Dissociative Disorder Patients Research Articles

Addressing Dissociative Trance Disorder Patients in India: An Interpretative Phenomenological Analysis of Adolescent Girls' Help-Seeking and Encounters with Inaccurate Medical Information

Addressing Dissociative Trance Disorder Patients in India: An Interpretative Phenomenological Analysis of Adolescent Girls' Help-Seeking and Encounters with Inaccurate Medical Information

STUDY ON CLINICAL PRESENTATIONS, LEVEL OF STRESS & ROLE OF FAMILY ENVIRONMENT AMONG DISSOCIATIVE DISORDER PATIENTS

Background: Dissociative disorder is a stress-related disorder usually present in adolescent and younger age group. It is also accompanied with significant impairment in activity of daily living and family relationship. Family environment plays important role in initiation and maintenance of symptoms and this put significant burden on family. To assess different types of clinical presentations, level of stress and role of family environment among dissociative disorder patients and check for association between sex distributions. Material and Method: This cross-sectional descriptive study was carried out on patients with primary diagnosis of dissociative disorder as per ICD-10 criteria coming to psychiatry outpatient department of Sri Aurobindo Medical College and Postgraduate Institute, Indore a premier tertiary care hospital situated at northern part of India, covering, and serving a large catchment area, during the period of 18 months. 80 patients were recruited for the purpose of study. The procedure and rationale for the study was explained to all subjects and informed written consent were taken in their local language. Patients were included after fulfilling inclusion criteria from both inpatients and outpatient department of psychiatry. Result: In our study, majority of the patients (48.75%) belonged to the age group 18-30 years. The prevalence rates decrease with age. 37.5% of the patients were between the age group 31-40 years and 13.75% were over the age of 40 years. In a study of 80 patients with dissociative (conversion) disorder, 77.5% were females and 22.5% were male. There was female predominance. Conclusion: Dissociative disorders are more common in females than males. It always occurs in the background of increased stressful life events and in the presence of significant psychosocial stressors. Future studies should be undertaken in a large sample with a prospective design to examine the impact of disease duration and other mediators, such as family type and coping style.

A study of stressors, family environment, coping patterns, and family burden in persons with dissociative disorder.

Dissociative disorder is a stress-related disorder usually present in adolescents and younger age groups. It is also accompanied by significant impairment in activity of daily living and family relations. Family environment and use of dysfunctional coping strategies play important roles in the initiation and maintenance of symptoms and this puts a considerable burden on the family. This study aims to study the presence of stressors, the role of family environment, the role of family burden, and the use of coping mechanisms in persons with dissociative disorder. This was a descriptive cross-sectional study in which 100 persons with a dissociative disorder were included after fulfilling inclusion and exclusion criteria from the outpatient department (OPD) of psychiatry. In this study, the major part of the sample were women (87%), most were educated up to 12th standard or less than 12 years of formal education. According to stressors, 44% had family stress/problems. 77% (mostly women) had dissociative stupor. The dissociative disorder caused a considerable degree of burden on the other family members. There was a significant difference in financial burden among caregivers of persons who were married, belonging to rural areas, joint families, and from lower socio-economic classes. There was a significant difference in disruption of routine family activities, and burden in persons having a longer duration of illness. There was a significant difference found in conflict, achievement orientation, and dimensions of family environment between males and females. A significant difference in the venting of emotions, behavioral disengagement, and restraint as a coping strategy between males and females was found. Present study showed dissociative disorder patients cause a considerable degree of burden on family members in terms of leisure, physical, mental, financial, and routine family interrelationship domains. In personal growth and relationship dimensions, the use of dysfunctional coping strategies in the family environment has a causal effect on the symptoms of dissociative disorder patients.

