower sleep quality and more cognitive failures tended to predict participants belonging to the PTSD group. PMID:24600412

Self-reported sleep disturbances in patients with dissociative identity disorder and post-traumatic stress disorder and how they relate to cognitive failures and fantasy proneness.

PubMed

van Heugten-van der Kloet, Dalena; Huntjens, Rafaele; Giesbrecht, Timo; Merckelbach, Harald

2014-01-01

Sleep disturbances, fantasy proneness, cognitive failures, and dissociative symptoms are related to each other. However, the co-occurrence of these phenomena has been primarily studied in non-clinical samples. We investigated the correlations between these phenomena in dissociative identity disorder (DID) patients, post-traumatic stress disorder (PTSD) patients, and healthy controls. Both patient groups reported more sleep problems and lower sleep quality and displayed higher levels of fantasy proneness and cognitive failures than controls. However, the two patient groups did not differ with regard to these variables. Moreover, a higher level of unusual sleep experiences tended to predict participants belonging to the DID group, while specifically a lower sleep quality and more cognitive failures tended to predict participants belonging to the PTSD group.

Fighting the Whole System: Dissociative Identity Disorder, Labeling Theory, and Iatrogenic Doubting.

PubMed

Floris, Jessica; McPherson, Susan

2015-01-01

This research examines how individuals diagnosed with dissociative identity disorder construe their experiences of being labeled with a contested diagnosis. Semistructured interviews were conducted in the United Kingdom with 5 women and 2 men diagnosed with dissociative identity disorder. A framework analysis was conducted. The analysis identified 2 overarching themes: diagnosis cross-examined and navigating care systems. The diagnosis appeared to be continually assessed by participants for its fit with symptoms, and the doubt among professionals seemed to be unhelpfully reflected in participants' attempts to understand and come to terms with their experiences. The findings are considered in light of labeling theory, the iatrogenic effects of professional doubt, and current debates concerning the reliability and validity of psychiatric diagnostic systems that have been reinvigorated by the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Dissociation and the Development of Psychopathology.

ERIC Educational Resources Information Center

Putnam, Frank W.; Trickett, Penelope K.

This paper reviews the research on dissociation and the development of psychopathology in children and adolescents. Definitions and dimensions of dissociation are addressed, noting its range from normative daydreaming to the extremes found in individuals with multiple personality disorder. Memory dysfunctions, disturbances of identity, passive…

Depression and dissociation as predictors of physical health symptoms among female rape survivors with posttraumatic stress disorder.

PubMed

Scioli-Salter, Erica R; Johnides, Benjamin D; Mitchell, Karen S; Smith, Brian N; Resick, Patricia A; Rasmusson, Ann M

2016-09-01

To investigate the relative contributions of depression and dissociation, as well as posttraumatic stress disorder (PTSD), to physical health symptoms and to examine the relationships among somatic symptoms, PTSD, depression, and dissociation in relation to childhood and adult trauma exposure. Cross-sectional data are from 132 female rape survivors with PTSD assessed before engaging in a study of trauma-focused cognitive therapy for PTSD. Measures included the Pennebaker Inventory of Limbic Languidness, Clinician Administered PTSD Scale, Beck Depression Inventory, Trauma Symptom Inventory-Dissociation Subscale, Childhood Sexual Abuse Exposure Questionnaire, and Assessing Environments-III-Physical Punishment Scale. Hierarchical regression analyses revealed that only dissociative and depression symptoms contributed significantly to physical health symptoms. Similarly, among the subsample of women with either childhood sexual or physical abuse, depression and dissociation were significant predictors of somatic symptoms. However, among women without childhood abuse, only dissociation significantly predicted somatic symptoms. Understanding the psychological and biological mechanisms that link childhood versus adult trauma exposure, PTSD, and comorbid depression or dissociation to physical health symptoms may aid development of individualized treatments for the physical and psychological consequences of trauma. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Structural brain aberrations associated with the dissociative subtype of post-traumatic stress disorder.

PubMed

Daniels, J K; Frewen, P; Theberge, J; Lanius, R A

2016-03-01

One factor potentially contributing to the heterogeneity of previous results on structural grey matter alterations in adult participants suffering from post-traumatic stress disorder (PTSD) is the varying levels of dissociative symptomatology. The aim of this study was therefore to test whether the recently defined dissociative subtype of PTSD characterized by symptoms of depersonalization and derealization is characterized by specific differences in volumetric brain morphology. Whole-brain MRI data were acquired for 59 patients with PTSD. Voxel-based morphometry was carried out to test for group differences between patients classified as belonging (n = 15) vs. not belonging (n = 44) to the dissociative subtype of PTSD. The correlation between dissociation (depersonalization/derealization) severity and grey matter volume was computed. Patients with PTSD classified as belonging to the dissociative subtype exhibited greater grey matter volume in the right precentral and fusiform gyri as well as less volume in the right inferior temporal gyrus. Greater dissociation severity was associated with greater volume in the right middle frontal gyrus. The results of this first whole-brain investigation of specific grey matter volume in dissociative subtype PTSD indentified structural aberrations in regions subserving the processing and regulation of emotional arousal. These might constitute characteristic biomarkers for the dissociative subtype PTSD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Meeting the Needs of Clients with Dissociative Identity Disorder: Considerations for Psychotherapy

ERIC Educational Resources Information Center

Ringrose, Jo L.

2011-01-01

Psychotherapy for clients with Dissociative Identity Disorder (DID) is different to therapy with most clients because these clients are multiple, comprising one or more host, and one or more alter personalities. The necessary components to be addressed in order that clients can live successfully either as a multiple or as an integrated person are…

Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective

PubMed Central

Şar, Vedat; Dorahy, Martin J; Krüger, Christa

2017-01-01

Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry. PMID:28496375

Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective.

PubMed

Şar, Vedat; Dorahy, Martin J; Krüger, Christa

2017-01-01

Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry.

Interfacial disorder drives charge separation in molecular semiconductors

NASA Astrophysics Data System (ADS)

Willard, Adam

One of the fundamental microscopic processes in photocurrent generation is the dissociation of neutral photo-excitations (i.e., Frenkel excitons) into free charge carriers (i.e., electrons and holes). This process requires the physical separation of oppositely charged electrons and holes, which are held to together by an attractive electrostatic binding energy. In traditional inorganic-based photovoltaic (PV) materials, this binding energy is generally small and easily overcome, however, in organic-based PVs (OPVs) the exciton binding energy can significantly exceed thermal energies. The inability of bound charges to overcome this large binding energy has been implicated as a primary source of efficiency loss in OPVs. Here I present results from our recent efforts to explore the role of static molecular disorder in mediating this process. Using a simple lattice model of exciton dynamics we demonstrate that random spatial variations in the energetic landscape can mitigate the attractive Coulomb interaction between electrons and holes. We show that this effect manifests as a reduction in the free energy barrier for exciton dissociation that grows more pronounced with increasing disorder. By considering the competition between this thermodynamic effect and the disorder-induced slowing of dissociation kinetics we demonstrate that exciton dissociation yields are expected to depend non-monotonically on the degree of static disorder.

Tracking Potentiating States of Dissociation: An Intensive Clinical Case Study of Sleep, Daydreaming, Mood, and Depersonalization/Derealization.

PubMed

Poerio, Giulia L; Kellett, Stephen; Totterdell, Peter

2016-01-01

This study examined in real time the role of sleep and daydreaming as potentiating states for subsequent dissociation in depersonalization/derealization disorder (DDD). Research and theory suggests that dissociation may be exacerbated and maintained by a labile sleep-wake cycle in which "dream-like" mentation intrudes into waking life and fuels dissociative symptoms. We explore and extend this idea by examining the state of daydreaming in dissociation. Daydreaming is a state of consciousness between dreaming and waking cognition that involves stimulus-independent and task-unrelated mentation. We report the results of a unique intensive N = 1 study with an individual meeting diagnostic criteria for DDD. Using experience-sampling methodology, the participant rated (six times daily for 40 days) current daydreaming, mood, and dissociative symptoms. At the start of each day sleep quality and duration was also rated. Daydreaming was reported on 45% of occasions and significantly predicted greater dissociation, in particular when daydreams were repetitive and negative (but not fanciful) in content. These relationships were mediated by feelings of depression and anxiety. Sleep quality but not duration was a negative predictor of daily dissociation and also negatively predicted depression but not anxiety. Findings offer initial evidence that the occurrence and content of daydreams may act as potentiating states for heightened, in the moment, dissociation. The treatment implications of targeting sleep and daydreaming for dissociative disorders are discussed.

Tracking Potentiating States of Dissociation: An Intensive Clinical Case Study of Sleep, Daydreaming, Mood, and Depersonalization/Derealization

PubMed Central

Poerio, Giulia L.; Kellett, Stephen; Totterdell, Peter

2016-01-01

This study examined in real time the role of sleep and daydreaming as potentiating states for subsequent dissociation in depersonalization/derealization disorder (DDD). Research and theory suggests that dissociation may be exacerbated and maintained by a labile sleep-wake cycle in which “dream-like” mentation intrudes into waking life and fuels dissociative symptoms. We explore and extend this idea by examining the state of daydreaming in dissociation. Daydreaming is a state of consciousness between dreaming and waking cognition that involves stimulus-independent and task-unrelated mentation. We report the results of a unique intensive N = 1 study with an individual meeting diagnostic criteria for DDD. Using experience-sampling methodology, the participant rated (six times daily for 40 days) current daydreaming, mood, and dissociative symptoms. At the start of each day sleep quality and duration was also rated. Daydreaming was reported on 45% of occasions and significantly predicted greater dissociation, in particular when daydreams were repetitive and negative (but not fanciful) in content. These relationships were mediated by feelings of depression and anxiety. Sleep quality but not duration was a negative predictor of daily dissociation and also negatively predicted depression but not anxiety. Findings offer initial evidence that the occurrence and content of daydreams may act as potentiating states for heightened, in the moment, dissociation. The treatment implications of targeting sleep and daydreaming for dissociative disorders are discussed. PMID:27582722

Exploring dissociation and oxytocin as pathways between trauma exposure and trauma-related hyperemesis gravidarum: a test-of-concept pilot

PubMed Central

SENG, JULIA; MILLER, JANIS; SPERLICH, MICKEY; VAN DE VEN, COSMAS J. M.; BROWN, STEPHANIE; CARTER, C. SUE; LIBERZON, ISRAEL

2012-01-01

Posttraumatic stress disorder (PTSD) is associated with gastrointestinal and genitourinary comorbidities. These map onto the somatization disorder symptoms in the Diagnostic and Statistical Manual of Mental Disorders (APA, 1994) and the dissociative [conversion] disorders symptoms in the International Classification of Diseases taxonomy (WHO, 2007). Hyperemesis gravidarum (HG) is one of these symptoms and a gastrointestinal comorbidity of PTSD occurring in pregnancy. It is an idiopathic condition defined as severe vomiting with dehydration, metabolic imbalance, wasting, and hospital care-seeking. HG is more severe than the normative phenomenon of nausea and vomiting of pregnancy (NV). This test-of-concept pilot (N=25) explored the hypothesis that there is a trauma-related subtype of HG characterized by (1) high levels of dissociative symptoms and (2) altered plasma concentrations of oxytocin. This hypothesis is informed by a theory of posttraumatic oxytocin dysregulation positing altered oxytocin function as a mechanism of gut smooth muscle peristalsis dysfunction. A four-group analysis compared controls with nausea and vomiting of pregnancy (NV only) and cases with HG only, NV and PTSD, or HG and PTSD. Oxytocin was correlated with nausea and vomiting symptom severity score (r = .464, p = .019) and with the dissociation symptom score (r = .570, p = .003). Women in the group with both PTSD and HG (the “trauma-related HG subtype”) had the highest levels of dissociation and the highest levels of oxytocin. A linear regression model indicated that the independent association of the trauma-related HG subtype with oxytocin level was mediated by high levels of dissociative symptoms. PMID:23282046

Memory Abilities in Williams Syndrome: Dissociation or Developmental Delay Hypothesis?

ERIC Educational Resources Information Center

Sampaio, Adriana; Sousa, Nuno; Fernandez, Montse; Henriques, Margarida; Goncalves, Oscar F.

2008-01-01

Williams syndrome (WS) is a neurodevelopmental genetic disorder often described as being characterized by a dissociative cognitive architecture, in which profound impairments of visuo-spatial cognition contrast with relative preservation of linguistic, face recognition and auditory short-memory abilities. This asymmetric and dissociative cognition…

Suggested posthypnotic amnesia in psychiatric patients and normals.

PubMed

Frischholz, Edward J; Lipman, Laurie S; Braun, Bennett G; Sachs, Roberta

2015-01-01

The present study examined both quantitative and qualitative hypnotizability differences among four psychiatric patient groups (dissociative disorder (n = 17), schizophrenic (n = 13), mood disorder (n = 14), and anxiety disorder (n = 14) patients), and normals (college students (n = 63)). Dissociative disorder patients earned significantly higher corrected total scores on the Stanford Hypnotic Susceptibility Scale, Form C (mean = 7.94), than all other groups. Likewise, dissociative disorder patients initially recalled significantly fewer items when the posthypnotic amnesia suggestion was in effect (mean = .41) and reversed significantly more items when the suggestion was canceled (mean = 3.82) than all other groups. In contrast, schizophrenic patients recalled significantly fewer items when the amnesia suggestion was in effect (mean = 1.85) and reversed significantly fewer items when it was canceled (mean = .77) than the remaining groups. This qualitative difference between schizophrenic patients and the other groups on the suggested posthypnotic amnesia item was observed even though there were no significant quantitative differences between groups in overall hypnotic responsivity.

Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

PubMed Central

Mauritz, Maria W.; Goossens, Peter J. J.; Draijer, Nel; van Achterberg, Theo

2013-01-01

Background Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. Objective To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. Methods We conducted a systematic review of four databases (1980–2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Results Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25–72%), sexual abuse 37% (range 24–49%), and posttraumatic stress disorder (PTSD) 30% (range 20–47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Conclusions Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI. PMID:23577228

Navigating Undiagnosed Dissociative Identity Disorder in the Inpatient Setting: A Case Report.

PubMed

Urbina, Theresa M; May, Tania; Hastings, Michelle

2017-05-01

This case illustrates previously undiagnosed dissociative identity disorder (DID) in a middle-aged female with extensive childhood trauma, who was high functioning prior to a trigger that caused a reemergence of her symptoms. The trigger sparked a dissociative state, attempted suicide, and subsequent inpatient psychiatric hospitalization. Practitioners should include in their differential and screen for undiagnosed DID in patients with episodic psychiatric hospitalizations refractory to the standard treatments for previously diagnosed mental illnesses. Case study. During hospitalization, the diagnosis of DID became apparent and treatment included low-dose risperidone, mirtazapine, sertraline, unconditional positive regard, normalization of her dissociative states in an attempt to decrease her anxiety during treatment, and documentation for the patient via written notes following interviews. These methods helped her come to terms with the diagnosis and allowed the treatment team to teach her coping skills to lessen the impact of dissociative states following discharge.

Comparison of brazilian spiritist mediumship and dissociative identity disorder.

PubMed

Moreira-Almeida, Alexander; Neto, Francisco Lotufo; Cardeña, Etzel

2008-05-01

We studied the similarities and differences between Brazilian Spiritistic mediums and North American dissociative identity disorder (DID) patients. Twenty-four mediums selected among different Spiritistic organizations in São Paulo, Brazil, were interviewed using the Dissociative Disorder Interview Schedule, and their responses were compared with those of DID patients described in the literature. The results from Spiritistic mediums were similar to published data on DID patients only with respect to female prevalence and high frequency of Schneiderian first-rank symptoms. As compared with individuals with DID, the mediums differed in having better social adjustment, lower prevalence of mental disorders, lower use of mental health services, no use of antipsychotics, and lower prevalence of histories of physical or sexual childhood abuse, sleepwalking, secondary features of DID, and symptoms of borderline personality. Thus, mediumship differed from DID in having better mental health and social adjustment, and a different clinical profile.

Similar cortical but not subcortical gray matter abnormalities in women with posttraumatic stress disorder with versus without dissociative identity disorder.

PubMed

Chalavi, Sima; Vissia, Eline M; Giesen, Mechteld E; Nijenhuis, Ellert R S; Draijer, Nel; Barker, Gareth J; Veltman, Dick J; Reinders, Antje A T S

2015-03-30

Neuroanatomical evidence on the relationship between posttraumatic stress disorder (PTSD) and dissociative disorders is still lacking. We acquired brain structural magnetic resonance imaging (MRI) scans from 17 patients with dissociative identity disorder (DID) and co-morbid PTSD (DID-PTSD) and 16 patients with PTSD but without DID (PTSD-only), and 32 healthy controls (HC), and compared their whole-brain cortical and subcortical gray matter (GM) morphological measurements. Associations between GM measurements and severity of dissociative and depersonalization/derealization symptoms or lifetime traumatizing events were evaluated in the patient groups. DID-PTSD and PTSD-only patients, compared with HC, had similarly smaller cortical GM volumes of the whole brain and of frontal, temporal and insular cortices. DID-PTSD patients additionally showed smaller hippocampal and larger pallidum volumes relative to HC, and larger putamen and pallidum volumes relative to PTSD-only. Severity of lifetime traumatizing events and volume of the hippocampus were negatively correlated. Severity of dissociative and depersonalization/derealization symptoms correlated positively with volume of the putamen and pallidum, and negatively with volume of the inferior parietal cortex. Shared abnormal brain structures in DID-PTSD and PTSD-only, small hippocampal volume in DID-PTSD, more severe lifetime traumatizing events in DID-PTSD compared with PTSD-only, and negative correlations between lifetime traumatizing events and hippocampal volume suggest a trauma-related etiology for DID. Our results provide neurobiological evidence for the side-by-side nosological classification of PTSD and DID in the DSM-5. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Before you diagnose a patient with a conversion disorder, perform a thorough general medical and neurological examination. Case study].

PubMed

Pawełczyk, Tomasz; Pawełczyk, Agnieszka; Rabe-Jabłońska, Jolanta

2012-01-01

Dissociative and conversion disorders are classified together according to ICD-10 as states that are not confirmed by the presence of somatic diseases, which they suggest. According to the DSM-IV, both disorders are classified separately. Conversion disorders are a group of psychiatric disorders whose symptoms mimic the presence of malfunction or loss of motor or sensory function, whereas the nature and dynamics of the observed symptoms is not fully explained by the results of objective assessments and consultations, nor is the direct effect of a psychoactive substance. Impaired mental integration of different functions which normally interact simultaneously in the perception of reality and inner experience of the individual is found in dissociative disorders. The article describes the case of 25-year old man, in whom after initial suspicion of myasthenia gravis and its exclusion, a diagnosis of conversion disorder was made on the basis of the clinical picture and treatment with an SSRI antidepressant and individual psychotherapy were recommended. No improvement in mental and neurological status after six month therapy resulted in an in-depth diagnostics in a clinical setting and diagnosis of brain stem tumor (aastrocytoma fibrillare). (a) Neuroimaging is a source of important clinical data and in many cases should constitute an inherent element of a psychiatric diagnosis. (b) Diagnosis of conversion (dissociative) disorders requires a precise differential diagnosis, excluding the somatic causes of observed neurological ailments. (c) A late diagnosis of neurological or somatic causes of symptoms which arouse a suspicion of conversion (dissociative) disorders may make a radical treatment impossible or may considerably aggravate the remote prognosis and quality of the patients' life.

Potential contributions of hypnosis to ego-strengthening procedures in EMDR. Eye Movement Desensitization Reprocessing.

PubMed

Phillips, M

2001-01-01

This paper explores how hypnotic principles can be systematically incorporated into the standard EMDR protocol to enhance various ego strength capacities during EMDR treatment. Expanding these skill areas can widen the therapeutic window of possibility for clients with a variety of complex clinical issues, including posttraumatic, dissociative or personality disorders, anxiety symptoms, and depressive difficulties. Clinical case examples are used to illustrate ways of integrating hypnotic principles within a proposed EMDR protocol to promote ego strengthening and facilitate therapeutic change.

Dissociation between facial and bodily expressions in emotion recognition: A case study.

PubMed

Leiva, Samanta; Margulis, Laura; Micciulli, Andrea; Ferreres, Aldo

2017-12-21

Existing single-case studies have reported deficit in recognizing basic emotions through facial expression and unaffected performance with body expressions, but not the opposite pattern. The aim of this paper is to present a case study with impaired emotion recognition through body expressions and intact performance with facial expressions. In this single-case study we assessed a 30-year-old patient with autism spectrum disorder, without intellectual disability, and a healthy control group (n = 30) with four tasks of basic and complex emotion recognition through face and body movements, and two non-emotional control tasks. To analyze the dissociation between facial and body expressions, we used Crawford and Garthwaite's operational criteria, and we compared the patient and the control group performance with a modified one-tailed t-test designed specifically for single-case studies. There were no statistically significant differences between the patient's and the control group's performances on the non-emotional body movement task or the facial perception task. For both kinds of emotions (basic and complex) when the patient's performance was compared to the control group's, statistically significant differences were only observed for the recognition of body expressions. There were no significant differences between the patient's and the control group's correct answers for emotional facial stimuli. Our results showed a profile of impaired emotion recognition through body expressions and intact performance with facial expressions. This is the first case study that describes the existence of this kind of dissociation pattern between facial and body expressions of basic and complex emotions.

Effect of ketamine dose on self-rated dissociation in patients with treatment refractory anxiety disorders.

PubMed

Castle, Cameron; Gray, Andrew; Neehoff, Shona; Glue, Paul

2017-10-01

Patients receiving ketamine for refractory depression and anxiety report dissociative symptoms in the first 60 min post-dose. The most commonly used instrument to assess this is the Clinician-Administered Dissociative States Scale (CADSS), developed based on the assessment of patients with dissociative symptoms. Its psychometric properties for ketamine-induced dissociation have not been reported. We evaluated these from a study using 0.25-1 mg/kg ketamine and midazolam (as an active control) in 18 patients with treatment-resistant anxiety. Dissociation ratings were increased by ketamine in a dose-dependent manner. In contrast, midazolam showed no effect on ratings of dissociation. For individual CADSS items, the magnitude of change and the ketamine dose at which changes were observed were not homogenous. The Cronbach alpha for the total scale was high (0.937), with acceptable item-rest correlations for almost all individual items. Purposefully removing items to maximise alpha did not lead to meaningful improvements. Acceptable internal consistency was still observed after removing items which lacked evidence of responsiveness at lower doses. The high Cronbach alpha values identified in this study suggests that the CADSS is an internally consistent instrument for evaluating ketamine-induced dissociation in clinical trials in anxiety, although it does not capture symptoms such as thought disorder.

Charge Transfer Dissociation of Complex Oligosaccharides: Comparison with Collision-Induced Dissociation and Extreme Ultraviolet Dissociative Photoionization

NASA Astrophysics Data System (ADS)

Ropartz, David; Li, Pengfei; Fanuel, Mathieu; Giuliani, Alexandre; Rogniaux, Hélène; Jackson, Glen P.

2016-10-01

The structural characterization of oligosaccharides still challenges the field of analytical chemistry. Tandem mass spectrometry offers many advantages toward this aim, although the generic fragmentation method (low-energy collision-induced dissociation) shows clear limitations and is often insufficient to retrieve some essential structural information on these molecules. In this work, we present the first application of helium charge transfer dissociation (He-CTD) to characterize the structure of complex oligosaccharides. We compare this method with low-energy collision-induced dissociation and extreme-ultraviolet dissociative photoionization (XUV-DPI), which was shown previously to ensure the successful characterization of complex glycans. Similarly to what could be obtained by XUV-DPI, He-CTD provides a complete description of the investigated structures by producing many informative cross-ring fragments and no ambiguous fragmentation. Unlike XUV-DPI, which is performed at a synchrotron source, He-CTD has the undeniable advantage of being implementable in a conventional benchtop ion trap in a conventional laboratory setting.

Exploring evidence of a dissociative subtype in PTSD: Baseline symptom structure, etiology, and treatment efficacy for those who dissociate.

PubMed

Burton, Mark S; Feeny, Norah C; Connell, Arin M; Zoellner, Lori A

2018-05-01

With the inclusion of a dissociative subtype, recent changes to the DSM-5 diagnosis of posttraumatic stress disorder (PTSD) have emphasized the role of dissociation in the experience and treatment of the disorder. However, there is a lack of research exploring the clinical impact for highly dissociative groups receiving treatment for PTSD. The current study examined the presence and clinical impact of a dissociative subtype in a sample of individuals receiving treatment for chronic PTSD. This study used latent transition analyses (LTA), an expanded form of latent profile analyses (LPA), to examine latent profiles of PTSD and dissociation symptoms before and after treatment for individuals (N = 200) receiving prolonged exposure (PE) or sertraline treatment for chronic PTSD. The best fitting LTA model was one with a 4-class solution at both pretreatment and posttreatment. There was a latent class at pretreatment with higher levels of dissociative symptoms. However, this class was also marked by higher reexperiencing symptoms, and membership was not predicted by chronic child abuse. Further, although those in the class were less likely to transition to the responder class overall, this was not the case for exposure-based treatment specifically. These findings are not in line with the dissociative-subtype theoretical literature that proposes those who dissociate represent a clinically distinct group that may respond worse to exposure-based treatments for PTSD. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Multiple Personality and the Pathological Dissociation of Self.

ERIC Educational Resources Information Center

Price, Reese E.

This paper considers the condition of Multiple Personality Disorder (MPD), which is defined as a separation of alternating personalities by rigid boundaries and amnestic barriers. It is proposed that MPD represents the end of a continuum of a defensive dissociation of the self that can result when a child employs a dissociative splitting of self…

Dissociation in patients with schizophrenia spectrum disorders: What is the role of different types of childhood adversity?

PubMed

Schroeder, Katrin; Langeland, Willemien; Fisher, Helen L; Huber, Christian G; Schäfer, Ingo

2016-07-01

Our study aimed to explore the effects of different types of adverse childhood experiences (e.g. domestic violence, early loss, parental dysfunction, sexual and physical abuse) as well as experiences of sexual and physical abuse in adulthood on dissociative symptoms in adult patients with schizophrenia-spectrum disorders. 145 patients were examined for psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS), for dissociative symptoms with the German version of the Dissociative Experiences Scale (DES) and for adverse experiences in childhood and adulthood with the Structured Trauma Interview (STI). Childhood physical abuse was reported by 32%, childhood sexual abuse by 17% of the patients. Other forms of childhood adversity were also quite common; 18% had witnessed domestic violence, 26% reported early loss, and nearly half of patients reported at least one condition potentially related to parental dysfunction. The DES total score was significantly associated with childhood sexual abuse, witnessing of domestic violence and paternal dysfunction, as well as with physical violence in adulthood. In the final regression model, reports of paternal dysfunction and sexual abuse in childhood were independently associated with adult dissociation. Variance in dissociative symptoms was mainly explained by paternal dysfunction (18%). Substantial rates of childhood adversity were found and specific associations were evident with adult dissociation amongst psychosis patients who reported sexual abuse or paternal dysfunction in childhood. Therefore, it is important that patients with schizophrenia-spectrum disorders are routinely asked about a broad range of possible adverse childhood experiences in order to provide appropriate interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

Dissociative Identity Disorder CPAP Adherence: An Uncommon Factor in Obstructive Sleep Apnea.

PubMed

Gandotra, Kamal; Golish, Joseph; Rosenberg, Carl; Strohl, Kingman

2018-04-15

We present a case of a patient with dissociative identity disorder and symptomatic sleep apnea who was treated with continuous positive airway pressure (CPAP). CPAP use depended upon which personality the patient exhibited but apnea reduction did not. This case illustrates in one individual how personality can positively or negatively affect CPAP adherence. © 2018 American Academy of Sleep Medicine.

[Willingness of Psychotherapists in Private Practice to Treat Patients With Complex Post-Traumatic Stress and Dissociative Disorders].

PubMed

Schnell, T; von Katte, S; Gast, U

2015-09-01

Analyses of patient care with severe mental disorders. Psychotherapists in private praxis were interviewed about their willingness to treat patients with a range of diagnoses in the context of post-traumatic disorders. Therapists were found more willing to treat "less severe" disorders, independent of years in practice, school of psychotherapy, a rural or urban practice setting. Therapists criticized the quality of their training and the health insurance review process. Therapists are generally willing to treat patients with severe mental disorders, but experience limits of competency attributed to training deficits. They further experience the bureaucratic procedures of the health insurance review process as barriers to accepting these patients into treatment.These results indicate that recently developed concepts of psychotherapy for these patient groups should be more intensively integrated into the existing training curricula. Furthermore, a simplified health insurance review process ought to be considered. © Georg Thieme Verlag KG Stuttgart · New York.

Peritraumatic dissociation and physiological response to trauma-relevant stimuli in Vietnam combat veterans with posttraumatic stress disorder.

PubMed

Kaufman, Milissa L; Kimble, Matthew O; Kaloupek, Danny G; McTeague, Lisa M; Bachrach, Peter; Forti, Allison M; Keane, Terence M

2002-03-01

A recent study found that female rape victims with acute posttraumatic stress disorder (PTSD) who received a high score on the Peritraumatic Dissociative Experiences Questionnaire exhibited suppression of physiological responses during exposure to trauma-related stimuli. The goal of our present study was to test whether the same relationship holds true for male Vietnam combat veterans with chronic PTSD, using secondary analyses applied to data derived from a Veteran's Affairs Cooperative Study. Vietnam combat veterans (N = 1238) completed measures to establish combat-related PTSD diagnostic status, extent of PTSD-related symptomatic distress, and presence of dissociative symptoms during their most stressful combat-related experiences. Extreme subgroups of veterans with current PTSD were classified as either low dissociators (N = 118) or high dissociators (N = 256) based on an abbreviated version of the Peritraumatic Dissociative Experiences Questionnaire. Dependent variables reflected subjective distress along with heart rate, skin conductance, electromyographic, and blood pressure data when responding to neutral and trauma-related audiovisual and imagery presentations. Veterans in the current PTSD group had significantly higher dissociation scores than did veterans in the lifetime and never PTSD groups. Among veterans with current PTSD, high dissociators reported greater PTSD-related symptomatic distress than did low dissociators, but the groups did not differ with respect to physiological reactivity to the trauma-related laboratory presentations. Our results replicate the previously reported relationship between peritraumatic dissociation and PTSD status in Vietnam combat veterans. However, we found no association between peritraumatic dissociation and the extent of physiological responding to trauma-relevant cues in male veterans with chronic combat-related PTSD.

Depersonalization and derealization in self-report and clinical interview: The spectrum of borderline personality disorder, dissociative disorders, and healthy controls.

PubMed

Sar, Vedat; Alioğlu, Firdevs; Akyuz, Gamze

2017-01-01

Depersonalization (DEP) and derealization (DER) were examined among college students with and without borderline personality disorder (BPD) and/or dissociative disorders (DDs) by self-report and clinician assessment. The Steinberg Depersonalization Questionnaire (SDEPQ), the Steinberg Derealization Questionnaire (SDERQ), the Childhood Trauma Questionnaire, and the screening tool of the BPD section of the Structured Clinical Interview for DSM-IV (SCID-BPD) were administered to 1,301 students. Those with BPD (n = 80) according to the SCID-BPD and 111 non-BPD controls were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders by a psychiatrist blind to the diagnosis. Of the participants, 19.7% reported SDEPQ (17.8%) and/or SDERQ (11.0%) scores above cutoff levels and impairment from these experiences. Principal component analysis of 26 items of both scales yielded 4 factors: cognitive-emotional self-detachment, perceptual detachment, bodily self-detachment, and detachment from reality. Participants with concurrent DD and BPD had the highest scores for DEP and DER in the clinical interview and self-report. The total number of BPD criteria was associated with the severity of childhood trauma and dissociation. Both BPD and DD were associated with clinician-assessed and self-reported DER, self-reported DEP, and the cognitive-emotional self-detachment factor. Unlike BPD, DD was associated with clinician-assessed DEP, and BPD was related to the self-reported detachment from reality factor. Although the latter was correlated with the total childhood trauma score, possibly because of dissociative amnesia, clinician-assessed DER was not. Being the closest factor to BPD, the factor of detachment from reality warrants further study.

Fable or fact?: did Janet really come to repudiate his dissociation theory?

PubMed

Dorahy, Martin J; van der Hart, Onno

2006-01-01

Commencing in the late 1880s Pierre Janet developed the most complete theory of dissociation of his time. It has been suggested that Janet later repudiated his belief in dissociation theory (e.g., Hacking, 1995). Recently this viewpoint has been cited to support skepticism in dissociative identity disorder and researchers and clinicians of dissociation may be faced with such suggestions to challenge their work. The veracity of whether Janet actually recanted, or even lost interest in his dissociation theory is investigated through an examination of his later writings. Although Janet expanded his theoretical interests well beyond phenomena accounted for by dissociation, there is no evidence to indicate he renounced or lost confidence in his dissociation theory.

Brain dysfunction behind functional symptoms: neuroimaging and somatoform, conversive, and dissociative disorders.

PubMed

García-Campayo, Javier; Fayed, Nicolas; Serrano-Blanco, Antoni; Roca, Miquel

2009-03-01

Neuroimaging research in psychiatry has been increasing exponentially in recent years, yet many psychiatrists are relatively unfamiliar with this field. This article summarizes the findings of the most relevant research articles on the neuroimaging of somatoform, conversive, and dissociative disorders published from January 2007 through June 2008. Neuroimaging findings summarized here include alterations of stress regulation and coping in somatoform pain disorders, the importance of catastrophizing in somatization disorder, and the relevance of a history of physical/sexual abuse in irritable bowel syndrome. Regarding fibromyalgia, three of the most significant advances have been the impossibility of differentiating primary and concomitant fibromyalgia in the presence of quiescent underlying disease, the role of hippocampal dysfunction, and the possibility that fibromyalgia may be characterized as an aging process. In dissociative disorders, the high levels of elaborative memory encoding and the reduced size of the parietal lobe are highlighted. The most promising clinical consequence of these studies, in addition to improving knowledge about the etiology of these illnesses, is the possibility of using neuroimaging findings to identify subgroups of patients, which could allow treatments to be tailored.

A computational study of the CO dissociation in cyclopentadienyl ruthenium complexes relevant to the racemization of alcohols.

PubMed

Stewart, Beverly; Nyhlen, Jonas; Martín-Matute, Belén; Bäckvall, Jan-E; Privalov, Timofei

2013-01-28

The formation of an active 16-electron ruthenium sec-alkoxide complex via loss of the CO ligand is an important step in the mechanism of the racemization of sec-alcohols by (η(5)-Ph(5)C(5))Ru(CO)(2)X ruthenium complexes with X = Cl and O(t)Bu. Here we show with accurate DFT calculations the potential energy profile of the CO dissociation pathway for a series of relevant (η(5)-Ph(5)C(5))Ru(CO)(2)X complexes, where X = Cl, O(t)Bu, H and COO(t)Bu. We have found that the CO dissociation energy increases in the following order: O(t)Bu (lowest), Cl, COO(t)Bu and H (highest). Using the distance between ruthenium and C(CO), r = Ru-C(CO), as a constraint, and by optimizing all other degrees of freedom for a range of Ru-CO distances, we obtained relative energies, ΔE(r) and geometries of a sufficient number of transient structures with the elongated Ru-CO bond up to r = 3.4 Å. Our calculations provide a quantitative understanding of the CO ligand dissociation in (η(5)-Ph(5)C(5))Ru(CO)(2)Cl and (η(5)-Ph(5)C(5))Ru(CO)(2)(O(t)Bu) complexes, which is relevant to the mechanism of their catalytic activity in the racemization of alcohols. We recently reported that exchange of the CO ligand by isotopically labeled (13)CO in the Ru-O(t)Bu complex occurs twenty times faster than that in the Ru-Cl complex. This corresponds to a difference of 1.8 kcal mol(-1) in the CO dissociation energy (at room temperature). This is in very good agreement with the calculated difference between the two potential energy curves for Ru-O(t)Bu and Ru-Cl complexes, which is about 1.8-2 kcal mol(-1) around the corresponding transition states of the CO dissociation. The calculated difference in the total energy for CO dissociation in (η(5)-Ph(5)C(5))Ru(CO)(2)X complexes is related to the stabilization provided by the X group in the final 16-electron complexes, which are formed via product-like transition states. In addition to the calculated transition states of CO dissociation in Ru-O(t)Bu and Ru-Cl complexes, the calculated transient structures with the elongated Ru-CO bond provide insight into how the geometry of the ruthenium complex with a potent heteroatom donor group (X) gradually changes when one of the COs is dissociating.

Assessing DSM-5 latent subtypes of acute stress disorder dissociative or intrusive?

PubMed

Armour, Cherie; Hansen, Maj

2015-02-28

Acute Stress Disorder (ASD) was first included in the DSM-IV in 1994. It was proposed to account for traumatic responding in the early post trauma phase and to act as an identifier for later Posttraumatic Stress Disorder (PTSD). Unlike PTSD it included a number of dissociative indicators. The revised DSM-5 PTSD criterion included a dissociative-PTSD subtype. The current study assessed if a dissociative-ASD subtype may be present for DSM-5 ASD. Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in symptomatic compared to a baseline ASD profile. We used data from 450 bank robbery victims. Latent profile analysis (LPA) was used to uncover latent profiles of ASD. Multinomial logistic regression was used to determine if female gender, age, social support, peritraumatic panic, somatization, and number of trauma exposures increased or decreased the probability of profile membership. Four latent profiles were uncovered and included an intrusion rather than dissociative subtype. Increased age and social support decreased the probability of individuals being grouped into the intrusion subtype whereas increased peritraumatic panic and somatization increased the probability of individuals being grouped into the intrusion subtype. Findings are discussed in regard to the ICD-11 and the DSM-5. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Peritraumatic dissociation mediates the relationship between acute panic and chronic posttraumatic stress disorder.

