Dissociative Symptoms In Patients Research Articles

Experimental induction of peritraumatic dissociation: The role of negative affect and pain and their psychophysiological and neural correlates

While research has elucidated processes underlying dissociative symptoms in patients with posttraumatic stress disorder, little is known about the circumstances under which trauma-related dissociation initially arises. To experimentally investigate causes and concomitants of peritraumatic dissociation, we subjected sixty-nine healthy women to aversive-audiovisual and painful-electrical stimulation in a 2(aversive/neutral film) x 2(pain/no pain) within-subject design while recording psychophysiological and fMRI-BOLD responses. Afterwards, participants rated negative-affect, pain, and dissociation for each condition. Using Bayesian multilevel regression models, we examined (1) whether aversive-audiovisual and painful-electrical stimulation elicit higher dissociation-levels than control conditions and (2) whether stronger negative-affect and pain responses (operationalized via self-report, psychophysiological, and neural markers) correlate with higher dissociation-levels. Several key findings emerged: Both aversive-audiovisual and painful-electrical stimulation elicited dissociation. Dissociation was linked to higher self-reported negative-affect, but we did not find enough evidence linking it to psychophysiological and neural negative-affect markers. However, dissociation was associated with higher levels of self-reported pain, a skin-conductance-response-based pain marker, and the fMRI-BOLD-based Neurologic-Pain-Signature. Results indicate that both aversive-audiovisual and painful stimuli can independently cause dissociation. Critically, pain responses captured via self-report, psychophysiological, and neural markers were consistently linked to higher dissociation-levels suggesting a specific, evolutionary meaningful, contribution of pain to the rise of dissociation.

Efficacy of traumatic memory reactivation with or without propranolol in PTSD with high dissociative experiences

ABSTRACT Background: Post-traumatic stress disorder (PTSD) with dissociative symptoms is now a full-fledged subtype of this disorder. The dissociative subtype is associated with a greater number of psychiatric comorbidities. To date, the impact of dissociation on the efficacy of PTSD treatment remains unclear. Objective: The aim of this study was to compare the efficacy of a traumatic memory reactivation procedure with the administration of propranolol or a placebo once a week for six consecutive weeks in reducing PTSD and MDE symptoms between PTSD subjects with or without high dissociative symptoms. Method: For that, we conducted a randomized clinical trial in 66 adults diagnosed with longstanding PTSD and measured the SCID PTSD module, the PTSD Checklist (PCL-S), Beck’s Depression Inventory-II (BDI-II), and the Dissociative Experiences Scale (DES). Results: Patients with and without high dissociative experience had significant improvement in their PCL-S scores over the 6 treatment sessions, and PCL-S scores continued to decline in all patients during the post-treatment period. However, there was no correlation between the presence/absence of high dissociative experiences and no specific effect of propranolol treatment. We found exactly the same results for MDE symptoms. Interestingly, patients with high dissociative experiences before treatment exhibited very significant improvement in their DES scores after the 6 treatment sessions, and patients maintained this improvement 3 months post-treatment. Conclusions: The traumatic memory reactivation procedure is an effective way to treat dissociative symptoms in patients with PTSD, and improvement of these dissociative symptoms was associated with a decrease in both PTSD and depression severity.

P610. Eliciting Peritraumatic Dissociation Using Highly Aversive Films and Pain Stimulation: An Experimental FMRI Study

While research has started to elucidate the processes underlying chronic dissociative symptoms in patients with posttraumatic stress disorder, little is known about the circumstances under which trauma-related dissociation initially arises, i.e., the triggers of and mechanisms behind peritraumatic dissociation. Here, we expanded the analogue trauma-film approach by pain stimulation to increase ecological validity and examined effects on dissociation.