Effects of Stressful Life Events on Somatoform and Dissociative Disorders

Background: Somatoform and dissociative disorder categories have emerged from a common root, there was no apparent anatomical and physiological basis and which had a temporal relationship to a precipitating event. Objectives: To evaluate and compare of stressful life events of the patients of somatoform disorders and dissociative disorders. Materials and methods: This was a comparative cross-sectional study carried out in the outpatient department of Psychiatry, Khwaja Yunus Ali Medical College, Sirajganj. The study populations were 100 somatoform disorder and 100 dissociative disorder patients. Data were collected by pre-designed data collection sheet. Then data were edited, cleaned and analyzed. Results: Stressful life events were observed to be significantly more frequent in both the groups. Family conflicts (29%) and sexual problem (16%) were more common in the somatoform disorder group of patients but marital conflict (26%) and death of the close family member (11%) were more common in the dissociative disorder group of patients. This study shows that dissociative disorder patients were observed to experience a variety of life events more than somatoform disorder group of patients. Conclusion: The stressful life events were reported more in dissociative disorder. The results suggest a substantial involvement of stressful life events in genesis of somatoform disorders and dissociative disorders, although no significant difference is noticed. KYAMC Journal Vol. 13, No. 02, July 2022: 63-65

Functional connectivity changes in the delta frequency band following trauma treatment in complex trauma and dissociative disorder patients.

ObjectivePhase-oriented trauma treatment is efficacious in the treatment of complex trauma and dissociative disorder patients. However, the neural correlates of this therapeutic effect are not yet well-understood. In the current study we investigated whether patients show a strengthening in functional network connectivity in the delta frequency band (1–3.5 Hz) over the course of phase-oriented inpatient trauma treatment while they performed an emotion regulation task. Further, we examined whether neural changes were associated with symptom reduction and improvement in emotion regulation skills.MethodsBefore and after 8 weeks of treatment, electroencephalography (EEG) was acquired in patients (n = 28) with a complex posttraumatic stress disorder (cPTSD) or complex dissociative disorder (CDD). They also completed clinical and emotion regulation questionnaires. To delimit data variability, patients participated as one dissociative part that is referred to as Apparently Normal Part (ANP). Patients' data were compared to a matched healthy control croup (n = 38), also measured twice.ResultsPrior to treatment, functional connectivity was significantly lower in patients compared to controls during cognitive reappraisal of unpleasant pictures and passive viewing of unpleasant and neutral pictures. These hypoconnected networks largely overlapped with networks typically activated during the recall of (emotional) autobiographical memories. Functional connectivity strength within these networks significantly increased following treatment and was comparable to controls. Patients showed symptom reduction across various clinical domains and improvement in the use of cognitive reappraisal as emotion regulation strategy. Treatment-related network normalizations were not related to changes in questionnaire data.ConclusionPhase-oriented treatment may strengthen connections between regions that are activated during autobiographical recall. These findings encourage further investigation of this circuitry as a therapeutic target in cPTSD and CDD patients.Clinial trial registrationwww.ClinicalTrials.gov, identifier: NCT02459340, https://www.kofam.ch/de/studienportal/suche/149284/studie/26681.

An examination of the relations between emotion dysregulation, dissociation, and self-injury among dissociative disorder patients

ABSTRACT Background Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To the best of our knowledge, however, the link between emotion dysregulation and self-injury has not yet been examined within a DD population. Objective The present study investigated relations between emotion dysregulation, dissociation, and self-injury in DD patients, and explored patterns of emotion dysregulation difficulties among DD patients with and without recent histories of self-injury. Method We utilized linear and logistic regressions and t-test statistical methods to examine data from 235 patient-clinician dyads enrolled in the TOP DD Network Study. Results Analyses revealed emotion dysregulation was associated with heightened dissociative symptoms and greater endorsement of self-injury in the past six months. Further, patients with a history of self-injury in the past six months reported more severe emotion dysregulation and dissociation than those without recent self-injury. As a group, DD patients reported the greatest difficulty engaging in goal-directed activities when distressed, followed by lack of emotional awareness and nonacceptance of emotional experiences. DD patients demonstrated similar patterns of emotion dysregulation difficulties irrespective of recent self-injury status. Conclusions Results support recommendations to strengthen emotion regulation skills as a means to decrease symptoms of dissociation and self-injury in DD patients.