PubMed

Bryant, Richard A; Brooks, Robert; Silove, Derrick; Creamer, Mark; O'Donnell, Meaghan; McFarlane, Alexander C

2011-05-01

Although peritraumatic dissociation predicts subsequent posttraumatic stress disorder (PTSD), little is understood about the mechanism of this relationship. This study examines the role of panic during trauma in the relationship between peritraumatic dissociation and subsequent PTSD. Randomized eligible admissions to 4 major trauma hospitals across Australia (n=244) were assessed during hospital admission and within one month of trauma exposure for panic, peritraumatic dissociation and PTSD symptoms, and subsequently re-assessed for PTSD three months after the initial assessment (n=208). Twenty (9.6%) patients met criteria for PTSD at 3-months post injury. Structural equation modeling supported the proposition that peritraumatic derealization (a subset of dissociation) mediated the effect of panic reactions during trauma and subsequent PTSD symptoms. The mediation model indicated that panic reactions are linked to severity of subsequent PTSD via derealization, indicating a significant indirect relationship. Whereas peritraumatic derealization is associated with chronic PTSD symptoms, this relationship is influenced by initial acute panic responses. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Identity and dissociation in cyberspace. A case of dissociative identity disorder associated with internet role playing].

PubMed

Te Wildt, B T; Kowalewski, E; Meibeyer, F; Huber, T

2006-01-01

By mediating dissociative experiences, the Internet can challenge the boundaries of people's sense of identity. To illustrate this hypothesis, a case of dissociative identity disorder (DID) is presented. A young unemployed woman created and frequently played several characters in an online game. For more than 2 years she spent up to 12 h a day in the Internet, assuming various personalities, which in return intruded upon her neglected real life. During the course of an inpatient psychotherapeutic treatment, the clinical diagnosis of DID was confirmed by psychometric testing. After 12 weeks of psychotherapy, the patient had managed to identify her fragmented identities as character traits and integrated them into her core personality. She rearranged her real everyday life, found a new job, and reduced her online activities. Even though the patient's psychopathology stems from a disposition in terms of a personality disorder with histrionic and narcissistic features, excessive internet role play obviously functioned as a trigger to develop DIS. Conclusively, cyberspace's anonymous interactivity may offer the possibility to explore one's identity while also putting at risk its coherence.

Non-suicidal self-injury in eating disordered patients: a test of a conceptual model.

PubMed

Muehlenkamp, Jennifer J; Claes, Laurence; Smits, Dirk; Peat, Christine M; Vandereycken, Walter

2011-06-30

A theoretical model explaining the high co-occurrence of non-suicidal self-injury (NSSI) in eating disordered populations as resulting from childhood traumatic experiences, low self-esteem, psychopathology, dissociation, and body dissatisfaction was previously proposed but not empirically tested. The current study empirically evaluated the fit of this proposed model within a sample of 422 young adult females (mean age=21.60; S.D.=6.27) consecutively admitted to an inpatient treatment unit for eating disorders. Participants completed a packet of questionnaires within a week of admission. Structural equation modeling procedures showed the model provided a good fit to the data, accounting for 15% of the variance in NSSI. Childhood trauma appears to have an indirect relationship to NSSI that is likely to be expressed via relationships to low self-esteem, psychopathology, body dissatisfaction, and dissociation. It appears that dissociation and body dissatisfaction may be particularly salient factors to consider in both understanding and treating NSSI within an eating disordered population. Copyright © 2010 Elsevier Ltd. All rights reserved.

Jactatio corporis nocturna and dissociative disorder: a case report.

PubMed

Pelin, Zerrin; Karataş, Semra; Kesebir, Sermin

2012-01-01

Jactatio corporis nocturna is a type of parasomnia. Rhythmic body movements during sleep are commonly observed in infancy and early childhood, and spontaneous resolution is expected after the age of 4 years. Rarely, the body movements persist until adulthood. Rhythmic body movements characteristically occur during the wake-sleep transition period, rather than during other sleep stages. Some psychiatric diseases can co-occur with sleep-related movement disorders. A relationship between parasomnias and dissociative disorders has been recently reported. Herein we present a 33-year-old male with nocturnal repetitive rolling body movements and daytime fatigue. The patient also had loss of memory of some important events (such as the day his daughter underwent surgery), and reported that he sometimes confused reality with dreams had fantasies during which he experienced his spirit rising above to watch his body and fantasy. Detailed neuropsychological assessment showed that the patient also had a dissociative disorder. Video-polysomnographic recordings showed repetitive, rolling body movements that occurred only during rapid eye movement (REM) sleep.

Method and apparatus for dissociating metals from metal compounds extracted into supercritical fluids

DOEpatents

Wai, Chien M.; Hunt, Fred H.; Smart, Neil G.; Lin, Yuehe

2000-01-01

A method for dissociating metal-ligand complexes in a supercritical fluid by treating the metal-ligand complex with heat and/or reducing or oxidizing agents is described. Once the metal-ligand complex is dissociated, the resulting metal and/or metal oxide form fine particles of substantially uniform size. In preferred embodiments, the solvent is supercritical carbon dioxide and the ligand is a .beta.-diketone such as hexafluoroacetylacetone or dibutyldiacetate. In other preferred embodiments, the metals in the metal-ligand complex are copper, silver, gold, tungsten, titanium, tantalum, tin, or mixtures thereof. In preferred embodiments, the reducing agent is hydrogen. The method provides an efficient process for dissociating metal-ligand complexes and produces easily-collected metal particles free from hydrocarbon solvent impurities. The ligand and the supercritical fluid can be regenerated to provide an economic, efficient process.

Dissociative Experiences of Sexual Offenders: A Comparison between Two Outpatient Groups and Those Found to be Falsely Accused.

ERIC Educational Resources Information Center

Dwyer, S. Margretta

1992-01-01

Administered Dissociative Experiences Scale, which distinguishes between subjects with dissociative disorder and those without, to 71 sex offenders and 14 men who were falsely accused of sexual abuse. Outpatient sex offenders scored in the range attributed to general population. Those falsely accused of child sexual abuse scored lower than…

Autonoesis and dissociative identity disorder.

PubMed

Morton, John

2018-01-01

Dissociative identity disorder is characterised by the presence in one individual of two or more alternative personality states (alters). For such individuals, the memory representation of a particular event can have full episodic, autonoetic status for one alter, while having the status of knowledge or even being inaccessible to a second alter. This phenomenon appears to create difficulties for a purely representational theory and is presented to Mahr & Csibra (M&C) for their consideration.

Characterizing associations and dissociations between anxiety, social, and cognitive phenotypes of Williams syndrome

PubMed Central

Ng, Rowena; Järvinen, Anna; Bellugi, Ursula

2014-01-01

Williams syndrome (WS) is a neurogenetic disorder known for its “hypersocial” phenotype and a complex profile of anxieties. The anxieties are poorly understood specifically in relation to the social-emotional and cognitive profiles. To address this gap, we employed a Wechsler intelligence test, the Brief Symptom Inventory, Beck Anxiety Inventory, and Salk Institute Sociability Questionnaire, to (1) examine how anxiety symptoms distinguish individuals with WS from typically developing (TD) individuals; and (2) assess the associations between three key phenotypic features of WS: intellectual impairment, social-emotional functioning, and anxiety. The results highlighted intensified neurophysiological symptoms and subjective experiences of anxiety in WS. Moreover, whereas higher cognitive ability was positively associated with anxiety in WS, the opposite pattern characterized the TD individuals. This study provides novel insight into how the three core phenotypic features associate/dissociate in WS, specifically in terms of the contribution of cognitive and emotional functioning to anxiety symptoms. PMID:24973548

Validity and reliability of the Turkish version of the DSM-5 Dissociative Symptoms Severity Scale-Child Form.

PubMed

Yalın Sapmaz, Şermin; Ergin, Dilek; Şen Celasin, Nesrin; Özek Erkuran, Handan; Karaarslan, Duygu; Öztekin, Siğnem; Uzel Tanrıverdi, Bengisu; Köroğlu, Ertuğrul; Aydemir, Ömer

2017-01-01

The goal of this study was to assess the validity and reliability of the Turkish version of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) Dissociative Symptoms Severity Scale-Child Form. The scale was prepared by translating and then back-translating the DSM-5 Dissociative Symptoms Severity Scale. The study groups included one group of 30 patients diagnosed with posttraumatic stress disorder who were treated in a child and adolescent psychiatry unit and another group of 83 healthy volunteers from middle and high schools in the community. For assessment, the Adolescent Dissociative Experiences Scale (ADES) was used in addition to the DSM-5 Dissociative Symptoms Severity Scale. Regarding the reliability of the DSM-5 Dissociative Symptoms Severity Scale, Cronbach's alpha was .824 and item-total score correlation coefficients were between .464 and .648. The test-retest correlation coefficient was calculated to be r = .784. In terms of construct validity, one factor accounted for 45.2% of the variance. Furthermore, in terms of concurrent validity, the scale showed a high correlation with the ADES. In conclusion, the Turkish version of the DSM-5 Dissociative Symptoms Severity Scale-Child Form is a valid and reliable tool for both clinical practice and research.

The Shutdown Dissociation Scale (Shut-D)

PubMed Central

Schalinski, Inga; Schauer, Maggie; Elbert, Thomas

2015-01-01

The evolutionary model of the defense cascade by Schauer and Elbert (2010) provides a theoretical frame for a short interview to assess problems underlying and leading to the dissociative subtype of posttraumatic stress disorder. Based on known characteristics of the defense stages “fright,” “flag,” and “faint,” we designed a structured interview to assess the vulnerability for the respective types of dissociation. Most of the scales that assess dissociative phenomena are designed as self-report questionnaires. Their items are usually selected based on more heuristic considerations rather than a theoretical model and thus include anything from minor dissociative experiences to major pathological dissociation. The shutdown dissociation scale (Shut-D) was applied in several studies in patients with a history of multiple traumatic events and different disorders that have been shown previously to be prone to symptoms of dissociation. The goal of the present investigation was to obtain psychometric characteristics of the Shut-D (including factor structure, internal consistency, retest reliability, predictive, convergent and criterion-related concurrent validity). A total population of 225 patients and 68 healthy controls were accessed. Shut-D appears to have sufficient internal reliability, excellent retest reliability, high convergent validity, and satisfactory predictive validity, while the summed score of the scale reliably separates patients with exposure to trauma (in different diagnostic groups) from healthy controls. The Shut-D is a brief structured interview for assessing the vulnerability to dissociate as a consequence of exposure to traumatic stressors. The scale demonstrates high-quality psychometric properties and may be useful for researchers and clinicians in assessing shutdown dissociation as well as in predicting the risk of dissociative responding. PMID:25976478

Assessing therapeutic change in patients with severe dissociative disorders: the progress in treatment questionnaire, therapist and patient measures.

PubMed

Schielke, Hugo; Brand, Bethany; Marsic, Angelika

2017-01-01

Background : Treatment research for dissociative identity disorder (DID) and closely related severe dissociative disorders (DD) is rare, and has been made more difficult by the lack of a reliable, valid measure for assessing treatment progress in these populations. Objective : This paper presents psychometric data for therapist and patient report measures developed to evaluate therapeutic progress and outcomes for individuals with DID and other DD: the Progress in Treatment Questionnaire - Therapist (PITQ-t; a therapist report measure) and the Progress in Treatment Questionnaire - Patient (PITQ-p; a patient self-report measure). Method : We examined the data of 177 patient-therapist pairs (total N  = 354) participating in the TOP DD Network Study, an online psychoeducation programme aimed at helping patients with DD establish safety, regulate emotions, and manage dissociative and posttraumatic symptoms. Results : The PITQ-t and PITQ-p demonstrated good internal consistency and evidence of moderate convergent validity in relation to established measures of emotional dysregulation, dissociation, posttraumatic stress disorder, and psychological quality of life, which are characteristic difficulties for DD patients. The measures also demonstrated significant relationships in the hypothesized directions with positive emotions, social relations, and self-harm and dangerous behaviours. The patient-completed PITQ-p, which may be used as an ongoing assessment measure to guide treatment planning, demonstrated evidence of stronger relationships with established symptom measures than the PITQ-t. Conclusions : The PITQ-t and PITQ-p merit use, additional research, and refinement in relation to the assessment of therapeutic progress with patients with DD.

Assessing therapeutic change in patients with severe dissociative disorders: the progress in treatment questionnaire, therapist and patient measures

PubMed Central

Schielke, Hugo; Brand, Bethany; Marsic, Angelika

2017-01-01

ABSTRACT Background: Treatment research for dissociative identity disorder (DID) and closely related severe dissociative disorders (DD) is rare, and has been made more difficult by the lack of a reliable, valid measure for assessing treatment progress in these populations. Objective: This paper presents psychometric data for therapist and patient report measures developed to evaluate therapeutic progress and outcomes for individuals with DID and other DD: the Progress in Treatment Questionnaire – Therapist (PITQ-t; a therapist report measure) and the Progress in Treatment Questionnaire – Patient (PITQ-p; a patient self-report measure). Method: We examined the data of 177 patient–therapist pairs (total N = 354) participating in the TOP DD Network Study, an online psychoeducation programme aimed at helping patients with DD establish safety, regulate emotions, and manage dissociative and posttraumatic symptoms. Results: The PITQ-t and PITQ-p demonstrated good internal consistency and evidence of moderate convergent validity in relation to established measures of emotional dysregulation, dissociation, posttraumatic stress disorder, and psychological quality of life, which are characteristic difficulties for DD patients. The measures also demonstrated significant relationships in the hypothesized directions with positive emotions, social relations, and self-harm and dangerous behaviours. The patient-completed PITQ-p, which may be used as an ongoing assessment measure to guide treatment planning, demonstrated evidence of stronger relationships with established symptom measures than the PITQ-t. Conclusions: The PITQ-t and PITQ-p merit use, additional research, and refinement in relation to the assessment of therapeutic progress with patients with DD. PMID:29163860

Childhood trauma and dissociation among women with genito-pelvic pain/penetration disorder

PubMed Central

Özen, Beliz; Özdemir, Y Özay; Beştepe, E Emrem

2018-01-01

Objective Causes such as childhood trauma, negative attitude about sexuality, inadequate sexual knowledge and education, relationship problems, and unconscious motivation are reported about psychosexual development in the etiology of genito-pelvic pain/penetration disorder (GPP/PD). There are few studies that focus directly on research etiology of GPP/PD and use structured scales. The aim of this study was to research childhood trauma and dissociation forms among women with GPP/PD. Patients and methods Fifty-five women with GPP/PD according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and 61 healthy women with no complaints of sexual function as a control group, in the age range of 18–60 years, were included in this study. Sociodemographic data form, Childhood Trauma Questionnaire (CTQ-28), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ-20) were administered to all participants. Results Sexual abuse, emotional abuse, and emotional neglect scores, which comprise the subgroups of CTQ, were found high among women with GPP/PD compared with the control group (p=0.003, p=0.006, p=0.001). While a significant difference between the two groups’ SDQ scores was obtained (p=0.000), no significant difference was detected between the two groups’ DES scores (p=0.392). Discussion The results evoke the question are genitopelvic pain conditions, vaginismus and dyspareunia, that cannot be explained with a medical cause and that cause penetration disorder, a kind of dissociative symptom prone to develop in some women with childhood psychogenic trauma. PMID:29503548

Parallel-Distinct Structures of Internal World and External Reality: Disavowing and Re-Claiming the Self-Identity in the Aftermath of Trauma-Generated Dissociation

PubMed Central

Şar, Vedat

2017-01-01

The nature of consciousness and the autonomy of the individual's mind have been a focus of interest throughout the past century and inspired many theories and models. Revival of studies on psychological trauma and dissociation, which remained outside mainstream psychiatry, psychology, and psychoanalysis for the most part of the past century, has provided a new opportunity to revisit this intellectual and scientific endeavor. This paper attempts to integrate a series of empirical and theoretical studies on psychological consequences of developmental traumatization, which may yield further insight into factors which threaten the integrity of human consciousness. The paper proposes that an individual's experience of distorted reality and betrayal precipitates a cyclical dynamic between the individual and the external world by disrupting the developmental function of mutuality which is essential for maintenance of the integrity of the internal world while this inner world is in turn regulated vis-à-vis external reality. Dissociation -the common factor in all types of post-traumatic syndromes- is facilitated by violation of boundaries by relational omission and intrusion as represented by distinct effects and consequences of childhood neglect and abuse. Recent research conducted on clinical and non-clinical populations shows both bimodal (undermodulation and overmodulation) and bipolar (intrusion and avoidance) neurobiological and phenomenological characteristics of post-traumatic response. These seem to reflect “parallel-distinct structures” that control separate networks covering sensori-motor and cognitive-emotional systems. This understanding provides a conceptual framework to assist explanation of diverse post-traumatic mental trajectories which culminate in a common final pathway comprised of partly overlapping clinical syndromes such as complex PTSD, dissociative depression, dissociative identity disorder (DID), or “borderline” phenomena. Of crucial theoretical and clinical importance is that these maladaptive post-traumatic psychological formations are regarded as processes in their own right rather than as a personality disorder innate to the individual. Such mental division may perform in that internal detachment can serve to preserve the genuine aspects of the subject until such time as they can be reclaimed via psychotherapy. The paper attempts to integrate these ideas with reference to the previously proposed theory of the “Functional Dissociation of Self” (Şar and Öztürk, 2007). PMID:28261144

Parallel-Distinct Structures of Internal World and External Reality: Disavowing and Re-Claiming the Self-Identity in the Aftermath of Trauma-Generated Dissociation.

PubMed

Şar, Vedat

2017-01-01

The nature of consciousness and the autonomy of the individual's mind have been a focus of interest throughout the past century and inspired many theories and models. Revival of studies on psychological trauma and dissociation, which remained outside mainstream psychiatry, psychology, and psychoanalysis for the most part of the past century, has provided a new opportunity to revisit this intellectual and scientific endeavor. This paper attempts to integrate a series of empirical and theoretical studies on psychological consequences of developmental traumatization, which may yield further insight into factors which threaten the integrity of human consciousness. The paper proposes that an individual's experience of distorted reality and betrayal precipitates a cyclical dynamic between the individual and the external world by disrupting the developmental function of mutuality which is essential for maintenance of the integrity of the internal world while this inner world is in turn regulated vis-à-vis external reality. Dissociation -the common factor in all types of post-traumatic syndromes- is facilitated by violation of boundaries by relational omission and intrusion as represented by distinct effects and consequences of childhood neglect and abuse. Recent research conducted on clinical and non-clinical populations shows both bimodal (undermodulation and overmodulation) and bipolar (intrusion and avoidance) neurobiological and phenomenological characteristics of post-traumatic response. These seem to reflect "parallel-distinct structures" that control separate networks covering sensori-motor and cognitive-emotional systems. This understanding provides a conceptual framework to assist explanation of diverse post-traumatic mental trajectories which culminate in a common final pathway comprised of partly overlapping clinical syndromes such as complex PTSD, dissociative depression, dissociative identity disorder (DID), or "borderline" phenomena. Of crucial theoretical and clinical importance is that these maladaptive post-traumatic psychological formations are regarded as processes in their own right rather than as a personality disorder innate to the individual. Such mental division may perform in that internal detachment can serve to preserve the genuine aspects of the subject until such time as they can be reclaimed via psychotherapy. The paper attempts to integrate these ideas with reference to the previously proposed theory of the "Functional Dissociation of Self" (Şar and Öztürk, 2007).

Meet Dr Jekyll: a case of a psychiatrist with dissociative identity disorder.

PubMed

Suetani, Shuichi; Markwick, Elizabeth

2014-10-01

Dissociative identity disorder (DID) is a controversial psychiatric diagnosis. This case review presents a retired psychiatrist with a history of DID. This case is used to illustrate current thinking about the characteristics and aetiology of DID. It also argues for the importance of being aware of both our personal and professional biases in our own clinical practice. © The Royal Australian and New Zealand College of Psychiatrists 2014.

The Palestinian/Israeli Conflict: a geopolitical identity disorder.

PubMed

Brenner, Ira

2009-03-01

In this paper, the author considers that the large-group dynamics in certain war-torn, hot spots throughout the world are symptoms of a "geopolitical identity disorder." He extrapolates from the model of the severely traumatized psyche in dissociative identity disorder in which there is so much intolerable emotion, destructive aggression and conflict that different selves with different identities develop which are unable to recognize how interdependent and related they actually are. In the most extreme cases, one dissociated self tries to kill off "the other" in order to gain exclusive control of the body and make it comply with his or her wishes and vision. In actuality, however, such an attempt is a dissociated suicide plan with lethal implications. This model is applied to the Palestinian/Israeli situation where there is a deadly battle over the land. A clinical vignette is offered to illustrate these ideas and offer possibilities for help.

A reconsideration of the clinical work of Harold Searles.

PubMed

Benatar, May

2008-01-01

A rereading of the work of Harold Searles in light of the more contemporary paradigm of dissociation refreshes our insights into transference and countertransference phenomena with patients who rely heavily on dissociation. Searles's perspective on the dependence of the analyst (therapist) on his or her patients, the reality of patients' projections, and patients' need to cure their analyst can be helpful in resolving conundrums and impasses in the treatment of dissociative disordered patients. The reciprocity of dissociative phenomena between patients and therapists, wherein therapists must own the reality of their own dissociative processes in the therapeutic transaction, recontextualizes Searles's clinical contributions.

[Transference in the treatment of dissociative identity disorder: A review of literature and a case example].

PubMed

Lambert, Ann Marie; Gagnon, Lise; Fontaine, Francine S

2014-01-01

A literature review about transference in the treatment of dissociative identity disorder (DID) is presented. Common transference reactions resulting from serious traumas are explored, considering that those kind of trauma are higly present in the pathways of DID patients. Post traumatic transference aspects specific to DID are also presented. In addition, common transference patterns and dissociative aspects of transference in the treatment of DID are explained. Transference is also discussed in relationship to the possible impact of disorganized attachment, which is a main component in the development of DID. The clinical implications of this proposition will be discussed and supported by a case example.

The Dissociative Subtype of PTSD Scale: Initial Evaluation in a National Sample of Trauma-Exposed Veterans.

PubMed

Wolf, Erika J; Mitchell, Karen S; Sadeh, Naomi; Hein, Christina; Fuhrman, Isaac; Pietrzak, Robert H; Miller, Mark W

2017-06-01

The fifth edition of the Diagnostic and Statistical Manual includes a dissociative subtype of posttraumatic stress disorder, but no existing measures specifically assess it. This article describes the initial evaluation of a 15-item self-report measure of the subtype called the Dissociative Subtype of Posttraumatic Stress Disorder Scale (DSPS) in an online survey of 697 trauma-exposed military veterans representative of the U.S. veteran population. Exploratory factor analyses of the lifetime DSPS items supported the intended structure of the measure consisting of three factors reflecting derealization/depersonalization, loss of awareness, and psychogenic amnesia. Consistent with prior research, latent profile analyses assigned 8.3% of the sample to a highly dissociative class distinguished by pronounced symptoms of derealization and depersonalization. Overall, results provide initial psychometric support for the lifetime DSPS scales; additional research in clinical and community samples is needed to further validate the measure.

Dissociation kinetics of open-chain and macrocyclic gadolinium(III)-aminopolycarboxylate complexes related to magnetic resonance imaging: catalytic effect of endogenous ligands.

PubMed

Baranyai, Zsolt; Pálinkás, Zoltán; Uggeri, Fulvio; Maiocchi, Alessandro; Aime, Silvio; Brücher, Ernő

2012-12-14

The kinetics of the metal exchange reactions between open-chain Gd(DTPA)(2-) and Gd(DTPA-BMA), macrocyclic Gd(DOTA)(-) and Gd(HP-DO3A) complexes, and Cu(2+)  ions were investigated in the presence of endogenous citrate, phosphate, carbonate and histidinate ligands in the pH range 6-8 in NaCl (0.15 M) at 25 °C. The rates of the exchange reactions of Gd(DTPA)(2-) and Gd(DTPA-BMA) are independent of the Cu(2+) concentration in the presence of citrate and the reactions occur via the dissociation of Gd(3+)  complexes catalyzed by the citrate ions. The HCO(3)(-)/CO(3)(2-) and H(2)PO(4)(-) ions also catalyze the dissociation of complexes. The rates of the dissociation of Gd(DTPA-BMA), catalyzed by the endogenous ligands, are about two orders of magnitude higher than those of the Gd(DTPA)(2-). In fact near to physiological conditions the bicarbonate and carbonate ions show the largest catalytic effect, that significantly increase the dissociation rate of Gd(DTPA-BMA) and make the higher pH values (when the carbonate ion concentration is higher) a risk-factor for the dissociation of complexes in body fluids. The exchange reactions of Gd(DOTA)(-) and Gd(HP-DO3A) with Cu(2+) occur through the proton assisted dissociation of complexes in the pH range 3.5-5 and the endogenous ligands do not affect the dissociation rates of complexes. More insights into the interaction scheme between Gd(DTPA-BMA) and Gd(DTPA)(2-) and endogenous ligands have been obtained by acquiring the (13)C NMR spectra of the corresponding diamagnetic Y(III)-complexes, indicating the increase of the rates of the intramolecular rearrangements in the presence of carbonate and citrate ions. The herein reported results may have implications in the understanding of the etiology of nephrogenic systemic fibrosis, a rare disease that has been associated to the administration of Gd-containing agents to patients with impaired renal function. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Dissociation of Rac1(GDP)·RhoGDI Complexes by the Cooperative Action of Anionic Liposomes Containing Phosphatidylinositol 3,4,5-Trisphosphate, Rac Guanine Nucleotide Exchange Factor, and GTP*

PubMed Central

Ugolev, Yelena; Berdichevsky, Yevgeny; Weinbaum, Carolyn; Pick, Edgar

2008-01-01

Rac plays a pivotal role in the assembly of the superoxide-generating NADPH oxidase of phagocytes. In resting cells, Rac is found in the cytosol in complex with Rho GDP dissociation inhibitor (RhoGDI). NADPH oxidase assembly involves dissociation of the Rac·RhoGDI complex and translocation of Rac to the membrane. We reported that liposomes containing high concentrations of monovalent anionic phospholipids cause Rac·RhoGDI complex dissociation (Ugolev, Y., Molshanski-Mor, S., Weinbaum, C., and Pick, E. (2006) J. Biol. Chem.281 ,19204 -1921916702219). We now designed an in vitro model mimicking membrane phospholipid remodeling during phagocyte stimulation in vivo. We showed that liposomes of “resting cell membrane” composition (less than 20 mol % monovalent anionic phospholipids), supplemented with 1 mol % of polyvalent anionic phosphatidylinositol 3,4,5-trisphosphate (PtdIns(3,4,5)P3) in conjunction with constitutively active forms of the guanine nucleotide exchange factors (GEFs) for Rac, Trio, or Tiam1 and a non-hydrolyzable GTP analogue, cause dissociation of Rac1(GDP)·RhoGDI complexes, GDP to GTP exchange on Rac1, and binding of Rac1(GTP) to the liposomes. Complexes were not dissociated in the absence of GEF and GTP, and optimal dissociation required the presence of PtdIns(3,4,5)P3 in the liposomes. Dissociation of Rac1(GDP)·RhoGDI complexes was correlated with the affinity of particular GEF constructs, via the N-terminal pleckstrin homology domain, for PtdIns(3,4,5)P3 and involved GEF-mediated GDP to GTP exchange on Rac1. Phagocyte membranes enriched in PtdIns(3,4,5)P3 responded by NADPH oxidase activation upon exposure in vitro to Rac1(GDP)·RhoGDI complexes, p67phox, GTP, and Rac GEF constructs with affinity for PtdIns(3,4,5)P3 at a level superior to that of native membranes. PMID:18505730

Speaking Out for Yourself: A Self-Help Guide. Recovering Your Mental Health Series.

ERIC Educational Resources Information Center

Copeland, Mary Ellen

If you experience troubling emotional or psychological symptomslike depression, bipolar disorder or manic depression, schizophrenia, borderline personality disorder, obsessive-compulsive disorder, dissociative disorder, post traumatic stress disorder, an eating disorder, or an anxiety disorderyou may be looking for some information and support on…

Pain and tactile dissociation, derealization and depersonalization symptoms in women and recalled traumatic events in childhood, adolescence and early adulthood.

PubMed

Smiatek-Mazgaj, Bogna; Sobański, Jerzy A; Rutkowski, Krzysztof; Klasa, Katarzyna; Dembińska, Edyta; Müldner-Nieckowski, Łukasz; Cyranka, Katarzyna; Mielimąka, Michał

2016-01-01

The symptoms of dissociation, depersonalization and derealization are often associated with exposure of patients to mental and physical injuries, usually occurring in childhood. Most of these observations were carried out in populations of patients with various disorders (posttraumatic, conversion-dissociation, personality disorders - especially borderline), who reported their exposure to adverse life circumstances through questionnaire interviews. Assessment of the risk associated with various traumatic events in childhood and adolescence concerning the symptoms of pain and tactile dissociation, depersonalization and derealization. The coexistence of the earlier life circumstances and the currently existing symptoms was examined on the basis of KO "0" Symptom Checklist and Life Inventory, completed prior to treatment in a day hospital for neurotic disorders. In the group of 2582 women, patients of a day hospital for neurotic and personality disorders, the symptoms of pain and tactile dissociation, depersonalization and derealization were present in 24-36 % of patients, while the maximum severity of these symptoms reported approximately 4-8 % of patients. The studied patients reported the exposure during childhood and adolescence (before 18yo) to numerous traumatic events of varying severity and frequency, including hostility of one parent (approximately 5% of respondents), the sexual initiation before 13yo (1%), worse than peers material conditions (23%), harassment of the family of origin (2%), reluctance of their peers (9%). Conducted regression analysis showed illustrated by the coefficients OR (odds ratios) a statistically significant relationship between the majority of the analyzed symptoms and many of the listed events, such as being regarded as worse than siblings, mother's anger in the situation of the patient's disease in childhood, lack of support, indifference of parent, poverty and worseness of the family of origin, inferior position in the classroom and the school grades, total sexual unawareness, incest or its attempt. The symptoms of dissociation, depersonalization and derealization occurred in significantly more patients reporting burdening life events - difficult situations in childhood and adolescence. Therefore, in clinical practice in patients presenting such symptoms, regardless of diagnosis (e. g. a specific neurotic disorder), we can expect revealing information about such events.

Dissociative experiences in patients with epilepsy.

PubMed

Özdemir, Osman; Cilingir, Vedat; Özdemir, Pınar Güzel; Milanlioglu, Aysel; Hamamci, Mehmet; Yilmaz, Ekrem

2016-03-01

A few studies have explored dissociative experiences in epilepsy patients. We investigated dissociative experiences in patients with epilepsy using the dissociative experiences scale (DES). Ninety-eight patients with epilepsy and sixty healthy controls were enrolled in this study. A sociodemographic questionnaire and the Dissociative Experiences Scale (DES), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to the participants. The DES scores were significantly higher for the patients with epilepsy than the healthy individuals. The number of individuals with pathological dissociation (DES ≥ 30) was higher in the epilepsy group (n = 28) than in the control group (n = 8). Also, higher levels of dissociation were significantly associated with frequency of seizures, but were not associated with duration of epilepsy and age at onset of the disorder. These findings demonstrate that patients with epilepsy are more prone to dissociation than controls. The high rate of dissociative experiences among patients with epilepsy suggest that some epilepsy-related factors are present.

Etiology, pathogenesis, and therapy according to Pierre Janet concerning conversion disorders and dissociative disorders.

PubMed

Bühler, Karl-Ernst; Heim, Gerhard

2011-01-01

Pierre Janet's works on conversion disorders or dissociative disorders has mainly fallen to the wayside in favour of Freud's works. In the first part of this paper, Janet's conception of hysteria is discussed and his place in French psychiatry described. Different aspects of Janet's diathesis-stress approach are presented (particularly the pathogenic concept of fixed ideas), which refer not only to a conception of hysteria but also to traumatic (stress) disorders and other psychological disturbances. The second part of the paper details the varieties of Janetian therapeutic treatments of these disorders: the "liquidation" of fixed ideas by hypnosis and suggestion, confrontation techniques, which resemble contemporary cognitive behavioural approaches, and special cognitive ("logagogic") interventions. Finally, we discuss the various treatment strategies based on psychoeconomic considerations such as physical or psycho-phyical therapies, psychoeducation, treatment through rest, and simplification of life for dealing with basic disturbances of psychic disorders.

Women's Auto/Biography and Dissociative Identity Disorder: Implications for Mental Health Practice.

PubMed

Tomlinson, Kendal; Baker, Charley

2017-09-06

Dissociative Identity Disorder (DID) is an uncommon disorder that has long been associated with exposure to traumatic stressors exceeding manageable levels commonly encompassing physical, psychological and sexual abuse in childhood that is prolonged and severe in nature. In DID, dissociation continues after the traumatic experience and produces a disruption in identity where distinct personality states develop. These personalities are accompanied by variations in behaviour, emotions, memory, perception and cognition. The use of literature in psychiatry can enrich comprehension over the subjective experience of a disorder, and the utilisation of 'illness narratives' in nursing research have been considered a way of improving knowledge about nursing care and theory development. This research explores experiences of DID through close textual reading and thematic analysis of five biographical and autobiographical texts, discussing the lived experience of the disorder. This narrative approach aims to inform empathetic understanding and support the facilitation of therapeutic alliances in mental healthcare for those experiencing the potentially debilitating and distressing symptoms of DID. Although controversies surrounding the biomedical diagnosis of DID are important to consider, the lived experiences of those who mental health nurses encounter should be priority.

The effect of menadione on glutathione S-transferase A1 (GSTA1): c-Jun N-terminal kinase (JNK) complex dissociation in human colonic adenocarcinoma Caco-2 cells.

PubMed

Adnan, Humaira; Antenos, Monica; Kirby, Gordon M

2012-10-02

Glutathione S-transferases (GSTs) act as modulators of mitogen-activated protein kinase signal transduction pathways via a mechanism involving protein-protein interactions. We have demonstrated that GSTA1 forms complexes with JNK and modifies JNK activation during cellular stress, but the factors that influence complex association and dissociation are unknown. We hypothesized that menadione causes dissociation of GSTA1-JNK complexes, activates JNK, and the consequences of menadione exposure depend on GSTA1 expression. We demonstrate that menadione causes GSTA1-JNK dissociation and JNK activation in preconfluent Caco-2 cells, whereas postconfluent cells are resistant to this effect. Moreover, preconfluent cells are more sensitive than postconfluent cells to menadione-induced cytotoxicity. Activation of JNK is transient since removal of menadione causes GSTA1 to re-associate with JNK reducing cytotoxicity. Over-expression and knockdown of GSTA1 did not alter JNK activation by menadione or sensitivity to menadione-induced cytotoxicity. These results indicate that GSTA1-JNK complex integrity does not affect the ability of menadione to activate JNK. N-acetyl cysteine prevents GSH depletion and blocks menadione-induced complex dissociation, JNK activation and inhibits menadione-induced cytotoxicity. JNK activation and inhibits menadione-induced cytotoxicity. The data suggest that the mechanism of menadione-induced JNK activation involves the production of reactive oxygen species, likely superoxide anion, and intracellular GSH levels play an important role in preventing GSTA1-JNK complex dissociation, subsequent JNK activation and induction of cytotoxicity. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Revisiting the concept of severe mental illness: severity indicators and healthcare spending in psychotic, depressive and dissociative disorders.

PubMed

Gonzalez Vazquez, Ana Isabel; Seijo Ameneiros, Natalia; Díaz Del Valle, Juan Carlos; Lopez Fernandez, Ester; Santed Germán, Miguel Angel

2017-08-10

The concept of severe mental illness (SMI) has been related to bipolar or psychotic diagnosis, or to some cases of depressive disorders. Other mental health problems such as personality disorders or posttraumatic dissociative conditions, which can sometimes lead to relevant functional impairments, remain separate from the SMI construct. This study aimed to evaluate the clinical severity as well as healthcare spending on dissociative disorders (DDs). This diagnostic group was compared with two other groups usually considered as causing severe impairment and high healthcare spending: bipolar and psychotic disorders, and unipolar depression. From a random sample of 200 psychiatric outpatients, 108 with unipolar depression (N = 45), psychotic/bipolar (N = 31) or DDs (N = 32) were selected for this study. The three groups were compared by the severity of their disorder and healthcare indicators. Of the three groups, those with a DD were more prone to and showed higher indices of suicide, self-injury, emergency consultations, as well as psychotropic drug use. This group ranked just below psychotic/bipolar patients in the amount of psychiatric hospitalisations. Despite a certain intra-professional stigma regarding DDs, these data supported the severity of these posttraumatic conditions, and their inclusion in the construct of SMI.

Music: a unique window into the world of autism.

PubMed

Molnar-Szakacs, Istvan; Heaton, Pamela

2012-04-01

Understanding emotions is fundamental to our ability to navigate the complex world of human social interaction. Individuals with autism spectrum disorders (ASD) experience difficulties with the communication and understanding of emotions within the social domain. Their ability to interpret other people's nonverbal, facial, and bodily expressions of emotion is strongly curtailed. However, there is evidence to suggest that many individuals with ASD show a strong and early preference for music and are able to understand simple and complex musical emotions in childhood and adulthood. The dissociation between emotion recognition abilities in musical and social domains in individuals with ASD provides us with the opportunity to consider the nature of emotion processing difficulties characterizing this disorder. There has recently been a surge of interest in musical abilities in individuals with ASD, and this has motivated new behavioral and neuroimaging studies. Here, we review this new work. We conclude by providing some questions for future directions. © 2012 New York Academy of Sciences.

The dissociative post-traumatic stress disorder (PTSD) subtype: A treatment outcome cohort study in veterans with PTSD.

