Dissociative Experiences Scale Taxon Research Articles

Dissociation mediates association between childhood trauma and distress from trauma research participation: analysis of pooled clinical data

ABSTRACT Background Childhood trauma and post-traumatic stress disorder (PTSD) are risk factors for emotional distress from trauma-related research participation. The role of dissociation, however, has not been investigated. This study examined the mediation effect of dissociation and PTSD on the relationship between childhood trauma and distress in trauma studies. Methods Pooled data of the Childhood Trauma Questionnaire, Impact of Events Scale-Revised, Dissociative Experiences Scale-Taxon, and Trauma Antecedents Questionnaire from 231 psychiatric patients (73% diagnosed with psychotic illnesses) at a psychiatric clinic in South Korea were analysed. We performed multiple mediation effect analysis to verify a structural model for distress in trauma-related questionnaires. Results Thirteen percent of participants reported distress after the survey. In the structural equation, the symptoms of PTSD did not show a significant relationship (p = .064). When the two parameters were included in the model, it was found that the direct effect of childhood trauma on distress was not significant (p = .43), but dissociation showed a direct effect on distress (p < .001). Discussion Childhood trauma affects distress through the sequential mediating effect of PTSD symptoms and dissociation. Dissociation should be considered as a significant contributor to distress from trauma research participation along with childhood trauma and PTSD.

State and trait dissociation in pathological skin picking

Dissociative experiences like trance or depersonalization may play a prominent role in pathological skin picking (PSP). However, trait and state dissociation and their relation to skin picking have hardly been studied in those with PSP. By means of an anonymous online survey, we recruited 323 adults with PSP defined by Skin Picking Scale-Revised (SPS-R) scores ≥ 7 as well as Skin Picking Impact Scale (SPIS) scores ≥ 7. Participants were administered the Dissociative Experiences Scale-Taxon (DES-T) to determine trait dissociation as well as the modified Peritraumatic Dissociative Experiences Questionnaire (PDEQ) to assess state dissociation during a typical episode of PSP. Sixty-three participants (19.5%) were assigned to the pathological dissociative taxon, that is, were high in trait dissociation. State dissociation during episodes of skin picking was reported by 221 individuals (68.4%) with the feeling of being on “automatic pilot” (49.6%) and alterations in time perception (33.1%) being the most frequent phenomena. Both trait and state dissociation were significantly associated with skin picking-related impairment, but effect sizes were small. Dissociation conceived as trait and state might be an important psychopathological dimension in skin picking. Its systematic detection and recognition may hold therapeutic implications as dissociation is a negative predictor of treatment outcome.

Improving care for SUD patients with complex trauma-relationships between childhood trauma, dissociation, and suicidal behavior in female patients with PTSD and SUD.

Posttraumatic disorders are among the most frequent co-occurring diagnoses in patients with substance use disorders (SUD). Individuals with this dual diagnosis often present with special treatment needs, especially after childhood traumatic experiences (CT). Along with posttraumatic stress disorder (PTSD) and dissociative symptoms, suicidal behaviors belong to the clinical challenges in this group of patients and may influence the course and outcome of SUD treatment. Therefore, a better understanding of the relationships between different forms of CT, psychopathology and suicidal behaviors seems to be important to tailor adequate concepts of care. We examined 343 female patients with SUD and Posttraumatic stress disorder (PTSD). All patients completed the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale-Taxon (DES-T) and the Structured Clinical Interview Axis I Disorders (SCID-I). To determine relationships between different symptoms with potential importance for concepts of treatment, we conducted analyses of moderated mediation for different models. We examined the direct and indirect effects of associations between the type of CT, dissociation and suicidal behavior, as well as the moderation effect of PTSD. All participants met DSM-criteria for either full PTSD (75.2%) or subsyndromal PTSD (24.8%). Almost all (94.5%) received at least one substance dependence diagnosis and the remaining 5.5% met substance abuse criteria. Most participants (93.3%) reported at least one type of childhood trauma. In all models, dissociation was a risk factor for suicidal ideation (SI) and for suicide attempts (SA). In both, participants with subsyndromal PTSD and participants with full PTSD, dissociation mediated the relationship between childhood sexual abuse and SI as well as SA. Moreover, we report direct effects between different childhood traumas and SI and SA. Furthermore, emotional abuse was a significant predictor of dissociation. In our sample of female patients with SUD and co-occurring PTSD, dissociation significantly increased suicidal behavior and served as a mediator of the relationship between childhood sexual abuse and suicidal behavior. Our findings underline the need to include interventions to address dissociative symptoms and other more complex consequences of childhood trauma into concepts of care for patients with SUD.