The reasons dissociative disorder patients self-injure

ABSTRACT Background Most individuals with dissociative disorders (DDs) report engaging in self-injury. Objective The present study aimed to understand the reasons for self-injury among a clinical sample of 156 DD patients enrolled in the TOP DD Network study. Method Participants answered questions about self-injury, including a prompt asking how often they are aware of the reasons they have urges to self-injure, as well as a prompt asking them to list three reasons they self-injure. Results Six themes of reasons for self-injury, each with subthemes, were identified in the qualitative data: (1) Trauma-related Cues, (2) Emotion Dysregulation, (3) Stressors, (4) Psychiatric and Physical Health Symptoms, (5) Dissociative Experiences, and (6) Ineffective Coping Attempts. Participants reported that they were able to identify their reasons for self-injuring sometimes (60.26%) or almost always (28.85%), with only 3.20% unable to identify any reasons for their self-injury. Conclusion Results suggest that the vast majority of DD patients (92.31%) reported being at least partially unaware of what leads them to have self-injury urges, and many individuals with DDs experience some reasons for self-injury that are different from those with other disorders. The treatment implications of these findings are discussed.

Resting-state functional connectivity in patients with a complex PTSD or complex dissociative disorder before and after inpatient trauma treatment.

IntroductionRecent research suggests that traumatized patients are characterized by disrupted resting‐state functional connectivity. We examined whether neural networks involved in resting‐state change over the course of a phase‐oriented inpatient treatment for complex traumatized and dissociative disorder patients. We also investigated associations between these network alterations and clinical symptoms and emotion regulation skills.MethodsPre‐ and post‐treatment, electroencephalography (EEG) was recorded during resting‐state in patients (n = 23) with a complex dissociative disorder (CDD) or complex posttraumatic stress disorder (cPTSD). Patients also completed clinical and emotion regulation questionnaires. To reduce variance in the collected data, patients were exclusively tested as one prototypical dissociative part referred to as Apparently Normal Part (ANP). Functional network connectivity was examined and compared with a matched healthy control group (n = 37), also measured twice.ResultsPrior to treatment and compared with controls, patients had a significantly lower functional connectivity strength within eyes‐open and eyes‐closed resting‐state networks in the theta and alpha frequency band. Following treatment, functional connectivity strength within these networks was comparable to the control group and comprised areas belonging to the default mode network (DMN) and prefrontal as well as anterior cingulate control regions. Treatment‐related network normalizations in the theta frequency band were associated with a self‐reported increase in the use of cognitive reappraisal strategies and reduction in emotion regulation difficulties.ConclusionPhase‐oriented trauma treatment can strengthen resting‐state network connectivity and can increase the capacity of complex traumatized and dissociative patients as ANP to handle emotional challenges effectively.

Divided mind – divided brain. The neurobiology of dissociative identity disorder from the perspective of dynamical systems theory

Explaining the biology of dissociative identity disorder and its clinical aspects is one of the major challenges in modern neuroscience. The complexity and the unique nature of this disorder, coupled with insufficient biopsychological models needed for creating universal therapeutic procedures, make the treatment difficult. The vast majority of neuroimaging studies in dissociative identity disorder patients proved to be inconclusive. Abnormalities of particular brain structures do not explain the wide range of symptoms in dissociative identity disorder. Moreover, the findings are partly contradictory. Collecting adequate representative study samples is difficult and most reports are in fact single case studies. On top of that, meta-analyses show that patients with dissociative identity disorder usually present with additional mental problems, which makes interpretation of neuroimaging data extremely difficult. Nowadays, scientific research on dissociative identity disorder focuses on child trauma and its influence on the development of the central nervous system. This article is an overview of recent research on the neurobiology of dissociative identity disorder, with particular emphasis on the impact of childhood trauma on the development of the central nervous system. It focuses on hypotheses attempting to capture the specific dynamics of neural activity leading to neural network fragmentation, and uses the dynamical systems theory to describe this phenomenon.

Can the Trauma Symptom Inventory-2 distinguish coached simulators from dissociative disorder patients?