PubMed

Haagen, Joris F G; van Rijn, Allison; Knipscheer, Jeroen W; van der Aa, Niels; Kleber, Rolf J

2018-06-01

Dissociation is a prevalent phenomenon among veterans with post-traumatic stress disorder (PTSD) that may interfere with the effectiveness of treatment. This study aimed to replicate findings of a dissociative PTSD subtype, to identify corresponding patterns in coping style, symptom type, and symptom severity, and to investigate its impact on post-traumatic symptom improvement. Latent profile analysis (LPA) was applied to baseline data from 330 predominantly (97%) male treatment-seeking veterans (mean age 39.5 years) with a probable PTSD. Multinomial logistic models were used to identify predictors of dissociative PTSD. Eighty veterans with PTSD that commenced with psychotherapy were invited for a follow-up measure after 6 months. The majority (n = 64, 80% response rate) completed the follow-up measure. Changes in post-traumatic stress between baseline and follow-up were explored as a continuous distal outcome. Latent profile analysis revealed four distinct patient profiles: 'low' (12.9%), 'moderate' (33.2%), 'severe' (45.1%), and 'dissociative' (8.8%) PTSD. The dissociative PTSD profile was characterized by more severe pathology levels, though not post-traumatic reactions symptom severity. Veterans with dissociative PTSD benefitted equally from PTSD treatment as veterans with non-dissociative PTSD with similar symptom severity. Within a sample of veterans with PTSD, a subsample of severely dissociative veterans was identified, characterized by elevated severity levels on pathology dimensions. The dissociative PTSD subtype did not negatively impact PTSD treatment. The present findings confirmed the existence of a distinct subgroup veterans that fit the description of dissociative PTSD. Patients with dissociative PTSD subtype symptoms uniquely differed from patients with non-dissociative PTSD in the severity of several psychopathology dimensions. Dissociative and non-dissociative PTSD patients with similar post-traumatic severity levels showed similar levels of improvement after PTSD treatment. The observational design and small sample size caution interpretation of the treatment outcome data. The IES-R questionnaire does not assess all PTSD DSM-IV diagnostic criteria (14 of 17), although it is considered a valid measure for an indication of PTSD. © 2018 The British Psychological Society.

The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder

PubMed Central

Sattel, Heribert; Schmidt, Ulrike; Sack, Martin

2018-01-01

ABSTRACT Background: Patients suffering from dissociative disorders (DD) are characterized by an avoidance of aversive stimuli. Clinical experience has shown that DD patients typically avoid the confrontation with their own faces in a mirror (CFM). Objective: To investigate potential CFM-associated self-reported and psychophysiological stress reactions of DD patients, which most likely inform on the still unknown pathophysiology of dysfunctional self-perception in DD. Method: Eighteen DD patients and 18 healthy controls (HCs) underwent CFM. They were assessed for CFM-induced subjective self-reported stress, acute dissociative symptoms and sympathetic and parasympathetic drive using impedance cardiography. Results: DD patients experienced more subjective stress and acute dissociation than HCs upon CFM. Their psychological stress response did not activate the sympathetic and parasympathetic nervous system. Conclusions: In DD patients, CFM constitutes serious self-reported stress and is associated with a blunted autonomic reactivity. Therapeutic approaches promoting self-perception and self-compassion, in particular by using CFM, might serve as goal-oriented diagnostic and therapeutic tools in DD.

The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder.

PubMed

Schäflein, Eva; Sattel, Heribert; Schmidt, Ulrike; Sack, Martin

2018-01-01

Background : Patients suffering from dissociative disorders (DD) are characterized by an avoidance of aversive stimuli. Clinical experience has shown that DD patients typically avoid the confrontation with their own faces in a mirror (CFM). Objective : To investigate potential CFM-associated self-reported and psychophysiological stress reactions of DD patients, which most likely inform on the still unknown pathophysiology of dysfunctional self-perception in DD. Method : Eighteen DD patients and 18 healthy controls (HCs) underwent CFM. They were assessed for CFM-induced subjective self-reported stress, acute dissociative symptoms and sympathetic and parasympathetic drive using impedance cardiography. Results : DD patients experienced more subjective stress and acute dissociation than HCs upon CFM. Their psychological stress response did not activate the sympathetic and parasympathetic nervous system. Conclusions : In DD patients, CFM constitutes serious self-reported stress and is associated with a blunted autonomic reactivity. Therapeutic approaches promoting self-perception and self-compassion, in particular by using CFM, might serve as goal-oriented diagnostic and therapeutic tools in DD.

[Anxiety disorders in DSM-5: an overview on changes in structure and content].

PubMed

Wittchen, H-U; Heinig, I; Beesdo-Baum, K

2014-05-01

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) "anxiety, obsessive-compulsive spectrum, posttraumatic, and dissociative disorders" work group addressed reconceptualization issues regarding all anxiety-related disorders. Based on systematic literature reviews, reanalyses of available data and evaluation of results following the DSM-5 principles it was decided to rearrange the disorder spectrum into separate groupings for the classical anxiety disorders, trauma- and stressor-related disorders, obsessive-compulsive and related disorders, and dissociative disorders. Among the classical anxiety disorders DSM-5 now also includes selective mutism and separation anxiety disorder. A major change from DSM-IV is a drastically simplified classification of panic disorder and agoraphobia. Both conditions can be separately coded in DSM-5 and the overlap is disclosed by a comorbid double diagnosis. The anxiety disorder criteria have been generally harmonized regarding content and order. It was assured that criteria are applicable to all age, gender and cultural groups. Furthermore, diagnosis-specific and cross-cutting dimensional anxiety scales have been developed to supplement categorical diagnosis which appears to facilitate assessment of severity and course of treatment.

Molecular beads on a charged molecular string

NASA Astrophysics Data System (ADS)

Zhang, Haizhen; Ferrell, Tyler A.; Asplund, Matthew C.; Dearden, David V.

2007-09-01

Complexes of [alpha],[omega]-alkyldiammonium cations [H3N+(CH2)nNH3+, n = 2-10] with the cyclic, hollow ligand cucurbit[6]uril (CB6) were characterized in the gas phase using Fourier transform ion cyclotron resonance mass spectrometry with energy resolved sustained off-resonance irradiation (SORI) collision induced dissociation, in combination with HF/6-31G* and B3LYP/6-31G* computational methods. All the complexes have the diammonium cation threaded through the cavity of CB6. The modeled supramolecular geometries, the SORI energies required for dissociation of the complexes and for appearance of singly protonated diamine product ions, and the branching ratios for the various dissociation channels all suggest that the optimum [alpha],[omega]-alkyldiammonium chain length for binding CB6 in the gas phase occurs for n = 4. This contrasts with observed complex stability constants in aqueous formic acid, which are maximum for n = 6, reflecting solvent stabilization of the ammonium groups that is not possible in the gas phase. At the B3LYP/6-31G* level of theory, the binding energy for the n = 4 complex with respect to dissociation to singly protonated butanediamine and protonated CB6 is 204 kJ mol-1. The n = 6 complex exhibits especially low dissociation thresholds, perhaps reflecting compression of the diammonium cation upon complexation with CB6, forming a loaded "molecular spring."

A woman lost in the cemetery: A case of time-limited amnesia.

PubMed

Comparelli, A; De Carolis, A; Kotzalidis, G D; Masillo, A; Ferracuti, S; Tatarelli, R

2010-02-01

A 43-year-old woman one day experienced a dissociative fugue which she could not recall. She was married, nulliparous, with no history of dissociative disorder or other psychiatric disorders. She had been sexually abused during late childhood-early adolescence. She was examined thoroughly from both psychiatric and medical standpoints to exclude organic causes for her condition. Magnetic Resonance Imaging showed only some non-specific abnormalities. On personality tests, a histrionic structure of personality emerged, with obsessive and narcissistic traits accompanied by rigidity and anxiety, dysphoria and high risk for depression; some impairment was found in executive function tests. Final diagnosis was one of dissociative fugue. In fact, organic traits were not sufficient to establish a diagnosis of Transient Global Amnesia.

[A dissociative patient].

PubMed

de Jongh, A; Abkhezr, S; Broers, D L M

2009-08-01

A 45-year-old woman attended a centre for special dental care. Initially, it seemed that the patient suffered from an extreme form of dental anxiety. However, the fact that she displayed 'dissociations' suggested that she had a severe psychiatric disorder, in this case Dissociative Identity Disorder. The key feature of this condition is a dysfunction of the normal integrative functions of identity, memory and consciousness. In such instances it is recommended to contact a psychologist or psychiatrist and the referring care provider to consider the consequences of the psychiatric condition regarding informed consent, treatment plan and actual treatment. Because it was not likely that the patient would respond to an intervention specifically aimed to reduce anxiety in the dental setting, dental treatment under general anesthesia was the best suited option.

Recent developments in the theory of dissociation

PubMed Central

SPITZER, CARSTEN; BARNOW, SVEN; FREYBERGER, HARALD J; GRABE, HANS JOERGEN

2006-01-01

Although the construct of dissociation was introduced into psychiatry at the end of the 19th century by Pierre Janet, the term still lacks a coherent conceptualization, which is partially reflected by differences in the classification of dissociative and conversion disorders in ICD-10 and DSM-IV. Given the clinical significance of dissociative psychopathology in numerous clinical conditions, it is very valuable that various efforts have been made to refine and to specify current conceptualizations in recent years. The most promising and convincing approaches converge in subdividing dissociation into qualitatively different types, i.e. pathological versus non-pathological dissociation, and "detachment" versus "compartmentalization". We review these concepts and discuss their scientific and clinical potential as well as their limitations. PMID:16946940

Self-mutilating behavior in patients with dissociative disorders: the role of innate hypnotic capacity.

PubMed

Ebrinc, Servet; Semiz, Umit B; Basoglu, Cengiz; Cetin, Mesut; Agargun, Mehmet Y; Algul, Ayhan; Ates, Alpay

2008-01-01

Despite the fact that the assumption of a relationship between self-mutilation and dissociative disorders (DD) has a long history, there is little empirical evidence to support this premise. The present study examined this relationship and investigated whether this commonality is associated with innate hypnotic capacity. Fifty patients diagnosed with DD and 50 control subjects with major depression were assessed by using a self-mutilation questionnaire, Dissociative Experiences Scale, Traumatic Experiences Checklist, and the Eye-Roll Sign for their self-mutilating behaviors, dissociative symptoms, early trauma, and innate hypnotic capacity, respectively. We have found that 82% of the present sample of patients with DD injured themselves. They had higher scores on trauma, dissociation and eye-roll measurements than controls. In addition, DD patients with self-mutilation were more likely to have high scores of trauma, dissociation and eye-roll than those without self-mutilation. Innate hypnotic capacity was a strong predictor of self-mutilating behavior in DD patients. This study strongly supports the assumption that patients with DD are at high risk for self-mutilating behavior and points to the necessity of routine screening for self-mutilating behavior as well as the hypnotic capacity which may constitute a high risk for self-injury in this patient group.

Disorder in the Representational Warehouse

ERIC Educational Resources Information Center

McGeer, Victoria; Schwitzgebel, Eric

2006-01-01

Although developmental psychologists are generally happy to endorse dissociations and gradualist views of development like Woolley's (2006), the design and interpretation of developmental research often suggests an implicit commitment to a cleaner, less dissociative, sudden-transition view of development. Such an implicit commitment may derive…

Activation of Latent Dihydroorotase from Aquifex aeolicus by Pressure*

PubMed Central

Hervé, Guy; Evans, Hedeel Guy; Fernado, Roshini; Patel, Chandni; Hachem, Fatme; Evans, David R.

2017-01-01

Elevated hydrostatic pressure was used to probe conformational changes of Aquifex aeolicus dihydroorotase (DHO), which catalyzes the third step in de novo pyrimidine biosynthesis. The isolated protein, a 45-kDa monomer, lacks catalytic activity but becomes active upon formation of a dodecameric complex with aspartate transcarbamoylase (ATC). X-ray crystallographic studies of the isolated DHO and of the complex showed that association induces several major conformational changes in the DHO structure. In the isolated DHO, a flexible loop occludes the active site blocking the access of substrates. The loop is mostly disordered but is tethered to the active site region by several electrostatic and hydrogen bonds. This loop becomes ordered and is displaced from the active site upon formation of DHO-ATC complex. The application of pressure to the complex causes its time-dependent dissociation and the loss of both DHO and ATC activities. Pressure induced irreversible dissociation of the obligate ATC trimer, and as a consequence the DHO is also inactivated. However, moderate hydrostatic pressure applied to the isolated DHO subunit mimics the complex formation and reversibly activates the isolated subunit in the absence of ATC, suggesting that the loop has been displaced from the active site. This effect of pressure is explained by the negative volume change associated with the disruption of ionic interactions and exposure of ionized amino acids to the solvent (electrostriction). The interpretation that the loop is relocated by pressure was validated by site-directed mutagenesis and by inhibition by small peptides that mimic the loop residues. PMID:27746403

Frontal dysfunctions of impulse control - a systematic review in borderline personality disorder and attention-deficit/hyperactivity disorder.

PubMed

Sebastian, Alexandra; Jung, Patrick; Krause-Utz, Annegret; Lieb, Klaus; Schmahl, Christian; Tüscher, Oliver

2014-01-01

Disorders such as borderline personality disorder (BPD) or attention-deficit/hyperactivity disorder (ADHD) are characterized by impulsive behaviors. Impulsivity as used in clinical terms is very broadly defined and entails different categories including personality traits as well as different cognitive functions such as emotion regulation or interference resolution and impulse control. Impulse control as an executive function, however, is neither cognitively nor neurobehaviorally a unitary function. Recent findings from behavioral and cognitive neuroscience studies suggest related but dissociable components of impulse control along functional domains like selective attention, response selection, motivational control, and behavioral inhibition. In addition, behavioral and neural dissociations are seen for proactive vs. reactive inhibitory motor control. The prefrontal cortex with its sub-regions is the central structure in executing these impulse control functions. Based on these concepts of impulse control, neurobehavioral findings of studies in BPD and ADHD were reviewed and systematically compared. Overall, patients with BPD exhibited prefrontal dysfunctions across impulse control components rather in orbitofrontal, dorsomedial, and dorsolateral prefrontal regions, whereas patients with ADHD displayed disturbed activity mainly in ventrolateral and medial prefrontal regions. Prefrontal dysfunctions, however, varied depending on the impulse control component and from disorder to disorder. This suggests a dissociation of impulse control related frontal dysfunctions in BPD and ADHD, although only few studies are hitherto available to assess frontal dysfunctions along different impulse control components in direct comparison of these disorders. Yet, these findings might serve as a hypothesis for the future systematic assessment of impulse control components to understand differences and commonalities of prefrontal cortex dysfunction in impulsive disorders.

Dissociative identity disorder and prepulse inhibition of the acoustic startle reflex

PubMed Central

Dale, Karl Yngvar; Flaten, Magne Arve; Elden, Åke; Holte, Arne

2008-01-01

A group of persons with dissociative identity disorder (DID) was compared with a group of persons with other dissociative disorders, and a group of nondiagnosed controls with regard to prepulse inhibition (PPI) of the acoustic startle reflex. The findings suggest maladaptive attentional processes at a controlled level, but not at a preattentive automatic level, in persons with DID. The prepulse occupied more controlled attentional resources in the DID group compared with the other two groups. Preattentive automatic processing, on the other hand, was normal in the DID group. Moreover, startle reflexes did not habituate in the DID group. In conclusion, increased PPI and delayed habituation is consistent with increased vigilance in individuals with DID. The present findings of reduced habituation of startle reflexes and increased PPI in persons with DID suggest the operation of a voluntary process that directs attention away from unpleasant or threatening stimuli. Aberrant voluntary attentional processes may thus be a defining characteristic in DID. PMID:18830396

Reduced amygdala reactivity and impaired working memory during dissociation in borderline personality disorder.

PubMed

Krause-Utz, Annegret; Winter, Dorina; Schriner, Friederike; Chiu, Chui-De; Lis, Stefanie; Spinhoven, Philip; Bohus, Martin; Schmahl, Christian; Elzinga, Bernet M

2018-06-01

Affective hyper-reactivity and impaired cognitive control of emotional material are core features of borderline personality disorder (BPD). A high percentage of individuals with BPD experience stress-related dissociation, including emotional numbing and memory disruptions. So far little is known about how dissociation influences the neural processing of emotional material in the context of a working memory task in BPD. We aimed to investigate whole-brain activity and amygdala functional connectivity (FC) during an Emotional Working Memory Task (EWMT) after dissociation induction in un-medicated BPD patients compared to healthy controls (HC). Using script-driven imagery, dissociation was induced in 17 patients ('BPD_D'), while 12 patients ('BPD_N') and 18 HC were exposed to neutral scripts during fMRI. Afterwards, participants performed the EWMT with neutral vs. negative IAPS pictures vs. no distractors. Main outcome measures were behavioral performance (reaction times, errors) and whole-brain activity during the EWMT. Psychophysiological interaction analysis was used to examine amygdala connectivity during emotional distraction. BPD patients after dissociation induction showed overall WM impairments, a deactivation in bilateral amygdala, and lower activity in left cuneus, lingual gyrus, and posterior cingulate than BPD_N, along with stronger left inferior frontal gyrus activity than HC. Furthermore, reduced amygdala FC with fusiform gyrus and stronger amygdala FC with right middle/superior temporal gyrus and left inferior parietal lobule was observed in BPD_D. Findings suggest that dissociation affects reactivity to emotionally salient material and WM. Altered activity in areas associated with emotion processing, memory, and self-referential processes may contribute to dissociative states in BPD.

Trauma, posttraumatic stress disorder symptoms, and dissociative experiences during men's intimate partner violence perpetration.

PubMed

LaMotte, Adam D; Murphy, Christopher M

2017-09-01

Research with partner-violent men has found that a subset of this population reports dissociative experiences during their violence (e.g., inability to remember violence [despite admission that it had occurred]; flashbacks during violence). However, the literature examining this phenomenon has been primarily limited to clinical observations and case studies, and there is a need for more thorough empirical investigation regarding the prevalence and correlates of dissociative violence among individuals in intimate partner violence (IPV) intervention programs. The primary goals of this study were to provide descriptive information about the rates of endorsement of dissociative experiences during IPV perpetration and to examine their associations with trauma exposure and posttraumatic stress disorder (PTSD) symptoms. Participants were 302 men presenting for services at a community-based IPV intervention program. All variables were assessed via self-report and clinician interview at program intake. Results indicated that 22.2% of participants reported 1 or more dissociative experiences during partner violence perpetration. Additionally, frequency of dissociative IPV perpetration showed significant positive correlations with the total number of potentially traumatic events (PTEs) reported and PTSD symptoms, with effect sizes in the small and medium ranges of magnitude, respectively. Finally, PTSD symptoms significantly mediated the relationship between total number of PTEs and dissociative IPV perpetration. Findings indicate a potentially meaningful relationship between trauma, PTSD symptoms, and dissociative experiences during IPV perpetration. Further qualitative and quantitative investigation is needed to better understand this phenomenon and how it can be addressed in IPV treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Response Inhibition in Adults with Autism Spectrum Disorder Compared to Attention Deficit/Hyperactivity Disorder

ERIC Educational Resources Information Center

Johnston, Kate; Madden, Anya K.; Bramham, Jessica; Russell, Ailsa J.

2011-01-01

Autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are hypothesised to involve core deficits in executive function. Previous studies have found evidence of a double dissociation between the disorders on specific executive functions (planning and response inhibition). To date most research has been conducted with…

Influence of Coulombic repulsion on the dissociation pathways and energetics of multiprotein complexes in the gas phase.

PubMed

Sinelnikov, Igor; Kitova, Elena N; Klassen, John S

2007-04-01

Thermal dissociation experiments, implemented with blackbody infrared radiative dissociation and Fourier-transform ion cyclotron resonance mass spectrometry, are performed on gaseous protonated and deprotonated ions of the homopentameric B subunits of Shiga toxin 1 (Stx1 B5) and Shiga toxin 2 (Stx2 B5) and the homotetramer streptavidin (S4). Dissociation of the gaseous, multisubunit complexes proceeds predominantly by the loss of a single subunit. Notably, the fractional partitioning of charge between the product ions, i.e., the leaving subunit and the resulting multimer, for a given complex is, within error, constant over the range of charge states investigated. The Arrhenius activation parameters (E(a), A) measured for the loss of subunit decrease with increasing charge state of the complex. However, the parameters for the protonated and deprotonated ions, with the same number of charges, are indistinguishable. The influence of the complex charge state on the dissociation pathways and the magnitude of the dissociation E(a) are modeled theoretically with the discrete charge droplet model (DCDM) and the protein structure model (PSM), wherein the structure of the subunits is considered. Importantly, the major subunit charge states observed experimentally for the Stx1 B5(n+/-) ions correspond to the minimum energy charge distribution predicted by DCDM and PSM assuming a late dissociative transition-state (TS); while for structurally-related Stx2 B5(n+) ions, the experimental charge distribution corresponds to an early TS. It is proposed that the lateness of the TS is related, in part, to the degree of unfolding of the leaving subunit, with Stx1 B being more unfolded than Stx2 B. PSM, incorporating significant subunit unfolding is necessary to account for the product ions observed for the S4(n+) ions. The contribution of Coulombic repulsion to the dissociation E(a) is quantified and the intrinsic activation energy is estimated for the first time.

Forgetting heart break: a fascinating case of transient left ventricular apical ballooning syndrome associated with dissociative amnesia.

PubMed

Toussi, Amir; Bryk, Jodie; Alam, Abdulkader

2014-01-01

Transient left ventricular apical ballooning syndrome (TLVABS), also known as takotsubo cardiomyopathy, is characterized by transient left ventricular dysfunction, electrocardiographic changes, and release of myocardial enzymes that mimic acute myocardial infarction in patients without angiographic evidence of coronary artery disease. Most patients are post-menopausal women and an emotional or physiologic stressor frequently precedes the presentation. Psychogenic or dissociative amnesia is a memory disorder characterized by sudden retrograde memory loss with inability to recall personal information said to occur for a period of time ranging from hours to years after a stressful event. Interestingly, the mechanism of both disorders has been linked to plasma elevation in catecholamines. Here we present the case of a 66-year-old female diagnosed with both TLVABS and dissociative amnesia following the sudden unexpected death of her sister. To our knowledge, this is surprisingly the first report of the co-occurrence of TLVABS and dissociative amnesia, two processes with a potential shared underlying etiology. © 2013.

Dispositional optimism and self-esteem as competing predictors of acute symptoms of generalized anxiety disorders and dissociative experiences among civilians exposed to war trauma.

PubMed

Weinberg, Michael; Besser, Avi; Zeigler-Hill, Virgil; Neria, Yuval

2015-01-01

Although previous studies have rarely examined predictors of acute emotional responses to war trauma, this "natural laboratory" study aimed to examine the role that individual differences in dispositional optimism and self-esteem play in the development of acute symptoms of generalized anxiety disorder (GAD) and dissociative experiences. A sample of 140 female adults exposed to missile and rocket fire during an eruption of violence in the Middle East in November 2012 was assessed during real-time exposure. The results demonstrate inverse associations between dispositional optimism and acute symptoms of GAD and dissociation. The associations were accounted for by individual differences in self-esteem. In addition, individuals with low levels of dispositional optimism demonstrated a higher risk for acute GAD and dissociative experiences, in part because of their low levels of self-esteem. Theoretical and clinical implications of the findings are discussed. (c) 2015 APA, all rights reserved).

Engendered Responses to, and Interventions for, Shame in Dissociative Disorders: A Survey and Experimental Investigation.

PubMed

Dorahy, Martin J; Gorgas, Julia; Seager, Lenaire; Middleton, Warwick

2017-11-01

This study examined shame and responses to it in adult dissociative disorder (DD; n = 24) and comparison psychiatric (n = 14) samples. To investigate how helpful different therapeutic responses are after shame disclosures in therapy, participants heard two vignettes from "mock" patients disclosing a) shame and b) surprise. Participants rated the helpfulness of five potential responses. Interventions covered withdrawing from the affect (withdrawal focused) to feeling it (feeling focused), with other interventions on cognitions (cognitive focused), management strategies (management focused), and previous experiences (history focused). The DD sample reported higher characterological and bodily shame, and more shame avoidance and withdrawal. There was no difference across groups for intervention ratings. For shame, interventions focused on feelings, cognitions, or previous shame experiences were deemed most helpful, but this was qualified by experiencing dissociation while hearing the script, where the history intervention was reported less helpful. Exposure to shame while monitoring dissociation should accompany therapy for DDs.

Native MS and ECD Characterization of a Fab-Antigen Complex May Facilitate Crystallization for X-ray Diffraction

NASA Astrophysics Data System (ADS)

Zhang, Ying; Cui, Weidong; Wecksler, Aaron T.; Zhang, Hao; Molina, Patricia; Deperalta, Galahad; Gross, Michael L.

2016-07-01

Native mass spectrometry (MS) and top-down electron-capture dissociation (ECD) combine as a powerful approach for characterizing large proteins and protein assemblies. Here, we report their use to study an antibody Fab (Fab-1)-VEGF complex in its near-native state. Native ESI with analysis by FTICR mass spectrometry confirms that VEGF is a dimer in solution and that its complex with Fab-1 has a binding stoichiometry of 2:2. Applying combinations of collisionally activated dissociation (CAD), ECD, and infrared multiphoton dissociation (IRMPD) allows identification of flexible regions of the complex, potentially serving as a guide for crystallization and X-ray diffraction analysis.

Perspectives on the conceptualization of the dissociative subtype of PTSD and implications for treatment.

PubMed

Dutra, Sunny J; Wolf, Erika J

2017-04-01

A dissociative subtype of PTSD was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to denote a distinct presentation of PTSD marked by symptoms of derealization and depersonalization. The subtype has brought renewed interest in the conceptualization of dissociation in PTSD, and raised questions about its treatment. We review the evidence for two models of PTSD-related dissociative symptoms and the treatment approaches that align with each. We find support for the contributions of biologically-based trait-level factors to dissociation, and suggest that empirically supported treatments for PTSD demonstrate efficacy for patients with the subtype. Published by Elsevier Ltd.

Type and timing of childhood maltreatment and severity of shutdown dissociation in patients with schizophrenia spectrum disorder.

PubMed

Schalinski, Inga; Teicher, Martin H

2015-01-01

Dissociation, particularly the shutting down of sensory, motor and speech systems, has been proposed to emerge in susceptible individuals as a defensive response to traumatic stress. In contrast, other individuals show signs of hyperarousal to acute threat. A key question is whether exposure to particular types of stressful events during specific stages of development can program an individual to have a strong dissociative response to subsequent stressors. Vulnerability to ongoing shutdown dissociation was assessed in 75 inpatients (46 M/29 F, M = 31 ± 10 years old) with schizophrenia spectrum disorder and related to number of traumatic events experienced or witnessed during childhood or adulthood. The Maltreatment and Abuse Chronology of Exposure (MACE) scale was used to collect retrospective recall of exposure to ten types of maltreatment during each year of childhood. Severity of shutdown dissociation was related to number of childhood but not adult traumatic events. Random forest regression with conditional trees indicated that type and timing of childhood maltreatment could predictably account for 31% of the variance (p < 0.003) in shutdown dissociation, with peak vulnerability occurring at 13-14 years of age and with exposure to emotional neglect followed by various forms of emotional abuse. These findings suggest that there may be windows of vulnerability to the development of shutdown dissociation. Results support the hypothesis that experienced events are more important than witnessed events, but challenge the hypothesis that "life-threatening" events are a critical determinant.

Method and apparatus for enhanced sequencing of complex molecules using surface-induced dissociation in conjunction with mass spectrometric analysis

DOEpatents

Laskin, Julia [Richland, WA; Futrell, Jean H [Richland, WA

2008-04-29

The invention relates to a method and apparatus for enhanced sequencing of complex molecules using surface-induced dissociation (SID) in conjunction with mass spectrometric analysis. Results demonstrate formation of a wide distribution of structure-specific fragments having wide sequence coverage useful for sequencing and identifying the complex molecules.

Dissociation in hysteria and hypnosis: evidence from cognitive neuroscience.

PubMed

Bell, Vaughan; Oakley, David A; Halligan, Peter W; Deeley, Quinton

2011-03-01

Jean-Martin Charcot proposed the radical hypothesis that similar brain processes were responsible for the unexplained neurological symptoms of 'hysteria', now typically diagnosed as 'conversion disorder' or 'dissociative (conversion) disorder', and the temporary effects of hypnosis. While this idea has been largely ignored, recent cognitive neuroscience studies indicate that (i) hypnotisability traits are associated with a tendency to develop dissociative symptoms in the sensorimotor domain; (ii) dissociative symptoms can be modelled with suggestions in highly hypnotisable subjects; and (iii) hypnotic phenomena engage brain processes similar to those seen in patients with symptoms of hysteria. One clear theme to emerge from the findings is that 'symptom' presentation, whether clinically diagnosed or simulated using hypnosis, is associated with increases in prefrontal cortex activity suggesting that intervention by the executive system in both automatic and voluntary cognitive processing is common to both hysteria and hypnosis. Nevertheless, while the recent literature provides some compelling leads into the understanding of these phenomena, the field still lacks well controlled systematically designed studies to give a clear insight into the neurocognitive processes underlying dissociation in both hysteria and hypnosis. The aim of this review is to provide an agenda for future research.

Dissociation: the clinical realities.

PubMed

Frankel, F H

1996-07-01

An attempt was made by the authors of DSM-III to restrict its focus to the experimental, the observable, and the measurable. The intention was to free the nosology from the influence of unproven theories, and the philosophy was driven largely by the importance of research being able to identify diagnostic categories to facilitate the study of homogeneous groups. So it is of interest that the authors accepted dissociation-an ambiguous event linked to an explicit theoretical concept that had been introduced by Janet-as the basis for classification of clinical presentations that were formerly included under the rubric of hysteria, a similarly unclear category. Since DSM-III, there have been an increasing number of reports of dissociative experiences and dissociative identity disorder (formerly known as multiple personality disorder), but neither of these clinical presentations seems able to withstand the concern that it is dramatically influenced by environmental cues, e.g., the expectations of the therapist. Thus, a restricted phenomenological perspective does not fully appreciate the distorting potential of suggestibility and imagination on the nature of the emerging clinical picture. These factors might well have contributed to and laid the conceptual groundwork for the growth in the number of reports of dissociation.

Dissociation of a Dynamic Protein Complex Studied by All-Atom Molecular Simulations.

PubMed

Zhang, Liqun; Borthakur, Susmita; Buck, Matthias

2016-02-23

The process of protein complex dissociation remains to be understood at the atomic level of detail. Computers now allow microsecond timescale molecular-dynamics simulations, which make the visualization of such processes possible. Here, we investigated the dissociation process of the EphA2-SHIP2 SAM-SAM domain heterodimer complex using unrestrained all-atom molecular-dynamics simulations. Previous studies on this system have shown that alternate configurations are sampled, that their interconversion can be fast, and that the complex is dynamic by nature. Starting from different NMR-derived structures, mutants were designed to stabilize a subset of configurations by swapping ion pairs across the protein-protein interface. We focused on two mutants, K956D/D1235K and R957D/D1223R, with attenuated binding affinity compared with the wild-type proteins. In contrast to calculations on the wild-type complexes, the majority of simulations of these mutants showed protein dissociation within 2.4 μs. During the separation process, we observed domain rotation and pivoting as well as a translation and simultaneous rolling, typically to alternate and weaker binding interfaces. Several unsuccessful recapturing attempts occurred once the domains were moderately separated. An analysis of protein solvation suggests that the dissociation process correlates with a progressive loss of protein-protein contacts. Furthermore, an evaluation of internal protein dynamics using quasi-harmonic and order parameter analyses indicates that changes in protein internal motions are expected to contribute significantly to the thermodynamics of protein dissociation. Considering protein association as the reverse of the separation process, the initial role of charged/polar interactions is emphasized, followed by changes in protein and solvent dynamics. The trajectories show that protein separation does not follow a single distinct pathway, but suggest that the mechanism of dissociation is common in that it initially involves transitions to surfaces with fewer, less favorable contacts compared with those seen in the fully formed complex. Copyright © 2016 Biophysical Society. Published by Elsevier Inc. All rights reserved.

Elena: A case of dissociative identity disorder from the 1920s.

PubMed

Schimmenti, Adriano

2017-01-01

In 1930, Italian psychiatrist Giovanni Enrico Morselli described the history, diagnosis, and treatment of his patient Elena. The case of Elena has been considered in literature as one of the most remarkable cases of multiple personality ever published. In fact, before treatment, Elena showed alternating French- and Italian-speaking personalities, with the Italian personality knowing nothing of her French counterparts. After a difficult treatment involving recovered memories of incestuous attacks by her father, which were proven to be true, Elena fully recovered from her symptoms. In this article, the author presents details of the case that were not available in the international literature before. He also discusses Elena's psychological and somatoform symptoms according to a contemporary perspective on the relationally traumatic origins of dissociation and dissociative identity disorder.

An eye for an I: a 35-year-old woman with fluctuating oculomotor deficits and dissociative identity disorder.

PubMed

Bhuvaneswar, Chaya; Spiegel, David

2013-01-01

Physiologic changes, including neurological or pseudo-neurological symptoms, occur across identity states in dissociative identity disorder DID) and can be objectively measured. The idea that dissociative phenomena might be associated with changes in brain function is consistent with research on the brain effects of hypnosis. The authors report a case of psycho-physiologic differences among 4 alter personalities manifested by a 35-year-old woman with DID. Differences in visual acuity, frequency of pendular nystagmus, and handedness were observed in this patient both when the alter personalities appeared spontaneously and when elicited under hypnosis. The authors consider several diagnostic possibilities for these findings and discuss whether prevailing treatment recommendations for DID patients could possibly be modified to ameliorate such visual and neurologic symptoms.

Identification of hemoglobin variants by top-down mass spectrometry using selected diagnostic product ions.

PubMed

Coelho Graça, Didia; Hartmer, Ralf; Jabs, Wolfgang; Beris, Photis; Clerici, Lorella; Stoermer, Carsten; Samii, Kaveh; Hochstrasser, Denis; Tsybin, Yury O; Scherl, Alexander; Lescuyer, Pierre

2015-04-01

Hemoglobin disorder diagnosis is a complex procedure combining several analytical steps. Due to the lack of specificity of the currently used protein analysis methods, the identification of uncommon hemoglobin variants (proteoforms) can become a hard task to accomplish. The aim of this work was to develop a mass spectrometry-based approach to quickly identify mutated protein sequences within globin chain variants. To reach this goal, a top-down electron transfer dissociation mass spectrometry method was developed for hemoglobin β chain analysis. A diagnostic product ion list was established with a color code strategy allowing to quickly and specifically localize a mutation in the hemoglobin β chain sequence. The method was applied to the analysis of rare hemoglobin β chain variants and an (A)γ-β fusion protein. The results showed that the developed data analysis process allows fast and reliable interpretation of top-down electron transfer dissociation mass spectra by nonexpert users in the clinical area.

Conversion, dissociative amnesia, and Ganser syndrome in a case of "chameleon" syndrome: anatomo-functional findings.

PubMed

Magnin, Eloi; Thomas-Antérion, Catherine; Sylvestre, Geraldine; Haffen, Sophie; Magnin-Feysot, Virgile; Rumbach, Lucien

2014-01-01

The term "chameleon" was first used in the seventeenth century by Sydenham to describe a patient with a protean semiology. We report a single case of "chameleon" syndrome that challenges the current international criteria for somatoform disorders, dissociative amnesia, and Ganser syndrome. The florid symptoms were as follows: anterograde and retrograde amnesia (including semantic, episodic, and procedural deficits), loss of identity, atypical neuropsychological impairment (approximate answers), left sensitive and motor deficit, and left pseudochoreoathetosis movement disorders. Additional behavioral disorders included the following: anxiety, clouded consciousness, hallucinations, and "belle indifference". A single photon emission computed tomography examination showed bilateral temporal, frontal and a right caudate (in the head of the caudate nucleus) hypoperfusion concordant with a common mechanism of repression in these disorders.

Measuring Intermolecular Binding Energies by Laser Spectroscopy.

PubMed

Knochenmuss, Richard; Maity, Surajit; Féraud, Géraldine; Leutwyler, Samuel

2017-02-22

The ground-state dissociation energy, D0(S0), of isolated intermolecular complexes in the gas phase is a fundamental measure of the interaction strength between the molecules. We have developed a three-laser, triply resonant pump-dump-probe technique to measure dissociation energies of jet-cooled M•S complexes, where M is an aromatic chromophore and S is a closed-shell 'solvent' molecule. Stimulated emission pumping (SEP) via the S0→S1 electronic transition is used to precisely 'warm' the complex by populating high vibrational levels v" of the S0 state. If the deposited energy E(v") is less than D0(S0), the complex remains intact, and is then mass- and isomer-selectively detected by resonant two-photon ionization (R2PI) with a third (probe) laser. If the pumped level is above D0(S0), the hot complex dissociates and the probe signal disappears. Combining the fluorescence or SEP spectrum of the cold complex with the SEP breakoff of the hot complex brackets D0(S0). The UV chromophores 1-naphthol and carbazole were employed; these bind either dispersively via the aromatic rings, or form a hydrogen bond via the -OH or -NH group. Dissociation energies have been measured for dispersively bound complexes with noble gases (Ne, Kr, Ar, Xe), diatomics (N2, CO), alkanes (methane to n-butane), cycloalkanes (cyclopropane to cycloheptane), and unsaturated compounds (ethene, benzene). Hydrogen-bond dissociation energies have been measured for H2O, D2O, methanol, ethanol, ethers (oxirane, oxetane), NH3 and ND3.

Description and control of dissociation channels in gas-phase protein complexes

NASA Astrophysics Data System (ADS)

Thachuk, Mark; Fegan, Sarah K.; Raheem, Nigare

2016-08-01

Using molecular dynamics simulations of a coarse-grained model of the charged apo-hemoglobin protein complex, this work expands upon our initial report [S. K. Fegan and M. Thachuk, J. Am. Soc. Mass Spectrom. 25, 722-728 (2014)] about control of dissociation channels in the gas phase using specially designed charge tags. Employing a charge hopping algorithm and a range of temperatures, a variety of dissociation channels are found for activated gas-phase protein complexes. At low temperatures, a single monomer unfolds and becomes charge enriched. At higher temperatures, two additional channels open: (i) two monomers unfold and charge enrich and (ii) two monomers compete for unfolding with one eventually dominating and the other reattaching to the complex. At even higher temperatures, other more complex dissociation channels open with three or more monomers competing for unfolding. A model charge tag with five sites is specially designed to either attract or exclude charges. By attaching this tag to the N-terminus of specific monomers, the unfolding of those monomers can be decidedly enhanced or suppressed. In other words, using charge tags to direct the motion of charges in a protein complex provides a mechanism for controlling dissociation. This technique could be used in mass spectrometry experiments to direct forces at specific attachment points in a protein complex, and hence increase the diversity of product channels available for quantitative analysis. In turn, this could provide insight into the function of the protein complex in its native biological environment. From a dynamics perspective, this system provides an interesting example of cooperative behaviour involving motions with differing time scales.