The association between neurocognitive functioning and clinical features of borderline personality disorder.

Objective:To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD).Methods:Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups.Results:BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale – Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decision-making and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity.Conclusion:Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.

Prevalence and clinical correlates of childhood trauma among inpatients diagnosed with bipolar disorder: a matched comparison with schizophrenia

ABSTRACT Background This study examined whether a particular type of childhood trauma (CT) is more prevalent in people diagnosed with bipolar disorder than in a matched sample of people diagnosed with schizophrenia and whether clinical variables of bipolar disorder are related to CT. Methods Seventy-one inpatients diagnosed with bipolar disorder were matched to those diagnosed with schizophrenia for age, sex, and duration of illness. Both groups completed the Childhood Trauma Questionnaire, the Traumatic Antecedent Questionnaire, the Impact of Events Scale, and the Dissociative Experiences Scale-Taxon. Second, clinical variables at discharge, course variables within one year (relapse, readmission, and time remained in therapy) and medication adherence were investigated for association with trauma types. Results Reported CT and protective factors did not differ between those diagnosed with bipolar disorder and schizophrenia. In addition, CT was not related to clinical features, course variables or medication adherence. The only significant correlations found were between childhood emotional neglect and prescription of anxiolytics (p < 0.05) and sleep pills (p < 0.001) at discharge. Conclusions We did not find any particular type of CT that distinguishes bipolar disorder from schizophrenia, implying there is no specific contribution of CT to different psychotic diagnoses. However, some types of trauma may correlate with the prescription of specific psychotropic medication.

The Association between General and Pathological Dissociation and Disaster-Related Psychopathology in Directly Exposed Survivors

Objective: Dissociation and trauma have a well-documented relationship, and dissociation is assumed to result from trauma exposure. If trauma generates dissociative psychopathology, it should be observed after exposure to disaster and be associated with disaster-related psychopathology. Few studies have focused specifically on dissociation as an outcome of disaster trauma. This study examined dissociation and its association with disaster-related psychopathology in survivors of five different disasters. Methods: In the first 6 postdisaster months, directly exposed survivors (N = 216) of mass shootings, floods, or a firestorm completed structured diagnostic interviews providing lifetime predisaster and postdisaster prevalent/incident psychiatric diagnoses and the Dissociative Experiences Scale (DES) 1–3 years after baseline. Results: DES scores were very low; only 1% met the DES Taxon signifying pathological dissociation. In multivariate models including predisaster lifetime major depression, lifetime panic disorder, lifetime generalized anxiety disorder, and lifetime alcohol use disorder; disaster-related PTSD; and number of incident somatoform symptoms as independent covariates, predisaster lifetime major depression and alcohol use disorder were independently associated with both general (DES score) and pathological (DES Taxon) dissociation, and postdisaster incident somatization symptoms were also associated with general dissociation, but postdisaster psychopathology including disaster-related PTSD was not associated with general or pathological dissociation. Conclusions: Neither general nor pathological dissociation was independently associated with disaster-related PTSD or other incident psychopathology. The only psychiatric disorders associated with dissociation were present before the disasters. Coupled with the low dissociation rates, these findings indicate that dissociation does not appear to be a mental health outcome of disaster trauma.

Dissociative, Schneiderian and borderline personality symptoms in a non-clinical sample in Hong Kong: A preliminary report

IntroductionDissociative symptoms are common in people with trauma-related disorders and often co-occur with other psychiatric conditions. In particular, the relationships between dissociative symptoms, Schneiderian first-rank symptoms and borderline personality symptoms are still contentious, poorly understood and require more attention. ObjectivesThis preliminary study investigated these three symptom clusters in a non-clinical Chinese sample in Hong Kong. MethodsA total of 190 college students in Hong Kong completed the Dissociative Experiences Scale-Taxon (DES-T), the 5-item Somatoform Dissociation Questionnaire (SDQ-5) and some sections of the Dissociative Disorders Interview Schedule (DDIS). ResultsAbout one-fourth of the participants (24.7%) screened positive for one symptom cluster, 12.1% were positive for two symptom clusters; and 5.26% were positive for all three symptom clusters. Preliminary analysis showed that the three symptom clusters were associated with distress/impairment. ConclusionDissociative, Schneiderian and borderline personality symptoms as measured in this study are not uncommon in this non-clinical Chinese sample. The data indicate that these three symptom clusters are highly related but are not the same constructs of psychopathology; the co-occurrence of these symptoms may require additional attention. The findings have significant implications for research and practice. Further studies are needed.