Childhood Trauma and Dissociative Symptoms in Patients Treated in the Forensic Psychiatry Service

Bu çalışmada, suç işlemiş olup adli psikiyatri servisinde takip edilen kişilerdeki dissosiyatif belirti yaygınlığı ve çocukluk çağı travmalarının klinik değişkenler ile ilişkisinin araştırılması amaçlanmıştır. Çalışmaya Elazığ Şehir Hastanesi Yüksek Güvenlikli Adli Psikiyatri (YGAP) servisinde takip edilen 55 hasta dahil edildi. Tüm katılımcılara yarı yapılandırılmış sosyodemografik veri formu, Çocukluk Çağı Travma Ölçeği (CTQ-28) ve Dissosiyatif Yaşantılar Ölçeği (DES) uygulandı. Bu çalışmada duygudurum bozukluğu tanılı suç işlemiş hastalarda DES toplam puanını 26,7±11,9 saptandı. DES amnezi, depersonalizasyon/derealizasyon alt puanları ile CTQ-28 fizikselistismar, fiziksel ihmal, cinselistismar ve minimalizasyon alt puanları arasında pozitif yönde anlamlı bir korelasyon tespit edildi. Araştırma bulgularına göre suç işleyen duygudurum bozukluğu tanılı hastalarda dissosiyatif yaşantılara sahip olma sıklığı düşük, diğer psikiyatrik hasta gruplarında ise yüksektir. Ayrıca bulgular suç işlemiş psikiyatri hastalarında dissosiyatif belirtiler ve çocukluk çağı ihmal-istismar açısından da rutin olarak araştırılması gerektiğini düşündürmektedir.

Childhood Traumatic Experiences and Dissociative Symptoms in Patients with Parasomnia

Childhood Traumatic Experiences and Dissociative Symptoms in Patients with Parasomnia

Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD

For patients with complex or other severe forms of PTSD, particularly in cases with dissociative symptoms, different treatment approaches have been suggested. However, the influence of somatoform dissociation on the effectiveness of trauma-focused treatment has hardly ever been studied. This study aims to test the hypotheses that (1) PTSD patients reporting a low level and those reporting a high level of somatoform dissociative symptoms would both benefit from an intensive trauma-focused treatment, and that (2) somatoform dissociative symptoms would alleviate. Participants were 220 patients with severe PTSD, enrolled in an intensive treatment program combining EMDR therapy and prolonged exposure therapy, without a preceding stabilization phase. Trauma history was diversified, and comorbidity was high. PTSD symptoms (CAPS-5 and PCL-5) and somatoform dissociative symptoms (SDQ-5 and SDQ-20) were assessed at pre-treatment, post-treatment and at six months after completion of treatment. The course of both PTSD and somatoform dissociative symptoms was compared for individuals reporting low and for those reporting high levels of somatoform dissociative symptoms. Large effect sizes were observed regarding PTSD symptoms reduction for patients with both low and high levels of somatoform dissociation. Somatoform dissociation did not impact improvement in terms of PTSD symptom reduction. The severity of somatoform dissociative symptoms decreased significantly in both groups. This decrease was greater for those with a positive screen for a dissociative disorder. These results add further support to the notion that the presence of strong somatoform dissociative symptoms in patients with PTSD does not necessarily call for a different treatment approach. Clinical implications are discussed.

Levels of Childhood Traumatic Experiences and Dissociative Symptoms in Patients with Major Depression: Is Dissociative Depression Real?

