Dissociative Episodes Research Articles

Effective treatment of neuropsychological deficits in Sjögren's syndrome.

Primary Sjögren's syndrome (SS) is an autoimmune disorder that can manifest as central nervous system (CNS) dysfunction and include neuropsychological deficits. Given the limited information published on the cognitive deficits associated with SS, a case of SS is reported here. The primary CNS manifestations were dissociative episodes, and objectively measured neuropsychological dysfunction which was most notable in visual-spatial abilities (as measured by the WAIS-R PIQ, WMS-R Visual Memory Index, and Rey Complex Figure) and in left-sided coordination (as assessed by the Lafayette Grooved Pegboard). Clinical symptomatology and cognition improved following therapy with high-dose corticosteroids.

Cataplexy and the switch process of multiple personality disorder

A case history is presented of an 18-year-old male with dissociative disorder and polysubstance abuse. The patient was observed to switch between three personalities, and the personality changes were often associated with symptoms of cataplexy. Both dissociative episodes and cataplexy are associated with strong affective stimuli. Similar reports in the literature are briefly reviewed.

Coping Strategies: A Psychoeducational Approach to Post-Traumatic Symptomatology

Survivors of extensive childhood abuse frequently present complicated clinical dilemmas in the inpatient setting; they experience complex post-traumatic and dissociative symptomatology, such as flashbacks and other reexperiencing phenomena, as well as intense affects and self-destructive impulses. Such patients seek recommendations of how to manage their post-traumatic symptomatology, as well as how to tolerate intense affects and maintain safety. The nursing staff at McLean Hospital's Dissociative Disorders Program have developed a psychoeducational approach that patients have found useful. Coping strategies, which the patients learn to formulate, help clients stall impulsivity and dissociative episodes through the use of healthy diversions, grounding techniques, and support networks.

DISSOCIATION & MULTIPLE PERSONALITY DISORDER a Challenge for Psychosocial Nurses

1. Multiple personality disorder (MPD) is a dissociative disorder in which two or more distinct personality states exist within an individual. At least two of these personalities recurrently take full control of the person's behavior. 2. Most MPD clients report histories of severe childhood trauma, particularly physical, sexual, and ritual cult abuse. MPD most likely originates in childhood, but is not usually diagnosed until adulthood. In most reported cases, the first dissociative episode is thought to have occurred at a very young age. 3. Signs and symptoms that may suggest MPD include a history of medical and psychiatric diagnoses; inconsistencies in accounts of elapsed time and physical behaviors; psychophysiological complaints; experiencing voices inside the head; and an individual referring to herself as "we" instead of "I."

Dissociative disorders in children: Behavioral profiles and problems

Transient dissociative episodes are a common and normative phenomenon during childhood that generally decrease during adolescence to relatively low levels in adults. Retrospective clinical research has firmly established a connection between childhood trauma and the development of dissociative disorders in adults. A growing number of clinicians are now identifying dissociative symptoms in abused children, and there is increasing evidence that dissociative disorders represent a significant and hitherto unrecognized form of psychopathology in traumatized children. Pathological dissociation is a complex psychobiological process that results in a failure to integrate information into the normal stream of consciousness. It produces a range of symptoms and behaviors including: (a) amnesias; (b) disturbances in sense of self; (c) trance-like states; (d) rapid shifts in mood and behavior; (e) perplexing shifts in access to knowledge, memory, and skills; (f) auditory and visual hallucinations; and (g) vivid imaginary companionship in children and adolescents. Many of these symptoms and behaviors are misdiagnosed as attention, learning or conduct problems, or even psychoses. Early identification and therapeutic intervention appear to be particularly efficacious in children in contrast to adults, although systematic studies of treatment and outcome are presently lacking.

Recall of traumatic memories following cerebral vascular accident

We present a case of delayed post-traumatic stress disorder (PTSD) in a WWII combat veteran who developed symptoms following medical retirement. Following a subsequent cerebral accident (CVA) Mr. J experienced intrusive thoughts, recalled forgotten war memories, began avoiding reminders of war (e.g., stopped teaching marksmanship), and experienced dissociative episodes in which he felt as though he was in hand-to-hand combat. Mr. J's example suggests that the disinhibiting sequelae of CVA's, and other neuropsychological deteriorations that are likely to occur with poor health and advancing age, may influence expression of PTSD symptoms.

Intentional Self-injection With HIV

<h3>To the Editor.</h3> —Several workers have expressed concern that psychopathology may play a predisposing role in the acquisition of human immunodeficiency virus (HIV) infection.^1,2We have recently encountered an unusual case that illustrates an extreme example of the role of psychopathology as a risk factor for HIV infection. A 45-year-old female laboratory technologist was seen in consultation for repeated intentional self-injection with hazardous biomaterials. She had a long psychiatric history marked by repeated suicide attempts, impulsive and occasionally violent acts, and dissociative episodes, all compatible with borderline personality disorder. In early 1989, after nearly 15 years of minimal psychiatric difficulties, increased domestic strife led to a resurgence of symptoms that necessitated psychiatric hospitalization. Her anxiety, dysphoria, dissociation, and suicidal tendencies, in the absence of any evidence of psychosis, were treated with 12 mg/d of perphenazine for several months with seemingly good response. During a work pass arranged in preparation