Contemporary concepts of dissociation.

PubMed

Avdibegović, Esmina

2012-10-01

The concept of dissociation was developed in the late 19th century by Pierre Janet for conditions of "double consciousness" in hypnosis, hysteria, spirit possession and mediumship. He defined dissociation as a deficit in the capacity of integration of two or more different "systems of ideas and functions that constitute personality", and suggested that it can be related to a genetic component, to severe illness and fatigue, and particularly to experiencing adverse, potentially traumatizing events. By the late 20th century, various and often contradictory concepts of dissociation were suggested, which were either insufficient or exceedingly including when compared to the original idea. Currently, dissociation is used to describe a wide range of normal and abnormal phenomena as a process in which behaviour, thoughts and emotions can become separated one from another. A complete presentation of mechanisms involved in dissociation is still unknown. Scientific research on basic processes of dissociation is derived mainly from studies of hypnosis and post-traumatic stress disorder. Given the controversies in modern concepts of dissociation, some researchers and theorists suggest return to the original understanding of dissociation as a basic premise for the further development of the concept of dissociation.

Dissociative amnesia after general anesthesia--a case report.

PubMed

Chang, Yi; Huang, Chi-Hsiang; Wen, Yeong-Ray; Chen, Jui-Yuan; Wu, Gong-Jhe

2002-06-01

Psychogenic unconsciousness is a rare cause of failure of prompt recovery from general anesthesia. The diagnosis is only made by exclusion of other conditions. We describe a young, healthy female who failed to wake up promptly after total intravenous anesthesia with alfentanil and propofol. She regained consciousness 24 hours later without any specific treatment. However she sustained amnesia for a period of 48 hours. Dissociative disorder was diagnosed after an extensive workup. This case report emphasizes the importance of inclusion of psychiatric disorder in the differential diagnosis should unexplainable delayed emergence from general anesthesia occur.

Reading Disorders in Primary Progressive Aphasia: A Behavioral and Neuroimaging Study

ERIC Educational Resources Information Center

Brambati, S. M.; Ogar, J.; Neuhaus, J.; Miller, B. L.; Gorno-Tempini, M. L.

2009-01-01

Previous neuropsychological studies on acquired dyslexia revealed a double dissociation in reading impairments. Patients with phonological dyslexia have selective difficulty in reading pseudo-words, while those with surface dyslexia misread exception words. This double dissociation in reading abilities has often been reported in brain-damaged…

Frontal Dysfunctions of Impulse Control – A Systematic Review in Borderline Personality Disorder and Attention-Deficit/Hyperactivity Disorder

PubMed Central

Sebastian, Alexandra; Jung, Patrick; Krause-Utz, Annegret; Lieb, Klaus; Schmahl, Christian; Tüscher, Oliver

2014-01-01

Disorders such as borderline personality disorder (BPD) or attention-deficit/hyperactivity disorder (ADHD) are characterized by impulsive behaviors. Impulsivity as used in clinical terms is very broadly defined and entails different categories including personality traits as well as different cognitive functions such as emotion regulation or interference resolution and impulse control. Impulse control as an executive function, however, is neither cognitively nor neurobehaviorally a unitary function. Recent findings from behavioral and cognitive neuroscience studies suggest related but dissociable components of impulse control along functional domains like selective attention, response selection, motivational control, and behavioral inhibition. In addition, behavioral and neural dissociations are seen for proactive vs. reactive inhibitory motor control. The prefrontal cortex with its sub-regions is the central structure in executing these impulse control functions. Based on these concepts of impulse control, neurobehavioral findings of studies in BPD and ADHD were reviewed and systematically compared. Overall, patients with BPD exhibited prefrontal dysfunctions across impulse control components rather in orbitofrontal, dorsomedial, and dorsolateral prefrontal regions, whereas patients with ADHD displayed disturbed activity mainly in ventrolateral and medial prefrontal regions. Prefrontal dysfunctions, however, varied depending on the impulse control component and from disorder to disorder. This suggests a dissociation of impulse control related frontal dysfunctions in BPD and ADHD, although only few studies are hitherto available to assess frontal dysfunctions along different impulse control components in direct comparison of these disorders. Yet, these findings might serve as a hypothesis for the future systematic assessment of impulse control components to understand differences and commonalities of prefrontal cortex dysfunction in impulsive disorders. PMID:25232313

Spontaneous and deliberate dissociative states in military personnel: are such states helpful?

PubMed

Morgan, Charles A; Taylor, Marcus K

2013-08-01

This study explored distinctions between spontaneous and deliberate dissociative states in 335 military personnel exposed to stressful survival training. Participants completed the Clinician-Administered Dissociative States Scale (CADSS) after a stressful mock-captivity event. They were also asked to indicate whether the dissociative experiences just happened (i.e., spontaneous), or whether they chose to have them happen (i.e., deliberate); and whether they appraised the dissociative experience as helpful (i.e., facilitative) or hurtful (i.e., debilitative) to their ability to cope with the stressful event. A majority (95.4%) endorsed dissociative states during stress. More than half (57.4%) described dissociative experiences as spontaneous, 13.0% as deliberate, and 29.5% endorsed neither. In Special Forces soldiers only, those who endorsed facilitative dissociation exhibited higher total CADSS scores than those who endorsed debilitative dissociation. Seventy-three percent of spontaneous dissociators described the experience as debilitative to coping with stress; conversely, 76% of deliberate dissociators said these experiences facilitated coping with stress. Individuals with prior trauma exposure tended to appraise dissociative states as more debilitative to coping. This research may enhance the fidelity of studies of dissociation constructs and may offer pivot points for prevention and treatment of stress-related disorders. Published 2013. This article is a US Government work and is in the public domain in the USA.

Reality versus fantasy: reply to Lynn et al. (2014).

PubMed

Dalenberg, Constance J; Brand, Bethany L; Loewenstein, Richard J; Gleaves, David H; Dorahy, Martin J; Cardeña, Etzel; Frewen, Paul A; Carlson, Eve B; Spiegel, David

2014-05-01

We respond to Lynn et al.'s (2014) comments on our review (Dalenberg et al., 2012) demonstrating the superiority of the trauma model (TM) over the fantasy model (FM) in explaining the trauma-dissociation relationship. Lynn et al. conceded that our meta-analytic results support the TM hypothesis that trauma exposure is a causal risk factor for the development of dissociation. Although Lynn et al. suggested that our meta-analyses were selective, we respond that each omitted study failed to meet inclusion criteria; our meta-analyses thus reflect a balanced view of the predominant trauma-dissociation findings. In contrast, Lynn et al. were hypercritical of studies that supported the TM while ignoring methodological problems in studies presented as supportive of the FM. We clarify Lynn et al.'s misunderstandings of the TM and demonstrate consistent superiority in prediction of time course of dissociative symptoms, response to psychotherapy of dissociative patients, and pattern of relationships of trauma to dissociation. We defend our decision not to include studies using the Dissociative Experiences Scale-Comparison, a rarely used revision of the Dissociative Experiences Scale that shares less than 10% of the variance with the original scale. We highlight several areas of agreement: (a) Trauma plays a complex role in dissociation, involving indirect and direct paths; (b) dissociation-suggestibility relationships are small; and (c) controls and measurement issues should be addressed in future suggestibility and dissociation research. Considering the lack of evidence that dissociative individuals simply fantasize trauma, future researchers should examine more complex models of trauma and valid measures of dissociation.

Superior colliculus resting state networks in post-traumatic stress disorder and its dissociative subtype.

PubMed

Olivé, Isadora; Densmore, Maria; Harricharan, Sherain; Théberge, Jean; McKinnon, Margaret C; Lanius, Ruth

2018-01-01

The innate alarm system (IAS) models the neurocircuitry involved in threat processing in posttraumatic stress disorder (PTSD). Here, we investigate a primary subcortical structure of the IAS model, the superior colliculus (SC), where the SC is thought to contribute to the mechanisms underlying threat-detection in PTSD. Critically, the functional connectivity between the SC and other nodes of the IAS remains unexplored. We conducted a resting-state fMRI study to investigate the functional architecture of the IAS, focusing on connectivity of the SC in PTSD (n = 67), its dissociative subtype (n = 41), and healthy controls (n = 50) using region-of-interest seed-based analysis. We observed group-specific resting state functional connectivity between the SC for both PTSD and its dissociative subtype, indicative of dedicated IAS collicular pathways in each group of patients. When comparing PTSD to its dissociative subtype, we observed increased resting state functional connectivity between the left SC and the right dorsolateral prefrontal cortex (DLPFC) in PTSD. The DLPFC is involved in modulation of emotional processes associated with active defensive responses characterising PTSD. Moreover, when comparing PTSD to its dissociative subtype, increased resting state functional connectivity was observed between the right SC and the right temporoparietal junction in the dissociative subtype. The temporoparietal junction is involved in depersonalization responses associated with passive defensive responses typical of the dissociative subtype. Our findings suggest that unique resting state functional connectivity of the SC parallels the unique symptom profile and defensive responses observed in PTSD and its dissociative subtype. Hum Brain Mapp 39:563-574, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Association of trauma-related disorders and dissociation with four idioms of distress among Latino psychiatric outpatients.

PubMed

Lewis-Fernández, Roberto; Gorritz, Magdaliz; Raggio, Greer A; Peláez, Clara; Chen, Henian; Guarnaccia, Peter J

2010-06-01

Past research on idioms of distress among U.S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis. It has been proposed that the idioms exert this effect because they are signs of distressing dissociative capacity associated with traumatic exposure. This study examines the relationships in an ethnically diverse Latino psychiatric outpatient sample (N = 230) among interpersonal trauma, posttraumatic stress disorder (PTSD), major depressive disorder, dissociative capacity and four cultural idioms of distress associated with the popular overall category of nervios. We particularly explore how these relationships change with varied measures of traumatic exposure, including trauma severity and timing or persistence of trauma. A series of adjusted bivariate regressions assessed the matrix of associations between the idioms and the clinical variables. In this highly traumatized population, we identified a strong 'nexus' of associations between dissociation and three of the idioms: currently being ill with nerves, ataque de nervios and altered perceptions. These idioms were largely independent from PTSD and depression and were associated with trauma persistence and severity. A fourth idiom, being nervous since childhood, was not associated with any other variable and may represent a personality trait rather than a diagnosable condition. Our results validate the clinical utility of the construct of nervios as a set of specific idioms associated with dissociation that are useful markers of mental health need among Latinos independently of their association with clinical diagnoses.

Sirt2 Deacetylase Is a Novel AKT Binding Partner Critical for AKT Activation by Insulin*

PubMed Central

Ramakrishnan, Gopalakrishnan; Davaakhuu, Gantulga; Kaplun, Ludmila; Chung, Wen-Cheng; Rana, Ajay; Atfi, Azeddine; Miele, Lucio; Tzivion, Guri

2014-01-01

AKT/PKB kinases transmit insulin and growth factor signals downstream of phosphatidylinositol 3-kinase (PI3K). AKT activation involves phosphorylation at two residues, Thr308 and Ser473, mediated by PDK1 and the mammalian target of rapamycin complex 2 (mTORC2), respectively. Impaired AKT activation is a key factor in metabolic disorders involving insulin resistance, whereas hyperactivation of AKT is linked to cancer pathogenesis. Here, we identify the cytoplasmic NAD+-dependent deacetylase, Sirt2, as a novel AKT interactor, required for optimal AKT activation. Pharmacological inhibition or genetic down-regulation of Sirt2 diminished AKT activation in insulin and growth factor-responsive cells, whereas Sirt2 overexpression enhanced the activation of AKT and its downstream targets. AKT was prebound with Sirt2 in serum or glucose-deprived cells, and the complex dissociated following insulin treatment. The binding was mediated by the pleckstrin homology and the kinase domains of AKT and was dependent on AMP-activated kinase. This regulation involved a novel AMP-activated kinase-dependent Sirt2 phosphorylation at Thr101. In cells with constitutive PI3K activation, we found that AKT also associated with a nuclear sirtuin, Sirt1; however, inhibition of PI3K resulted in dissociation from Sirt1 and increased association with Sirt2. Sirt1 and Sirt2 inhibitors additively inhibited the constitutive AKT activity in these cells. Our results suggest potential usefulness of Sirt1 and Sirt2 inhibitors in the treatment of cancer cells with up-regulated PI3K activity and of Sirt2 activators in the treatment of insulin-resistant metabolic disorders. PMID:24446434

Determination of thermodynamic values of acidic dissociation constants and complexation constants of profens and their utilization for optimization of separation conditions by Simul 5 Complex.

PubMed

Riesová, Martina; Svobodová, Jana; Ušelová, Kateřina; Tošner, Zdeněk; Zusková, Iva; Gaš, Bohuslav

2014-10-17

In this paper we determine acid dissociation constants, limiting ionic mobilities, complexation constants with β-cyclodextrin or heptakis(2,3,6-tri-O-methyl)-β-cyclodextrin, and mobilities of resulting complexes of profens, using capillary zone electrophoresis and affinity capillary electrophoresis. Complexation parameters are determined for both neutral and fully charged forms of profens and further corrected for actual ionic strength and variable viscosity in order to obtain thermodynamic values of complexation constants. The accuracy of obtained complexation parameters is verified by multidimensional nonlinear regression of affinity capillary electrophoretic data, which provides the acid dissociation and complexation parameters within one set of measurements, and by NMR technique. A good agreement among all discussed methods was obtained. Determined complexation parameters were used as input parameters for simulations of electrophoretic separation of profens by Simul 5 Complex. An excellent agreement of experimental and simulated results was achieved in terms of positions, shapes, and amplitudes of analyte peaks, confirming the applicability of Simul 5 Complex to complex systems, and accuracy of obtained physical-chemical constants. Simultaneously, we were able to demonstrate the influence of electromigration dispersion on the separation efficiency, which is not possible using the common theoretical approaches, and predict the electromigration order reversals of profen peaks. We have shown that determined acid dissociation and complexation parameters in combination with tool Simul 5 Complex software can be used for optimization of separation conditions in capillary electrophoresis. Copyright © 2014 Elsevier B.V. All rights reserved.

Sexual abuse and the problem of embodiment.

PubMed

Young, L

1992-01-01

In this paper, trauma, sexual abuse, and some of the potential resulting long-term effects, are explored in terms of the problem of embodiment and the formation of personal identity and psychological integrity. That is, what effect does severe sexual abuse have on an individual's, particularly a child's, sense of living in his or her body and, by extension, living in the world? First, trauma and dissociation are analyzed and linked to the development and maintenance of a "posttraumatic" sense of personal identity. Then, several disorders associated with sexual abuse--dissociation, multiple personality disorder, eating disorders, somatization disorder, self-mutilation, suicide, and suicide attempts--are examined in terms of their phenomenological coherence and relation to the problem of embodiment. This conceptual framework may be of use to clinicians and researchers assessing and treating the survivors of sexual abuse.

Clinical correlates of childhood trauma and dissociative phenomena in patients with severe psychiatric disorders.

PubMed

Bozkurt Zincir, Selma; Yanartaş, Omer; Zincir, Serkan; Semiz, Umit Başar

2014-12-01

In this present study, we aim to investigate the possibility of a link between psychotic disorders and traumatic experiences in a group of female patients diagnosed with psychotic disorders by comparing childhood trauma exposure with a group of non-psychotic psychiatric disorder attending the same pschiatric clinic. Secondary purpose of this study is to examine the clinical correlates of trauma exposure, dissociative phenomena and psychiatric symptomatology between these two group of patients. Two psychiatric sample groups, those with psychotic disorders-mostly schizophrenic-(n = 54), and those with a non-psychotic severe psychiatric disorders (n = 24), were recruited. Data were collected for demographic, psychiatric and trauma histories and psychiatric symptomatology for all patients. In this study, high prevalance rates of childhood traumatic experiences and dissociative phenomena were found in both groups. Total scores of childhood trauma questionnaire in favor of the non-psychotic group were found to be close to significance (p = 0.052). DES scores of non-psychotic group were also higher although not statistically significant. 54.2 % of nonpsychotic cases had DES scores >20 on the other hand, that percentage of psychotic cases were found to be as 38.9 %. Furthermore, psychiatric patients who have suffered childhood traumatic experiences are far more likely to try to kill themselves than psychiatric patients who have not experienced such abuse. The high rates of childhood traumatic events in our present samples of both schizophrenia-spectrum patients and nonpsychotic patients confirm the need for clinicans to take trauma histories routinely.

Coping strategies, hope, and treatment efficacy in pharmacoresistant inpatients with neurotic spectrum disorders

PubMed Central

Ociskova, Marie; Prasko, Jan; Kamaradova, Dana; Grambal, Ales; Kasalova, Petra; Sigmundova, Zuzana; Latalova, Klara; Vrbova, Kristyna

2015-01-01

Background Approximately 30%–60% of patients with neurotic spectrum disorders remain symptomatic despite treatment. Identifying the predictors of good response to psychiatric and psychotherapeutic treatment may be useful for increasing treatment efficacy in neurotic patients. The objective of this study was to investigate the influence of hope, coping strategies, and dissociation on the treatment response of this group of patients. Methods Pharmacoresistant patients, who underwent a 6-week psychotherapeutic program, were enrolled in the study. All patients completed the Clinical Global Impression (CGI) – both objective and subjective forms, Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI)-II at baseline and after 6 weeks. The COPE Inventory, the Adult Dispositional Hope Scale (ADHS), and the Dissociative Experiences Scale (DES) were completed at the start of the treatment. Results Seventy-six patients completed the study. The mean scores for all scales measuring the severity of the disorders (BAI, BDI-II, subjective and objective CGI) significantly decreased during the treatment. Several subscores of the COPE Inventory, the overall score of ADHS, and the overall score of DES significantly correlated with the treatment outcome. Multiple regression was used to find out which factors were the most significant predictors of the therapeutic outcomes. The most important predictors of the treatment response were the overall levels of hope and dissociation. Conclusion According to our results, a group of patients with a primary neurotic disorder, who prefer the use of maladaptive coping strategies, feel hopelessness, and have tendencies to dissociate, showed poor response to treatment. PMID:26028972

DISSOCIATION OF ARSENITE-PEPTIDE COMPLEXES: TRIPHASIC NATURE, RATE CONSTANTS, HALF LIVES AND BIOLOGICAL IMPORTANCE

EPA Science Inventory

We determined the number and the dissociation rate constants of different complexes formed from arsenite and two peptides containing either one (RV AVGNDYASGYHYGV for peptide 20) or three cysteines (LE AWQGK VEGTEHLYSMK K for peptide 10) via radioactive 73As labeled arsenite and ...

[Factitious disorders in dermatology: Value of the dissociative state concept].

PubMed

Fekih-Romdhane, F; Homri, W; Labbane, R

2016-03-01

Factitious disorders in dermatology consist of intentionally self-inflicted skin lesions that vary in morphology and distribution and occur on surfaces readily accessible to the patient's hands. They tend to be a chronic condition that waxes and wanes according to the circumstances of the patient's life. Patient management poses a particular challenge to the clinician and the prognosis is considered poor. The aetiopathogenesis of factitious disorders in dermatology is not completely understood. We present a case in which we suggested the occurrence of factitious behaviour during a dissociative state, and we briefly describe our diagnostic and therapeutic approach. A 48-year-old unemployed woman was referred to our department of psychiatry by her dermatologist for suspected factitious disorder. The patient was diagnosed with diabetes mellitus type 1 and had been hospitalized repeatedly for confirmed diabetic ketoacidosis. The onset of the disease was related to marital discord with her spouse. Numerous skin lesions had appeared on her face, arms, legs, neck and back. These lesions resulted in multiple hospital admissions and in amputation of her left leg. The condition had worsened considerably after her separation from her husband. During the initial conversation, the patient was unable to provide a clear history of the disease. She denied any knowledge of the circumstances in which these skin lesions appeared, and she did not admit self-infliction. Her mood was depressed and her speech was slow. We suspected that our patient was herself causing her skin lesions while in a dissociative state. Several arguments militate in favour of our hypothesis, particularly her history of childhood maltreatment and the association of traumatic life events with simultaneous deterioration of the skin. The explanation of the dissociative mechanism helped us to strengthen the therapeutic relationship. Within a few days, we noted a slow regression of the lesions, but the patient was still unable to explain how the lesions had occurred. The pathophysiology of factitious disorders in dermatology is poorly understood. It has strong ties with other psychiatric disorders, and according to several authors, skin lesions occur in dissociative states, after which patients do not remember how the skin change started. Management of this disease is challenging. An improved understanding of its mechanisms may enhance the prognosis for this particular group of patients. Copyright © 2015. Published by Elsevier Masson SAS.

Dissociative States and Neural Complexity

ERIC Educational Resources Information Center

Bob, Petr; Svetlak, Miroslav

2011-01-01

Recent findings indicate that neural mechanisms of consciousness are related to integration of distributed neural assemblies. This neural integration is particularly vulnerable to past stressful experiences that can lead to disintegration and dissociation of consciousness. These findings suggest that dissociation could be described as a level of…

Hepatocyte Growth Factor Modulates MET Receptor Tyrosine Kinase and β-Catenin Functional Interactions to Enhance Synapse Formation

PubMed Central

Xie, Zhihui; Eagleson, Kathie L.

2016-01-01

MET, a pleiotropic receptor tyrosine kinase implicated in autism risk, influences multiple neurodevelopmental processes. There is a knowledge gap, however, in the molecular mechanism through which MET mediates developmental events related to disorder risk. In the neocortex, MET is expressed transiently during periods of peak dendritic outgrowth and synaptogenesis, with expression enriched at developing synapses, consistent with demonstrated roles in dendritic morphogenesis, modulation of spine volume, and excitatory synapse development. In a recent coimmunoprecipitation/mass spectrometry screen, β-catenin was identified as part of the MET interactome in developing neocortical synaptosomes. Here, we investigated the influence of the MET/β-catenin complex in mouse neocortical synaptogenesis. Western blot analysis confirms that MET and β-catenin coimmunoprecipitate, but N-cadherin is not associated with the MET complex. Following stimulation with hepatocyte growth factor (HGF), β-catenin is phosphorylated at tyrosine142 (Y142) and dissociates from MET, accompanied by an increase in β-catenin/N-cadherin and MET/synapsin 1 protein complexes. In neocortical neurons in vitro, proximity ligation assays confirmed the close proximity of these proteins. Moreover, in neurons transfected with synaptophysin-GFP, HGF stimulation increases the density of synaptophysin/bassoon (a presynaptic marker) and synaptophysin/PSD-95 (a postsynaptic marker) clusters. Mutation of β-catenin at Y142 disrupts the dissociation of the MET/β-catenin complex and prevents the increase in clusters in response to HGF. The data demonstrate a new mechanism for the modulation of synapse formation, whereby MET activation induces an alignment of presynaptic and postsynaptic elements that are necessary for assembly and formation of functional synapses by subsets of neocortical neurons that express MET/β-catenin complex. PMID:27595133

Pre-deployment dissociation and personality as risk factors for post-deployment post-traumatic stress disorder in Danish soldiers deployed to Afghanistan

PubMed Central

Ponce de León, Beatriz; Andersen, Søren; Karstoft, Karen-Inge; Elklit, Ask

2018-01-01

ABSTRACT Objective: This study investigated whether pre-deployment dissociation was associated with previously identified post-traumatic stress disorder (PTSD) symptom trajectories from before to 2.5 years after military deployment. Furthermore, it examined whether the tendency to dissociate, pre-deployment personality factors, conceptualized by the Big Five model, and previous trauma represented independent risk factors for post-deployment PTSD symptoms. Method: This prospective study included the entire team of 743 soldiers from the Danish Contingent of the International Security Assistance Force 7 deployed to Afghanistan in 2009. Data consisted of self-report measures and were collected six times: before deployment; during deployment; and 1–3 weeks, 2 months, 7 months and 2.5 years after homecoming. Results: The findings indicate significant associations between pre-deployment dissociation and six PTSD trajectories (p < 0.001, η2 = 0.120). Based on mean differences in dissociation for the six trajectories, two main groups emerged: a group with high dissociation scores at pre-deployment, which had moderate PTSD symptom levels at pre-deployment and fluctuated over time; and a group with low dissociation scores at pre-deployment, which had low initial PTSD symptom levels and diverged over time. Our study also confirmed previous findings of a positive association between neuroticism and dissociation (r = 0.31, p < 0.001). This suggests that negative emotionality may be a vulnerability that enhances dissociative experiences, although a causal link cannot be concluded from the findings. Finally, pre-deployment dissociation, pre-deployment neuroticism and a history of traumatic events, as independent factors, were significant predictors of post-deployment PTSD (p < 0.001, R2 = 0.158). Conclusions: The study emphasizes the multiplicity of factors involved in the development of PTSD, and group differences in dissociative symptoms support the heterogeneity in PTSD. Further, this study points to specific aspects of personality that may be targeted in a clinical setting and in pre-deployment assessments in the military. PMID:29707166

A Preliminary Evaluation of Repeated Exposure for Depersonalization and Derealization

ERIC Educational Resources Information Center

Weiner, Elliot; McKay, Dean

2013-01-01

Dissociative symptoms including depersonalization and derealization are commonly experienced by individuals suffering from panic disorder or posttraumatic stress disorder (PTSD). Few studies have been published investigating the specific treatment of these symptoms in individuals diagnosed with panic disorder or PTSD, despite evidence that the…

Exploring racial disparity in posttraumatic stress disorder diagnosis: implications for care of African American women.

PubMed

Seng, Julia S; Kohn-Wood, Laura P; Odera, Lilian A

2005-01-01

To explore factors contributing to disparities in posttraumatic stress disorder (PTSD) diagnosis between African Americans and White Americans, while controlling for gender and class by using a data set limited to poor women. A cross-sectional epidemiological secondary analysis. Michigan Medicaid fee-for-service claims data from 1994 through 1997. A total of 20,298 African American and White American adolescents and adult women, including 2,996 with PTSD diagnosis. Victimization, PTSD diagnosis, psychiatric and somatic comorbidities, and PTSD treatment. African American women were under-represented in the group diagnosed with PTSD (12% versus 31% in the comparison group), despite having equal rates of hospitalization for rape and battering. They were less likely to be diagnosed with comorbidities associated with complex PTSD, such as dissociative disorder (OR = 0.259, p < .001) or borderline personality disorder (OR = 0.178, p < .001), but were equally likely to be diagnosed with conduct disorder, schizophrenia, or substance abuse. African American women were 40% less likely to have continuous insurance coverage. Patient, provider, and system factors appear to interact to create disparities in PTSD diagnosis and treatment. Attention to case finding and provider or system bias may help reduce disparities.

Restoring literary wholeness to the fragmented account of Antoine Despine's magnetic cure of Estelle L'Hardy's dissociative disorder.

PubMed

McKeown, Joanne M

2007-10-01

Dr. Charles-Humbert Antoine Despine's (1777-1852) De L'Emploi du magnétisme animal et des eaux minerales dans le traitement des maladies nerveuses, suivi d'une observation très curieuse de guérison de névropathie [A Study of the uses of animal magnetism in the treatment of disorders of the nervous system followed by a case of a highly unusual cure of neuropathy] (Paris: Germer, Baillière, 1840) is one of the earliest published, complete accounts of a successful cure with animal magnetism of a dissociative disorder. Despine's methodical and gentle treatment of more than 20 patients with multiple personalities repeatedly brought fusion to separation. His writing style displays a lack of order and unity that resembles the dissociative symptoms of his patients, but the monograph's sloppiness belies Despine's methodical approach to his work and his thoughtful handling of his patients. This paper explores these inconsistencies and how translators of the monograph act as literary therapists for his confused and fragmented account.

Unresolved Attachment, PTSD, and Dissociation in Women with Childhood Abuse Histories

ERIC Educational Resources Information Center

Stovall-McClough, K. Chase; Cloitre, Marylene

2006-01-01

The primary objective of this study was to examine unresolved trauma as assessed by the Adult Attachment Interview and current psychiatric symptoms, focusing on posttraumatic stress disorder (PTSD) and dissociation, in a group of adult female childhood abuse survivors. The authors examined psychiatric symptoms and attachment representations in a…

Childhood trauma and eating psychopathology: a mediating role for dissociation and emotion dysregulation?

PubMed

Moulton, Stuart J; Newman, Emily; Power, Kevin; Swanson, Vivien; Day, Kenny

2015-01-01

The present study examined the relationship between different forms of childhood trauma and eating psychopathology using a multiple mediation model that included emotion dysregulation and dissociation as hypothesised mediators. 142 female undergraduate psychology students studying at two British Universities participated in this cross-sectional study. Participants completed measures of childhood trauma (emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect), eating psychopathology, dissociation and emotion dysregulation. Multiple mediation analysis was conducted to investigate the study's proposed model. Results revealed that the multiple mediation model significantly predicted eating psychopathology. Additionally, both emotion dysregulation and dissociation were found to be significant mediators between childhood trauma and eating psychopathology. A specific indirect effect was observed between childhood emotional abuse and eating psychopathology through emotion dysregulation. Findings support previous research linking childhood trauma to eating psychopathology. They indicate that multiple forms of childhood trauma should be assessed for individuals with eating disorders. The possible maintaining role of emotion regulation processes should also be considered in the treatment of eating disorders. Copyright © 2014 Elsevier Ltd. All rights reserved.

Peritraumatic dissociation, acute stress, and early posttraumatic stress disorder in victims of general crime.

PubMed

Birmes, P; Carreras, D; Ducassé, J L; Charlet, J P; Warner, B A; Lauque, D; Schmitt, L

2001-09-01

To compare the relation between peritraumatic dissociation and acute stress and the early development of posttraumatic stress disorder (PTSD) in victims of general crime. A total of 48 subjects were assessed within 24 hours of the trauma, using the Peritraumatic Dissociative Experiences Questionnaire Self-Report Version (PDEQ-SRV). They were followed longitudinally to assess acute stress (2 weeks after the assault,) using the Standford Acute Stress Reaction Questionnaire (SASRQ), and posttraumatic stress (at 5 weeks), using the Clinician-Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES). Among PTSD subjects mean PDEQ scores were significantly higher (mean 3, SD 0.9) than in those without PTSD (mean 2.3, SD 0.7) (t = 2.78, df 46, P = 0.007). Among PTSD subjects, mean SASRQ scores were significantly higher (mean 97.9, SD 29.2) than in those without PTSD (mean 54.8, SD 28.2) (t = 4.9, df 46, P = 0.00007). High levels of peritraumatic dissociation and acute stress following violent assault are risk factors for early PTSD. Identifying acute reexperiencing can help the clinician identify subjects at highest risk.

Development and Preliminary Psychometric Properties of an Instrument for the Measurement of Obsessional Dissociative Experiences: The Van Obsessional Dissociation Questionnaire (VOD-Q).

PubMed

Boysan, Murat; Yıldırım, Abdullah; Beşiroğlu, Lütfullah; Kefeli, Mehmet Celal; Kağan, Mücahit

2018-01-04

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.

Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: a PET study and neurobiological model.

PubMed

Reinders, Antje A T S; Willemsen, Antoon T M; den Boer, Johan A; Vos, Herry P J; Veltman, Dick J; Loewenstein, Richard J

2014-09-30

Imaging studies in posttraumatic stress disorder (PTSD) have shown differing neural network patterns between hypo-aroused/dissociative and hyper-aroused subtypes. Since dissociative identity disorder (DID) involves different emotional states, this study tests whether DID fits aspects of the differing brain-activation patterns in PTSD. While brain activation was monitored using positron emission tomography, DID individuals (n=11) and matched DID-simulating healthy controls (n=16) underwent an autobiographic script-driven imagery paradigm in a hypo-aroused and a hyper-aroused identity state. Results were consistent with those previously found in the two PTSD subtypes for the rostral/dorsal anterior cingulate, the prefrontal cortex, and the amygdala and insula, respectively. Furthermore, the dissociative identity state uniquely activated the posterior association areas and the parahippocampal gyri, whereas the hyper-aroused identity state uniquely activated the caudate nucleus. Therefore, we proposed an extended PTSD-based neurobiological model for emotion modulation in DID: the hypo-aroused identity state activates the prefrontal cortex, cingulate, posterior association areas and parahippocampal gyri, thereby overmodulating emotion regulation; the hyper-aroused identity state activates the amygdala and insula as well as the dorsal striatum, thereby undermodulating emotion regulation. This confirms the notion that DID is related to PTSD as hypo-aroused and hyper-arousal states in DID and PTSD are similar. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2.

PubMed

Brand, Bethany L; Chasson, Gregory S

2015-01-01

Due to high elevations on validity and clinical scales on personality and forensic measures, it is challenging to determine if individuals presenting with symptoms of dissociative identity disorder (DID) are genuine or not. Little research has focused on malingering DID, or on the broader issue of the profiles these patients obtain on the Minnesota Multiphasic Personality Inventory (MMPI-2), despite increasing awareness of dissociation. This study sought to characterize the MMPI-2 profiles of DID patients and to determine the utility of the MMPI-2 in distinguishing DID patients from uncoached and coached DID simulators. The analyses revealed that Infrequency, Back Infrequency, and Infrequency-Psychopathology (Fp) distinguished simulators from genuine DID patients. Fp was best able to discriminate simulated DID. Utility statistics and classification functions are provided for classifying individual profiles as indicative of genuine or simulated DID. Despite exposure to information about DID, the simulators were not able to accurately feign DID, which is inconsistent with the iatrogenic/sociocultural model of DID. Given that dissociation was strongly associated with elevations in validity, as well as clinical scales, including Scale 8 (i.e., Schizophrenia), considerable caution should be used in interpreting validity scales as indicative of feigning, and Scale 8 as indicative of schizophrenia, among highly dissociative individuals. (c) 2015 APA, all rights reserved).

Adsorption, vibration and diffusion of oxygen on Ag(110)

NASA Astrophysics Data System (ADS)

Rawal, Takat; Hong, Sampyo; Pulkkinen, Aki; Alatalo, Matti; Rahman, Talat

2015-03-01

We have performed density functional theory calculations for the adsorption, vibration and diffusion of oxygen on Ag(110). At low coverage, O2 adsorbs at the four-fold hollow (FFH) with the molecular axis aligned along the [ 1 1 0 ] direction. The dissociation of O2 is easier along the [001] direction than along the [ 1 1 0 ] direction. For O2 species in FFH aligned along the [001] the O-O intra-molecular stretching mode is coupled with the substrate vibration and thus its dissociation can be induced by surface phonon. In addition, O diffusion barrier from FFH to next FFH along the [ 1 1 0 ] is small (0.07 eV only) but is by far larger (0.4 eV) along [001]. On the other hand, O species in the short-bride (SB) site prefers to diffuse along the [001] (to FFH) rather than along the [ 1 1 0 ] direction (to next SB). Finally, the preference of atomic oxygen to form O-Ag-O complex on Ag(110) is responsible for disordering of the surface by means of substantial lateral and vertical displacements of Ag atoms in the topmost layer. In fact, such disordering phase of Ag(110) may act as a precursor of the reconstructed phase of Ag(110). Work supported in part by NSF under Grant CHE-1310327.

Risk factors predict post-traumatic stress disorder differently in men and women

PubMed Central

Christiansen, Dorte M; Elklit, Ask

2008-01-01

Background About twice as many women as men develop post-traumatic stress disorder (PTSD), even though men as a group are exposed to more traumatic events. Exposure to different trauma types does not sufficiently explain why women are more vulnerable. Methods The present work examines the effect of age, previous trauma, negative affectivity (NA), anxiety, depression, persistent dissociation, and social support on PTSD separately in men and women. Subjects were exposed to either a series of explosions in a firework factory near a residential area or to a high school stabbing incident. Results Some gender differences were found in the predictive power of well known risk factors for PTSD. Anxiety predicted PTSD in men, but not in women, whereas the opposite was found for depression. Dissociation was a better predictor for PTSD in women than in men in the explosion sample but not in the stabbing sample. Initially, NA predicted PTSD better in women than men in the explosion sample, but when compared only to other significant risk factors, it significantly predicted PTSD for both men and women in both studies. Previous traumatic events and age did not significantly predict PTSD in either gender. Conclusion Gender differences in the predictive value of social support on PTSD appear to be very complex, and no clear conclusions can be made based on the two studies included in this article. PMID:19017412

Ketamine as a Rapid Treatment for Post-Traumatic Stress Disorder

DTIC Science & Technology

2011-10-01

Post - traumatic stress disorder ( PTSD ) is a debilitating anxiety disorder characterized by intrusive re-experiences of the traumatic events...08-1-0602 TITLE: Ketamine as a Rapid Treatment for Post - Traumatic Stress Disorder PRINCIPAL INVESTIGATOR: Dennis Charney...dissociative effects of ketamine but not have any sustained anxiolytic and antidepressant effects. Forty individuals diagnosed with post - traumatic

The impact of dissociation on perceptual priming and intrusions after listening to auditory narratives.

PubMed

Dorahy, Martin J; Peck, Rowan K; Huntjens, Rafaele J C

2016-01-01

This study investigates the causal role of dissociation in intrusive memory development and possible underlying aberrant memory processes (e.g., increased perceptual priming). Using an audio-only adaption of the trauma film paradigm, we divided 60 participants into 3 conditions and presented them with different visual tasks-mirror staring, dot staring, or neutral images. The former 2 conditions were hypothesized to induce dissociation. Postaudio, a number of factors were assessed, including state dissociation, perceptual priming and conceptual priming, as well as intrusions over 3 days. Participants in the dissociation conditions displayed an increase in perceptual priming compared to those in the control condition and reported more distressing intrusions. No differences were found in conceptual priming and the overall number of intrusions between conditions. Findings contribute to the growing knowledge on the impact of dissociation and cognitive processing in the etiology of posttraumatic stress disorder intrusions.

Dissociative absorption, mind-wandering, and attention-deficit symptoms: Associations with obsessive-compulsive symptoms.