Psychometric properties of the pathological dissociation measures among Chinese – a pilot study using online methods

ABSTRACTPurpose: Pathological dissociation (PD) is an easily overlooked phenomenon in the mental health field. Standardized assessment is important for identifying dissociative symptoms and disorders. However, the use of PD measures in Chinese cultures needs investigation. This pilot study investigated the psychometric properties of three PD measures among Hong Kong Chinese. Methods: The psychometric properties of the Dissociative Experiences Scale-Taxon, the 5-item Somatoform Dissociation Questionnaire, and the Self-Report Version of the Dissociative Disorders Interview Schedule (SR-DDIS) were evaluated using online methods in Hong Kong. Results: The PD measures exhibited adequate to excellent internal consistency. The PD measures were negatively related to family support and can discriminate between participants with and without self-reported childhood abuse. There was excellent agreement between the online SR-DDIS results and the clinical diagnoses for presence of any dissociative disorder (DD) versus no DD. The DDs group scored significantly higher on PD measures than the depression group and the college student group. Discussion: The initial findings suggest that PD can be assessed online in Hong Kong. Further investigation is necessary.

Pathological Dissociation and Its Relationships with Aggression and Delinquency in a College Student Sample in Hong Kong

ABSTRACTPathological dissociation is widely regarded as a cross-culturally occurring condition related to trauma and adversity and is an important construct in the mental health field. Yet, the frequency of pathological dissociation in both clinical and nonclinical populations in Hong Kong remains unknown. In addition, the relationship of pathological dissociation with aggression and delinquency requires further investigation. To investigate these relationships, we administered the Dissociative Experiences Scale-Taxon (DES-T), the 5-item Somatoform Dissociation Questionnaire (SDQ-5), selected sections from the Self-Report Version of the Dissociative Disorders Interview Schedule (SR-DDIS), the Reactive–Proactive Aggression Questionnaire (RPQ), and a delinquent behaviors checklist to 177 college students in Hong Kong. The findings suggest that pathological dissociation is not as rare as it is traditionally believed to be in Hong Kong. In our sample, 4.52% of the participants may have a DSM-5 dissociative disorder (including other specified dissociative disorder) while 9.60% met the DSM-5 diagnostic criteria for borderline personality disorder (BPD). Our findings indicate that the RPQ total score and delinquency may be more characteristic of BPD than of pathological dissociation. In addition, while reactive aggression was related to pathological dissociation and BPD symptoms in both genders, proactive aggression was related to pathological dissociation and BPD symptoms only in females. Although the findings of this study are preliminary and the results should be interpreted with caution, the study provides the first data regarding pathological dissociation and its relationship with aggression and delinquency in Hong Kong. Some implications for research and practice are highlighted. Further investigation of pathological dissociation in Hong Kong is necessary. In addition, more studies are essential to further examine the relationships between pathological dissociation, aggression, and delinquency in both clinical and nonclinical populations.

The Association among Childhood Trauma, Pathological Dissociation and Gambling Severity in Casino Gamblers.

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.

Dissociative experiences in epilepsy: Effects of epilepsy-related factors on pathological dissociation

Psychogenic nonepileptic seizures (PNESs) in patients with epilepsy can be categorized as dissociative disorders. The prevalence of PNESs in patients with epilepsy appears to be much higher than that of dissociative experiences in nonclinical subjects. In order to clarify as to whether epilepsy-related factors were associated with pathological dissociation, we conducted a controlled study with 225 patients with epilepsy and 334 nonclinically matched individuals. All participants completed the Japanese version of the Dissociative Experiences Scale (DES). There was no significant difference in the DES score (DES-S) between the group with epilepsy and the control group. The group with epilepsy showed a significantly higher DES taxon (DES-T; a subset of DES-S and an index of pathological dissociation) than the control group. Thirty-one out of the 225 patients with epilepsy (13.8%) had PNESs. Because of its strong association with the DES-S and DES-T, PNESs can be regarded as a symptom of dissociation. With multiple regression analysis, the patients with a shorter duration of epilepsy, higher seizure frequency, or shorter period in education tend to suffer from pathological dissociation. These findings demonstrate that patients with epilepsy are more prone to experiencing pathological dissociation when having certain clinical factors.