Background: A possible relationship between major depressive disorder (MDD) and, childhood traumatic experiences and dissociation has been proposed. This study assesses childhood traumatic experiences, the dissociative, depressive, and anxiety symptoms in patients with MDD, and aims to question the reality of dissociative depression Methods: The 99 psychotropic drug-naive patients participating in the study met the DSM-V criteria for MDD. Dissociation Questionnaire (DIS-Q), the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and the Childhood Trauma Questionnaire (CTQ) were applied. Results: The patients were divided into two groups using the DIS-Q (DIS-Q < 2.5 and DIS-Q ≥ 2.5) and the groups were compared. The study demonstrated that patients with high dissociative scores return significantly higher depression and anxiety scores than those with low dissociation and that the high dissociative group returned elevated emotional, sexual, and physical abuse scores compared to the low dissociative group. In the logistic regression analysis, the onset age of MDD (< 30 years), BDI, and BAI scores (scores ≥30) increased the participants’ likelihood of having DIS-Q ≥ 2.5. Conclusions: Results suggest that dissociative symptomatology in MDD may about early-onset age of MDD, childhood traumatic experiences, and severity level of both depression and anxiety. The clinician should carefully consider whether dissociation is a concomitant condition or a significant problem when working with patients with both depression and dissociation. However, clinicians should not neglect the underlying childhood traumatic experiences among these patients.

S165. ALTERED ASSOCIATION BETWEEN PARIETAL GRAY-MATTER VOLUME AND DISSOCIATIVE SYMPTOMS IN SCHIZOPHRENIA: A VOXEL-BASED MORPHOMETRY STUDY

BackgroundThe presence of dissociative symptoms has been constantly reported in patients with schizophrenia. Dissociative-like experience is also part of the prodromal symptoms in those who have higher risk for psychosis. While the underlying neurobiological causes of dissociative symptoms in patients with schizophrenia remains unclear, a history of trauma seems to be related to their dissociative symptoms, as is seen in dissociative disorders. The traumatic experience has been linked to volumetric alterations in patients with schizophrenia. The current study aimed to explore the associations between past traumatic experience, brain volume alteration and the presence of dissociative symptoms in patient with schizophrenia.MethodsWe employed voxel-based morphometry (VBM) to compare the distributions of gray matter volumes (GMV) in 20 patients with schizophrenia (SCZ, 10 Male) and 26 age- and sex-matched healthy volunteers (HV, 11 male). All participants underwent high resolution T1-weighted anatomical images on a 3T MRI system. Past traumatic experience was examined by Brief Betrayal Trauma Survey (BBTS), and the dissociative symptoms were measured by Traumatic Dissociation Scale (TDS).ResultsWe found a significant GMV reduction in right thalamus area in SCZ relative to HV group (p=0.01, whole-brain FWE corrected). The GMV in thalamus was negatively associated with high-betrayal traumatic experience in SCZ group (r=-0.48, p=0.033), but not in HV (r=-0.08, p=0.71). While examining the association between GMV and dissociative experience, a significant group by dissociation interaction was observed in the left superior parietal lobule/angular gyrus (SPL/AG) was observed (p=0.024, whole-brain cluster corrected), where negative correlations was observed in HV (r=-0.62, p=0.001) but positive correlations were observed in SCZ group (r=0.67, p=0.001). In SCZ group, both traumatic experience and the left SPL/AG GMV significantly predicted the dissociative experience (p=0.001 and p=0.011, respectively; R2 increased from 0.56 to 0.70 by adding the left SPL/AG GMV into the prediction model).DiscussionIn line with previous literature, we observed a decreased thalamic GMV in SCZ group, which is uniquely associated with their high-betrayal traumatic experience. Superior parietal lobe and angular gyrus has been reported to involved in dissociative experiences in psychiatric illnesses, and modulates sensory, cognitive and self processing in schizophrenia. The positive association we observed between SPL/AG GMV and dissociation experience in SCZ suggests its crucial role in dissociative psychopathology observed in schizophrenia spectrum disorder. Future studies focusing on functional and connectivity alterations of superior parietal/angular area in SCZ and its contribution to dissociative symptoms is warranted.