PubMed

Soffer-Dudek, Nirit

2018-06-05

Dissociative absorption is a tendency to become absorbed in imagination or in an external stimulus (movie, book) to the point of obliviousness to one's surroundings and reduced self-awareness. It has been hypothesized to play a role in the maintenance of obsessive-compulsive (OC) symptoms. However, because absorption is a trait of reduced attentional control, a possible confound may be attention-deficit/hyperactivity (ADHD) symptoms, which have been reported to be comorbid with obsessive-compulsive disorder (OCD). This study aimed to validate dissociative absorption as unique from ADHD symptoms as well as from mind-wandering and to show that it has incremental predictive value over these constructs in predicting OC symptoms. Cross-sectional. Three-hundred and three undergraduate students completed online questionnaires, which were analysed using exploratory and confirmatory factor analyses. As hypothesized, dissociative absorption emerged as a unique construct, separate from ADHD, and mind-wandering (whereas the latter two were not completely separate from each other). Additionally, absorption was uniquely associated with OC symptoms, with a moderate-to-strong effect size, demonstrating incremental predictive value over the other constructs. Attentional deficits and mind-wandering cannot account for the association between absorption and OC symptoms. Future research should explore whether reports of comorbidity between ADHD and OC symptoms may be inflated due to misdiagnosis of absorption tendencies as ADHD. Dissociative absorption is a personality tendency that may interact with obsessive-compulsive symptoms, and thus, it may deserve clinical attention when treating obsessive-compulsive disorder (OCD) Dissociative absorption might bring about an unnecessary diagnosis of attention-deficit hyperactivity disorder (ADHD) in individuals with obsessive-compulsive symptoms, and thus, it should be screened for. This study was based on a non-clinical sample; future studies should replicate the findings among samples with an OCD diagnosis. This study is based on self-report questionnaires; future studies should use clinician interviews. © 2018 The British Psychological Society.

Monensin inhibits intracellular dissociation of asialoglycoproteins from their receptor

PubMed Central

1983-01-01

Treatment of short-term monolayer cultures of rat hepatocytes with the proton ionophore, monensin, abolishes asialoglycoprotein degradation, despite little effect of the drug on either surface binding of ligand or internalization of prebound ligand. Centrifuging cell homogenates on Percoll density gradients indicates that, as a result of monensin treatment, ligand does not enter lysosomes but sediments instead in a lower density subcellular fraction that is likely an endocytic vesicle. Analyzing the degree of receptor association of intracellular ligand revealed that monensin prevents the dissociation of the receptor-ligand complex that normally occurs subsequent to endocytosis. The weak base, chloroquine, also blocks this intracellular dissociation. Evidence from sequential substitution experiments is presented, indicating that monensin and chloroquine act at the same point in the sequence of events leading to ligand dissociation. These data are discussed in terms of a pH-mediated dissociation of the receptor-ligand complex within a prelysosomal endocytic vesicle. PMID:6304116

Phototoxicity of strained Ru(ii) complexes: is it the metal complex or the dissociating ligand?

PubMed

Azar, Daniel F; Audi, Hassib; Farhat, Stephanie; El-Sibai, Mirvat; Abi-Habib, Ralph J; Khnayzer, Rony S

2017-09-12

A photochemically dissociating ligand in Ru(bpy) 2 (dmphen)Cl 2 [bpy = 2,2'-bipyridine; dmphen = 2,9-dimethyl-1,10-phenanthroline] was found to be more cytotoxic on the ML-2 Acute Myeloid Leukemia cell line than Ru(bpy) 2 (H 2 O) 2 2+ and prototypical cisplatin. Our findings illustrate the potential potency of diimine ligands in photoactivatable Ru(ii) complexes.

Cumulative trauma, PTSD and dissociation among Ethiopian refugees in Israel.

PubMed

Finklestein, Michal; Solomon, Zahava

2009-01-01

The aim of this study was to examine the exposure of Ethiopian refugees to pre-, peri- and post-migration stressful events and their implications for both posttraumatic stress disorder (PTSD) and dissociation. A random sample (N = 478) of three groups of refugees took part in the research ("Moses" immigrants, 1984, n = 165; "Solomon" immigrants, 1991, n = 169; "Family Reunification" immigrants, 1995, n = 144). Exposure to stressful events and posttraumatic symptoms were assessed via the Harvard Trauma Questionnaire (HTQ). Post-migration difficulties were assessed via the Post Migration Living Difficulties (PMLD) scale. Dissociation was evaluated using the Dissociation Experience Scale (DES). Significant differences were found among the groups in the rates of PTSD (27%, 15%, and 26%, respectively), but no differences were found in dissociation. A significant relationship was found between PTSD symptoms and cumulative trauma among the three groups, but no such relationship was found between dissociation and cumulative trauma. The differences among the groups were discussed in light of the unique characteristics of cumulative trauma, PTSD and dissociation among Ethiopian refugees.

A simple model for metal cation-phosphate interactions in nucleic acids in the gas phase: alkali metal cations and trimethyl phosphate.

PubMed

Ruan, Chunhai; Huang, Hai; Rodgers, M T

2008-02-01

Threshold collision-induced dissociation techniques are employed to determine the bond dissociation energies (BDEs) of complexes of alkali metal cations to trimethyl phosphate, TMP. Endothermic loss of the intact TMP ligand is the only dissociation pathway observed for all complexes. Theoretical calculations at the B3LYP/6-31G* level of theory are used to determine the structures, vibrational frequencies, and rotational constants of neutral TMP and the M+(TMP) complexes. Theoretical BDEs are determined from single point energy calculations at the B3LYP/6-311+G(2d,2p) level using the B3LYP/6-31G* optimized geometries. The agreement between theory and experiment is reasonably good for all complexes except Li+(TMP). The absolute M+-(TMP) BDEs are found to decrease monotonically as the size of the alkali metal cation increases. No activated dissociation was observed for alkali metal cation binding to TMP. The binding of alkali metal cations to TMP is compared with that to acetone and methanol.

Ionization dynamics of the water trimer: A direct ab initio MD study

NASA Astrophysics Data System (ADS)

Tachikawa, Hiroto; Takada, Tomoya

2013-03-01

Ionization dynamics of the cyclic water trimer (H2O)3 have been investigated by means of direct ab initio molecular dynamics (AIMD) method. Two reaction channels, complex formation and OH dissociation, were found following the ionization of (H2O)3. In both channels, first, a proton was rapidly transferred from H2O+ to H2O (time scale is ˜15 fs after the ionization). In complex channel, an ion-radical contact pair (H3O+-OH) solvated by the third water molecule was formed as a long-lived H3O+(OH)H2O complex. In OH dissociation channel, the second proton transfer further takes place from H3O+(OH) to H2O (time scale is 50-100 fs) and the OH radical is separated from the H3O+. At the same time, the OH dissociation takes place when the excess energy is efficiently transferred into the kinetic energy of OH radical. The OH dissociation channel is significantly minor, and almost all product channels were the complex formation. The reaction mechanism was discussed on the basis of theoretical results.

Association of Trauma-Related Disorders and Dissociation with Four Idioms of Distress Among Latino Psychiatric Outpatients

PubMed Central

Gorritz, Magdaliz; Raggio, Greer A.; Peláez, Clara; Chen, Henian; Guarnaccia, Peter J.

2015-01-01

Past research on idioms of distress among U.S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis. It has been proposed that the idioms exert this effect because they are signs of distressing dissociative capacity associated with traumatic exposure. This study examines the relationships in an ethnically diverse Latino psychiatric outpatient sample (N = 230) among interpersonal trauma, posttraumatic stress disorder (PTSD), major depressive disorder, dissociative capacity and four cultural idioms of distress associated with the popular overall category of nervios. We particularly explore how these relationships change with varied measures of traumatic exposure, including trauma severity and timing or persistence of trauma. A series of adjusted bivariate regressions assessed the matrix of associations between the idioms and the clinical variables. In this highly traumatized population, we identified a strong ‘nexus’ of associations between dissociation and three of the idioms: currently being ill with nerves, ataque de nervios and altered perceptions. These idioms were largely independent from PTSD and depression and were associated with trauma persistence and severity. A fourth idiom, being nervous since childhood, was not associated with any other variable and may represent a personality trait rather than a diagnosable condition. Our results validate the clinical utility of the construct of nervios as a set of specific idioms associated with dissociation that are useful markers of mental health need among Latinos independently of their association with clinical diagnoses. PMID:20414799

Risk factors for DSM-5 posttraumatic stress symptoms (PTSS) among Israeli civilians during the 2014 Israel-Hamas war.

PubMed

Gil, Sharon; Weinberg, Michael; Shamai, Michal; Ron, Pnina; Harel, Hila; Or-Chen, Keren

2016-01-01

In light of current modifications in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for posttraumatic stress disorder (PTSD), this study aimed to revalidate well-known PTSD risk factors related to terrorism and war in Israel, namely, proximity to the Gaza Strip, dissociative symptoms, acute stress disorder (ASD) symptoms, and social support. One hundred and sixty Israeli civilians were assessed during the 2014 Israel-Hamas war at 2 time points: 1 week after the beginning of the operation (t1) and 1 month after initial evaluation (t2), using the DSM-5 PTSD Symptom Levels Scale (PSLS; Gil, Weinberg, Or-Chen, & Harel, 2015). A paired t test analysis showed significant reduction in the respondents' posttraumatic stress symptoms (PTSS) 1 month after the initial assessment point. A structural equation model (SEM) showed that higher ASD symptoms at t1 and higher dissociative symptoms at t2 increased the risk for PTSS at t2. Conversely, higher peritraumatic dissociation at t1 decreased the risk for PTSS at t2. Proximity to the Gaza Strip, and social support, failed to demonstrate significant association with PTSS at t2. DSM-5 PTSS 1 month after prolonged traumatic exposure are strongly associated with high ASD symptoms at 1 week as a risk factor; high levels of peritraumatic dissociation at 1 week as a protective factor; and high levels of dissociative symptoms at 1 month as a risk factor. Theoretically and clinically the findings of the study further suggest that ongoing massive terrorism and war cannot be viewed or treated as identical to other traumas. (c) 2016 APA, all rights reserved).

I Working with dissociative dynamics and the longing for excess in binge eating disorders.

PubMed

Austin, Sue

2013-06-01

In this paper the author describes her work with a woman who, in her mid 20s, sought analysis for her non-vomiting binge eating disorder. The paper explores how two aspects of Jung's view of the psyche as healthily dissociable were used to think about the potential for change contained within the explosive, aggressive energies in this patient's bingeing. The resultant approach takes the patient's splitting defences, dissociations and self-destructive behaviour as a point of access to her unconscious. Seen in this way, these behaviours contain the seeds of recovery and are the starting point for analysis rather than defences against it. The paper also brings a number of Jungian and post-Jungian ideas into conversation with aspects of contemporary thinking about subjectivity, identity and the longing for excess developed by Leo Bersani and Judith Butler. © 2013, The Society of Analytical Psychology.

Memory transfer for emotionally valenced words between identities in dissociative identity disorder.

PubMed

Huntjens, Rafaële J C; Peters, Madelon L; Woertman, Liesbeth; van der Hart, Onno; Postma, Albert

2007-04-01

The present study aimed to determine interidentity retrieval of emotionally valenced words in dissociative identity disorder (DID). Twenty-two DID patients participated together with 25 normal controls and 25 controls instructed to simulate DID. Two wordlists A and B were constructed including neutral, positive and negative material. List A was shown to one identity, while list B was shown to another identity claiming total amnesia for the words learned by the first identity. The identity claiming amnesia was tested for intrusions from list A words into the recall of words from list B and recognition of the words learned by both identities. Test results indicated no evidence of total interidentity amnesia for emotionally valenced material in DID. It is argued that dissociative amnesia in DID may more adequately be described as a disturbance in meta-memory functioning instead of an actual retrieval inability.

On the history of dissociative identity disorders in Germany: the doctor Justinus Kerner and the girl from Orlach, or possession as an "exchange of the self".

PubMed

Peter, Burkhard

2011-01-01

The history of hypnosis is closely linked to the theme of possession; one such link is that the forerunner of hypnosis, animal magnetism, replaced exorcism in 1775 when Franz Anton Mesmer testified against Father Johann Joseph Gassner's exorcism. Modern authors have noted remarkable similarities between states of possession and dissociation. The treatment of possession by animal magnetism and exorcism represents the special romantic-magnetic therapy of the German medical doctor Justinus Kerner in the early 19th century. This article describes the man, his methods, and his thinking and presents one of his most famous case studies, the girl from Orlach, which, by today's standards, was a true case of dissociative identity disorder (DID). This article describes how contemporary principles of treatment were used and controversial issues about the nature and causes of DID were discussed 175 years ago.

A review of published research on adult dissociative identity disorder: 2000-2010.

PubMed

Boysen, Guy A; VanBergen, Alexandra

2013-01-01

The purpose of this study was to assess the scientific and etiological status of dissociative identity disorder (DID) by examining cases published from 2000 to 2010. In terms of scientific status, DID is a small but ongoing field of study. The review yielded 21 case studies and 80 empirical studies, presenting data on 1171 new cases of DID. A mean of 9 articles, each containing a mean of 17 new cases of DID, emerged each year. In terms of etiological status, many of the central criticisms of the disorder's validity remain unaddressed. Most cases of DID emerged from a small number of countries and clinicians. In addition, documented cases occurring outside treatment were almost nonexistent. Finally, people simulating DID in the laboratory were mostly indistinguishable from individuals with DID. Overall, DID is still a topic of study, but the research lacks the productivity and focus needed to resolve ongoing controversies surrounding the disorder.

Therapist concerns and process issues in grappling with functional autobiographical amnesia.

PubMed

Tripathi, Ravikesh; Bharath, Srikala; Desai, Geetha; Mehrotra, Seema

2013-07-01

Dissociative amnesia is relatively rare form of the dissociative disorder. This paper aims at describing the salient features of a case of functional autobiographical amnesia in a young adult and the approach adopted in the psychological management of this case. The case highlights concerns of the therapist at various stages of the therapy process.

Prevalence of Trauma, PTSD, and Dissociation in Court-Referred Adolescents

ERIC Educational Resources Information Center

Brosky, Beverly A.; Lally, Stephen J.

2004-01-01

This study examines the prevalence of trauma, posttraumatic stress disorder (PTSD), and dissociative symptoms in adolescents. The sample consisted of 76 females and 76 males, between the ages of 12 and 18, referred to the Child Guidance Clinic of the Superior Court of the District of Columbia for a psychological evaluation. Two sets of analyses…

Using Images, Metaphor, and Hypnosis in Integrating Multiple Personality and Dissociative States: A Review of the Literature.

ERIC Educational Resources Information Center

Crawford, Carrie L.

1990-01-01

Reviews literature on hypnosis, imagery, and metaphor as applied to the treatment and integration of those with multiple personality disorder (MPD) and dissociative states. Considers diagnostic criteria of MPD; explores current theories of etiology and treatment; and suggests specific examples of various clinical methods of treatment using…

Assessment of dissociation in Bosnian treatment-seeking refugees in Denmark.

PubMed

Palic, Sabina; Carlsson, Jessica; Armour, Cherie; Elklit, Ask

2015-05-01

Dissociative experiences are common in traumatized individuals, and can sometimes be mistaken for psychosis. It is difficult to identify pathological dissociation in the treatment of traumatized refugees, because there is a lack of systematic clinical descriptions of dissociative phenomena in refugees. Furthermore, we are currently unaware of how dissociation measures perform in this clinical group. To describe the phenomenology of dissociative symptoms in Bosnian treatment-seeking refugees in Denmark. As a part of a larger study, dissociation was assessed systematically in 86 Bosnian treatment-seeking refugees using a semi-structured clinical interview (Structured Interview for Disorders of Extreme Stress-dissociation subscale; SIDES-D) and a self-report scale (Dissociative Experiences Scale; DES). The SIDES-D indicated twice as high prevalence of pathological dissociation as the DES. According to the DES, 30% of the refugees had pathological dissociation 15 years after their resettlement. On the SIDES-D, depersonalization and derealization experiences were the most common. Also, questions about depersonalization and derealization at times elicited reporting of visual and perceptual hallucinations, which were unrelated to traumatic re-experiencing. Questions about personality alteration elicited spontaneous reports of a phenomenon of "split" pre- and post-war identity in the refugee group. Whether this in fact is a dissociative phenomenon, characteristic of severe traumatization in adulthood, needs further examination. Knowledge of dissociative symptoms in traumatized refugees is important in clinical settings to prevent misclassification and to better target psychotherapeutic interventions. Much development in the measurement of dissociation in refugees is needed.

Validation of the factor structure of the adolescent dissociative experiences scale in a sample of trauma-exposed detained youth.

PubMed

Kerig, Patricia K; Charak, Ruby; Chaplo, Shannon D; Bennett, Diana C; Armour, Cherie; Modrowski, Crosby A; McGee, Andrew B

2016-09-01

The inclusion of a dissociative subtype in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5 ) criteria for the diagnosis of posttraumatic stress disorder (PTSD) has highlighted the need for valid and reliable measures of dissociative symptoms across developmental periods. The Adolescent Dissociative Experiences Scale (A-DES) is 1 of the few measures validated for young persons, but previous studies have yielded inconsistent results regarding its factor structure. Further, research to date on the A-DES has been based upon nonclinical samples of youth or those without a known history of trauma. To address these gaps in the literature, the present study investigated the factor structure and construct validity of the A-DES in a sample of highly trauma-exposed youth involved in the juvenile justice system. A sample of 784 youth (73.7% boys) recruited from a detention center completed self-report measures of trauma exposure and the A-DES, a subset of whom (n = 212) also completed a measure of PTSD symptoms. Confirmatory factor analyses revealed a best fitting 3-factor structure comprised of depersonalization or derealization, amnesia, and loss of conscious control, with configural and metric invariance across gender. Logistic regression analyses indicated that the depersonalization or derealization factor effectively distinguished between those youth who did and did not likely meet criteria for a diagnosis of PTSD as well as those with PTSD who did and did not likely meet criteria for the dissociative subtype. These results provide support for the multidimensionality of the construct of posttraumatic dissociation and contribute to the understanding of the dissociative subtype of PTSD among adolescents. (PsycINFO Database Record PsycINFO Database Record (c) 2016 APA, all rights reserved

Rotational and angular distributions of NO products from NO-Rg(Rg = He, Ne, Ar) complex photodissociation

DOE PAGES

Heather L. Holmes-Ross; Hall, Gregory E.; Valenti, Rebecca J.; ...

2016-01-29

In this study, we present the results of an investigation into the rotational and angular distributions of the NO A ~ state fragment following photodissociation of the NO-He, NO-Ne and NO-Ar van der Waals complexed excited via the A ~ ← X ~ transition. For each complex the dissociation is probed for several values of E a, the available energy above the dissociation threshold.

Are symptoms of spirit possessed patients covered by the DSM-IV or DSM-5 criteria for possession trance disorder? A mixed-method explorative study in Uganda.

PubMed

van Duijl, Marjolein; Kleijn, Wim; de Jong, Joop

2013-09-01

As in many cultures, spirit possession is a common idiom of distress in Uganda. The DSM-IV contains experimental research criteria for dissociative and possession trance disorder (DTD and PTD), which are under review for the DSM-5. In the current proposed categories of the DSM-5, PTD is subsumed under dissociative identity disorder (DID) and DTD under dissociative disorders not elsewhere classified. Evaluation of these criteria is currently urgently required. This study explores the match between local symptoms of spirit possession in Uganda and experimental research criteria for PTD in the DSM-IV and proposed criteria for DID in the DSM-5. A mixed-method approach was used combining qualitative and quantitative research methods. Local symptoms were explored of 119 spirit possessed patients, using illness narratives and a cultural dissociative symptoms' checklist. Possible meaningful clusters of symptoms were inventoried through multiple correspondence analysis. Finally, local symptoms were compared with experimental criteria for PTD in the DSM-IV and proposed criteria for DID in the DSM-5. Illness narratives revealed different phases of spirit possession, with passive-influence experiences preceding the actual possession states. Multiple correspondence analysis of symptoms revealed two dimensions: 'passive' and 'active' symptoms. Local symptoms, such as changes in consciousness, shaking movements, and talking in a voice attributed to spirits, match with DSM-IV-PTD and DSM-5-DID criteria. Passive-influence experiences, such as feeling influenced or held by powers from outside, strange dreams, and hearing voices, deserve to be more explicitly described in the proposed criteria for DID in the DSM-5. The suggested incorporation of PTD in DID in the DSM-5 and the envisioned separation of DTD and PTD in two distinctive categories have disputable aspects.

Selective preservation of memory for people in the context of semantic memory disorder: patterns of association and dissociation.

PubMed

Lyons, Frances; Kay, Janice; Hanley, J Richard; Haslam, Catherine

2006-01-01

A number of single cases in the literature demonstrate that person-specific semantic knowledge can be selectively impaired after acquired brain damage compared with that of object categories. However, there has been little unequivocal evidence for the reverse dissociation, selective preservation of person-specific semantic knowledge. Recently, three case studies have been published which provide support for the claim that such knowledge can be selectively preserved [Kay, J., & Hanley, J. R. (2002). Preservation of memory for people in semantic memory disorder: Further category-specific semantic dissociation. Cognitive Neuropsychology, 19, 113-134; Lyons, F., Hanley, J. R., & Kay, J. (2002). Anomia for common names and geographical names with preserved retrieval of names of people: A semantic memory disorder. Cortex, 38, 23-35; Thompson, S. A, Graham, K. S., Williams, G., Patterson, K., Kapur, N., & Hodges, J. R. (2004). Dissociating person-specific from general semantic knowledge: Roles of the left and right temporal lobes. Neuropsychologia, 42, 359-370]. In this paper, we supply further evidence from a series of 18 patients with acquired language disorder. Of this set, a number were observed to be impaired on tests of semantic association and word-picture matching using names of object categories (e.g. objects, animals and foods), but preserved on similar tests using names of famous people. Careful methodology was applied to match object and person-specific categories for item difficulty. The study also examined whether preservation of person-specific semantic knowledge was associated with preservation of knowledge of 'biological categories' such as fruit and vegetables and animals, or with preservation of 'token' knowledge of singular categories such as countries. The findings are discussed in the context of a variety of accounts that examine whether semantic memory has a categorical structure.

Simulation of multiple personalities: a review of research comparing diagnosed and simulated dissociative identity disorder.

PubMed

Boysen, Guy A; VanBergen, Alexandra

2014-02-01

Dissociative Identity Disorder (DID) has long been surrounded by controversy due to disagreement about its etiology and the validity of its associated phenomena. Researchers have conducted studies comparing people diagnosed with DID and people simulating DID in order to better understand the disorder. The current research presents a systematic review of this DID simulation research. The literature consists of 20 studies and contains several replicated findings. Replicated differences between the groups include symptom presentation, identity presentation, and cognitive processing deficits. Replicated similarities between the groups include interidentity transfer of information as shown by measures of recall, recognition, and priming. Despite some consistent findings, this research literature is hindered by methodological flaws that reduce experimental validity. Copyright © 2013 Elsevier Ltd. All rights reserved.

Ionization and order disorder transition of hydrogels with ionizable hydrophobic side chain

NASA Astrophysics Data System (ADS)

Matsuda, A.; Katayama, Y.; Kaneko, T.; Gong, J. P.; Osada, Y.

2000-10-01

pH dependence of the structural change of the amphiphilic copolymer gels containing the crystallizable side chain with carboxylic end group, poly(16-acryloylhexadecanoic acid (AHA)- co-acrylic acid (AA)), has been investigated. The poly(AHA- co-AA) gels could maintain the crystalline domain of AHA units up to pH=11 at ambient temperature, which abruptly transferred into disordered state beyond this pH due to the dissociation of the carboxylic group of AHA. However, the addition of salt or divalent ion enabled to crystallize the gel even at pH=11.5 due to the effective shielding of the electrostatic repulsion. The mechanism of order-disorder transition through changes of pH and salt concentration was discussed in terms of association-dissociation of AHA groups.

Fanconi anemia proteins FANCD2 and FANCI exhibit different DNA damage responses during S-phase

PubMed Central

Sareen, Archana; Chaudhury, Indrajit; Adams, Nicole; Sobeck, Alexandra

2012-01-01

Fanconi anemia (FA) pathway members, FANCD2 and FANCI, contribute to the repair of replication-stalling DNA lesions. FA pathway activation relies on phosphorylation of FANCI by the ataxia telangiectasia and Rad3-related (ATR) kinase, followed by monoubiquitination of FANCD2 and FANCI by the FA core complex. FANCD2 and FANCI are thought to form a functional heterodimer during DNA repair, but it is unclear how dimer formation is regulated or what the functions of the FANCD2–FANCI complex versus the monomeric proteins are. We show that the FANCD2–FANCI complex forms independently of ATR and FA core complex, and represents the inactive form of both proteins. DNA damage-induced FA pathway activation triggers dissociation of FANCD2 from FANCI. Dissociation coincides with FANCD2 monoubiquitination, which significantly precedes monoubiquitination of FANCI; moreover, monoubiquitination responses of FANCD2 and FANCI exhibit distinct DNA substrate specificities. A phosphodead FANCI mutant fails to dissociate from FANCD2, whereas phosphomimetic FANCI cannot interact with FANCD2, indicating that FANCI phosphorylation is the molecular trigger for FANCD2–FANCI dissociation. Following dissociation, FANCD2 binds replicating chromatin prior to—and independently of—FANCI. Moreover, the concentration of chromatin-bound FANCD2 exceeds that of FANCI throughout replication. Our results suggest that FANCD2 and FANCI function separately at consecutive steps during DNA repair in S-phase. PMID:22753026

First-Principles Calculations for Chemical Reaction between Sodium Diethyldithiocarbamate and Transition-Metal (Cr) atom to Produce Cr(DDC)3 and Cr(DDC)2ODDC

NASA Astrophysics Data System (ADS)

Setiyanto, Henry; Muhida, Rifki; Kishi, Tomoya; Rempillo, Ofelia; Rahman, Mahmudur; Dipojono, Hermawan Kresno; Di\\ {n}o, Wilson Agerico; Matsumoto, Shigeno; Kasai, Hideaki

2006-10-01

We investigate the chemical reaction between a Cr transition-metal atom and sodium diethyldithiocarbamate (NaDDC), a complexing agent used to detect and extract Cr in human blood samples. Using density-functional-theory-based calculations, we determine their stable structures of Cr(DDC)2ODDC and Cr(DDC)3 complexes and obtain their dissociation energies. We found dissociation energies of -10.66 and -3.24 eV for Cr(DDC)2ODDC and Cr(DDC)3 complexes, respectively. Hence, on the basis of dissociation energies, we have verified that the reaction of NaDDC with Cr produces Cr(DDC)2ODDC as a major product.

Ethical Issues and Considerations for Working with Community College Students with Severe and Persistent Mental Disorders

ERIC Educational Resources Information Center

Francis, Perry C.; Abbassi, Amir

2010-01-01

Students with severe and persistent mental illnesses (e.g., schizophrenia or other psychotic disorders; moderate to severe mood, anxiety, dissociative, eating, or personality disorders) are attending community colleges in increasing numbers. Their need for counseling services presents counseling centers with unique ethical issues to consider. This…

Traumatic Memories in Acute Stress Disorder: An Analysis of Narratives before and after Treatment

ERIC Educational Resources Information Center

Moulds, Michelle L.; Bryant, Richard A.

2005-01-01

The dissociative reactions in acute stress disorder purportedly impede encoding and organization of traumatic memories and consequently impair the individual's ability to retrieve trauma-related details. A qualitative examination was conducted on trauma narratives of individuals with acute stress disorder (N = 15) prior to cognitive behavior…

The scientific status of childhood dissociative identity disorder: a review of published research.

PubMed

Boysen, Guy A

2011-01-01

Dissociative identity disorder (DID) remains a controversial diagnosis due to conflicting views on its etiology. Some attribute DID to childhood trauma and others attribute it to iatrogenesis. The purpose of this article is to review the published cases of childhood DID in order to evaluate its scientific status, and to answer research questions related to the etiological models. I searched MEDLINE and PsycINFO records for studies published since 1980 on DID/multiple personality disorder in children. For each study I coded information regarding the origin of samples and diagnostic methods. The review produced a total of 255 cases of childhood DID reported as individual case studies (44) or aggregated into empirical studies (211). Nearly all cases (93%) emerged from samples of children in treatment, and multiple personalities was the presenting problem in 23% of the case studies. Four US research groups accounted for 65% of all 255 cases. Diagnostic methods typically included clinical evaluation based on Diagnostic and Statistical Manual of Mental Disorder criteria, but hypnosis, structured interviews, and multiple raters were rarely used in diagnoses. Despite continuing research on the related concepts of trauma and dissociation, childhood DID itself appears to be an extremely rare phenomenon that few researchers have studied in depth. Nearly all of the research that does exist on childhood DID is from the 1980s and 1990s and does not resolve the ongoing controversies surrounding the disorder. Copyright © 2011 S. Karger AG, Basel.

Influence of variable chemical conditions on EDTA-enhanced transport of metal ions in mildly acidic groundwater

USGS Publications Warehouse

Kent, D.B.; Davis, J.A.; Joye, J.L.; Curtis, G.P.

2008-01-01

Adsorption of Ni and Pb on aquifer sediments from Cape Cod, Massachusetts, USA increased with increasing pH and metal-ion concentration. Adsorption could be described quantitatively using a semi-mechanistic surface complexation model (SCM), in which adsorption is described using chemical reactions between metal ions and adsorption sites. Equilibrium reactive transport simulations incorporating the SCMs, formation of metal-ion-EDTA complexes, and either Fe(III)-oxyhydroxide solubility or Zn desorption from sediments identified important factors responsible for trends observed during transport experiments conducted with EDTA complexes of Ni, Zn, and Pb in the Cape Cod aquifer. Dissociation of Pb-EDTA by Fe(III) is more favorable than Ni-EDTA because of differences in Ni- and Pb-adsorption to the sediments. Dissociation of Ni-EDTA becomes more favorable with decreasing Ni-EDTA concentration and decreasing pH. In contrast to Ni, Pb-EDTA can be dissociated by Zn desorbed from the aquifer sediments. Variability in adsorbed Zn concentrations has a large impact on Pb-EDTA dissociation.

Theoretical study on the cooperative exciton dissociation process based on dimensional and hot charge-transfer state effects in an organic photocell

NASA Astrophysics Data System (ADS)

Shimazaki, Tomomi; Nakajima, Takahito

2016-06-01

This paper discusses the exciton dissociation process at the donor-acceptor interface in organic photocells. In our previous study, we introduced a local temperature to handle the hot charge-transfer (CT) state and calculated the exciton dissociation probability based on the 1D organic semiconductor model [T. Shimazaki and T. Nakajima, Phys. Chem. Chem. Phys. 17, 12538 (2015)]. Although the hot CT state plays an essential role in exciton dissociations, the probabilities calculated are not high enough to efficiently separate bound electron-hole pairs. This paper focuses on the dimensional (entropy) effect together with the hot CT state effect and shows that cooperative behavior between both effects can improve the exciton dissociation process. In addition, we discuss cooperative effects with site-disorders and external-electric-fields.

Dynamics, Conformational Entropy, and Frustration in Protein-Protein Interactions Involving an Intrinsically Disordered Protein Domain.

PubMed

Lindström, Ida; Dogan, Jakob

2018-05-18

Intrinsically disordered proteins (IDPs) are abundant in the eukaryotic proteome. However, little is known about the role of subnanosecond dynamics and the conformational entropy that it represents in protein-protein interactions involving IDPs. Using nuclear magnetic resonance side chain and backbone relaxation, stopped-flow kinetics, isothermal titration calorimetry, and computational studies, we have characterized the interaction between the globular TAZ1 domain of the CREB binding protein and the intrinsically disordered transactivation domain of STAT2 (TAD-STAT2). We show that the TAZ1/TAD-STAT2 complex retains considerable subnanosecond motions, with TAD-STAT2 undergoing only a partial disorder-to-order transition. We report here the first experimental determination of the conformational entropy change for both binding partners in an IDP binding interaction and find that the total change even exceeds in magnitude the binding enthalpy and is comparable to the contribution from the hydrophobic effect, demonstrating its importance in the binding energetics. Furthermore, we show that the conformational entropy change for TAZ1 is also instrumental in maintaining a biologically meaningful binding affinity. Strikingly, a spatial clustering of very high amplitude motions and a cluster of more rigid sites in the complex exist, which through computational studies we found to overlap with regions that experience energetic frustration and are less frustrated, respectively. Thus, the residual dynamics in the bound state could be necessary for faster dissociation, which is important for proteins that interact with multiple binding partners.

Six-year follow-up of the treatment of patients with dissociative disorders study.

PubMed

Myrick, Amie C; Webermann, Aliya R; Loewenstein, Richard J; Lanius, Ruth; Putnam, Frank W; Brand, Bethany L

2017-01-01

Objective : Literature on the treatment of dissociative disorders (DDs) suggests that these individuals require long-term and specialized treatment to achieve stabilization and functionality. There is considerable empirical support for specialized phasic, dissociation-focused treatment in reducing a myriad of psychological symptoms and self-harm in this population. However, until recently, there has been a paucity of longitudinal treatment research on DD patients. Method : In the present six-year follow-up study, 61 therapists who participated in the initial phase of the Treatment of Patients with Dissociative Disorders (TOP DD) study answered questionnaires about their study patient's stressors, quality of life, global functioning, victimization, and safety. These results provided a view of patients' progress six years since the beginning of the TOP DD study. Results : Longitudinal analyses demonstrated patients had significantly fewer stressors ( Χ 2 (6) = 18.76, p  < .01, canonical r  = .48, N  = 76), instances of sexual revictimization ( X 2 (1) = 107.05, p  < .001) and psychiatric hospitalizations ( t (54) = 2.57, p  < .05, Cohen's d  = .43), as well as higher global functioning ( Χ 2 (2) = 59.27, p  < .001, canonical r  = .65, N  = 111). Conclusions : These findings continue to support the initial results of the TOP DD study that, despite marked initial difficulties and functional impairment, DD patients benefit from specialized treatment.

Psychosocial aspects of resistance in complex treatment of depressive disorder.

PubMed

Sedlackova, Zuzana; Prasko, Jan; Latalova, Klara; Kamaradova, Dana; Ociskova, Marie; Grambal, Ales; Sigmundova, Zuzana; Kasalova, Petra; Cakirpaloglu, Snezana

2015-01-01

Treatment of major depressive disorder can be affected by a broad range of factors. In our study, we focused on the relationships of demographic, psychological, clinical and social factors to the course of treatment of depression. The study included 151 patients (finally 140 patients were evaluated) hospitalized for major depressive disorder. They were assessed for demographic characteristics, the rates of depression and anxiety, quality of life, the rates of dissociation and insomnia, and subjective and objective disease severity at different times during treatment. Patients were treated with standard doses of antidepressants or other psychiatric medication. They also completed a 6-week long daily cognitive-behavioural therapy. Data were statistically analyzed. There were significant decreases in the overall severity of the disorder, anxiety level and depression rate during treatment. Improvement measured by objective Clinical Global Impression (oCGI-I) at the end of treatment was not significantly correlated with any of the measured parameters (age of patient, onset of illness, duration of disease, doses of medication etc.). It only significantly positively correlated with the initial evaluation of the patient by oCGI. However, the improvement in subjective assessment (using sCGI-I) correlated with many parameters (increased age, later onset of the disease, greater disease severity at baseline in both overall and subjective evaluation of the severity, anxiety and depressive symptomatology). Furthermore, it was negatively correlated with most quality of life parameters, such as H (Home), F (Feelings), L (Leisure), Sr (Social relations) and G (General). The results suggest that individual variables, such as the degree of psychopathology, particularly depression and anxiety, most quality of life parameters, higher patient age and age of disorder onset may be associated with poorer subjective response to complex treatment of patients with major depressive disorder.

Dissociative identity disorder: a feminist approach to inpatient treatment using Jean Baker Miller's Relational Model.

PubMed

Riggs, S R; Bright, M A

1997-08-01

Women diagnosed with Dissociative Identity Disorder (DID) may experience episodic crises characterized by intense states of disconnection from self and others. Crises which result in potential harm to self/others may require inpatient treatment. With economic emphasis on shorter lengths of stay, a treatment program or model which focuses on the DID patient's sense of connectedness to self and others can enhance treatment efforts during brief inpatient hospitalizations. The Relational Model of Jean Baker Miller uses mutuality and empowerment within the therapeutic relationship and inpatient mileu to move the patient beyond therapeutic impasse/crisis toward a state of greater connectedness to self and others.

A Study of Charge Transport: Correlated Energetic Disorder in Organic Semiconductors, and the Fragment Hamiltonian

NASA Astrophysics Data System (ADS)

Allen, Jonathan Robert

This dissertation details work done on two different descriptions of charge transport. The first topic is energetic disorder in organic semiconductors, and its effect on charge transport. This is motivated primarily by solar cells, which can be broadly classified as either inorganic or organic. The inorganic class of solar cells is older, and more well-developed, with the most common type being constructed from crystalline silicon. The large silicon crystals required for these cells are expensive to manufacture, which gave rise to interest in photovoltaic cells made from much less costly organic polymers. These organic materials are also less efficient than their silicon counterparts, due to a large degree of spatial and energetic disorder. In this document, the sources and structure of energetic disorder in organic semiconductors are explored, with an emphasis on spatial correlations in energetic disorder. In order for an organic photovoltaic device to function, there must be photogeneration of an exciton (a bound electron-hole pair), exciton transport, exciton dissociation, and transport of the individual charges to their respective terminals. In the case of this thesis, the main focus is exciton dissociation. The effects of correlation on exciton dissociation are examined through computer simulation, and compared to the theory and simulations of previous researchers. We conclude that energetic disorder in organic semiconductors is spatially correlated, and that this correlation improves the ability of excitons to dissociate. The second topic of this dissertation is the Fragment Hamiltonian model. This is a model currently in development as a means of describing charge transport across a range of systems. Currently there are many different systems which exhibit various charge transport behaviors, which are described by several different models. The overarching goal of the Fragment Hamiltonian model is to construct a description of charge transport which accurately describes the behavior of multiple different materials (i.e. metallic conductors or ceramic insulators) in the appropriate limits. The Fragment Hamiltonian model is explored in the context of the tight-binding model, and properties such as the conductivity of several different systems are deduced.