Psychometric properties of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in Korean patients with schizophrenia

ObjectiveDespite increasing interest in the relationship between childhood trauma and psychosis, measures used to assess early trauma have not had their psychometric properties extensively tested among individuals with serious mental illness. This study investigated the reliability and validity of one of the most widely-used self-reports of early adversity, the Childhood Trauma Questionnaire, Short Form (CTQ), among patients with schizophrenia. MethodsThe CTQ was administered to 100 patients (52 inpatients and 48 outpatients) diagnosed with schizophrenia in three training hospitals. Internal consistency, four-week test–retest reliability and validity were calculated. Participants also completed the Trauma Antecedents Questionnaire (TAQ), the Impact of Events Scale-Revised (IES-R), and the Dissociative Experiences Scale-Taxon (DES-T). ResultsOur analysis indicated high test–retest reliability (Spearman ρ=0.75) and internal consistency (Cronbach α=0.89). Concurrent validity was confirmed as each type of childhood trauma was significantly correlated with the corresponding subscales of the TAQ. In addition, the CTQ was positively related to post-traumatic stress symptoms and pathological dissociation, demonstrating the convergent validity of the scale. ConclusionThe CTQ is a reliable and valid self-report measure for assessing childhood trauma in both inpatients and outpatients with schizophrenia.

Dancing with the Muses: Dissociation and Flow

This study investigated dissociative psychological processes and flow (dispositional and state) in a group of professional and pre-professional dancers (n = 74). In this study, high scores for global (Mdn = 4.14) and autotelic (Mdn = 4.50) flow suggest that dancing was inherently integrating and rewarding, although 17.6% of the dancers were identified as possibly having clinical levels of dissociation (Dissociative Experiences Scale–Taxon cutoff score ≥20). The results of the multivariate analysis of variance indicated that subjects with high levels of dissociation had significantly lower levels of global flow (p < .05). Stepwise linear regression analyses demonstrated that dispositional flow negatively predicted the dissociative constructs of depersonalization and taxon (p < .05) but did not significantly predict the variance in absorption/imagination (p > .05). As hypothesized, dissociation and flow seem to operate as different mental processes.

Reliability and Validity of the Korean Version of the Childhood Trauma Questionnaire-Short Form for Psychiatric Outpatients

ObjectiveThe Childhood Trauma Questionnaire (CTQ) is perhaps the most widely used and well-studied retrospective measure of childhood abuse or neglect. This study tested the initial reliability and validity of a Korean translation of the Childhood Trauma Questionnaire (CTQ-K) among non-psychotic psychiatric outpatients.MethodsThe CTQ-K was administered to a total of 163 non-psychotic psychiatric outpatients at a university-affiliated training hospital. Internal consistency, four-week test-retest reliability, and validity were calculated. A portion of the participants (n=65) also completed the Trauma Assessment Questionnaire (TAQ), the Impact of Events Scale-Revised, and the Dissociative Experiences Scale-Taxon.ResultsFour-week test-retest reliability was high (r=0.87) and internal consistency was good (Cronbach's α=0.88). Each type of childhood trauma was significantly correlated with the corresponding subscale of the TAQ, thus confirming its concurrent validity. In addition, the CTQ-K total score was positively related to post-traumatic symptoms and pathological dissociation, demonstrating the convergent validity of the scale. The CTQ-K was also negatively correlated with the competence and safety subscale of the TAQ, confirming discriminant validity. Additionally, we confirmed the factorial validity by identifying a five-factor structure that explained 64% of the total variance.ConclusionOur study indicates that the CTQ-K is a measure of psychometric soundness that can be used to assess childhood abuse or neglect in Korean patients. It also supports the cross-cultural equivalence of the scale.

Relationship between dissociative experiences, abnormal sleep experiences, and sleep quality in undergraduate students

Relationship between dissociative experiences, abnormal sleep experiences, and sleep quality in undergraduate students Objective: To investigate the association between dissociative experiences, sleep related experiences and sleep quality. Method: 127 undergraduate students have completed the Dissociative Experiences Scale (DES), the Iowa Sleep Experiences Scales (ISES) and the Pittsburg Sleep Quality Index (PSQI). Results: DES total and DES Taxon scores were moderately correlated with total ISES and ISES General Sleep Experiences (GS) subscale scores. PSQI total scores as well as the scores from PSQI subscales of sleep disturbances, use of sleeping medication and daytime dysfunction were weakly correlated with total ISES and ISES GS subscale scores. DES and PSQI total and subscale scores were not correlated with the lucid dreaming (LD) subscale of ISES. DES total scores explained a considerable amount of variance in ISES GS scores. Sleep disturbances and use of sleeping medication as indicators of sleep problems, were related to ISES GS. Conclusions: The present study showed the association between dissociative experiences and nighttime experiences and further revealed that some aspects of general sleep quality, especially the ones related to sleep problems are also related to both dissociation and general sleep experiences.