English

The present study attempted to assess childhood trauma events and dissociative symptoms in patients with obsessive compulsive disorder (OCD). The study included all patients who were admitted for the first time to the psychiatric outpatient unit over a 24-month period. Seventy-eight patients were diagnosed as having OCD during the two-year study period. Childhood traumatic events were assessed with a Childhood Trauma Questionnaire (CTQ). Obsessive compulsive disorder symptoms were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). A Dissociation Questionnaire (DIS-Q) was also used to measure dissociative symptoms. The mean of Y-BOCS points were 23.37 +/- 7.27. Dissociation questionnaire scores were between 0.40 and 3.87 and the mean was 2.23 +/- 0.76. Childhood trauma points were 1.27-4.77 and the mean was 2.38 +/- 0.56. There was no statistically significant relationship between Y-BOCS points and childhood trauma points (p > 0.05). There was a statistically significant positive relationship between Y-BOCS points and DIS-Q points. There was no statistically significant relationship between DIS-Q points and childhood trauma points (p > 0.05). Childhood trauma questionnaire points might be significant clinically, although there was not a statistically significant correlation in our study. We also conclude that dissociative symptoms among patients with OCD should alert clinicians to treatment of the disorder.

Kadın fibromiyalji hastalarında çocukluk çağı travmaları, disosiyatif yaşantılar ve depresyonun ağrı ile ilişkisi: Kesitsel bir çalışma

Objective: The aim of this study was to investigate childhood trauma (CT) and dissociative symptoms in patients with fibromyalgia and evaluate the relationship of these characteristics with pain intensity. Methods: Forty patients followed up with fibromyalgia diagnosis in the physical therapy and rehabilitation outpatient clinic; and as a control group, 38 healthy individuals who have similar age, gender, and educational status, were included in the study. A sociodemographic and clinical data form, Beck Depression Inventory (BDI), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ) and Visual Analogue Scale (VAS) were administered to participants. Results: Emotional abuse, physical neglect, physical abuse, CTQ total, SDQ and DES scores were found to be significantly higher in the fibromyalgia group than the control group. Only the difference for SDQ scores remained significant when a comparison made between groups by controlling depression levels. Somatoform dissociation scores were found to be a significant predictor of pain intensity in patients with fibromyalgia. Conclusion: Somatoform dissociative symptoms are found to be higher in patients with fibromyalgia than the control group. These symptoms may contribute to development and exacerbation of pain in fibromyalgia. Taking the dissociative symptoms into account have an important role in the treatment of patients with fibromyalgia who have a frequent history of CT, so the treatment of these patients should be carried out in cooperation with psychiatrists.

Psychiatric Comorbidity in Patients with Conversion Disorder and Prevalence of Dissociative Symptoms

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.

Dissociation Is Associated with Emotional Maltreatment in a Sample of Traumatized Women with a History of Child Abuse

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.

The Association Among Childhood Maltreatment, Somatic Symptom Intensity, Depression, and Somatoform Dissociative Symptoms in Patients with Fibromyalgia Syndrome: A Single-Center Cohort Study

Research demonstrates strong associations between childhood maltreatment and health problems that include dissociative symptoms and fibromyalgia syndrome (FMS). We assessed the associations among childhood maltreatment, somatic symptom severity, depression, and somatoform dissociative symptoms in all consecutive adult FMS patients of a tertiary referral pain medicine center between January 2010 and December 2011. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire, somatoform dissociative symptoms with the Somatoform Dissociation Questionnaire, somatic symptom severity with the Patient Health Questionnaire–15 and depression by the Patient Health Questionnaire–2. A total of 117 patients (84% women) were included in the analysis, of whom 20.5% reported severe emotional abuse, 8.6% severe physical abuse, 12.8% severe sexual abuse, 25.6% severe emotional neglect, and 12.0% severe physical neglect in childhood and adolescence. On average, patients reported high levels of somatoform dissociative symptoms and moderate levels of somatic symptom severity and depression. Somatoform dissociative symptoms and emotional abuse were moderately correlated (r = .32). In hierarchical regression analysis, gender (p = .01) and somatic symptom severity (p < .0001) but not childhood maltreatment and depression were significant predictors of somatoform dissociative symptoms. Reports of somatoform dissociative symptoms by FMS patients might be attributed to their tendency to report multiple somatic symptoms.