Dispelling myths about dissociative identity disorder treatment: an empirically based approach.

PubMed

Brand, Bethany L; Loewenstein, Richard J; Spiegel, David

2014-01-01

Some claim that treatment for dissociative identity disorder (DID) is harmful. Others maintain that the available data support the view that psychotherapy is helpful. We review the empirical support for both arguments. Current evidence supports the conclusion that phasic treatment consistent with expert consensus guidelines is associated with improvements in a wide range of DID patients' symptoms and functioning, decreased rates of hospitalization, and reduced costs of treatment. Research indicates that poor outcome is associated with treatment that does not specifically involve direct engagement with DID self-states to repair identity fragmentation and to decrease dissociative amnesia. The evidence demonstrates that carefully staged trauma-focused psychotherapy for DID results in improvement, whereas dissociative symptoms persist when not specifically targeted in treatment. The claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment and the phenomenology of DID. Given the severe symptomatology and disability associated with DID, iatrogenic harm is far more likely to come from depriving DID patients of treatment that is consistent with expert consensus, treatment guidelines, and current research.

Posttraumatic stress disorder, alcohol use, and perceived safety after the terrorist attack on the pentagon.

PubMed

Grieger, Thomas A; Fullerton, Carol S; Ursano, Robert J

2003-10-01

The authors examined posttraumatic stress disorder (PTSD), alcohol use, and perceptions of safety in a sample of survivors of the September 11, 2001, terrorist attack on the Pentagon. Analyses were conducted to examine the effect of past traumatic experience, trauma exposure, initial emotional response, and peritraumatic dissociation on probable PTSD, substance use, and perceived safety among 77 survivors seven months after the attack. Eleven respondents (14 percent) had PTSD. Those with PTSD reported higher levels of initial emotional response and peritraumatic dissociation. Ten respondents (13 percent) reported increased use of alcohol. Women were more than five times as likely as men to have PTSD and almost seven times as likely to report increased use of alcohol. Persons with higher peritraumatic dissociation were more likely to develop PTSD and report increased alcohol use. Those with lower perceived safety at seven months had higher initial emotional response and greater peritraumatic dissociation and were more likely to have PTSD, to have increased alcohol use, and to be female. The association of perceived safety with gender, the presence of PTSD, and increased alcohol use among survivors of the terrorist attack on the Pentagon warrants further study.

Evaluation of Relationship between Obsessive-compulsive Disorder and Dissociative Experiences.

PubMed

Tatlı, Mustafa; Cetinkaya, Ozlem; Maner, Fulya

2018-05-31

The aim of the study is to evaluate the relationship between obsessive-compulsive disorder (OCD) symptoms and dissociative experiences and the effect of childhood traumatic experiences on this relationship in OCD patients. Fifty consecutive OCD patients and 50 healthy controls are enrolled for this study. Sociodemographic and Clinical Data Form, Dissociative Experiences Scale (DES), Padua Inventory (PI) and Childhood Trauma Questionnaire (CTQ) are applied to participants. Average DES total score in the patient group is 20.58 and in the control group it is 4.87. In the patient group, when we evaluate the relation strengths of DES total and subscale scores with PI total score, we found out that amnesia subscale has r=0.361 ( p <0.01), absorption subscale has r=0.611 ( p <0.01), depersonalization/derealization subscale has r=0.574 ( p <0.01), and DES total score has r=0.55 ( p <0.01) relation strengths with PI total score. In patient group both DES total score and CTQ total score have influence on PI total score independently from each other. In addition to this, the level of the influence of DES total scores on PI total scores is, R²=0.399 ( p <0.01) and the level of the influence of CTQ total scores on PI total scores is R²=0.343 ( p <0.01). Dissociative experiences are seen more frequently in OCD patients than healthy controls. Among dissociative experiences, absorption has stronger relation with OCD symptoms. The relation between OCD and dissociation is independent from and stronger than the relation between childhood traumatic experiences and OCD.

Lipid levels in dissociative disorders: effects of psychodynamic psychotherapy.

PubMed

Damsa, Cristian; Lazignac, Coralie; Miller, Nick; Maris, Susanne; Adam, Eric; Rossignon, Kevin

2014-09-01

Although there are several data suggesting a link between lower lipids levels and the risk of suicide, there are few data concerning lower lipids levels in patients with dissociative disorders (DD). This is the first longitudinal study investigating the evolution of the lipids levels during a specific 8 weeks of psychodynamic psychotherapy (PP) for patients with DD. 32 patients diagnosed with DD (SCID for DSMIVR) were assessed with Dissociative Experiences Scale (DES), Clinical Global Impression and Improvement Scale and their lipids levels (total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein and very low density lipoprotein) were measured at inclusion and after 3 and 8 weeks of PP. 30 patients finished the study. There is a significant positive (p < 0.05) link between lower lipids levels (total cholesterol, LDL, triglycerids) and a higher level of dissociation (DES scores) at the beginning and at the end of the study. Interestingly, we found a significant (p = 0.018) positive link between the reduction of the dissociation (DES) and the increase of the triglycerides levels after 8 weeks of treatment. While lower lipids seems related to a higher level of dissociation before and after the treatment, an increasing triglycerides level was observed after 8 weeks of PP in patients with a better outcome. Further studies are needed with larger samples and control groups, in order to confirm these preliminary data. These findings could open the way for hypothesis about the role of lipids in the pathophysiology of DD and raise the question of the patients with DD receiving antilipidemiants agents.

Cyclophilins facilitate dissociation of the human papillomavirus type 16 capsid protein L1 from the L2/DNA complex following virus entry.

PubMed

Bienkowska-Haba, Malgorzata; Williams, Carlyn; Kim, Seong Man; Garcea, Robert L; Sapp, Martin

2012-09-01

Human papillomaviruses (HPV) are composed of the major and minor capsid proteins, L1 and L2, that encapsidate a chromatinized, circular double-stranded DNA genome. At the outset of infection, the interaction of HPV type 16 (HPV16) (pseudo)virions with heparan sulfate proteoglycans triggers a conformational change in L2 that is facilitated by the host cell chaperone cyclophilin B (CyPB). This conformational change results in exposure of the L2 N terminus, which is required for infectious internalization. Following internalization, L2 facilitates egress of the viral genome from acidified endosomes, and the L2/DNA complex accumulates at PML nuclear bodies. We recently described a mutant virus that bypasses the requirement for cell surface CyPB but remains sensitive to cyclosporine for infection, indicating an additional role for CyP following endocytic uptake of virions. We now report that the L1 protein dissociates from the L2/DNA complex following infectious internalization. Inhibition and small interfering RNA (siRNA)-mediated knockdown of CyPs blocked dissociation of L1 from the L2/DNA complex. In vitro, purified CyPs facilitated the dissociation of L1 pentamers from recombinant HPV11 L1/L2 complexes in a pH-dependent manner. Furthermore, CyPs released L1 capsomeres from partially disassembled HPV16 pseudovirions at slightly acidic pH. Taken together, these data suggest that CyPs mediate the dissociation of HPV L1 and L2 capsid proteins following acidification of endocytic vesicles.

Cyclophilins Facilitate Dissociation of the Human Papillomavirus Type 16 Capsid Protein L1 from the L2/DNA Complex following Virus Entry

PubMed Central

Bienkowska-Haba, Malgorzata; Williams, Carlyn; Kim, Seong Man; Garcea, Robert L.

2012-01-01

Human papillomaviruses (HPV) are composed of the major and minor capsid proteins, L1 and L2, that encapsidate a chromatinized, circular double-stranded DNA genome. At the outset of infection, the interaction of HPV type 16 (HPV16) (pseudo)virions with heparan sulfate proteoglycans triggers a conformational change in L2 that is facilitated by the host cell chaperone cyclophilin B (CyPB). This conformational change results in exposure of the L2 N terminus, which is required for infectious internalization. Following internalization, L2 facilitates egress of the viral genome from acidified endosomes, and the L2/DNA complex accumulates at PML nuclear bodies. We recently described a mutant virus that bypasses the requirement for cell surface CyPB but remains sensitive to cyclosporine for infection, indicating an additional role for CyP following endocytic uptake of virions. We now report that the L1 protein dissociates from the L2/DNA complex following infectious internalization. Inhibition and small interfering RNA (siRNA)-mediated knockdown of CyPs blocked dissociation of L1 from the L2/DNA complex. In vitro, purified CyPs facilitated the dissociation of L1 pentamers from recombinant HPV11 L1/L2 complexes in a pH-dependent manner. Furthermore, CyPs released L1 capsomeres from partially disassembled HPV16 pseudovirions at slightly acidic pH. Taken together, these data suggest that CyPs mediate the dissociation of HPV L1 and L2 capsid proteins following acidification of endocytic vesicles. PMID:22761365

Dissociation free-energy profiles of specific and nonspecific DNA-protein complexes.

PubMed

Yonetani, Yoshiteru; Kono, Hidetoshi

2013-06-27

DNA-binding proteins recognize DNA sequences with at least two different binding modes: specific and nonspecific. Experimental structures of such complexes provide us a static view of the bindings. However, it is difficult to reveal further mechanisms of their target-site search and recognition only from static information because the transition process between the bound and unbound states is not clarified by static information. What is the difference between specific and nonspecific bindings? Here we performed adaptive biasing force molecular dynamics simulations with the specific and nonspecific structures of DNA-Lac repressor complexes to investigate the dissociation process. The resultant free-energy profiles showed that the specific complex has a sharp, deep well consistent with tight binding, whereas the nonspecific complex has a broad, shallow well consistent with loose binding. The difference in the well depth, ~5 kcal/mol, was in fair agreement with the experimentally obtained value and was found to mainly come from the protein conformational difference, particularly in the C-terminal tail. Also, the free-energy profiles were found to be correlated with changes in the number of protein-DNA contacts and that of surface water molecules. The derived protein spatial distributions around the DNA indicate that any large dissociation occurs rarely, regardless of the specific and nonspecific sites. Comparison of the free-energy barrier for sliding [~8.7 kcal/mol; Furini J. Phys. Chem. B 2010, 114, 2238] and that for dissociation (at least ~16 kcal/mol) calculated in this study suggests that sliding is much preferred to dissociation.

PTSD and Substance Abuse

DTIC Science & Technology

2011-08-01

9 4 INTRODUCTION Substance use disorders (SUD) and Posttraumatic stress disorder ( PTSD ) are some of the most prominent...Fee, F. (in press). Substance use disorder , PTSD , and traumatic brain injury. In J. Vasterling, R. Bryant, T. Keane (Eds). PTSD and Mild Traumatic ...another DoD investigator, on a paper on dissociation, PTSD , and substance use disorder , using DoD Naval Health research data.  Dr. Najavits presented at

Static and kinetic studies of calmodulin and melittin complex.

PubMed

Itakura, M; Iio, T

1992-08-01

Ca2+ binding to calmodulin triggers conformational change of the protein which induces exposure of hydrophobic surfaces. Melittin has been believed to bind to Ca(2+)-bound calmodulin through the exposed hydrophobic surfaces. However, tryptophan fluorescence measurements and gel chromatography experiments with the melittin-calmodulin system revealed that melittin bound to calmodulin at zero salt concentration even in the absence of Ca2+; addition of salt removed melittin from Ca(2+)-free calmodulin. This means not only the hydrophobic interaction but also the electrostatic interaction contributes to the melittin-calmodulin binding. The fluorescence stopped-flow studies of the dissociation reaction of melittin-calmodulin complex revealed that Ca2+ removal from the complex induced a conformational change of calmodulin, resulting in reduction of the hydrophobic interaction between melittin and calmodulin, but the electrostatic interaction kept melittin still bound to calmodulin for a subsecond lag period, after which melittin dissociated from calmodulin. The fluorescence stopped-flow experiments on the dissociation reaction of complex of melittin and tryptic fragment(s) of calmodulin revealed that the lag period of the melittin dissociation reaction was attributable to the interaction between the C-terminal half of calmodulin and the C-terminal region of melittin.

Autobiographical memory specificity in dissociative identity disorder.

PubMed

Huntjens, Rafaële J C; Wessel, Ineke; Hermans, Dirk; van Minnen, Agnes

2014-05-01

A lack of adequate access to autobiographical knowledge has been related to psychopathology. More specifically, patients suffering from depression or a history of trauma have been found to be characterized by overgeneral memory, in other words, they show a relative difficulty in retrieving a specific event from memory located in time and place. Previous studies of overgeneral memory have not included patients with dissociative disorders. These patients are interesting to consider, as they are hypothesized to have the ability to selectively compartmentalize information linked to negative emotions. This study examined avoidance and overgeneral memory in patients with dissociative identity disorder (DID; n = 12). The patients completed the autobiographical memory test (AMT). Their performance was compared with control groups of posttraumatic stress disorder (PTSD) patients (n = 26), healthy controls (n = 29), and DID simulators (n = 26). Specifically, we compared the performance of separate identity states in DID hypothesized to diverge in the use of avoidance as a coping strategy to deal with negative affect. No significant differences in memory specificity were found between the separate identities in DID. Irrespective of identity state, DID patients were characterized by a lack of memory specificity, which was similar to the lack of memory specificity found in PTSD patients. The converging results for DID and PTSD patients add empirical evidence for the role of overgeneral memory involved in the maintenance of posttraumatic psychopathology.

Alienation appraisals distinguish adults diagnosed with DID from PTSD.

PubMed

DePrince, Anne P; Huntjens, Rafaële J C; Dorahy, Martin J

2015-11-01

Studies are beginning to show the importance of appraisals to different types and severities of psychiatric disorders. Yet, little work in this area has assessed whether trauma-related appraisals can differentiate complex trauma-related disorders, such as posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). The current study evaluated whether any of 6 trauma-related appraisals distinguished adults diagnosed with DID from those diagnosed with PTSD. To accomplish this, we first examined the basic psychometric properties of a Dutch-translated short-form of the Trauma Appraisals Questionnaire (TAQ) in healthy control (n = 57), PTSD (n = 27) and DID (n = 12) samples. The short-form Dutch translation of the TAQ showed good internal reliability and criterion-related validity for all 6 subscales (betrayal, self-blame, fear, alienation, shame, anger). Of the 6 subscales, the alienation appraisal subscale specifically differentiated DID from PTSD, with the former group reporting more alienation. Abuse-related appraisals that emphasize disconnection from self and others may contribute to reported problems of memory and identity common in DID. The current findings suggest that addressing experiences of alienation may be particularly important in treatment for clients diagnosed with DID. (c) 2015 APA, all rights reserved).

Neuroanatomical Markers of Neurological Soft Signs in Recent-Onset Schizophrenia and Asperger-Syndrome.

PubMed

Hirjak, Dusan; Wolf, Robert C; Paternoga, Isa; Kubera, Katharina M; Thomann, Anne K; Stieltjes, Bram; Maier-Hein, Klaus H; Thomann, Philipp A

2016-05-01

Neurological soft signs (NSS) are frequently found in psychiatric disorders of significant neurodevelopmental origin. Previous MRI studies in schizophrenia have shown that NSS are associated with abnormal cortical, thalamic and cerebellar structure and function. So far, however, no neuroimaging studies investigated brain correlates of NSS in individuals with Asperger-Syndrome (AS) and the question whether the two disorders exhibit common or disease-specific cortical correlates of NSS remains unresolved. High-resolution MRI data at 3 T were obtained from 48 demographically matched individuals (16 schizophrenia patients, 16 subjects with AS and 16 healthy individuals). The surface-based analysis via Freesurfer enabled calculation of cortical thickness, area and folding (local gyrification index, LGI). NSS were examined on the Heidelberg Scale and related to cortical measures. In schizophrenia, higher NSS were associated with reduced cortical thickness and LGI in fronto-temporo-parietal brain areas. In AS, higher NSS were associated with increased frontotemporal cortical thickness. This study lends further support to the hypothesis that disorder-specific mechanisms contribute to NSS expression in schizophrenia and AS. Pointing towards dissociable neural patterns may help deconstruct the complex processes underlying NSS in these neurodevelopmental disorders.

Latent profile analysis and principal axis factoring of the DSM-5 dissociative subtype.

PubMed

Frewen, Paul A; Brown, Matthew F D; Steuwe, Carolin; Lanius, Ruth A

2015-01-01

A dissociative subtype has been recognized based on the presence of experiences of depersonalization and derealization in relation to DSM-IV posttraumatic stress disorder (PTSD). However, the dissociative subtype has not been assessed in a community sample in relation to the revised DSM-5 PTSD criteria. Moreover, the 20-item PTSD Checklist for DSM-5 (PCL-5) currently does not assess depersonalization and derealization. We therefore evaluated two items for assessing depersonalization and derealization in 557 participants recruited online who endorsed PTSD symptoms of at least moderate severity on the PCL-5. A five-class solution identified two PTSD classes who endorsed dissociative experiences associated with either 1) severe or 2) moderate PTSD symptom severity (D-PTSD classes). Those in the severe dissociative class were particularly likely to endorse histories of childhood physical and sexual abuse. A principal axis factor analysis of the symptom list identified six latent variables: 1) Reexperiencing, 2) Emotional Numbing/Anhedonia, 3) Dissociation, 4) Negative Alterations in Cognition & Mood, 5) Avoidance, and 6) Hyperarousal. The present results further support the presence of a dissociative subtype within the DSM-5 criteria for PTSD.

The role of impulsivity in the association between childhood trauma and dissociative psychopathology: mediation versus moderation.

PubMed

Somer, Eli; Ginzburg, Karni; Kramer, Lilach

2012-03-30

Previous studies on survivors of childhood trauma documented associations between psychological dysregulation, impulsivity, and both behavioral and emotional manifestations of distress. Yet, the mechanism that links these variables remains unclear. The current study aims to examine the pattern of relations between a history of child abuse, impulsivity and dissociation. More specifically, it examines whether impulsivity serves as a moderator or mediator in the association between childhood trauma and dissociation. Eighty-one inpatients from the acute wards of two psychiatric hospitals participated in this study. Data were collected by clinician-administered questionnaires. A highly significant linear hierarchical regression analysis revealed that both psychiatric comorbidity and childhood trauma made unique contributions to the variance of dissociation. Yet, the significant association between childhood trauma and dissociation decreased when impulsivity was entered into the regression model. Our findings suggest that impulsivity mediates the association between childhood trauma and dissociative psychopathology and imply that the identification and treatment of impulsivity could be a potentially valuable clinical target in individuals with dissociative disorders. Copyright © 2012 Elsevier Ltd. All rights reserved.

Paranormal experiences in the general population.

PubMed

Ross, C A; Joshi, S

1992-06-01

The Dissociative Disorders Interview Schedule was administered to a random sample of 502 adults in the general population of Winnipeg, a midwestern Canadian city. Results showed that paranormal/extrasensory experiences were common in the general population. They were linked to a history of childhood trauma and to other dissociative symptom clusters. A factor analysis of the paranormal experiences identified three factors which together accounted for 44.0% of the combined variance of the scores. A model is proposed in which paranormal experiences are conceptualized as an aspect of normal dissociation. Like dissociation in general, paranormal experiences can be triggered by trauma, especially childhood physical or sexual abuse. Such experiences discriminate individuals with childhood trauma histories from those without at high levels of significance.

From Childhood Trauma to Self-Harm: An Investigation of Theoretical Pathways among Female Prisoners.

PubMed

Howard, Ruth; Karatzias, Thanos; Power, Kevin; Mahoney, Adam

2017-07-01

Despite empirical evidence suggesting complex associations between childhood trauma and self-harm, there is a dearth of research investigating this association in the female prison population. The current study explored pathways to self-harm following childhood trauma, by investigating the mediating roles of Post-traumatic Stress Disorder (PTSD) symptoms, emotion regulation and dissociation, in this relationship, within a sample of 89 female prisoners. Cross-sectional, interview-format, questionnaire study within a female prison population. Measures of childhood trauma, self-harm, PTSD, emotion regulation and dissociation were administered. The majority of the sample (58.4%) reported history of self-harm. Bootstrapped mediation analyses indicated an indirect effect of emotion regulation on the relationship between childhood trauma and self-harm. An indirect effect was also found for PTSD arousal/reactivity cluster of symptoms. Multiple mediation analyses revealed that interactional effects were present for emotion regulation and arousal/reactivity, and emotion regulation and dissociation, respectively. Self-harm is highly prevalent among female prisoners. Interventions promoting emotion regulation and addressing arousal/reactivity symptoms following traumatization may provide an effective way of addressing this problem. Copyright © 2016 John Wiley & Sons, Ltd. Self-harm is highly prevalent amongst female prisoners, occurring in 58.4% of this sample. Emotion regulation and the arousal/reactivity symptom cluster of PTSD were found to mediate the relationship between childhood trauma and self-harm, both independently and simultaneously. Emotion regulation and dissociation were found to interactionally mediate this relationship. Strategies targeting emotion dysregulation and hyperarousal symptoms, amongst female prisoners who have experienced childhood trauma, may be helpful in reducing self-harming behaviours. Copyright © 2016 John Wiley & Sons, Ltd.

Complex Mental Health Sequelae of Psychological Trauma Among Women in Prenatal Care

PubMed Central

Seng, Julia S.; D’Andrea, Wendy; Ford, Julian D.

2014-01-01

Pregnancy is a critical time to identify and address maternal mental health problems, for the health of both mother and child. Pregnant women with histories of exposure to interpersonal psychological trauma may experience a range of mental health problems including but not limited to posttraumatic stress disorder (PTSD). In a community sample of 1,581 pregnant women, 25% reported symptoms consistent with at least one of six syndromes, including PTSD, major depressive disorder (MDD), generalized anxiety disorder (GAD), or clinically significant dissociation, somatization, or affect dysregulation. Six sub-groups with distinct mental health problem profiles were identified by cluster analysis. Controlling for sociodemographic risk factors, women with histories of interpersonal trauma were over-represented in four sub-groups characterized by: (1) PTSD comorbid with depression (childhood sexual abuse), (2) PTSD comorbid with affect/interpersonal dysregulation (childhood physical or emotional abuse), (3) somatization (adult abuse), and (4) GAD (foster/adoptive placement). Findings suggest risk relationships warranting further study between different types of interpersonal trauma exposure and psychiatric outcomes in pregnant women, including PTSD with two types of comorbidity. PMID:25558308

Somatization disorders in dermatology.

PubMed

Gupta, Madhulika A

2006-02-01

This paper reviews a wide range of somatization-related symptoms that are encountered in dermatology. These include the unexplained cutaneous sensory syndromes especially the cutaneous dysesthesias associated with pain, numbness and pruritus; traumatic memories in post-traumatic stress disorder (PTSD) which are experienced on a sensory level as 'body memories' and may present as local or generalized pruritic states, urticaria and angioedema; and unexplained flushing reactions and profuse perspiration, in addition to unexplained exacerbations of stress-reactive dermatoses such as psoriasis and atopic eczema secondary to the autonomic hyperarousal in PTSD; classic 'pseudoneurologic' symptoms associated with dissociation including unexplained loss of touch or pain, in addition to the self-induced dermatoses such as dermatitis artefacta and trichotillomania that are encountered with dissociative states; and body dysmorphic disorder where the patient often presents with a somatic preoccupation involving the skin or hair.

Dissociative identity disorder (DID) in clinical practice - what you don't see may hurt you.

PubMed

Leonard, David; Tiller, John

2016-02-01

To identify problems that interfere with the recognition, diagnosis and management of people with dissociative identity disorder (DID) presenting to psychiatric outpatient and inpatient services and suggest solutions. Problems and suggested solutions associated with clinical presentations and management of people with DID are outlined with references to relevant literature. Problems in the recognition and management of DID are described. These lead to delays in diagnosis and costly, inappropriate management, destructive to services, staff and patients alike. Problems include lack of understanding and experience and scepticism about the disorder, resulting in failure to provide appropriate treatment.Some suggestions to improve recognition and management are included. Better recognition, diagnosis and management of DID will lead to better and more cost effective outcomes. © The Royal Australian and New Zealand College of Psychiatrists 2015.

The self-report Dissociative Disorders Interview Schedule: A preliminary report.

PubMed

Ross, Colin A; Browning, Elena

2017-01-01

A self-report version of the Dissociative Disorders Interview Schedule (SR-DDIS) was administered to 100 inpatients in a hospital-based trauma program. All participants had previously completed the interviewer-administered version of the DDIS. When we compared the overall results on the DDIS and SR-DDIS for the 100 inpatients, the findings were very consistent for both symptom clusters and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), diagnoses. The agreement rate between the 2 versions for DSM-5 diagnoses was fair to substantial using Cohen's kappa, with agreement being substantial for 4 out of the 7 diagnoses made by the DDIS. It appears likely that the SR-DDIS can be used instead of the DDIS, at least in clinical populations, with no clinically or conceptually significant differences between the results obtained with the 2 versions.

Validity of CBCL-derived PTSD and dissociation scales: further evidence in a sample of neglected children and adolescents.

PubMed

Milot, Tristan; Plamondon, André; Ethier, Louise S; Lemelin, Jean-Pascal; St-Laurent, Diane; Rousseau, Michel

2013-05-01

There is growing evidence that child neglect is an important risk factor for posttraumatic stress disorder (PTSD) and dissociation. Considering that the Child Behavior Checklist (CBCL) is a widely used measure, the possibility of using validated CBCL-derived trauma symptoms scales could be particularly useful to better understand how trauma symptoms develop among neglected children and adolescents. This study examined the factor structure of three CBCL-derived measures of PTSD and dissociation (namely, PTSD scale, Dissociation scale, and PTSD/Dissociation scale) in a sample of 239 neglected children and adolescents aged 6 to 18 years using the latest version of CBCL (CBCL 6-18). Evidence of convergent validity of these scales was also examined for participants aged 12 and under using two well-validated measures of PTSD and Dissociation: the Trauma Symptoms Checklist for Young Children and the Child Dissociation Checklist. Findings suggest that CBCL-derived measures of trauma symptoms, especially PTSD and Dissociations scales, may be of heuristic value in the study of trauma symptomatology in neglected samples. Factor structure and evidence of convergent validity were supported for these two scales. Results also provide further support to the well-established assumption that PTSD and dissociation are two related but different constructs.

[Somnambulism: clinical and eletrophysiological aspects].

PubMed

Szúcs, Anna; Halász, Péter

2005-06-05

The authors review the literature on the epidemiology, the clinical and electrophysiological symptoms of somnambulism. The disorder specified as "nREM parasomnia with awakening disorder" belongs to the nREM sleep (awakening) parasomnias. In most of the cases its occurence is familial with the highest prevalence at age 12 year. Above age 12 year most cases recover whereas 6% of prevalence is reported in adults. It is probable that most patients seek medical help only in severe cases associated with injuries, accidents or violence. Its etiology is unknown; in essence it is a sleep regulation disorder characterised by a dissociated state of partial awakening from nREM sleep: the motor system becomes awake while consciousness remains clouded. There are several medicines inducing somnambulism in patients otherwise free from this disorder. In somnambule patients the most important provoking factors are sleep deprivation as well as pathological states and circumstances evoking sleep loss. Somnambulism should be differentiated from complex partial epileptic seizures and REM behaviour disorder. As there is no specific treatment at the moment it is important to assure safe sleeping circumstances - ground flour, closed windows, and no fragile furniture. Clonazepam and selective serotonin reuptake inhibitors prove sometimes effective, but the most effective methods in decreasing the frequency of somnambule episodes are the regular sleep-wakefulness schedule and the avoidance of sleep deprivation.

High Structural Resolution Hydroxyl Radical Protein Footprinting Reveals an Extended Robo1-Heparin Binding Interface*

PubMed Central

Li, Zixuan; Moniz, Heather; Wang, Shuo; Ramiah, Annapoorani; Zhang, Fuming; Moremen, Kelley W.; Linhardt, Robert J.; Sharp, Joshua S.

2015-01-01

Interaction of transmembrane receptors of the Robo family and the secreted protein Slit provides important signals in the development of the central nervous system and regulation of axonal midline crossing. Heparan sulfate, a sulfated linear polysaccharide modified in a complex variety of ways, serves as an essential co-receptor in Slit-Robo signaling. Previous studies have shown that closely related heparin octasaccharides bind to Drosophila Robo directly, and surface plasmon resonance analysis revealed that Robo1 binds more tightly to full-length unfractionated heparin. For the first time, we utilized electron transfer dissociation-based high spatial resolution hydroxyl radical protein footprinting to identify two separate binding sites for heparin interaction with Robo1: one binding site at the previously identified site for heparin dp8 and a second binding site at the N terminus of Robo1 that is disordered in the x-ray crystal structure. Mutagenesis of the identified N-terminal binding site exhibited a decrease in binding affinity as measured by surface plasmon resonance and heparin affinity chromatography. Footprinting also indicated that heparin binding induces a minor change in the conformation and/or dynamics of the Ig2 domain, but no major conformational changes were detected. These results indicate a second low affinity binding site in the Robo-Slit complex as well as suggesting the role of the Ig2 domain of Robo1 in heparin-mediated signal transduction. This study also marks the first use of electron transfer dissociation-based high spatial resolution hydroxyl radical protein footprinting, which shows great utility for the characterization of protein-carbohydrate complexes. PMID:25752613

Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research

PubMed Central

Lanius, Ruth A.

2015-01-01

The primary aim of this commentary is to describe trauma-related dissociation and altered states of consciousness in the context of a four-dimensional model that has recently been proposed (Frewen & Lanius, 2015). This model categorizes symptoms of trauma-related psychopathology into (1) those that occur within normal waking consciousness and (2) those that are dissociative and are associated with trauma-related altered states of consciousness (TRASC) along four dimensions: (1) time; (2) thought; (3) body; and (4) emotion. Clinical applications and future research directions relevant to each dimension are discussed. Conceptualizing TRASC across the dimensions of time, thought, body, and emotion has transdiagnostic implications for trauma-related disorders described in both the Diagnostic Statistical Manual and the International Classifications of Diseases. The four-dimensional model provides a framework, guided by existing models of dissociation, for future research examining the phenomenological, neurobiological, and physiological underpinnings of trauma-related dissociation. PMID:25994026

Theoretical study on the cooperative exciton dissociation process based on dimensional and hot charge-transfer state effects in an organic photocell

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shimazaki, Tomomi; Nakajima, Takahito

2016-06-21

This paper discusses the exciton dissociation process at the donor–acceptor interface in organic photocells. In our previous study, we introduced a local temperature to handle the hot charge-transfer (CT) state and calculated the exciton dissociation probability based on the 1D organic semiconductor model [T. Shimazaki and T. Nakajima, Phys. Chem. Chem. Phys. 17, 12538 (2015)]. Although the hot CT state plays an essential role in exciton dissociations, the probabilities calculated are not high enough to efficiently separate bound electron–hole pairs. This paper focuses on the dimensional (entropy) effect together with the hot CT state effect and shows that cooperative behaviormore » between both effects can improve the exciton dissociation process. In addition, we discuss cooperative effects with site-disorders and external-electric-fields.« less

Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive-compulsive disorder, major depressive disorder, or borderline personality disorder.

PubMed

Didonna, Fabrizio; Rossi, Roberta; Ferrari, Clarissa; Iani, Luca; Pedrini, Laura; Rossi, Nicoletta; Xodo, Erica; Lanfredi, Mariangela

2018-03-25

To explore differences in mindfulness facets among patients with a diagnosis of either obsessive-compulsive disorder (OCD), major depressive disorder (MDD), or borderline personality disorder (BPD), and healthy controls (HC), and their associations with clinical features. One hundred and fifty-three patients and 50 HC underwent a clinical assessment including measures of mindfulness (Five Facets Mindfulness Questionnaire - FFMQ), psychopathological symptoms (Symptom Check List-90-R), dissociation (Dissociative Experience Scale), alexithymia (Alexithymia Scale 20), and depression (Beck Depression Inventory-II). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were performed to assess differences in mindfulness scores and their associations with clinical features. The three diagnostic groups scored lower on all mindfulness facets (apart from FFMQobserving) compared to the HC group. OCD group had a significant higher FFMQ total score (FFMQ-TS) and FFMQacting with awareness compared to the BPD group, and scored higher on FFMQdescribing compared to BPD and MDD groups. The scores in non-judging facet were significantly lower in all the three diagnostic groups compared to the HC group. Interestingly, higher FFMQ-TS was inversely related to all psychological measures, regardless of diagnostic group. Deficits in mindfulness skills were present in all diagnostic groups. Furthermore, we found disease-specific relationships between some mindfulness facets and specific psychological variables. Clinical implications are discussed. The study showed deficits in mindfulness scores in all diagnostic groups compared to a healthy control group. Overall, mindfulness construct has a significantly negative association with indexes of global distress, dissociative symptoms, alexithymia, and depression. Mindfulness-based interventions in clinical settings should take into account different patterns of mindfulness skills and their impact on disease-specific maladaptive cognitive strategies or symptomatology. © 2018 The British Psychological Society.

Solution NMR investigation of the CD95/FADD homotypic death domain complex suggests lack of engagement of the CD95 C terminus.

PubMed

Esposito, Diego; Sankar, Andrew; Morgner, Nina; Robinson, Carol V; Rittinger, Katrin; Driscoll, Paul C

2010-10-13

We have addressed complex formation between the death domain (DD) of the death receptor CD95 (Fas/APO-1) with the DD of immediate adaptor protein FADD using nuclear magnetic resonance (NMR) spectroscopy, mass spectrometry, and size-exclusion chromatography with in-line light scattering. We find complexation to be independent of the C-terminal 12 residues of CD95 and insensitive to mutation of residues that engage in the high-order clustering of CD95-DD molecules in a recently reported crystal structure obtained at pH 4. Differential NMR linewidths indicate that the C-terminal region of the CD95 chains remains in a disordered state and (13)C-methyl TROSY data are consistent with a lack of high degree of symmetry for the complex. The overall molecular mass of the complex is inconsistent with that in the crystal structure, and the complex dissociates at pH 4. We discuss these findings using sequence analysis of CD95 orthologs and the effect of FADD mutations on the interaction with CD95. Copyright © 2010 Elsevier Ltd. All rights reserved.

Modeling of the Structure of Disordered Metallic Alloys and Its Transformation Under Thermal Forcing

NASA Astrophysics Data System (ADS)

Cress, Ryan Paul

The morphology of disordered binary metallic alloys is investigated. The structure of disordered binary metallic alloys is modeled as a randomly close packed (RCP) assembly of atoms. It was observed through a 2-D binary hard sphere experiment that RCP structure can be modeled as a mixture of nano-crystallites and glassy matter. We define the degree of crystallinity as the fraction of atoms contained in nano-crystallites in an RCP medium. Nano-crystallites by size in a crystallite size distribution were determined experimentally to define the morphology of the RCP medium. Both the degree of crystallinity and the crystallite size distribution have been found to be determined by the composition of a given binary mixture. A 2-D Monte Carlo simulation was developed in order to replicate the RCP structure observed in the experiment which is then extended to cases of arbitrary composition. Crystallites were assumed to be spherical with isotropic cross sections. The number of atoms in an individual crystallite in 2-D is simply transformed into the number of atoms in 3-D; we then obtain the crystallite size distribution in 3-D. This experiment accounts for the contribution from the repulsive core of the inter-atomic potential. The attractive part of the potential is recovered by constructing spherical nano-crystallites of a given radius from a crystalline specimen of each given alloy. A structural model of a disordered alloy is thus obtained. With the basic structure of the RCP medium defined, the response to heating would be in the form of changes to the crystallite size distribution. This was first investigated in a hard sphere mechanical oven experiment. The experimental setup consists of a 2-D cell which is driven by two independent stepper motors. The motors drive a binary RCP bed of spheres on a slightly tilted plane according to a chaotic algorithmm. The motors are driven at four different speed settings. The RCP medium was analyzed using a sequence of digital images taken of the beds. The bursts of images provide a Gaussian distribution of particle speeds in x and y directions thus giving rise to the notion of "temperature." This temperature scales with the motor speed settings. The measured average degree of crystallinity is found to decrease as the effective temperature was raised suggesting that nano-crystallites dissociate under thermal forcing. The evolution of a specimen's structure is calculated rigorously by means of the law of mass action formalism. A system of thermal dissociation reaction equations is written out for the set of nano-crystallites according to the 3-D crystallite size distribution. The equilibrium treatment is justified because the energy differences between metastable RCP structures fall within kT. Thermal dissociation of one surface atom at a time is assumed because the energy cost in dissociation of a surface atom on a nano-crystallite is significantly less than that of a multi atom cluster. The full set of reaction equations cover all possible dissociation steps, which may amount to several thousand for a disordered alloy specimen. The primary determining factor in each of these dissociation equations is the dissociation potential or the amount of attractive energy needed to remove a surface atom on a nano-crystallite of a given size. The attractive potential between atoms is calculated using a Lennard-Jones potential between a pair of atoms for which quantum chemistry calculations exist in the literature. All interactions impinged on the surface atom by all other atoms in a crystallite are summed. As the nano-crystallites dissociate due to heating, the structure of the alloy changes, and this leads to modifications of alloy's transport properties. The model is found to predict the melting temperature of various disordered binary alloys as well as refractory metals in good agreement with known data. The structure model for disordered binary alloys gives an excellent characterization of the alloy morphology. It therefore provides fruitful avenues for making predictions about how thermophysical properties of disordered binary alloys change as the alloy temperature is raised by heating.

A critical review of dissociative trance and possession disorders: etiological, diagnostic, therapeutic, and nosological issues.