The Dissociative Experiences Taxon Is Related to Fantasy Proneness

Some authors have argued that nonpathological dissociation should be distinguished from a taxon form of pathological dissociation, which is indexed by the Dissociative Experiences Scale Taxon (DES-T). We tested to what extent DES-T scores are independent from fantasy immersion and whether DES-T scores are uniquely related to trauma self-reports. To this end, subsamples of undergraduate students (n = 930), healthy adults (n = 20), schizophrenic patients (n = 22), borderline personality disordered patients (n = 20), patients with mood disorder without psychosis (n = 19), and women with a history of childhood sexual abuse (n = 55) completed the Dissociative Experiences Scale and a measure of fantasy immersion. DES-T scores were related to absorption and fantasy immersion to a lesser extent than the original DES. However, the fact that nontrivial percentages within all groups, except for the healthy adults, were classified as taxon members casts doubts on the assumption that DES-T is a reliable index of pathological dissociation. Also, we found that the DES-T was not exclusively related to reports of childhood sexual abuse.

Factors Associated with Pathological Dissociation in the General Population

This study assessed the prevalence of pathological dissociation in the general population, and the relationship between pathological dissociation and sociodemographic and several psychiatric variables. The stratified population sample consisted of 2001 subjects. The study questionnaires included the Dissociative Experiences Scale, the Dissociative Experiences Scale-Taxon, the Toronto Alexithymia Scale, the Beck Depression Inventory, and sociodemographic background. The prevalence of pathological dissociation (DES-T >/= 20) was 3.4% in the general population and did not differ significantly between genders. Men scored higher than women in the amnesia subscale, and women in the absorption and imaginative involvement subscale. The relationship between pathological dissociation, alexithymia, depression and suicidality was strong. The likelihood of pathological dissociation was nearly nine-fold higher among depressive subjects, more than seven-fold higher among alexithymic subjects, and more than four-fold higher among suicidal subjects than among the others. Frequent alcohol consumption also associated significantly with pathological dissociation. A significant relationship between pathological dissociation, depression, alexithymia, and suicidality was found in the general population. The importance of these factors should be examined in a prospective study design to determine causality.

The Relationship Between Pathological Dissociation, Self-Injury and Childhood Trauma in Patients with Personality Disorders Using Taxometric Analyses

ABSTRACT Objective: Dissociative phenomena exist on a spectrum ranging from psychological absorption to highly symptomatic disruptions of identity and memory. A statistical methodology called taxometric analysis has established a set of indicators that identify patients who have pathological dissociation, a qualitatively different form of dissociative phenomena. Using taxometric methodology, this study examines the relationship of pathological dissociation to personality diagnosis and self-directed injury, including suicide and history of childhood abuse, in a sample of outpatients with personality disorders. Method: Patients were recruited from advertisements or referred from local clinicians. Participants completed a diagnostic interview and rating scales for dissociation, self-injury and childhood trauma. Pathological dissociation was identified using the Dissociative Experiences Scale-Taxon (DES-T; Waller, Putnam, & Carlson, 1996). Membership in the pathological dissociation taxon was established by calculating Bayesian posterior taxon membership probabilities; the method advocated by Waller, and compared to an approximation, used widely in the literature, based simply on the unweighted mean of the DES-T items. Results: Overlapping, but not identical groups of patients were identified, indicating that the two methods are not interchangeable in this sample of personality disordered individuals. Surprisingly, no associations were detected between indices of childhood trauma and membership in the pathological dissociation taxon nor for the high dissociators identified through the approximation method. Conclusions: This study serves as a replication of the ability to detect pathological dissociation as measured by the DES-T. Nonetheless, the failure to confirm our hypotheses regarding an association between pathological dissociation, childhood trauma, and personality diagnosis raise a challenge to some parts of existing etiologic theories.

Dissociative Experiences Scale Taxon and Measurement of Dissociative Pathology: Does the Taxon Add to an Understanding of Dissociation and Its Associated Pathologies?

The Dissociative Experiences Scale Taxon (DES-T) is a modified version of the Dissociative Experiences Scale (DBS) that relies on a subset of eight categorical variables to overcome errors introduced into diagnostic classification by virtue of the use of dimensional measures of dissociation (e.g., DES) that mix normal and abnormal dissociative experiences. The present study examined the diagnostic accuracy of the DES-T and the DES in two non-dissociative psychiatric samples and four dissociative disorders. Classification of the six groups by the two measures yielded more errors with the DES-T and a high degree of correlation between normal and abnormal dissociative experience. The DES-T was sensitive for only the most extreme forms of dissociative pathology. There was no support for the use of the DES-T in lieu of the DES, or for reliance on either as a definitive diagnostic measure.