The first objective was to understand how individuals with complex dissociative disorders (CDD) score on the Trauma Symptom Inventory-2 (TSI-2). These individuals have high elevations on many psychological measures' validity and clinical scales because of the severe traumatic reactions they experience; thus, creating a challenge for clinicians who seek to determine whether these individuals are exaggerating reported symptoms. The second objective was to compare coached CDD simulators to CDD profiles on the TSI-2s clinical and validity scales. The third objective was to examine the utility rates of the TSI-2s Atypical Response Scale (ATR) in distinguishing feigned CDD from clinical CDD. This study compared 39 CDD inpatients to 51 coached CDD simulators on the TSI-2. A profile analysis compared the CDD group and coached simulators on the TSI-2 scales, and post hoc 1-way analysis of covariances (ANCOVAS) examined significant differences between the groups. The CDD patients elevated on most of the TSI-2 clinical scales and factors. There were significant differences between CDD patients' and CDD simulators' TSI-2 profiles, with simulators failing to endorse some of the co-occurring symptoms common in CDD. The ATR correctly classified only 60-73% of participants and its specificity scores were low. It is important to understand how CDD individuals score on the TSI-2 so that their results can be recognized and meaningfully interpreted. The TSI-2 may not be a useful measure for distinguishing feigned CDD from CDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Partition Weighted Approach For Estimating the Marginal Posterior Density With Applications

The computation of marginal posterior density in Bayesian analysis is essential in that it can provide complete information about parameters of interest. Furthermore, the marginal posterior density can be used for computing Bayes factors, posterior model probabilities, and diagnostic measures. The conditional marginal density estimator (CMDE) is theoretically the best for marginal density estimation but requires the closed-form expression of the conditional posterior density, which is often not available in many applications. We develop the partition weighted marginal density estimator (PWMDE) to realize the CMDE. This unbiased estimator requires only a single Markov chain Monte Carlo output from the joint posterior distribution and the known unnormalized posterior density. The theoretical properties and various applications of the PWMDE are examined in detail. The PWMDE method is also extended to the estimation of conditional posterior densities. We carry out simulation studies to investigate the empirical performance of the PWMDE and further demonstrate the desirable features of the proposed method with two real data sets from a study of dissociative identity disorder patients and a prostate cancer study, respectively. Supplementary materials for this article are available online.

An Online Educational Program for Individuals With Dissociative Disorders and Their Clinicians: 1-Year and 2-Year Follow-Up.

Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self‐injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web‐based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web‐based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample |d|s = 0.44–0.90, as well as reduced NSSI. The improvements in NSSI among the most self‐injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation |d|s = 0.54–1.04 vs. |d|s  = 0.24–0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.

Trauma-Related Dissociation Is No Fantasy: Addressing the Errors of Omission and Commission in Merckelbach and Patihis (2018)

Dissociation is commonly a response to trauma that can be associated with significant impairment. In order to deal with dissociation in court from a comprehensive, scientifically informed, and valid perspective, Brand, Schielke, and Brams (Psychological Injury and Law, 10, 283-297, 2017a, b) provided a balanced view of dissociation, its characteristics, evidence base, and best assessment practices. Without an approach such as this, forensic experts risk having insufficient knowledge in its causation, phenomenology, and assessment and accordingly misunderstand trauma-related dissociation (TRD). Brand et al. (Psychological Injury and Law, 10, 283-297, 2017a, b) addressed this issue by providing an overview of TRD relevant to forensic contexts, acknowledging some of the erroneous and misinformed approaches to the topic. Merckelbach and Patihis (2018) offered a critique of Brand et al. (Psychological Injury and Law, 10, 283-297, 2017a, b) that illustrated this lack of knowledge and misunderstanding about TRD. Many of the statements made by these authors are conceptually inaccurate or scientifically misinformed. As we show, they were incorrect when they stated that research is lacking about the inter-rater reliability of dissociative disorder (DD) diagnoses. They were unaware of the error rates of tests and interviews among dissociative samples, which we present here. Merckelbach and Patihis challenged Brand et al., arguing their methods and literature review “lacked a connectivity to existing science” (p. 3), despite extensive citations of studies with DD patients. They argued that we failed to adequately consider malingering despite our discussions of empirically supported methods for assessing it. We show that Merckelbach and Patihis overlooked research that does not support their views. As we review their comments, we illustrate their pattern of misreading and misunderstanding our papers, as well as lapses in their reasoning. The current paper reinforces that in the forensic context, experts can acquire adequate understanding of TRD and its evidence base, and put forward arguments against any harsh critique of the area that is uninformed about, misunderstands, or includes omissions and errors in critical conceptualization, state-of-the-art assessment practices, and research methodology and results.