PubMed

During, Emmanuel H; Elahi, Fanny M; Taieb, Olivier; Moro, Marie-Rose; Baubet, Thierry

2011-04-01

Although the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, acknowledges the existence of dissociative trance and possession disorders, simply named dissociative trance disorder (DTD), it asks for further studies to assess its clinical utility in the DSM-5. To answer this question, we conducted the first review of the medical literature. The MEDLINE, CINAHL, and PsycINFO databases were searched from 1988 to 2010, seeking case reports of DTD according to the DSM or the International Classification of Diseases definitions. For each article, we collected epidemiologic and clinical data, explanatory models used by authors, treatments, and information on the outcome. We found 28 articles reporting 402 cases of patients with DTD worldwide. The data show an equal proportion of female and male patients, and a predominance of possession (69%), compared with trance (31%). Amnesia is reported by 20% of patients. Conversely, hallucinatory symptoms during possession episodes were found in 56% of patients and thus should feature as an important criterion. Somatic complaints are found in 34% of patients. Multiple explanatory models are simultaneously held and appear to be complementary. Data strongly suggest the inclusion of DTD in the DSM-5, provided certain adjustments are implemented. DTD is a widespread disorder that can be understood as a global idiom of distress, probably underdiagnosed in Western countries owing to cultural biases, whose incidence could increase given the rising flow of migration. Accurate diagnosis and appropriate management should result from a comprehensive evaluation both of sociocultural and of idiosyncratic issues, among which acculturation difficulties should systematically be considered, especially in cross-cultural settings.

Dissociative identity disorder: Medicolegal challenges.

PubMed

Farrell, Helen M

2011-01-01

Persons with dissociative identity disorder (DID) often present in the criminal justice system rather than the mental health system and perplex experts in both professions. DID is a controversial diagnosis with important medicolegal implications. Defendants have claimed that they committed serious crimes, including rape or murder, while they were in a dissociated state. Asserting that their alter personality committed the bad act, defendants have pleaded not guilty by reason of insanity (NGRI). In such instances, forensic experts are asked to assess the defendant for DID and provide testimony in court. Debate continues over whether DID truly exists, whether expert testimony should be allowed into evidence, and whether it should exculpate defendants for their criminal acts. This article reviews historical and theoretical perspectives on DID, presents cases that illustrate the legal implications and controversies of raising an insanity defense based on multiple personalities, and examines the role of forensic experts asked to comment on DID with the goal of assisting clinicians in the medicolegal assessment of DID in relation to crimes.

Women With Dissociative Identity Disorder Who Experience Intimate Partner Violence.

PubMed

Snyder, Briana L

2018-05-01

Women with dissociative identity disorder (DID) are significantly more likely than other women to experience intimate partner violence (IPV). The purpose of this qualitative investigation was to explicate the experiences of women with DID who experience IPV and describe how they cope. Grounded theory was used to conduct this investigation. Purposive sampling was used to recruit participants (N = 5) for face-to-face, semi-structured interviews. Verbatim transcripts were coded and categorized, and reflective memos were developed to explicate substantive categories. Women with DID used coping strategies that were consistent with their diagnoses, such as switching and dissociating. These coping mechanisms reflect past self-preservation strategies that were developed in association with severe childhood maltreatment. Women with DID who experienced IPV sought to mitigate and safeguard themselves from danger using strategies they developed as maltreated children. Nurses can use these findings to better recognize and understand the motivations and behaviors of women with DID who experience IPV. [Journal of Psychosocial Nursing and Mental Health Services, 56(5), 26-32.]. Copyright 2018, SLACK Incorporated.

What we know and what we need to learn about the treatment of dissociative disorders.

PubMed

Brand, Bethany L

2012-01-01

In this editorial, I briefly review research design issues and the current treatment research for dissociative disorders (DD), discuss the limitations and challenges of conducting treatment studies for patients with DD, and conclude by describing what I see as the first wave and second wave in the field of dissociation. Insurers and federally funded programs are increasingly requiring that treatment be empirically supported in order for treatment to be reimbursed. For example, psychoanalysis will no longer be reimbursed in The Netherlands because of what is perceived as a lack of empirical support. Other countries have also established standards about the treatments that have sufficient empirical support to merit government payment. I believe it is only a matter of time before it is common for patients with DD to be required to seek out empirically supported treatment if they want treatment to be reimbursed. We need to financially support treatment studies in order to develop a more solid empirical basis for the treatment of DD.

PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample

PubMed Central

Powers, Abigail; Cross, Dorthie; Fani, Negar; Bradley, Bekh

2015-01-01

Exposure to multiple traumas has been shown to result in many negative mental health outcomes, including posttraumatic stress disorder (PTSD). Dissociation, which involves disruptions in memory, identity, and perceptions, may be a component of PTSD, particularly among individuals who have experienced childhood trauma. Emotion regulation difficulties are also strongly associated with childhood trauma and emotion dysregulation may be a particularly important factor to consider in the development and maintenance of dissociative symptoms. The goal of the present study was to determine whether emotion dysregulation mediated the relationship between PTSD symptoms and dissociation in a sample of 154 (80% female, 97% African-American) adults recruited from a public, urban hospital. PTSD was measured using the Clinician Administered PTSD Scale, emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale, and dissociation was measured using the Multiscale Dissociation Inventory. A linear regression analysis showed that both PTSD and emotion dysregulation were statistically significant predictors of dissociation even after controlling for trauma exposure. Alexithymia and an inability to use emotion regulation strategies in particular were predictive of dissociation above and beyond other predictor variables. Using bootstrapping techniques, we found that overall emotion dyregulation partially mediated the effect of PTSD symptoms on dissociative symptoms. Our results suggest that emotion dysregulation may be important in understanding the relation between PTSD and dissociative symptoms. Treatment approaches may consider a focus on training in emotional understanding and the development of adaptive regulation strategies as a way to address dissociative symptoms in PTSD patients. PMID:25573648

Can the dissociative PTSD subtype be identified across two distinct trauma samples meeting caseness for PTSD?

PubMed

Hansen, Maj; Műllerová, Jana; Elklit, Ask; Armour, Cherie

2016-08-01

For over a century, the occurrence of dissociative symptoms in connection to traumatic exposure has been acknowledged in the scientific literature. Recently, the importance of dissociation has also been recognized in the long-term traumatic response within the DSM-5 nomenclature. Several studies have confirmed the existence of the dissociative posttraumatic stress disorder (PTSD) subtype. However, there is a lack of studies investigating latent profiles of PTSD solely in victims with PTSD. This study investigates the possible presence of PTSD subtypes using latent class analysis (LCA) across two distinct trauma samples meeting caseness for DSM-5 PTSD based on self-reports (N = 787). Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in a dissociative compared with a non-dissociative PTSD class. The results of LCA revealed a two-class solution with two highly symptomatic classes: a dissociative class and a non-dissociative class across both samples. Increased emotion-focused coping increased the probability of individuals being grouped into the dissociative class across both samples. Social support reduced the probability of individuals being grouped into the dissociative class but only in the victims of motor vehicle accidents (MVAs) suffering from whiplash. The results are discussed in light of their clinical implications and suggest that the dissociative subtype can be identified in victims of incest and victims of MVA suffering from whiplash meeting caseness for DSM-5 PTSD.

The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD.

PubMed

Armour, Cherie; Karstoft, Karen-Inge; Richardson, J Don

2014-08-01

A dissociative-posttraumatic stress disorder (PTSD) subtype has been included in the DSM-5. However, it is not yet clear whether certain socio-demographic characteristics or psychological/clinical constructs such as comorbid psychopathology differentiate between severe PTSD and dissociative-PTSD. The current study investigated the existence of a dissociative-PTSD subtype and explored whether a number of trauma and clinical covariates could differentiate between severe PTSD alone and dissociative-PTSD. The current study utilized a sample of 432 treatment seeking Canadian military veterans. Participants were assessed with the Clinician Administered PTSD Scale (CAPS) and self-report measures of traumatic life events, depression, and anxiety. CAPS severity scores were created reflecting the sum of the frequency and intensity items from each of the 17 PTSD and 3 dissociation items. The CAPS severity scores were used as indicators in a latent profile analysis (LPA) to investigate the existence of a dissociative-PTSD subtype. Subsequently, several covariates were added to the model to explore differences between severe PTSD alone and dissociative-PTSD. The LPA identified five classes: one of which constituted a severe PTSD group (30.5 %), and one of which constituted a dissociative-PTSD group (13.7 %). None of the included, demographic, trauma, or clinical covariates were significantly predictive of membership in the dissociative-PTSD group compared to the severe PTSD group. In conclusion, a significant proportion of individuals report high levels of dissociation alongside their PTSD, which constitutes a dissociative-PTSD subtype. Further investigation is needed to identify which factors may increase or decrease the likelihood of membership in a dissociative-PTSD subtype group compared to a severe PTSD only group.

Deuterium kinetic isotope effects on the dissociation of a protein-fatty acid complex in the gas phase.

PubMed

Liu, Lan; Michelsen, Klaus; Kitova, Elena N; Schnier, Paul D; Brown, Alex; Klassen, John S

2012-04-04

Deuterium kinetic isotope effects (KIEs) are reported for the first time for the dissociation of a protein-ligand complex in the gas phase. Temperature-dependent rate constants were measured for the loss of neutral ligand from the deprotonated ions of the 1:1 complex of bovine β-lactoglobulin (Lg) and palmitic acid (PA), (Lg + PA)(n-) → Lg(n-) + PA, at the 6- and 7- charge states. At 25 °C, partial or complete deuteration of the acyl chain of PA results in a measurable inverse KIE for both charge states. The magnitude of the KIEs is temperature dependent, and Arrhenius analysis of the rate constants reveals that deuteration of PA results in a decrease in activation energy. In contrast, there is no measurable deuterium KIE for the dissociation of the (Lg + PA) complex in aqueous solution at pH 8. Deuterium KIEs were calculated using conventional transition-state theory with an assumption of a late dissociative transition state (TS), in which the ligand is free of the binding pocket. The vibrational frequencies of deuterated and non-deuterated PA in the gas phase and in various solvents (n-hexane, 1-chlorohexane, acetone, and water) were established computationally. The KIEs calculated from the corresponding differences in zero-point energies account qualitatively for the observation of an inverse KIE but do not account for the magnitude of the KIEs nor their temperature dependence. It is proposed that the dissociation of the (Lg + PA) complex in aqueous solution also proceeds through a late TS in which the acyl chain is extensively hydrated such that there is no significant differential change in the vibrational frequencies along the reaction coordinate and, consequently, no significant KIE.

Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states.

PubMed

Reinders, A A T S; Reinders, A A T Simone; Willemsen, Antoon T M; Vos, Herry P J; den Boer, Johan A; Nijenhuis, Ellert R S

2012-01-01

Dissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion. DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation. The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin.

For better or worse: the role of revictimization and stress in the course of treatment for dissociative disorders.

PubMed

Myrick, Amie C; Brand, Bethany L; Putnam, Frank W

2013-01-01

Revictimization and life stressors are common among dissociative disorder (DD) patients, yet no studies have examined the prevalence rates for these experiences or their relationships with treatment outcome. This study aimed to examine the rates of revictimization and victimization of others using therapist-DD patient pairs from the naturalistic Treatment of Patients with Dissociative Disorders (TOP DD) study while also considering the role of revictimization and life stressors among 49 patients who greatly improved or worsened during 30 months of treatment. Therapists reported that sexual and physical revictimization in the previous 6 months was high among the patients (3.5%-7.0% and 4.1%-7.1% in the overall TOP DD sample, respectively), and emotional revictimization was quite high (29%-36%). Revictimization showed a decreasing trend over the 30 months of the study. Therapists reported that more than a quarter of the patients who were revictimized were also occasionally emotionally or physically abusive to others. More patients showed sudden improvement versus sudden worsening in patient-reported symptoms at 1 or more time point(s). Patients who improved had significantly fewer revictimizations and stressors overall than patients who worsened, suggesting that revictimization and/or stressors may contribute to worsening in treatment. Further research is needed to learn more about the roles of revictimization, victimization of others, and stressors in DD treatment. [Supplementary material is available for this article. Go to the publisher's online edition of Journal of Trauma & Dissociation for the following supplemental resource: Baseline Demographic Information of TOP DD Improving and Worsening Subgroups].

Treatment of a Patient with Borderline Personality Disorder Based on Phase-Oriented Model of Eye Movement Desensitization and Reprocessing (EMDR): A Case Report.

PubMed

Momeni Safarabad, Nahid; Asgharnejad Farid, Ali-Asghar; Gharraee, Banafsheh; Habibi, Mojtaba

2018-01-01

Objective: This study aimed at reporting the effect of the 3-phase model of eye movement desensitization and reprocessing in the treatment of a patient with borderline personality disorder. Method : A 33-year-old female, who met the DSM-IV-TR criteria for borderline personality disorder, received a 20-session therapy based on the 3-phase model of eye movement desensitization and reprocessing. Borderline Personality Disorder Checklist (BPD-Checklist), Dissociative Experience Scale (DES-II), Beck Depression Inventory-II-second edition (BDI-II), and Anxiety Inventory (BAI) were filled out by the patient at all treatment phases and at the 3- month follow- up. Results: According to the obtained results, the patient's pretest scores in all research tools were 161, 44, 37, and 38 for BPD-Checklist, DES-II, BDI-II, and BAI, respectively. After treatment, these scores decreased significantly (69, 14, 6 and 10 respectively). So, the patient exhibited improvement in borderline personality disorder, dissociative, depression and anxiety symptoms, which were maintained after the 3-month follow-up. Conclusion: The results supported the positive effect of phasic model of eye movement desensitization and reprocessing on borderline personality disorder.

Treatment of a Patient with Borderline Personality Disorder Based on Phase-Oriented Model of Eye Movement Desensitization and Reprocessing (EMDR): A Case Report

PubMed Central

Momeni Safarabad, Nahid; Asgharnejad Farid, Ali-Asghar; Gharraee, Banafsheh; Habibi, Mojtaba

2018-01-01

Objective: This study aimed at reporting the effect of the 3-phase model of eye movement desensitization and reprocessing in the treatment of a patient with borderline personality disorder. Method : A 33-year-old female, who met the DSM-IV-TR criteria for borderline personality disorder, received a 20-session therapy based on the 3-phase model of eye movement desensitization and reprocessing. Borderline Personality Disorder Checklist (BPD-Checklist), Dissociative Experience Scale (DES-II), Beck Depression Inventory-II-second edition (BDI-II), and Anxiety Inventory (BAI) were filled out by the patient at all treatment phases and at the 3- month follow- up. Results: According to the obtained results, the patient’s pretest scores in all research tools were 161, 44, 37, and 38 for BPD-Checklist, DES-II, BDI-II, and BAI, respectively. After treatment, these scores decreased significantly (69, 14, 6 and 10 respectively). So, the patient exhibited improvement in borderline personality disorder, dissociative, depression and anxiety symptoms, which were maintained after the 3-month follow-up. Conclusion: The results supported the positive effect of phasic model of eye movement desensitization and reprocessing on borderline personality disorder. PMID:29892320

Interidentity amnesia for neutral, episodic information in dissociative identity disorder.

PubMed

Huntjens, Rafaële J C; Postma, Albert; Peters, Madelon L; Woertman, Liesbeth; van der Hart, Onno

2003-05-01

Interidentity amnesia is considered a hallmark of dissociative identity disorder (DID) in clinical practice. In this study, objective methods of testing episodic memory transfer between identities were used. Tests of both recall (interference paradigm) and recognition were used. A sample of 31 DID patients was included. Additionally, 50 control subjects participated, half functioning as normal controls and the other half simulating interidentity amnesia. Twenty-one patients subjectively reported complete one-way amnesia for the learning episode. However, objectively, neither recall nor recognition scores of patients were different from those of normal controls. It is suggested that clinical models of amnesia in DID may be specified to exclude episodic memory impairments for emotionally neutral material.

Psychological factors and treatment effectiveness in resistant anxiety disorders in highly comorbid inpatients

PubMed Central

Ociskova, Marie; Prasko, Jan; Latalova, Klara; Kamaradova, Dana; Grambal, Ales

2016-01-01

Background Anxiety disorders are a group of various mental syndromes that have been related with generally poor treatment response. Several psychological factors may improve or hinder treatment effectiveness. Hope has a direct impact on the effectiveness of psychotherapy. Also, dissociation is a significant factor influencing treatment efficiency in this group of disorders. Development of self-stigma could decrease treatment effectiveness, as well as several temperamental and character traits. The aim of this study was to explore a relationship between selected psychological factors and treatment efficacy in anxiety disorders. Subjects and methods A total of 109 inpatients suffering from anxiety disorders with high frequency of comorbidity with depression and/or personality disorder were evaluated at the start of the treatment by the following scales: the Mini-International Neuropsychiatric Interview, the Internalized Stigma of Mental Illness scale, the Adult Dispositional Hope Scale, and the Temperament and Character Inventory – revised. The participants, who sought treatment for anxiety disorders, completed the following scales at the beginning and end of an inpatient-therapy program: Clinical Global Impression (objective and subjective) the Beck Depression Inventory – second edition, the Beck Anxiety Inventory, and the Dissociative Experiences Scale. The treatment consisted of 25 group sessions and five individual sessions of cognitive behavioral therapy or psychodynamic therapy in combination with pharmacotherapy. There was no randomization to the type of group-therapy program. Results Greater improvement in psychopathology, assessed by relative change in objective Clinical Global Impression score, was connected with low initial dissociation level, harm avoidance, and self-stigma, and higher amounts of hope and self-directedness. Also, individuals without a comorbid personality disorder improved considerably more than comorbid patients. According to backward-stepwise multiple regression, the best significant predictor of treatment effectiveness was the initial level of self-stigma. Conclusion The initial higher levels of self-stigma predict a lower effectiveness of treatment in resistant-anxiety-disorder patients with high comorbidity with depression and/or personality disorder. The results suggest that an increased focus on self-stigma during therapy could lead to better treatment outcomes. PMID:27445474

Accelerated Disassembly of IgE:Receptor Complexes by a Disruptive Macromolecular Inhibitor

PubMed Central

Kim, Beomkyu; Eggel, Alexander; Tarchevskaya, Svetlana S.; Vogel, Monique; Prinz, Heino; Jardetzky, Theodore S.

2012-01-01

IgE antibodies bind the high affinity IgE Fc receptor (FcεRI), found primarily on mast cells and basophils, and trigger inflammatory cascades of the allergic response1,2. Inhibitors of IgE:FcεRI binding have been identified and an anti-IgE therapeutic antibody (omalizumab) is used to treat severe allergic asthma3,4. However, preformed IgE:FcεRI complexes that prime cells prior to allergen exposure dissociate extremely slowly5 and cannot be disrupted by strictly competitive inhibitors. IgE-Fc conformational flexibility indicated that inhibition could be mediated by allosteric or other non-classical mechanisms6–8. Here we demonstrate that an engineered protein inhibitor, DARPin E2_799–11, acts through a non-classical inhibition mechanism, not only blocking IgE:FcεRI interactions, but actively stimulating the dissociation of preformed ligand-receptor complexes. The structure of the E2_79:IgE-Fc3-4 complex predicts the presence of two non-equivalent E2_79 sites in the asymmetric IgE:FcεRI complex, with Site 1 distant from the receptor and Site 2 exhibiting partial steric overlap. While the structure is suggestive of an allosteric inhibition mechanism, mutational studies and quantitative kinetic modeling indicate that E2_79 acts through a facilitated dissociation mechanism at Site 2 alone. These results demonstrate that high affinity IgE:FcεRI complexes can be actively dissociated to block the allergic response and suggest that protein:protein complexes may be more generally amenable to active disruption by macromolecular inhibitors. PMID:23103871

Evaluation of Relationship between Obsessive-compulsive Disorder and Dissociative Experiences

PubMed Central

Cetinkaya, Ozlem; Maner, Fulya

2018-01-01

Objective The aim of the study is to evaluate the relationship between obsessive-compulsive disorder (OCD) symptoms and dissociative experiences and the effect of childhood traumatic experiences on this relationship in OCD patients. Methods Fifty consecutive OCD patients and 50 healthy controls are enrolled for this study. Sociodemographic and Clinical Data Form, Dissociative Experiences Scale (DES), Padua Inventory (PI) and Childhood Trauma Questionnaire (CTQ) are applied to participants. Results Average DES total score in the patient group is 20.58 and in the control group it is 4.87. In the patient group, when we evaluate the relation strengths of DES total and subscale scores with PI total score, we found out that amnesia subscale has r=0.361 (p<0.01), absorption subscale has r=0.611 (p<0.01), depersonalization/derealization subscale has r=0.574 (p<0.01), and DES total score has r=0.55 (p<0.01) relation strengths with PI total score. In patient group both DES total score and CTQ total score have influence on PI total score independently from each other. In addition to this, the level of the influence of DES total scores on PI total scores is, R2=0.399 (p<0.01) and the level of the influence of CTQ total scores on PI total scores is R2=0.343 (p<0.01). Conclusion Dissociative experiences are seen more frequently in OCD patients than healthy controls. Among dissociative experiences, absorption has stronger relation with OCD symptoms. The relation between OCD and dissociation is independent from and stronger than the relation between childhood traumatic experiences and OCD. PMID:29739129

fMRI functional connectivity of the periaqueductal gray in PTSD and its dissociative subtype.

PubMed

Harricharan, Sherain; Rabellino, Daniela; Frewen, Paul A; Densmore, Maria; Théberge, Jean; McKinnon, Margaret C; Schore, Allan N; Lanius, Ruth A

2016-12-01

Posttraumatic stress disorder (PTSD) is associated with hyperarousal and active fight or flight defensive responses. By contrast, the dissociative subtype of PTSD, characterized by depersonalization and derealization symptoms, is frequently accompanied by additional passive or submissive defensive responses associated with autonomic blunting. Here, the periaqueductal gray (PAG) plays a central role in defensive responses, where the dorsolateral (DL-PAG) and ventrolateral PAG (VL-PAG) are thought to mediate active and passive defensive responses, respectively. We examined PAG subregion (dorsolateral and ventrolateral) resting-state functional connectivity in three groups: PTSD patients without the dissociative subtype ( n  = 60); PTSD patients with the dissociative subtype ( n  = 37); and healthy controls ( n  = 40) using a seed-based approach via PickAtlas and SPM12. All PTSD patients showed extensive DL- and VL-PAG functional connectivity at rest with areas associated with emotional reactivity and defensive action as compared to controls ( n  = 40). Although all PTSD patients demonstrated DL-PAG functional connectivity with areas associated with initiation of active coping strategies and hyperarousal (e.g., dorsal anterior cingulate; anterior insula), only dissociative PTSD patients exhibited greater VL-PAG functional connectivity with brain regions linked to passive coping strategies and increased levels of depersonalization (e.g., temporoparietal junction; rolandic operculum). These findings suggest greater defensive posturing in PTSD patients even at rest and demonstrate that those with the dissociative subtype show unique patterns of PAG functional connectivity when compared to those without the subtype. Taken together, these findings represent an important first step toward identifying neural and behavioral targets for therapeutic interventions that address defensive strategies in trauma-related disorders.

Hydrogenation of coal liquid utilizing a metal carbonyl catalyst

DOEpatents

Feder, Harold M.; Rathke, Jerome W.

1979-01-01

Coal liquid having a dissolved transition metal, catalyst as a carbonyl complex such as Co.sub.2 (CO.sub.8) is hydrogenated with hydrogen gas or a hydrogen donor. A dissociating solvent contacts the coal liquid during hydrogenation to form an immiscible liquid mixture at a high carbon monoxide pressure. The dissociating solvent, e.g. ethylene glycol, is of moderate coordinating ability, while sufficiently polar to solvate the transition metal as a complex cation along with a transition metal, carbonyl anion in solution at a decreased carbon monoxide pressure. The carbon monoxide pressure is reduced and the liquids are separated to recover the hydrogenated coal liquid as product. The dissociating solvent with the catalyst in ionized form is recycled to the hydrogenation step at the elevated carbon monoxide pressure for reforming the catalyst complex within fresh coal liquid.

A Unified Kinetics and Equilibrium Experiment: Rate Law, Activation Energy, and Equilibrium Constant for the Dissociation of Ferroin

ERIC Educational Resources Information Center

Sattar, Simeen

2011-01-01

Tris(1,10-phenanthroline)iron(II) is the basis of a suite of four experiments spanning 5 weeks. Students determine the rate law, activation energy, and equilibrium constant for the dissociation of the complex ion in acid solution and base dissociation constant for phenanthroline. The focus on one chemical system simplifies a daunting set of…

Dissociation of Multisubunit Protein-Ligand Complexes in the Gas Phase. Evidence for Ligand Migration

NASA Astrophysics Data System (ADS)

Zhang, Yixuan; Deng, Lu; Kitova, Elena N.; Klassen, John S.

2013-10-01

The results of collision-induced dissociation (CID) experiments performed on gaseous protonated and deprotonated ions of complexes of cholera toxin B subunit homopentamer (CTB5) with the pentasaccharide (β-D-Gal p-(1→3)-β-D-Gal pNAc-(1→4)[α-D-Neu5Ac-(2→3)]-β-D-Gal p-(1→4)-β-D-Glc p (GM1)) and corresponding glycosphingolipid (β-D-Gal p-(1→3)-β-D-Gal pNAc-(1→4)[α-D-Neu5Ac-(2→3)]-β-D-Gal p-(1→4)-β-D-Glc p-Cer (GM1-Cer)) ligands, and the homotetramer streptavidin (S4) with biotin (B) and 1,2-dipalmitoyl- sn-glycero-3-phosphoethanolamine-N-(biotinyl) (Btl), are reported. The protonated (CTB5 + 5GM1)n+ ions dissociated predominantly by the loss of a single subunit, with the concomitant migration of ligand to another subunit. The simultaneous loss of ligand and subunit was observed as a minor pathway. In contrast, the deprotonated (CTB5 + 5GM1)n- ions dissociated preferentially by the loss of deprotonated ligand; the loss of ligand-bound and ligand-free subunit were minor pathways. The presence of ceramide (Cer) promoted ligand migration and the loss of subunit. The main dissociation pathway for the protonated and deprotonated (S4 + 4B)n+/- ions, as well as for deprotonated (S4 + 4Btl)n- ions, was loss of the ligand. However, subunit loss from the (S4 + 4B)n+ ions was observed as a minor pathway. The (S4 + 4Btl)n+ ions dissociated predominantly by the loss of free and ligand-bound subunit. The charge state of the complex and the collision energy were found to have little effect on the relative contribution of the different dissociation channels. Thermally-driven ligand migration between subunits was captured in the results of molecular dynamics simulations performed on protonated (CTB5 + 5GM1)15+ ions (with a range of charge configurations) at 800 K. Notably, the migration pathway was found to be highly dependent on the charge configuration of the ion. The main conclusion of this study is that the dissociation pathways of multisubunit protein-ligand complexes in the gas phase depend, not only on the native topology of the complex, but also on structural changes that occur upon collisional activation.

Inositol hexakisphosphate kinase-1 mediates assembly/disassembly of the CRL4–signalosome complex to regulate DNA repair and cell death

PubMed Central

Rao, Feng; Xu, Jing; Khan, A. Basit; Gadalla, Moataz M.; Cha, Jiyoung Y.; Xu, Risheng; Tyagi, Richa; Dang, Yongjun; Chakraborty, Anutosh; Snyder, Solomon H.

2014-01-01

Inositol polyphosphates containing an energetic pyrophosphate bond are formed primarily by a family of three inositol hexakisphosphate (IP6) kinases (IP6K1–3). The Cullin-RING ubiquitin ligases (CRLs) regulate diverse biological processes through substrate ubiquitylation. CRL4, comprising the scaffold Cullin 4A/B, the E2-interacting Roc1/2, and the adaptor protein damage-specific DNA-binding protein 1, is activated by DNA damage. Basal CRL4 activity is inhibited by binding to the COP9 signalosome (CSN). UV radiation and other stressors dissociate the complex, leading to E3 ligase activation, but signaling events that trigger signalosome dissociation from CRL4 have been unclear. In the present study, we show that, under basal conditions, IP6K1 forms a ternary complex with CSN and CRL4 in which IP6K1 and CRL4 are inactive. UV dissociates IP6K1 to generate IP7, which then dissociates CSN–CRL4 to activate CRL4. Thus, IP6K1 is a novel CRL4 subunit that transduces UV signals to mediate disassembly of the CRL4–CSN complex, thereby regulating nucleotide excision repair and cell death. PMID:25349427

Probing the energetics of dissociation of carbonic anhydrase-ligand complexes in the gas phase.

PubMed Central

Gao, J; Wu, Q; Carbeck, J; Lei, Q P; Smith, R D; Whitesides, G M

1999-01-01

This paper describes the use of electrospray ionization-Fourier transform ion cyclotron mass spectrometry (ESI-FTICR-MS) to study the relative stabilities of noncovalent complexes of carbonic anhydrase II (CAII, EC 4.2.1.1) and benzenesulfonamide inhibitors in the gas phase. Sustained off-resonance irradiation collision-induced dissociation (SORI-CID) was used to determine the energetics of dissociation of these CAII-sulfonamide complexes in the gas phase. When two molecules of a benzenesulfonamide (1) were bound simultaneously to one molecule of CAII, one of them was found to exhibit significantly weaker binding (DeltaE50 = 0.4 V, where E50 is defined as the amplitude of sustained off-resonance irradiation when 50% of the protein-ligand complexes are dissociated). In solution, the benzenesulfonamide group coordinates as an anion to a Zn(II) ion bound at the active site of the enzyme. The gas phase stability of the complex with the weakly bound inhibitor was the same as that of the inhibitor complexed with apoCAII (i.e., CAII with the Zn(II) ion removed from the binding site). These results indicate that specific interactions between the sulfonamide group on the inhibitor and the Zn(II) ion on CAII were preserved in the gas phase. Experiments also showed a higher gas phase stability for the complex of para-NO2-benzenesulfonamide-CAII than that for ortho-NO2-benzenesulfonamide-CAII complex. This result further suggests that steric interactions of the inhibitors with the binding pocket of CAII parallel those in solution. Overall, these results are consistent with the hypothesis that CAII retains, at least partially, the structure of its binding pocket in the gas phase on the time scale (seconds to minutes) of the ESI-FTICR measurements. PMID:10354450

Understanding Phonological Memory Deficits in Boys with Attention-Deficit/Hyperactivity Disorder (ADHD): Dissociation of Short-Term Storage and Articulatory Rehearsal Processes

ERIC Educational Resources Information Center

Bolden, Jennifer; Rapport, Mark D.; Raiker, Joseph S.; Sarver, Dustin E.; Kofler, Michael J.

2012-01-01

The current study dissociated and examined the two primary components of the phonological working memory subsystem--the short-term store and articulatory rehearsal mechanism--in boys with ADHD (n = 18) relative to typically developing boys (n = 15). Word lists of increasing length (2, 4, and 6 words per trial) were presented to and recalled by…

[Mental disorders in adolescence: current trends in therapy].

PubMed

de Vries, Ulrike; Lehmkuhl, Gerd; Petermann, Franz

2013-01-01

On the basis of the high prevalence for behavioural problems and mental disorders in adolescence and its persistence into adulthood it is tested whether and based upon which emphasis this topic is considered in the recent discussion on psychotherapy. Therefore, a bibliometric analysis is given that summarizes the issue in the 2011 and 2012 volumes of representative German child and adolescent psychological and psychiatric journals. The focus lies on conduct disorder, depression, deliberate self-harm, dissociative disorder, and post traumatic stress disorder.

Acute Stress Disorder Symptoms Predict All-Cause Mortality Among Myocardial Infarction Patients: a 15-Year Longitudinal Study.

PubMed

Ginzburg, Karni; Kutz, Ilan; Koifman, Bella; Roth, Arie; Kriwisky, Michael; David, Daniel; Bleich, Avi

2016-04-01

Studies have recognized myocardial infarction (MI) as a risk for acute stress disorder (ASD), manifested in dissociative, intrusive, avoidant, and hyperarousal symptoms during hospitalization. This study examined the prognostic role of ASD symptoms in predicting all-cause mortality in MI patients over a period of 15 years. One hundred and ninety-three MI patients filled out questionnaires assessing ASD symptoms during hospitalization. Risk factors and cardiac prognostic measures were collected from patients' hospital records. All-cause mortality was longitudinally assessed, with an endpoint of 15 years after the MI. Of the participants, 21.8 % died during the follow-up period. The decedents had reported higher levels of ASD symptoms during hospitalization than had the survivors, but this effect became nonsignificant when adjusting for age, sex, education, left ventricular ejection fraction, and depression. A series of analyses conducted on each of the ASD symptom clusters separately indicated that-after adjusting for age, sex, education, left ventricular ejection fraction, and depression-dissociative symptoms significantly predicted all-cause mortality, indicating that the higher the level of in-hospital dissociative symptoms, the shorter the MI patients' survival time. These findings suggest that in-hospital dissociative symptoms should be considered in the risk stratification of MI patients.

Dissociation in Optokinetic Stimulation Sensitivity between Omission and Substitution Reading Errors in Neglect Dyslexia.

PubMed

Daini, Roberta; Albonico, Andrea; Malaspina, Manuela; Martelli, Marialuisa; Primativo, Silvia; Arduino, Lisa S

2013-01-01

Although omission and substitution errors in neglect dyslexia (ND) patients have always been considered as different manifestations of the same acquired reading disorder, recently, we proposed a new dual mechanism model. While omissions are related to the exploratory disorder which characterizes unilateral spatial neglect (USN), substitutions are due to a perceptual integration mechanism. A consequence of this hypothesis is that specific training for omission-type ND patients would aim at restoring the oculo-motor scanning and should not improve reading in substitution-type ND. With this aim we administered an optokinetic stimulation (OKS) to two brain-damaged patients with both USN and ND, MA and EP, who showed ND mainly characterized by omissions and substitutions, respectively. MA also showed an impairment in oculo-motor behavior with a non-reading task, while EP did not. The two patients presented a dissociation with respect to their sensitivity to OKS, so that, as expected, MA was positively affected, while EP was not. Our results confirm a dissociation between the two mechanisms underlying omission and substitution reading errors in ND patients. Moreover, they suggest that such a dissociation could possibly be extended to the effectiveness of rehabilitative procedures, and that patients who mainly omit contralesional-sided letters would benefit from OKS.

Which method of posttraumatic stress disorder classification best predicts psychosocial function in children with traumatic brain injury?

PubMed

Iselin, Greg; Le Brocque, Robyne; Kenardy, Justin; Anderson, Vicki; McKinlay, Lynne

2010-10-01

Controversy surrounds the classification of posttraumatic stress disorder (PTSD), particularly in children and adolescents with traumatic brain injury (TBI). In these populations, it is difficult to differentiate TBI-related organic memory loss from dissociative amnesia. Several alternative PTSD classification algorithms have been proposed for use with children. This paper investigates DSM-IV-TR and alternative PTSD classification algorithms, including and excluding the dissociative amnesia item, in terms of their ability to predict psychosocial function following pediatric TBI. A sample of 184 children aged 6-14 years were recruited following emergency department presentation and/or hospital admission for TBI. PTSD was assessed via semi-structured clinical interview (CAPS-CA) with the child at 3 months post-injury. Psychosocial function was assessed using the parent report CHQ-PF50. Two alternative classification algorithms, the PTSD-AA and 2 of 3 algorithms, reached statistical significance. While the inclusion of the dissociative amnesia item increased prevalence rates across algorithms, it generally resulted in weaker associations with psychosocial function. The PTSD-AA algorithm appears to have the strongest association with psychosocial function following TBI in children and adolescents. Removing the dissociative amnesia item from the diagnostic algorithm generally results in improved validity. Copyright 2010 Elsevier Ltd. All rights reserved.

Associations of emotional arousal, dissociation and symptom severity with operant conditioning in borderline personality disorder.

PubMed

Paret, Christian; Hoesterey, Steffen; Kleindienst, Nikolaus; Schmahl, Christian

2016-10-30

Those with borderline personality disorder (BPD) display altered evaluations regarding reward and punishment compared to others. The processing of rewards is basal for operant conditioning. However, studies addressing operant conditioning in BPD patients are rare. In the current study, an operant conditioning task combining learning acquisition and reversal was used. BPD patients and matched healthy controls (HCs) were exposed to aversive and neutral stimuli to assess the influence of emotion on learning. Picture content, dissociation, aversive tension and symptom severity were rated. Error rates were measured. Results showed no group interactions between aversive versus neutral scenes. The higher emotional arousal, dissociation and tension, the worse the acquisition, but not reversal, scores were for BPD patients. Scores from the Borderline Symptom List were associated with more errors in the reversal, but not the acquisition phase. The results are preliminary evidence for impaired acquisition learning due to increased emotional arousal, dissociation and tension in BPD patients. A failure to process punishment in the reversal phase was associated with symptom severity and may be related to neuropsychological dysfunctioning involving the ventromedial prefrontal cortex. Conclusions are limited due to the correlational study design and the small sample size. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Dissociation in Optokinetic Stimulation Sensitivity between Omission and Substitution Reading Errors in Neglect Dyslexia

PubMed Central

Daini, Roberta; Albonico, Andrea; Malaspina, Manuela; Martelli, Marialuisa; Primativo, Silvia; Arduino, Lisa S.

2013-01-01

Although omission and substitution errors in neglect dyslexia (ND) patients have always been considered as different manifestations of the same acquired reading disorder, recently, we proposed a new dual mechanism model. While omissions are related to the exploratory disorder which characterizes unilateral spatial neglect (USN), substitutions are due to a perceptual integration mechanism. A consequence of this hypothesis is that specific training for omission-type ND patients would aim at restoring the oculo-motor scanning and should not improve reading in substitution-type ND. With this aim we administered an optokinetic stimulation (OKS) to two brain-damaged patients with both USN and ND, MA and EP, who showed ND mainly characterized by omissions and substitutions, respectively. MA also showed an impairment in oculo-motor behavior with a non-reading task, while EP did not. The two patients presented a dissociation with respect to their sensitivity to OKS, so that, as expected, MA was positively affected, while EP was not. Our results confirm a dissociation between the two mechanisms underlying omission and substitution reading errors in ND patients. Moreover, they suggest that such a dissociation could possibly be extended to the effectiveness of rehabilitative procedures, and that patients who mainly omit contralesional-sided letters would benefit from OKS. PMID:24062678

Relationships between a Dissociative Subtype of PTSD and Clinical Characteristics in Patients with Substance Use Disorders.

