Mean Dissociative Experiences Scale Score Research Articles

Dissociative experiences and health anxiety in panic disorder.

Background:Dissociative experiences and health anxiety are frequently encountered in anxiety disorders and contribute to the burden of illness.Aim:The aim was to assess and compare dissociative experiences and level of health anxiety in patients with panic disorder and normal individuals.Materials and Methods:We recruited forty eligible patients with panic disorder and forty healthy volunteers without any psychiatric diagnoses. Health anxiety was evaluated by the Short Health Anxiety Inventory and dissociative symptoms were assessed by the Dissociative Experiences Scale (DES).Results:Dissociative experiences were more frequently reported by patients with panic disorder compared to normal controls, but overall mean DES scores were lower in both groups compared to previous literature. A high level of health anxiety was also seen in panic disorder compared to normal individuals.Conclusion:Health anxiety and dissociative experiences, especially depersonalization-derealization, are commonly encountered in panic disorder and should be actively explored to understand how they influence psychopathology and treatment outcome.

Dissociative Experiences In Iranian Depressed Patients

ABSTRACTIn the present study, 229 major depressive disorder (MDD) patients (57.6% female; 42.4% male) were selected by convenience sampling and examined for rate of dissociative experiences. Research tools were Dissociative Experiences Scale (DES) and demographic questionnaire. Group difference examinations were performed for gender, settlement region (place of residence), and chief complaints using standard t-test, analysis of variance, and Chi-square tests as appropriate. Ordinal regression was implemented for model building. The average age of the sample was 36.78 ± 10.73. Of which, 150 (65.5%) lived in the urban and 79 (34.5%) in the rural areas. The chief complaint of the 146 patients (63.8%) was psychiatric symptoms specific to MDD, and the remaining 83 patients (36.2%) had physical symptoms. The average DES score was 10.59 ± 13.59; and a significant mean DES score differences (P < 0.01) between patients’ referred to physician for physical versus psychological complaints (physical: 23.61 ± 14.39; psychological: 3.19 ± 4.5) and geographic settlements (rural: 19.58 ± 15.13; urban: 5.86 ± 9.86) were observed. This study highlights the presence of subtype within MDD patients with significant dissociative tendencies. Given the relationship between trauma history and dissociation, this subgroup could be considered as probable cases with childhood history of abuse, lending to use dissociation as a defense mechanism. Given the evidence for promising results of trauma-focused psychotherapy in treating such patients, paying proper attention to childhood history of depression especially with somatization may minimize pain and suffering of these individuals overtime.

Studying the Prevalence of Dissociative Experiences Among Methadone Maintenance Treatment Patients at Different Dosages and its Effect on Addiction Severity Index Subscales

Background: According to “chemical dissociation” hypothesis, is suggested that substance use disorder patients may not experience a high level of dissociation due to substance use, they may experience some level of dissociative-like states. There are few and albeit contradictory reports about prevalence of dissociative experiences among patients with substance use disorder. Objectives: The aim of this study was to consider the dissociative experiences among patients referred to Addiction Treatment Clinic of Baharan Hospital of psychiatry, Zahedan, IR. Methods: In this descriptive cross-sectional study, 231 patients, referred to MMT Clinic of Baharan Psychiatric Hospital in Zahedan, were studied. Sampling was convenient and patients were divided to two groups, including those receiving less than 60 mg of methadone daily (group A) and those receiving equal or more than 60 mg of methadone daily (group B). Dissociative experiences scale (DES) and addiction severity index (ASI) forms were completed. Finally, data were analyzed by using SPSS version 19 and independent t-test. Results: A total of 231 patients participated in this study. Mean age of patients was 33.9 ± 8.0 (P = 0.053). They included 204 males (88.3%) and 27 females (11.7%) (P = 0.328). Total mean DES score was 15.3 ± 11.7. Mean DES scores were 15.6 ± 11.2 in group A and 16.1 ± 11.7% in group B (t (1) = -0.1, P = 0.827). Addiction severity index were 0.74 ± 1.69 in patients with DES scores more than 30 and 0.43 ± 1.51 in patients with DES scores less than 30 (t (1) = 1.1, P value = 0.204). Conclusions: Based on the current study, it can be concluded that different dosages of methadone induce the same chemical dissociation and this has no significant relationship with different areas of ASI.

The frequency of dissociation and childhood trauma among obsessive-compulsive patients by comparing with healthy controls

Objective: To determine the frequency of dissociation and childhood trauma among obsessive-compulsive patients by comparing with healthy controls. Methods: This study comprises of a group of 50 patients attending to Hamidiye Etfal Training and Research Hospital Psychiatric Outpatients Department who had been diagnosed as obsessive-compulsive disorder according to DSM-5 and a control group of 50 participants with no psychiatric diagnosis. The groups were collected between September 2014 and January 2015. SCID-I, SCID-D, Dissociative Experiences Scale (DES), Childhood Trauma Quetionnaire (CTQ-28) and a short instrument gathering qualitative information about childhood traumatic experiences were administered to all attendees with a sociodemographic form. Results: Mean DES and CTQ-28 total scores were determined as significantly different between OCD and control groups. In the OCD group, the percentage of existence of at least one type of dissociative disorder was 14%. In CTQ-28 subscales scores, there were significant differences between OCD and control groups for emotional neglect, emoti-onal abuse and physical abuse. Moreover, 70% of the OCD group has had at least one type of childhood trauma. In childhood trauma subscales, there were also significant differences between OCD and control groups for at least one type of childhood trauma, emotional neglect, emotional abuse, physical abuse and sexual abuse. Discussion: Findings of significant differences between OCD patients and healthy controls according to dissociation and child-hood trauma, 14% of at least one type of dissociative disorder and 70% of at least one type of childhood trauma in OCD patients are main findings of this study. Our study differentiates from other studies in our country that its having a control group. Considering above findings, it has revealed that because of its probable effects on the diagnosis and treatment, co-existence of OCD with dissociation and childhood trauma is needed to be taken account.