Childhood origins of self-destructive behavior

Clinical reports suggest that many adults who engage in self-destructive behavior have childhood histories of trauma and disrupted parental care. This study explored the relations between childhood trauma, disrupted attachment, and self-destruction, using both historical and prospective data. Seventy-four subjects with personality disorders or bipolar II disorder were followed for an average of 4 years and monitored for self-destructive behavior such as suicide attempts, self-injury, and eating disorders. These behaviors were then correlated with independently obtained self-reports of childhood trauma, disruptions of parental care, and dissociative phenomena. Histories of childhood sexual and physical abuse were highly significant predictors of self-cutting and suicide attempts. During follow-up, the subjects with the most severe histories of separation and neglect and those with past sexual abuse continued being self-destructive. The nature of the trauma and the subjects' age at the time of the trauma affected the character and the severity of the self-destructive behavior. Cutting was also specifically related to dissociation. Childhood trauma contributes to the initiation of self-destructive behavior, but lack of secure attachments helps maintain it. Patients who repetitively attempt suicide or engage in chronic self-cutting are prone to react to current stresses as a return of childhood trauma, neglect, and abandonment. Experiences related to interpersonal safety, anger, and emotional needs may precipitate dissociative episodes and self-destructive behavior.

Symptom differences in acute and chronic presentation of childhood post-traumatic stress disorder

The authors report on 24 children diagnosed with post-traumatic stress disorder (PTSD) according to DSM-III criteria. Each child was designated as presenting with acute or chronic PTSD depending upon the duration of symptoms. Children with the acute form of PTSD presented with a relative increase in spontaneously acting as though the trauma were recurring upon real or symbolic exposure, difficulty falling asleep, hypervigilance, nightmares, exaggerated startle response, and generalized anxiety/agitation. Those presenting with the chronic form had relative increases in symptoms of detachment, restricted range of affect, dissociative episodes, sadness, and a belief that life will be too hard.

Psychosis in Borderline Patients with Depression

The authors compared psychotic symptoms in 24 prospectively identified borderline inpatients who met criteria for major depressive disorder with 20 major depressive disorder nonborderline controls. They found significantly more borderline subjects with dissociative phenomena, but there were few instances of true psychotic symptoms, even brief ones, in either of the groups. The dissociative episodes occurred primarily in women, and an etiology for the episodes is proposed. These results suggest that the criterion “brief or prolonged altered experiences of reality” rather than “brief psychosis” be considered as a prototypic borderline symptom.

Case Report: Flashback as a Post-traumatic Stress Disorder (PTSD) Symptom in a World War II Veteran

With many thousands of retirement age World War Π combat veterans now requiring medical and psychiatric hospitalization more frequently, the following case report should alert military, Veterans Administration, and civilian health care personnel to an often unrecognized diagnostic entity. This is an example of post-traumatic stress disorder in a combat veteran expressed via a single dissociative episode or flashback after more than 40 years of healthy functioning.

Posttraumatic stress disorder as an insanity defense: medicolegal quicksand.

A growing awareness of posttraumatic stress disorder has led to recent use of the disorder as a legal defense against criminal responsibility for both violent and nonviolent crimes. Diagnosis of posttraumatic stress disorder is difficult because the symptoms are mostly subjective, often nonspecific, usually well publicized, and, therefore, relatively easy to imitate. Accurate psychiatric testimony in such cases requires diligent searching for collateral sources of information. The authors argue that the insanity defense is appropriate only in the rare instance that a dissociative episode related to posttraumatic stress disorder directly leads to criminal activity.

Post-Traumatic Stress Disorder and the Insanity Defense: A Critical Analysis

As the concept of post-traumatic stress disorder (PTSD) has become more widely publicized, it has been used as a defense for criminal charges in a number of court cases. The implications of PTSD for the insanity defense are examined with reference to case examples. It is concluded that in most cases the argument for a finding of insanity based on PTSD rests on invalid, deterministic reasoning. In rare cases, an individual with PTSD will experience a psychotic or dissociative episode and may then meet the criteria for legal insanity.

A Case of Recurrent Dissociative Episodes in a Patient with Congenital Defects

Case Report Marie, a 30 year old American-born Hispanic female, was first seen in the emergency room with suicidal ideation (the impulse to jump in front of an oncoming car), depression, anxiety, and distress about "always getting attacked so much."

Hypnotherpay with a severe dissociative hysterical disorder.

Abstract Hypnosis was successfully used, on an out-patient basis, to treat a 25-year old male with a dissociative hysterical disorder. His dissociative episodes began five years prior to the initiation of treatment and were generally characterized by violent behavior usually involving destruction of property. Hypnosis was utilized during six of eight weekly therapy sessions. Regressions were performed to determine the etiology of the disorder and the specific precipitating stimuli for the episodes. “Ego-strengthening” suggestions were also used. The violent reaction ceased to appear. At the time of an eight-month follow-up, the patient was still free of dissociative episodes.

Comparison of corticocerebral activity as revealed in the electro-encephalogram and individual behavior as portrayed in the szondi test administered in the normal waking state and during the revivification of acute dissociative episodes in a hypnotically regressed state

Comparison of corticocerebral activity as revealed in the electro-encephalogram and individual behavior as portrayed in the szondi test administered in the normal waking state and during the revivification of acute dissociative episodes in a hypnotically regressed state