PubMed

Mergler, Michaela; Driessen, Martin; Lüdecke, Christel; Ohlmeier, Martin; Chodzinski, Claudia; Weirich, Steffen; Schläfke, Detlef; Wedekind, Dirk; Havemann-Reinecke, Ursula; Renner, Walter; Schäfer, Ingo

2017-01-01

The increasing support for a dissociative subtype of post-traumatic stress disorder (PTSD-D) has led to its inclusion in DSM-5. We examined relationships between PTSD-D and relevant variables in patients with substance use disorders (SUD). The sample comprised N = 459 patients with SUD. The International Diagnostic Checklist and the Posttraumatic Diagnostic Scale were used to diagnose PTSD. In addition, participants completed the Childhood Trauma Questionnaire and the Dissociative Experiences Scale. The course of SUD was assessed by means of the European Addiction Severity Index. One-fourth of participants fulfilled a diagnosis of PTSD (25.3%). Patients with PTSD-D (N = 32, 27.6% of all patients with PTSD) reported significantly more current depressive symptoms, more current suicidal thoughts, more lifetime anxiety/tension, and more suicide attempts. The PTSD-D group also showed a significantly higher need for treatment due to drug problems, higher current use of opiates/analgesics, and a higher number of lifetime drug overdoses. In a regression model, symptoms of depression in the last month and lifetime suicide attempts significantly predicted PTSD-D. These findings suggest that PTSD-D is related to additional psychopathology and to a more severe course of substance-related problems in patients with SUD, indicating that this group also has additional treatment needs.

Dissociable attentional and affective circuits in medication-naïve children with attention-deficit/hyperactivity disorder.

PubMed

Posner, Jonathan; Rauh, Virginia; Gruber, Allison; Gat, Inbal; Wang, Zhishun; Peterson, Bradley S

2013-07-30

Current neurocognitive models of attention-deficit/hyperactivity disorder (ADHD) suggest that neural circuits involving both attentional and affective processing make independent contributions to the phenomenology of the disorder. However, a clear dissociation of attentional and affective circuits and their behavioral correlates has yet to be shown in medication-naïve children with ADHD. Using resting-state functional connectivity MRI (rs-fcMRI) in a cohort of medication naïve children with (N=22) and without (N=20) ADHD, we demonstrate that children with ADHD have reduced connectivity in two neural circuits: one underlying executive attention (EA) and the other emotional regulation (ER). We also demonstrate a double dissociation between these two neural circuits and their behavioral correlates such that reduced connectivity in the EA circuit correlates with executive attention deficits but not with emotional lability, while on the other hand, reduced connectivity in the ER circuit correlates with emotional lability but not with executive attention deficits. These findings suggest potential avenues for future research such as examining treatment effects on these two neural circuits as well as the potential prognostic and developmental significance of disturbances in one circuit vs the other. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Association among Childhood Trauma, Pathological Dissociation and Gambling Severity in Casino Gamblers.

PubMed

Imperatori, Claudio; Innamorati, Marco; Bersani, Francesco Saverio; Imbimbo, Francesca; Pompili, Maurizio; Contardi, Anna; Farina, Benedetto

2017-01-01

The aim of the present study was to explore the role of pathological dissociation in mediating the association between childhood trauma (CT) and gambling severity. One hundred seventy-one (134 men and 37 women) gamblers recruited in gambling environments (i.e., two Italian casinos) have been enrolled in the study. Psychopathological assessments included the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale-Taxon (DES-T), the South Oaks Gambling Screen (SOGS), the CAGE and the Hospital Anxiety and Depression Scale. A mediational model, analyzing the direct and indirect effects of CTQ on SOGS through the mediating role of DES-T, showed that the relation between CTQ and SOGS was fully mediated by DES-T scores (b = 0.07; se = 0.15; p < 0.001). This finding raises the possibility that CT explains gambling severity through the presence of pathological dissociative symptoms and dissociative pathogenetic processes. Copyright © 2015 John Wiley & Sons, Ltd. Gambling severity is associated with both childhood trauma and pathological dissociation in casino gamblers. A mediational model shows that the effect of childhood trauma on gambling severity is entirely mediated by pathological dissociation. From a clinical point of view, our results highlight the importance of assessing, and possibly treating, dissociative symptoms in individuals with gambling disorder. Copyright © 2015 John Wiley & Sons, Ltd.

Solution Structure of the N-Terminal Domain of Mediator Subunit MED26 and Molecular Characterization of Its Interaction with EAF1 and TAF7.

PubMed

Lens, Zoé; Cantrelle, François-Xavier; Peruzzini, Riccardo; Hanoulle, Xavier; Dewitte, Frédérique; Ferreira, Elisabeth; Baert, Jean-Luc; Monté, Didier; Aumercier, Marc; Villeret, Vincent; Verger, Alexis; Landrieu, Isabelle

2017-10-13

MED26 is a subunit of Mediator, a large complex central to the regulation of gene transcription by RNA Polymerase II. MED26 plays a role in the switch between the initiation and elongation phases of RNA Polymerase II-mediated transcription process. Regulation of these steps requires successive binding of MED26 N-terminal domain (NTD) to TATA-binding protein-associated factor 7 (TAF7) and Eleven-nineteen lysine-rich in leukemia-Associated Factor 1 (EAF1). In order to investigate the mechanism of regulation by MED26, MED26-NTD structure was solved by NMR, revealing a 4-helix bundle. EAF1 (239-268) and TAF7 (205-235) peptide interactions were both mapped to the same groove formed by H3 and H4 helices of MED26-NTD. Both interactions are characterized by dissociation constants in the 10-μM range. Further experiments revealed a folding-upon-binding mechanism that leads to the formation of EAF1 (N247-S260) and TAF7 (L214-S227) helices. Chemical shift perturbations and nuclear Overhauser enhancement contacts support the involvement of residues I222/F223 in anchoring TAF7 helix to a hydrophobic pocket of MED26-NTD, including residues L48, W80 and I84. In addition, Ala mutations of charged residues located in the C-terminal disordered part of TAF7 and EAF1 peptides affected the binding, with a loss of affinity characterized by a 10-time increase of dissociation constants. A structural model of MED26-NTD/TAF7 complex shows bi-partite components, combining ordered and disordered segments, as well as hydrophobic and electrostatic contributions to the binding. This study provides molecular detail that will help to decipher the mechanistic basis for the initiation to elongation switch-function mediated by MED26-NTD. Copyright © 2017 Elsevier Ltd. All rights reserved.

Adsorption and reactions on a surface alloy: CO, NO, O 2 and CO 2 on Pd(100)-Mn-c(2×2)

NASA Astrophysics Data System (ADS)

Sandell, A.; Jaworowski, A. J.; Beutler, A.; Wiklund, M.

1999-02-01

The adsorption properties of the Pd(100)-Mn-c(2×2) surface alloy have been investigated using photoemission of both core and valence levels. CO adsorbs in a molecular form without affecting the alloy structure. Two CO species were found, one bonded to Pd, which desorbs upon heating to 270 K , and one bonded to Mn, which desorbs when heating to 400 K. O 2 destroys the alloy, leading to a disordered surface with MnO x complexes. The MnO x aggregates stabilize adsorbed CO 2 and act as active sites for the following oxidation reactions at 110 K: CO+O→CO 2, CO+2O→CO 3δ- and CO 2+O→CO 3δ-. The CO 2 species desorbs upon heating to 170 K , whereas the CO 3δ- species is stable up to temperatures between 300 and 500 K. When exposed to low amounts of NO at 110 K, the major part of the molecules dissociates in order to form MnO x, thereby destroying the alloy. Larger NO doses yield an increasing amount of molecular NO, which dissociate upon heating to 300 K. CO can react with the dissociated NO to form CO 2 and another species with a C 1s binding energy and thermal stability similar to that of CO 3δ-. This species was tentatively identified as -NCO or -NCO 2.

Latent profile analysis and principal axis factoring of the DSM-5 dissociative subtype

PubMed Central

Frewen, Paul A.; Brown, Matthew F. D.; Steuwe, Carolin; Lanius, Ruth A.

2015-01-01

Objective A dissociative subtype has been recognized based on the presence of experiences of depersonalization and derealization in relation to DSM-IV posttraumatic stress disorder (PTSD). However, the dissociative subtype has not been assessed in a community sample in relation to the revised DSM-5 PTSD criteria. Moreover, the 20-item PTSD Checklist for DSM-5 (PCL-5) currently does not assess depersonalization and derealization. Method We therefore evaluated two items for assessing depersonalization and derealization in 557 participants recruited online who endorsed PTSD symptoms of at least moderate severity on the PCL-5. Results A five-class solution identified two PTSD classes who endorsed dissociative experiences associated with either 1) severe or 2) moderate PTSD symptom severity (D-PTSD classes). Those in the severe dissociative class were particularly likely to endorse histories of childhood physical and sexual abuse. A principal axis factor analysis of the symptom list identified six latent variables: 1) Reexperiencing, 2) Emotional Numbing/Anhedonia, 3) Dissociation, 4) Negative Alterations in Cognition & Mood, 5) Avoidance, and 6) Hyperarousal. Conclusions The present results further support the presence of a dissociative subtype within the DSM-5 criteria for PTSD. PMID:25854673

Structures and physical properties of gaseous metal cationized biological ions.

PubMed

Burt, Michael B; Fridgen, Travis D

2012-01-01

Metal chelation can alter the activity of free biomolecules by modifying their structures or stabilizing higher energy tautomers. In recent years, mass spectrometric techniques have been used to investigate the effects of metal complexation with proteins, nucleobases and nucleotides, where small conformational changes can have significant physiological consequences. In particular, infrared multiple photon dissociation spectroscopy has emerged as an important tool for determining the structure and reactivity of gas-phase ions. Unlike other mass spectrometric approaches, this method is able to directly resolve structural isomers using characteristic vibrational signatures. Other activation and dissociation methods, such as blackbody infrared radiative dissociation or collision-induced dissociation can also reveal information about the thermochemistry and dissociative pathways of these biological ions. This information can then be used to provide information about the structures of the ionic complexes under study. In this article, we review the use of gas-phase techniques in characterizing metal-bound biomolecules. Particular attention will be given to our own contributions, which detail the ability of metal cations to disrupt nucleobase pairs, direct the self-assembly of nucleobase clusters and stabilize non-canonical isomers of amino acids.

The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders

PubMed Central

Cronin, Elisabeth; Brand, Bethany L.; Mattanah, Jonathan F.

2014-01-01

Background Research has shown that the therapeutic alliance plays an important role in enhancing treatment outcome among individuals with a variety of disorders, including posttraumatic stress disorder (PTSD). However, the therapeutic alliance and treatment outcome has not yet been studied in dissociative disorders (DD). Objectives The current study sought to investigate the impact of alliance on treatment outcome for DD patients. Methods Data from a naturalistic, longitudinal international treatment study of DD patients and their therapists were analyzed to determine if the alliance, as reported by patients and therapists, was associated with treatment outcome. Results Patients with higher self-rated alliance had fewer symptoms of dissociation, PTSD, and general distress, as well as higher levels of therapist-rated adaptive functioning. Over time, self-rated alliance scores predicted better outcomes, after controlling for patient adaptive capacities including symptom management at the time when the alliance ratings were made. Patient-rated alliance was more strongly associated with outcome than therapist-rated alliance. Conclusion Therapists who work with DD patients should understand the importance of the alliance on treatment outcome. These findings are consistent with previous literature demonstrating the importance of developing and maintaining a strong therapeutic alliance, although the effect sizes of individuals with DD were stronger than what has been found in many other patient groups. A greater understanding of the impact of the alliance in traumatized individuals may contribute to better outcomes for these individuals. PMID:24616755

The Evolving Construct of Posttraumatic Stress Disorder (PTSD): DSM-5 Criteria Changes and Legal Implications

PubMed Central

Zoellner, Lori A.; Bedard-Gilligan, Michele A.; Jun, Janie J.; Marks, Libby H.; Garcia, Natalia M.

2014-01-01

In the DSM-5, the diagnosis of posttraumatic stress disorder (PTSD) has undergone multiple, albeit minor, changes. These changes include shifting PTSD placement from within the anxiety disorders into a new category of traumatic and stressor-related disorders, alterations in the definition of a traumatic event, shifting of the symptom cluster structure from three to four clusters, the addition of new symptoms including persistent negative beliefs and expectations about oneself or the world, persistent distorted blame of self or others, persistent negative trauma-related emotions, and risky or reckless behaviors, and the addition of a dissociative specifier. The evidence or lack thereof behind each of these changes is briefly reviewed. These changes, although not likely to change overall prevalence, have the potential to increase the heterogeneity of individuals receiving a PTSD diagnosis both by altering what qualifies as a traumatic event and by adding symptoms commonly occurring in other disorders such as depression, borderline personality disorder, and dissociative disorders. Legal implications of these changes include continued confusion regarding what constitutes a traumatic stressor, difficulties with differential diagnosis, increased ease in malingering, and improper linking of symptoms to causes of behavior. These PTSD changes are discussed within the broader context of DSM reliability and validity concerns. PMID:24470838

Nativism versus Neuroconstructivism: Rethinking the Study of Developmental Disorders

ERIC Educational Resources Information Center

Karmiloff-Smith, Annette

2009-01-01

This article argues that one dominant position in psychology, linguistics, neuroscience, and philosophy about how genetic disorders point to the innate specification of dissociated modules in the human brain should be replaced by a dynamic, neuroconstructivist approach in which genes, brain, cognition, and environment interact multidirectionally.…

New Jersey Journal of Professional Counseling, 2001/2002.

ERIC Educational Resources Information Center

Westburg, Nancy G., Ed.

2002-01-01

This journal volume focuses on three areas: technology and the appropriate use of the internet for support groups; diversity issues that affect clients and counselors-in-training; and the clinical issues section that provides an integrated view of Attention Deficit/Hyperactivity Disorder and an overview of Dissociative Identity Disorder. It…

Altered Pre-Reflective Sense of Agency in Autism Spectrum Disorders as Revealed by Reduced Intentional Binding

ERIC Educational Resources Information Center

Sperduti, Marco; Pieron, Marie; Leboyer, Marion; Zalla, Tiziana

2014-01-01

Autism spectrum disorders (ASDs) are neurodevelopmental conditions that severely affect social interaction, communication and several behavioural and cognitive functions, such as planning and monitoring motor actions. A renewed interest in intrapersonal cognition has recently emerged suggesting a putative dissociation between impaired declarative…

Dissociation and purification of the endogenous membrane-bound Vo complex from Pichia pastoris.

PubMed

Li, Sumei; Hong, Tao; Wang, Kun; Lu, Yinghong; Zhou, Min

2017-10-01

Most proteins occur and function in complexes rather than as isolated entities in membranes. In most cases macromolecules with multiple subunits are purified from endogenous sources. In this study, an endogenous membrane-protein complex was obtained from Pichia pastoris, which can be grown at high densities to significantly improve the membrane protein yield. We successfully isolated the membrane-bound Vo complex of V-ATPase from P. pastoris using a fusion FLAG tag attached to the C-terminus of subunit a to generate the vph-tag strain, which was used for dissociation and purification. After FLAG affinity and size exclusion chromatography purification, the production quantity and purity of the membrane-bound Vo complex was 20 μg l -1 and >98%, respectively. The subunits of the endogenous membrane-bound Vo complex observed in P. pastoris were similar to those obtained from S. cerevisiae, as demonstrated by liquid chromatography-tandem mass spectrometry (LC-MS-MS). Therefore, successful dissociation and purification of the membrane-bound Vo complex at a high purity and sufficient quantity was achieved via a rapid and simple procedure that can be used to obtain the endogenous membrane-protein complexes from P. pastoris. Copyright © 2017 Elsevier Inc. All rights reserved.

Gas-phase behaviour of Ru(II) cyclopentadienyl-derived complexes with N-coordinated ligands by electrospray ionization mass spectrometry: fragmentation pathways and energetics.

PubMed

Madeira, Paulo J Amorim; Morais, Tânia S; Silva, Tiago J L; Florindo, Pedro; Garcia, M Helena

2012-08-15

The gas-phase behaviour of six Ru(II) cyclopentadienyl-derived complexes with N-coordinated ligands, compounds with antitumor activities against several cancer lines, was studied. This was performed with the intent of establishing fragmentation pathways and to determine the Ru-L(N) and Ru-L(P) ligand bond dissociation energies. Such knowledge can be an important tool for the postulation of the mechanisms of action of these anticancer drugs. Two types of instruments equipped with electrospray ionisation were used (ion trap and a Fourier transform ion cyclotron resonance (FTICR) mass spectrometer). The dissociation energies were determined using energy-variable collision-induced dissociation measurements in the ion trap. The FTICR instrument was used to perform MS(n) experiments on one of the compounds and to obtain accurate mass measurements. Theoretical calculations were performed at the density functional theory (DFT) level using two different functionals (B3LYP and M06L) to estimate the dissociation energies of the complexes under study. The influence of the L(N) on the bond dissociation energy (D) of RuCp compounds with different nitrogen ligands was studied. The lability order of L(N) was: imidazole<1-butylimidazole<5-phenyl-1H-tetrazole<1-benzylimidazole. Both the functionals used gave the following ligand lability order: imidazole<1-benzylimidazole<5-phenyl-1H-tetrazole<1-butylimidazole. It is clear that there is an inversion between 1-benzylimidazole and 1-butylimidazole for the experimental and theoretical lability orders. The M06L functional afforded values of D closer to the experimental values. The type of phosphane (L(P) ) influenced the dissociation energies, with values of D being higher for Ru-L(N) with 1-butylimidazole when the phosphane was 1,2-bis(diphenylphosphino)ethane. The Ru-L(P) bond dissociation energy for triphenylphosphane was independent of the type of complex. The D values of Ru-L(N) and Ru-L(P) were determined for all six compounds and compared with the values calculated by the DFT method. For the imidazole-derived ligands the energy trend was rationalized in terms of the increasing extension of the σ-donation/π-backdonation effect. The bond dissociation energy of Ru-PPh(3) was independent of the fragmentations. Copyright © 2012 John Wiley & Sons, Ltd.

EXAFS characterisation of metal bonding in highly luminescent, UV stable, water-soluble and biocompatible lanthanide complexes

NASA Astrophysics Data System (ADS)

Kalyakina, A.; Utochnikova, V.; Trigub, A.; Zubavichus, Y.; Kuzmina, N.; Bräse, S.

2016-05-01

The combination of X-ray diffraction with EXAFS was employed to assess the coordination environment of lanthanide complexes in solutions. This method is based on the assumption that the local structure of lanthanide complexes in solution combines elements of the crystal structure of the complex in the solid state (single- or polycrystalline) and the elements of the local structure of a lanthanide salt, completely dissociated in the solvent (usually chlorides). The success of this approach is demonstrated with the lanthanide (III) 2,3,4,5,6-pentafluorobenzoate complexes, where the local structure in aqueous and methanol solutions were estimated. Moreover, the dissociation degree of the complexes in aqueous and methanol solutions was evaluated.

Individual correlates of self-stigma in patients with anxiety disorders with and without comorbidities

PubMed Central

Ociskova, Marie; Prasko, Jan; Kamaradova, Dana; Grambal, Ales; Sigmundova, Zuzana

2015-01-01

Background A number of psychiatric patients experience stigma connected to prejudices about mental disorders. It has been shown that stigma is most harmful when it is internalized. Most of the studies were performed on individuals either with psychoses or with mood disorders, and hence, there are almost no studies with other diagnostic categories. The goals of this research were to identify factors that are significantly related to self-stigma in patients with anxiety disorders and to suggest possible models of causality for these relationships. Methods A total of 109 patients with anxiety disorders and possible comorbid depressive or personality disorders, who were admitted to the psychotherapeutic department participated in this study. All patients completed several psychodiagnostic methods, ie, the Internalized Stigma of Mental Illness Scale, Temperament and Character Inventory-Revised Version, Adult Dispositional Hope Scale, Dissociative Experiences Scale, Beck Anxiety Inventory, Beck Depression Inventory-Second Edition, and Clinical Global Impression (also completed by the senior psychiatrist). Results The overall level of self-stigma was positively associated with a comorbid personality disorder, more severe symptomatology, more intense symptoms of anxiety and depression, and higher levels of dissociation and harm avoidance. Self-stigma was negatively related to hope, reward dependence, persistence, self-directedness, and cooperativeness. Multiple regression analysis showed that the most significant factors connected to self-stigma are harm avoidance, the intensity of depressive symptoms, and self-directedness. Two models of causality were proposed and validated. It seems that the tendency to dissociate in stress increases the probability of development of self-stigma, and this relationship is entirely mediated by avoidance of harm. Conversely, self-directedness lowers the probability of occurrence of self-stigma, and this effect is partly mediated by hope. Conclusion Patients with anxiety disorders accompanied with or without comorbid depressive or personality disorders may suffer from self-stigma. Individuals with greater sensitivity to rejection and other socially aversive stimuli are prone to the development of self-stigma. Other personality factors, such as hopeful thinking and self-acceptance serve as factors promoting resilience concerning self-stigma. PMID:26229471

Density Functional Study for Chemical Reaction between Cr and Fe with Sodium Diethyldithiocarbamate (NaDDC)

NASA Astrophysics Data System (ADS)

Setiyanto, Henry; Muhida, Rifki; Kishi, Tomoya; Rahman, Md. Mahmudur; Dipojono, Hermawan K.; Diño, Wilson A.; Matsumoto, Shigeno; Kasai, Hideaki

Analytical chemistry in the perspective of ab initio molecular orbital calculation is introduced by investigating the chemical reaction between transition metals Cr and Fe with sodium diethyldithiocarbamate (NaDDC), a complexing agent to detect and extract Cr in human blood sample. Using density functional theory—based calculations, we determine the stable structure of the Cr-DDC and Fe-DDC complexes and obtain its dissociation energies. We found dissociation energy values of -3.24 and -2.67 eV for Cr and Fe complexes, respectively; and hence the formation of the former complex is more favorable than the formation of the latter.

Solvent-coordinate free-energy landscape view of water-mediated ion-pair dissociation

NASA Astrophysics Data System (ADS)

Yonetani, Yoshiteru

2017-12-01

Water-mediated ion-pair dissociation is studied by molecular dynamics simulations of NaCl in water. Multidimensional free-energy analysis clarifies the relation between two essential solvent coordinates: the water coordination number and water-bridge formation. These two are related in a complex way. Both are necessary to describe ion-pair dissociation. The mechanism constructed with both solvent variables clearly shows the individual roles. The water coordination number is critical for starting ion-pair dissociation. Water-bridge formation is also important because it increases the likelihood of ion-pair dissociation by reducing the dissociation free-energy barrier. Additional Ca-Cl and NH4-Cl calculations show that these conclusions are unaffected by changes in the ion charge and shape. The present results will contribute to future explorations of many other molecular events such as surface water exchange and protein-ligand dissociation because the same mechanism is involved in such events.

Dissociative tendencies and facilitated emotional processing.

PubMed

Oathes, Desmond J; Ray, William J

2008-10-01

Dissociation is a process linked to lapses of attention, history of abuse or trauma, compromised emotional memory, and a disintegrated sense of self. It is theorized that dissociation stems from avoiding emotional information, especially negative emotion, to protect a fragile psyche. The present study tested whether or not dissociaters do actually avoid processing emotion by asking groups scoring high or low on the Dissociative Experiences Scale to judge the affective valence of several types of emotional stimuli. Manipulations of valence, modality (pictures or words), task complexity, and personal relevance lead to results suggesting that dissociation is linked to facilitated rather than deficient emotional processing. Our results are consistent with a theory that sensitivity to emotional material may be a contributing factor in subsequent dissociation to avoid further elaboration of upsetting emotion in these individuals. The findings for dissociation further exemplify the influence of individual differences in the link between cognition and emotion. (c) 2008 APA, all rights reserved

Memory for murder. A psychological perspective on dissociative amnesia in legal contexts.

PubMed

Porter, S; Birt, A R; Yuille, J C; Hervé, H F

2001-01-01

There is currently a complex and inconsistent state in the law relating to dissociation and dissociative amnesia (McSherry, 1998). Although dissociative amnesia in defendants is relevant to both competency to stand trial and criminal responsibility in principle, courts have typically assumed a skeptical stance toward such claims in practice. However, there is considerable evidence from both nonoffender and offender populations to support the validity of dissociative amnesia in defendants. Further, there is information available to aid in the evaluation of amnesia, such as the quality of the report itself and characteristics of the person reporting the amnesia (e.g., psychopathy). When consideration is given to the legal response to reports of dissociative amnesia by complainants, the situation becomes even more complex. While some courts have rejected recovered memory evidence, others have convicted defendants of historical offenses based on such evidence. In some cases, judges have argued that jurors should be left to decide on the validity of recovered memories based on their common sense and experience. The uncritical acceptance of the validity of repressed memories in complainants by many courts stands in stark contrast to the response to claims of amnesia from defendants. It seems apparent that the courts need better guidelines around the issue of dissociative amnesia in both populations. We think that the increasing scientific understanding of memory in the past decade (see Schacter, 1999) can meaningfully contribute to the development of such guidelines. Responsible, nonpartisan expert testimony from mental health professionals would be one step in the direction of rectifying the current state of law in regards to dissociation.

Salt Bridge Rearrangement (SaBRe) Explains the Dissociation Behavior of Noncovalent Complexes

NASA Astrophysics Data System (ADS)

Loo, Rachel R. Ogorzalek; Loo, Joseph A.

2016-06-01

Native electrospray ionization-mass spectrometry, with gas-phase activation and solution compositions that partially release subcomplexes, can elucidate topologies of macromolecular assemblies. That so much complexity can be preserved in gas-phase assemblies is remarkable, although a long-standing conundrum has been the differences between their gas- and solution-phase decompositions. Collision-induced dissociation of multimeric noncovalent complexes typically distributes products asymmetrically (i.e., by ejecting a single subunit bearing a large percentage of the excess charge). That unexpected behavior has been rationalized as one subunit "unfolding" to depart with more charge. We present an alternative explanation based on heterolytic ion-pair scission and rearrangement, a mechanism that inherently partitions charge asymmetrically. Excessive barriers to dissociation are circumvented in this manner, when local charge rearrangements access a lower-barrier surface. An implication of this ion pair consideration is that stability differences between high- and low-charge state ions usually attributed to Coulomb repulsion may, alternatively, be conveyed by attractive forces from ion pairs (salt bridges) stabilizing low-charge state ions. Should the number of ion pairs be roughly inversely related to charge, symmetric dissociations would be favored from highly charged complexes, as observed. Correlations between a gas-phase protein's size and charge reflect the quantity of restraining ion pairs. Collisionally-facilitated salt bridge rearrangement (SaBRe) may explain unusual size "contractions" seen for some activated, low charge state complexes. That some low-charged multimers preferentially cleave covalent bonds or shed small ions to disrupting noncovalent associations is also explained by greater ion pairing in low charge state complexes.

Salt Bridge Rearrangement (SaBRe) Explains the Dissociation Behavior of Noncovalent Complexes.

PubMed

Loo, Rachel R Ogorzalek; Loo, Joseph A

2016-06-01

Native electrospray ionization-mass spectrometry, with gas-phase activation and solution compositions that partially release subcomplexes, can elucidate topologies of macromolecular assemblies. That so much complexity can be preserved in gas-phase assemblies is remarkable, although a long-standing conundrum has been the differences between their gas- and solution-phase decompositions. Collision-induced dissociation of multimeric noncovalent complexes typically distributes products asymmetrically (i.e., by ejecting a single subunit bearing a large percentage of the excess charge). That unexpected behavior has been rationalized as one subunit "unfolding" to depart with more charge. We present an alternative explanation based on heterolytic ion-pair scission and rearrangement, a mechanism that inherently partitions charge asymmetrically. Excessive barriers to dissociation are circumvented in this manner, when local charge rearrangements access a lower-barrier surface. An implication of this ion pair consideration is that stability differences between high- and low-charge state ions usually attributed to Coulomb repulsion may, alternatively, be conveyed by attractive forces from ion pairs (salt bridges) stabilizing low-charge state ions. Should the number of ion pairs be roughly inversely related to charge, symmetric dissociations would be favored from highly charged complexes, as observed. Correlations between a gas-phase protein's size and charge reflect the quantity of restraining ion pairs. Collisionally-facilitated salt bridge rearrangement (SaBRe) may explain unusual size "contractions" seen for some activated, low charge state complexes. That some low-charged multimers preferentially cleave covalent bonds or shed small ions to disrupting noncovalent associations is also explained by greater ion pairing in low charge state complexes. Graphical Abstract ᅟ.

Ab initio calculations of the effects of H+ and NH4+ on the initial decomposition of HMX.

PubMed

Wang, Luoxin; Tuo, Xinlin; Yi, Changhai; Wang, Xiaogong

2008-10-01

In this work, the effects of H(+) and NH(4)(+) on the initial decomposition of HMX were investigated on the basis of the B3P86/6-31G** and B3LYP/6-31G* calculations. Three initial decomposition pathways including the N-NO(2) bond fission, HONO elimination and C-N bond dissociation were considered for the complexes formed by HMX with H(+) (PHMX1 and PHMX2) or with NH(4)(+) (AHMX). We found that H(+) and NH(4)(+) did not evidently induce the HMX to trigger the N-NO(2) heterolysis because the energy barrier of N-NO(2) heterolysis was found to be higher than the bond dissociation energy of N-NO(2) homolytic cleavage. Meanwhile, the transition state barriers of the HONO elimination from the complexes were found to be similar to that from the isolated HMX, which means that the HONO elimination reaction of HMX was not affected by the H(+) and NH(4)(+). As for the ring-opening reaction of HMX due to the C-N bond dissociation, the calculated potential energy profile showed that the energy of the complex (AHMX) went uphill along the C-N bond length and no transition state existed on the curve. However, the transition state energy barriers of C-N bond dissociation were calculated to be only 5.0 kcal/mol and 5.5 kcal/mol for the PHMX1 and PHMX2 complexes, respectively, which were much lower than the C-N bond dissociation energy of isolated HMX. Moreover, among the three initial decomposition reactions, the C-N bond dissociation was also the most energetically favorable pathway for the PHMX1 and PHMX2. Our calculation results showed that the H(+) can significantly promote the initial thermal decomposition of C-N bond of HMX, which, however, is influenced by NH(4)(+) slightly.

Murine Ia-associated invariant chain's processing to complex oligosaccharide forms and its dissociation from the I-Ak complex.

PubMed

Holt, G D; Swiedler, S J; Freed, J H; Hart, G W

1985-07-01

The processing of murine invariant chain (Ii) to a cell surface form bearing complex N-linked oligosaccharides has been demonstrated in the B cell lymphoma, AKTB-1b. In addition, the rate of processing of pulse-labeled Ii has been determined relative to its rate of dissociation from the alpha/beta complex of I-Ak. Ii, alpha-, and beta-chains were immunoprecipitated with anti-I-Ak or anti-Ii monoclonal antibodies. The heretofore uncharacterized complex oligosaccharide form of Ii (Ii-c) was identified in gel-purified immunoprecipitates by peptide mapping with reverse-phase HPLC. Ii-c is resistant to deglycosylation by Endo H, which is specific for high-mannose N-linkages, but can be digested with Endo F, a glycosidase capable of cleaving both complex and high-mannose N-linked oligosaccharides. Immunoprecipitation of surface iodinated cells indicates that Ii-c is expressed on the plasma membrane. Pulse-chase metabolic labeling data show that the processing of Ii to Ii-c occurs with a t1/2 of about 120 min. In contrast, the processing of both alpha- and beta-chains of I-Ak to complex forms occurs with a t1/2 of 15 to 20 min. Our data show that Ii-hm begins to dissociate rapidly from the I-Ak complex after 100 to 120 min of chase. Only a small amount (less than 5% on a per mole basis) of Ii-c was found associated with the I-Ak complexes after 300 min of continuous metabolic labeling. These results are consistent with Ii serving as a carrier for Ia antigens as they are transported to the cell surface. In addition, they suggest that the processing of Ii to Ii-c, or a late processing event of the alpha- and beta-chains, such as their sialylation, may be a possible mechanism for inducing the dissociation of Ii from the I-Ak complex.

An Electrostatic Charge Partitioning Model for the Dissociation of Protein Complexes in the Gas Phase

NASA Astrophysics Data System (ADS)

Sciuto, Stephen V.; Liu, Jiangjiang; Konermann, Lars

2011-10-01

Electrosprayed multi-protein complexes can be dissociated by collisional activation in the gas phase. Typically, these processes follow a mechanism whereby a single subunit gets ejected with a disproportionately high amount of charge relative to its mass. This asymmetric behavior suggests that the departing subunit undergoes some degree of unfolding prior to being separated from the residual complex. These structural changes occur concomitantly with charge (proton) transfer towards the subunit that is being unraveled. Charge accumulation takes place up to the point where the subunit loses physical contact with the residual complex. This work develops a simple electrostatic model for studying the relationship between conformational changes and charge enrichment during collisional activation. Folded subunits are described as spheres that carry continuum surface charge. The unfolded chain is envisioned as random coil bead string. Simulations are guided by the principle that the system will adopt the charge configuration with the lowest potential energy for any backbone conformation. A finite-difference gradient algorithm is used to determine the charge on each subunit throughout the dissociation process. Both dimeric and tetrameric protein complexes are investigated. The model reproduces the occurrence of asymmetric charge partitioning for dissociation events that are preceded by subunit unfolding. Quantitative comparisons of experimental MS/MS data with model predictions yield estimates of the structural changes that occur during collisional activation. Our findings suggest that subunit separation can occur over a wide range of scission point structures that correspond to different degrees of unfolding.

Using Online Methods to Develop and Examine the Hong Kong Chinese Translation of the Dissociative Experiences Scale.

PubMed

Chan, Chitat; Fung, Hong Wang; Choi, Tat Ming; Ross, Colin A

2017-01-01

Identifying dissociation is important for mental health services because it could fundamentally affect one's diagnosis and treatment plan. The Dissociative Experiences Scale (DES) is a widely-used self-report scale for measuring dissociative experiences. It has been translated into many languages and used in many countries. However, there is no validated Hong Kong Chinese version of the DES available in the field, and there is no other validated Hong Kong Chinese instrument for assessing dissociative disorders. This pilot study used online methods to translate the DES to Hong Kong Chinese (HKC-DES). The results indicated that the HKC-DES has excellent internal consistency (α = .953) and very good test-retest reliability (r = .797). Bilingual participants' responses to the DES and HKC-DES indicated high similarity, and were significantly correlated (r = .960). These results initially verified the reliability and cross-language equivalence of the scale. Implications for healthcare practice and research are discussed.

Organic photovoltaics: elucidating the ultra-fast exciton dissociation mechanism in disordered materials.

PubMed

Heitzer, Henry M; Savoie, Brett M; Marks, Tobin J; Ratner, Mark A

2014-07-14

Organic photovoltaics (OPVs) offer the opportunity for cheap, lightweight and mass-producible devices. However, an incomplete understanding of the charge generation process, in particular the timescale of dynamics and role of exciton diffusion, has slowed further progress in the field. We report a new Kinetic Monte Carlo model for the exciton dissociation mechanism in OPVs that addresses the origin of ultra-fast (<1 ps) dissociation by incorporating exciton delocalization. The model reproduces experimental results, such as the diminished rapid dissociation with increasing domain size, and also lends insight into the interplay between mixed domains, domain geometry, and exciton delocalization. Additionally, the model addresses the recent dispute on the origin of ultra-fast exciton dissociation by comparing the effects of exciton delocalization and impure domains on the photo-dynamics.This model provides insight into exciton dynamics that can advance our understanding of OPV structure-function relationships. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Procedural memory in dissociative identity disorder: when can inter-identity amnesia be truly established?

PubMed

Huntjens, Rafaële J C; Postma, Albert; Woertman, Liesbeth; van der Hart, Onno; Peters, Madelon L

2005-06-01

In a serial reaction time task, procedural memory was examined in Dissociative Identity Disorder (DID). Thirty-one DID patients were tested for inter-identity transfer of procedural learning and their memory performance was compared with 25 normal controls and 25 controls instructed to simulate DID. Results of patients seemed to indicate a pattern of inter-identity amnesia. Simulators, however, were able to mimic a pattern of inter-identity amnesia, rendering the results of patients impossible to interpret as either a pattern of amnesia or a pattern of simulation. It is argued that studies not including DID-simulators or simulation-free memory tasks, should not be taken as evidence for (or against) amnesia in DID.

Fact or Factitious? A Psychobiological Study of Authentic and Simulated Dissociative Identity States

PubMed Central

Simone Reinders, A. A. T.; Willemsen, Antoon T. M.; Vos, Herry P. J.; den Boer, Johan A.; Nijenhuis, Ellert R. S.

2012-01-01

Background Dissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion. Methodology/Principal Findings DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation. Conclusions/Significance The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin. PMID:22768068

Premorbid Expertise Produces Category-Specific Impairment in a Domain-General Semantic Disorder

ERIC Educational Resources Information Center

Jefferies, Elizabeth; Rogers, Timothy T.; Ralph, Matthew A. Lambon

2011-01-01

For decades, category-specific semantic impairment--i.e., better comprehension of items from one semantic category than another--has been the driving force behind many claims about the organisation of conceptual knowledge in the brain. Double dissociations between patients with category-specific disorders are widely interpreted as showing that…

Alterity: Learning Polyvalent Selves, Resisting Disabling Notions of the Self

ERIC Educational Resources Information Center

Walker, Wayland

2011-01-01

This article queries how one type of human difference--alterity, the experience of multiple distinct consciousnesses, or "alters," by one person--is pathologized in American culture. This experience is inscribed as a mental illness, labeled now as dissociative identity disorder (DID) and formerly known as multiple personality disorder (MPD). In…

Implicit and Explicit Memory in Autism: Is Autism an Amnesic Disorder?

ERIC Educational Resources Information Center

Renner, Peggy; Klinger, Laura Grofer; Klinger, Mark R.

2000-01-01

This study examined whether children with high-functioning autism have a dissociation between explicit and implicit memory abilities characteristic of medial temporal lobe amnesic disorder. Children (N=14 and ages 6-14) with autism showed intact implicit and explicit memory abilities but did not show typical memory patterns, suggesting they used…