P-473 - Oxytocin reflects levels of trauma-related and dissociative symptoms in patients with severe depression

Introduction Recent findings suggest that functional irregularities in oxytocin biology may play a role in the pathophysiology of depression. One of the proposed pathways is related to stress, as oxytocin exerts a regulatory effect over neuroendocrine stress axis. Moreover, stress exposure and stress axis dysregulation are likely connected to dissociative symptoms. Objectives Therefore, the study investigates the relationship between depression severity, stress symptoms levels, dissociation and plasma oxytocin levels. Methods Depression severity was assessed by Beck Depression Inventory (BDI-II), symptoms related to stress were assessed by Trauma Symptom Checklist (TSC-40), psychological and somatoform dissociative symptoms were assessed by Dissociative Experiences Scale (DES) and Somatoform Dissociation Questionnaire (SDQ-20), respectively. Plasma oxytocin was measured using radioimmunoassays. Results 69 patients were included in the study, 34 in severe depression group (BDI-II≥29) and 35 in mild to moderate depression group (BDI-II≤28). The groups did not differ significantly in oxytocin levels. In severe depression group, negative correlations between oxytocin and TSC-40 and SDQ-20 were found (R = −0,55; p Conclusion The negative correlation between oxytocin and symptoms related to trauma and somatoform dissociation in severe depression group is, to our knowledge, the first finding in this context. It is consistent with stress-reducing effect of oxytocin in acute stress paradigms and suggests that stress and somatoform dissociation may represent important factors in complex relationship linking oxytocin to depression. The directionality of these relationships need to be assessed in longitudinal studies.

Evaluation of naltrexone for dissociative symptoms in borderline personality disorder

Data from a pilot study suggest that naltrexone might reduce dissociative symptoms in patients with borderline personality disorder. However, the interpretation of these data is limited by the lack of a control group and by the nonblind nature of this study. Hence, we examined the effects of naltrexone using a more rigorous design that controlled for major confounders such as spontaneous reduction of dissociation over time and placebo effects. Unmedicated patients with BPD [according to Diagnostic and Statistical Manual of Mental Disorders-IVth edition (DSM-IV)] were included in two small double-blind placebo-controlled randomized trials (total n=29). Patients received both 3 weeks of naltrexone (50 or 200 mg/day) and 3 weeks of placebo in a randomized order. Twenty-five patients completed the study according to protocol. Dissociation under naltrexone and placebo, respectively, was compared by repeated-measures analyses of variance. In either trial, both the intensity and duration of dissociative symptoms were numerically lower under naltrexone than under placebo. However, the effects were too small to reach statistical significance. Our data provide the first estimate of the pure pharmacological antidissociative efficacy of naltrexone from a rigorously designed trial.

Dissociative symptoms in patients with schizophrenia: relationships with childhood trauma and psychotic symptoms

ObjectiveThis study sought to examine the stability of dissociative symptoms in patients with schizophrenia spectrum disorders as well as relationships between psychotic symptoms, childhood trauma, and dissociation. MethodOne hundred forty-five patients with schizophrenia spectrum disorders (72% schizophrenia, 67% men) were examined at admission to inpatient treatment and 3 weeks later using the Positive and Negative Syndrome Scale, the Childhood Trauma Questionnaire, and the Dissociative Experiences Scale. ResultsDissociative symptoms significantly decreased over time (mean, 19.2 vs 14.1; P < .001). The best predictor of dissociative symptoms at admission was the Positive and Negative Syndrome Scale positive subscale (Finc3,64 = 3.66, P = .017), whereas childhood sexual abuse best predicted dissociation when patients were stabilized (Finc10,80 = 2.00, P = .044). ConclusionDissociative symptoms in patients with schizophrenia spectrum disorders are related to childhood trauma. Dissociation seems to be state dependent in this diagnostic group. Moreover, diagnostic interviews, in addition to the Dissociative Experiences Scale, should be considered to avoid measurement artifacts.