Dissociation debates: everything you know is wrong

Controversy about dissociation and the dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence support a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and that DD are artefactual conditions produced by iatrogenesis and/or socio-cultural factors. Almost no research or clinical data support this view. DD are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior. Prospective treatment outcome studies of severely ill DD patients show significant improvement in symptoms including suicidal/self-destructive behaviors, with reductions in treatment cost. A major public health effort is needed to raise awareness about dissociation/DD, including educational efforts in all mental health training programs and increased funding for research.

Supplemental Material for Can the Trauma Symptom Inventory-2 Distinguish Coached Simulators From Dissociative Disorder Patients?

Supplemental Material for Can the Trauma Symptom Inventory-2 Distinguish Coached Simulators From Dissociative Disorder Patients?

Disconnected - Impaired Interoceptive Accuracy and Its Association With Self-Perception and Cardiac Vagal Tone in Patients With Dissociative Disorder.

Patients suffering from dissociative disorders are characterized by an avoidance of aversive stimuli. This includes the avoidance of emotions and, in particular, bodily perceptions. In the present pilot study, we explored the potential interoceptive accuracy deficit of patients suffering from dissociative disorders in a heartbeat detection task. Moreover, we investigated the impact of facial mirror-confrontation on interoceptive accuracy and the potential association between cardiac vagal tone derived from heart rate variability and interoceptive accuracy. Eighteen patients suffering from dissociative disorders and 18 healthy controls were assessed with the Mental Tracking Paradigm by Schandry for heartbeat detection at baseline and after confrontations exposing them to their own faces in a mirror (2 min each, accompanied by a negative or positive cognition). During the experiment, cardiac vagal tone was assessed. We used Pearson correlations to calculate potential associations between cardiac vagal tone and interoceptive accuracy. Patients performed significantly worse than the healthy controls in the heartbeat detection task at baseline. They displayed no significant increase in interoceptive accuracy following facial mirror-confrontation. In the patient group, higher cardiac vagal tone was associated with a more precise heartbeat detection performance. Dissociative disorder patients showed a considerable deficit in interoceptive accuracy. Our results fit with the assumption that highly dissociative patients tend to tune out the perceiving of bodily signals. To the extent that bodily signal perception may play a causal role in these disorders, therapeutic approaches enhancing interoceptive accuracy and cardiac vagal tone may be considered important and practicable steps to improve the therapy outcome of this patient group.

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

ABSTRACTBackground: 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.

[Approach to the Development of Mind and Persona].

To access medical specialists by health specialists working in the regional health field, the possibility of utilizing the voice approach for dissociative identity disorder (DID) patients as a health assessment for medical access (HAMA) was investigated. The first step is to investigate whether the plural personae in a single DID patient can be discriminated by voice analysis. Voices of DID patients including these with different personae were extracted from YouTube and were analysed using the software PRAAT with basic frequency, oral factors, chin factors and tongue factors. In addition, RAKUGO story teller voices made artificially and dramatically were analysed in the same manner. Quantitive and qualitative analysis method were carried out and nested logistic regression and a nested generalized linear model was developed. The voice from different personae in one DID patient could be visually and easily distinquished using basic frequency curve, cluster analysis and factor analysis. In the canonical analysis, only Roy's maximum root was <0.01. In the nested generalized linear model, the model using a standard deviation (SD) indicator fit best and some other possibilities are shown here. In DID patients, the short transition time among plural personae could guide to the risky situation such as suicide. So if the voice approach can show the time threshold of changes between the different personae, it would be useful as an Access Assessment in the form of a simple HAMA.

