Evaluating the Impact of Dissociation in Psychiatric Disorders

Ionuț Dragoș Rădulescu,Codrina Moraru,Anamaria Ciubară,Alexandru Bogdan Ciubara,Stefan Lucian Burlea

doi:10.18662/brain/11.3sup1/132

Abstract

Introduction: Dissociative symptoms are present in a various number of psychiatric disorders and are viewed as a major risk factor for suicidal and self-destructive behavior. Dissociation is defined in DSM-5 as a “disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior”. Assessing dissociation within different categories of mental disorders can be used to predict symptom severity and nonresponse to psychotherapeutic treatments. The most important tool in this process is the Dissociative Experiences Scale (DES). The purpose of the current study is to extend the understanding of dissociation in Psychiatric Disorders. Material and methods: The current study used PubMed and Cochrane databases to identify relevant articles that refer to the subject of dissociation in Psychiatric Disorders. Results and Discussions: Dissociation and dissociative disorders have been at the root of continuous controversy in psychiatric and psychology communities. The general confusion comes from the reduced conceptual distinction between dissociation as a symptom, process, deficit and psychological defense. At the high end of the DES score we find dissociative disorders, but closely followed by posttraumatic stress disorder, borderline personality disorder and conversion disorder with eating disorders, schizophrenia and anxiety disorders at midrange and the lowest scoring DES psychiatric disorder is found in bipolar disorders. Early intervention, based on these scores, show major improvement in maladaptive functionality, suicidal and self-destructive behavior, coupled with a reduction in total treatment cost. Conclusions: There is a significant benefit in careful assessment of dissociative symptoms for the entire spectrum of mental disorders. There is a major need to raise awareness in all mental health facilities, of the value that this has in the current clinical setting.

Highlights

Dissociative symptoms are present in a various number of psychiatric disorders and are viewed as a major risk factor for suicidal and self-destructive behavior
Dissociation is found at the core of dissociative disorders and is a diagnostic criterion for acute stress disorder (ASD), post-traumatic stress disorder (PTSD) and borderline personality disorder
The primary author completed a literature review of PubMed/MEDLINE databases to identify relevant articles that refer to the subject of dissociation in Psychiatric Disorders

Summary

Introduction

Dissociative symptoms are present in a various number of psychiatric disorders and are viewed as a major risk factor for suicidal and self-destructive behavior. Dissociation is defined in its simplest form as a separation in the structure of normal mental processes like emotions, memories, perceptions and others, that are usually integrated and accessible to the conscious experience (Burlea et al, 2010; Huidu, 2019; Spiegel, 2003). Dissociation is found at the core of dissociative disorders and is a diagnostic criterion for acute stress disorder (ASD), post-traumatic stress disorder (PTSD) and borderline personality disorder This class of psychopathology is found in varying intensity in almost all mental disorders ranging from schizophrenia to obsessive-compulsive disorder, anxiety disorders and many more. A series of scales were introduced to help objectify and track dissociative episodes and symptoms, e.g. Dissociative Experiences Scale (DES), the DES-Taxon Scale (DES-T), the Adolescent DES, the Dissociative Disorders Interview Schedule (DDIS), the Clinician Administered Dissociative States Scale (CADSS) and the Structured Clinical Interview for DSM Dissociative Disorders (SCID-D) (Spiegel et al, 2011, Lyssenko et al, 2017)

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Conclusion