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

Background 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. Methods 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. Results 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. Conclusions 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.

S49-03 Posttraumatic disorders in patients with substance use disorders: A German multi-center study

Aims:This multi-center study examined the prevalence of posttraumatic stress disorder (PTSD) and the level of dissociative symptoms in a German population of patients with different substance use disorders (SUD).Method:A total of 459 participants (59.7% male) were recruited in 14 study centers. Of these, 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). Diagnostic measures included the Addiction Severity Index (ASI), the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale (DES), and the Posttraumatic diagnostic scale (PDS). The International Diagnostic Checklists (IDCL) were used to confirm DSM-IV diagnoses of PTSD and SUD.Results:25.3% of the subjects had PTSD confirmed by both IDCL and PDS. Higher rates were found in the AD (34.1%) and D (29.9%) groups as compared to group A (15.4%, p &lt; .001). Similarly, rates of dissociative symptoms as measured by the DES differed significantly between the different subgroups (AD: M=15.1±11.3; D: M=12.9±11.7; A: M=9.9±8.8; p &lt; .001). In a stepwise linear regression model, childhood trauma severity was associated with dissociation independent from current PTSD. The relationships between SUD group and dissociation ceased to be statistically significant when age and gender were included in the model.Conclusion:The findings support significant rates of PTSD and dissociative symptoms in patients with SUD and marked differences between the different SUD subgroups. The complex relationship between childhood trauma, dissociation, and PTSD in patients with SUD requires more research.

Dissociation in patients with schizophrenia: Relationships with childhood trauma and psychotic symptoms

Background and Aims:Only few studies have investigated the relationship between childhood trauma and dissociative symptoms in patients with schizophrenia spectrum disorders. Moreover, most of the existing studies did not pay attention to potential relationships between dissociation and psychotic symptoms.Methods:We examined 103 consecutively admitted patients with schizophrenia spectrum disorders using the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale (DES) and the Positive and Negative Symptom Scale (PANSS). Relationships between dissociative symptoms, childhood trauma and psychotic symptoms were examined at admission (t0) and when patients were stabilised (t1).Results:The DES mean score decreased significantly between t0 and t1 (M=20.1 vs. M=14.5). When patients were stabilized, sexual abuse, physical abuse, emotional abuse and the CTQ total score were significantly correlated with the DES total score (r=.36**, r=.20*, r=.28**, and r=.32**) and different subscales of the DES, most strongly with the amnesia subscale. The amnesia subscale of the DES also showed significant correlations with physical neglect (r=.28**). At t1, positive symptoms as measured by the PANSS were correlated with the depersonalisation subscale of the DES (r=.24*). No relationship existed with negative symptoms.Conclusions:Our results confirm the relationships between childhood trauma and dissociation in patients with schizophrenia spectrum disorders. Furthermore, they suggest a relationship between dissociation and positive, but not negative psychotic symptoms.

Childhood Trauma and Dissociation in Female Patients With Schizophrenia Spectrum Disorders

The few studies that have investigated the relationship between trauma and dissociative symptoms in patients with schizophrenia have not assessed the role of the severity of psychotic symptoms. The current study examined correlations among five domains of childhood trauma and dissociative symptoms in 30 female patients with schizophrenia spectrum disorders, using the Dissociative Experiences Scale and the Childhood Trauma Questionnaire. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale. Consistent with previous studies, high levels of childhood traumatic experiences were found (Childhood Trauma Questionnaire total score M = 48.5, SD = 18.3). Physical neglect and emotional abuse showed significant correlations with dissociative symptoms at admission. When patients were stabilized, about a month after admission, emotional abuse still showed a significant correlation with dissociative symptoms. However, in contrast to previous findings, Dissociative Experiences Scale findings were not stable over time. Our results confirm the relevance of childhood trauma in schizophrenic patients but also demonstrate the need to develop appropriate methodologies for measuring dissociation in this population.