Somatoform dissociation and posttraumatic stress syndrome \u2013 two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms and patients with PTSD

BackgroundHistory of traumatic experience is common in dissociative disorder (DD), and similarity of symptoms and characteristics between DD and posttraumatic stress disorder (PTSD) encouraged to consider DD as trauma-related disorder. However, conceptualization of DD as a trauma-related syndrome would critically affect diagnosis and treatment strategies. The present study addressed overlap and disparity of DD and PTSD by directly comparing correspondence of symptoms, adverse/traumatic experience, and altered affect regulation between patients diagnosed with dissociative disorder (characterized by negative functional neurological symptoms) and patients diagnosed with PTSD.MethodsSomatoform and psychoform dissociation, symptoms of posttraumatic stress, general childhood adversities and lifetime traumata, and alexithymia as index of altered affect regulation were screened with standardized questionnaires and semi-structured interviews in 60 patients with DD (ICD-codes F44.4, F44.6, F44.7), 39 patients with PTSD (ICD-code F43.1), and 40 healthy comparison participants (HC).ResultsDD and PTSD patients scored higher than HC on somatoform and psychoform dissociative symptom scales and alexithymia, and reported more childhood adversities and higher trauma load. PTSD patients reported higher symptom severity and more traumata than DD patients. Those 20 DD patients who met criteria of co-occuring PTSD did not differ from PTSD patients in the amount of reported symptoms of somatoform dissociation, physical and emotional childhood adversities and lifetime traumata, while emotional neglect/abuse in childhood distinguished DD patients with and without co-occuring PTSD (DD patients with co-occuring PTSD reporting more emotional maltreatment).ConclusionThe pattern of distinctive somatoform and psychoform dissociative symptom severity, type of childhood and lifetime traumata, and amount of alexithymia suggests that DD and PTSD are distinctive syndromes and, therefore, challenges the conceptualization of DD as trauma-related disorder. Together with the detected close correspondence of symptom and experience profiles in DD patients with co-occuring PTSD and PTSD patients, these findings suggest that adverse/traumatic experience may intensify dissociative symptoms, but are not a necessary condition in the generation of functional neurological symptoms. Still, diagnosis and treatment of DD need to consider this impact of traumata and post-traumatic stress symptoms.

Patterns of dissociative (conversion) disorder cases in private psychiatric facility and the effectiveness of an indigene model of psychotherapy

This is descriptive study was carried out on newly diagnosed dissociative (conversion) disorder patients admitted in private health care facility, Iftikhar Psychiatric Hospital Peshawar.The studied was carried out from January 2012 to December 2012. Cases were diagnosed according to international classification of disease (ICD-10) diagnostic criteria. Subjects were selected through purposive sampling. A total of 139 patients were included in this study. Patterns of and disorder and demographic will be presented in presentation.Due to sociocultural sensitivity of applying dialectical and CBT an indigenes model of psychotherapy was applied.Stage 1: admission of conversion disorder cases for four days admission with informed consent, supportive psychotherapy, and brief psycho-education of attendants to avoid reinforcement of the patient's behavior. Parental single dose medication to break the cycle of fits.Stage 2: it involves exploratory session with the patient and her/his family members focusing on what is the problem with the patient nature of stressors, and the family environment. Meanwhile, we involve the patient in the recreational and occupational therapy to avoid sick role and illness behavior.Stage 3: psychotherapy session with the patient to give psycho-education and insight of her/his mental problem. Discussing different options, and facilitating the patient to come up with the best possible desirable option. Psychotherapy of the family members involved psycho-education about the patient's mental illness, its association with the prevailing stressors, and avoiding reinforcement. Responses have been 85% improvement in conversion disorder, 90% in sensory symptoms, 98% in motor symptoms, 95% in mixed symptoms.Disclosure of interestThe author has not supplied his declaration of competing interest.