Sleep-Related Violence, Self-Mutilation, and Dissociative Experiences

Twenty-eight subjects with and 46 subjects without sleep-related violence (VBS) were evaluated regarding the presence of self-mutilative behaviors (SMBs). The subjects with and without VBS were compared using dissociative experiences scale (DES). The subjects with VBS had higher mean DES score and more frequent SMBs than those without VBS. These findings suggest that dissociation may be related to both daytime SMBs and violent behaviors during sleep in young population.

Childhood traumas in patients with bipolar disorder: association with alexithymia and dissociative experiences

Objective: The number of studies investigating the traumatic events experienced during childhood period in patients with bipolar disorder (BD) are limited and to our knowledge no previous study was conducted about alexithymia and dissociative experiences of these patients as well. Besides investigation of childhood traumas and associated dissociative and alexithymic properties, identification of the differences between BD patients with and without childhood trauma (CT) was aimed in this study. Methods: Among the admissions to the psychiatry outpatient clinic, 70 BD patients and 70 healthy control subjects were included into the study. Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I), Dissociative Experiences Scale (DES), Childhood Trauma Questionnaire (CTQ) and Toronto Alexithymia Scale (TAS-20) were administered. Results: Mean subscale and total scores of patients with BD in both CTQ and TAS-20, and mean DES score were found to be significantly higher than healthy control subjects. Psychopathological acts, number of episodes and suicide attempts were higher in the BD patients with childhood trauma history than that of the BD patients without any history of childhood trauma. Additionally, positive correlations were found between ‘sexual abuse’ and alexithymia total score along with ‘difficulty identifying feelings’ subscale score. Moreover, mean DES score was also found to be positively correlated with ‘difficulty identifying feelings’ subscale score, ‘difficulty to describe feelings’ subscale score, alexithymia total score, and episode frequency. Conclusion: These results highlight the importance of protective mental health in the treatment of BD and reveal that childhood traumas should be questioned when evaluating patients especially with the diagnosis of BD.

Assessment of dissociation among combat-exposed soldiers with and without posttraumatic stress disorder

BackgroundDissociation is a disruption of and/or discontinuity in the normal, subjective integration of one or more aspects of psychological functioning, including memory, identity, consciousness, perception, and motor control. A limited number of studies investigated combat-related dissociation.ObjectiveThe primary aim of this study was to evaluate the relationship between dissociative symptoms and combat-related trauma.MethodThis study included 184 individuals, including 84 patients who were exposed to combat and diagnosed with posttraumatic stress disorder (PTSD) (Group I), 50 subjects who were exposed to combat but were not diagnosed with PTSD (Group II), and 50 healthy subjects without combat exposure (Group III). The participants were evaluated using the Dissociative Experiences Scale (DES) to determine their total and sub-factor (i.e., amnesia, depersonalization/derealization, and absorption) dissociative symptom levels. In addition, Group I and Group II were compared with respect to the relationship between physical injury and DES scores.ResultsThe mean DES scores (i.e., total and sub-factors) of Group I were higher than those of Group II (p<0.001), and Group II's mean DES scores (i.e., total and sub-factors) were higher than those of Group III (p<0.001). Similarly, the number of subjects with high total DES scores (i.e.,>30) was highest in Group I, followed by Group II and Group III. When we compared combat-exposed subjects with high total DES scores, Group I had higher scores than Group II. In contrast, no relationship between the presence of bodily injury and total DES scores could be demonstrated. In addition, our results demonstrated that high depersonalization/derealization factor scores were correlated with bodily injury in PTSD patients. A similar relationship was found between high absorption factor scores and bodily injury for Group II.ConclusionsOur results demonstrated that the level of dissociation was significantly higher in subjects with combat-related PTSD than in subjects without combat-related PTSD. In addition, combat-exposed subjects without PTSD also had higher dissociation levels than healthy subjects without combat experience.

Three Dimensions of Dissociative Amnesia

Principal axis factor analysis with promax rotation extracted 3 factors from the 42 memory and amnesia items of the Multidimensional Inventory of Dissociation (MID) database (N = 2,569): Discovering Dissociated Actions, Lapses of Recent Memory and Skills, and Gaps in Remote Memory. The 3 factors' shared variance ranged from 36% to 64%. Construed as scales, the 3 factor scales had Cronbach's alpha coefficients of .96, .94, and .93, respectively. The scales correlated strongly with mean Dissociative Experiences Scale scores, mean MID scores, and total scores on the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised (SCID-D-R). What is interesting is that the 3 amnesia factors exhibited a range of correlations with SCID-D-R Amnesia scores (.52, .63, and .70, respectively), suggesting that the SCID-D-R Amnesia score emphasizes gaps in remote memory over amnesias related to dissociative identity disorder. The 3 amnesia factor scales exhibited a clinically meaningful pattern of significant differences among dissociative identity disorder, dissociative disorder not otherwise specified–1, dissociative amnesia, depersonalization disorder, and nonclinical participants. The 3 amnesia factors may have greater clinical utility for frontline clinicians than (a) amnesia as discussed in the context of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nosology of the dissociative disorders or (b) P. Janet's (1893/1977) 4-fold classification of dissociative amnesia. The author recommends systematic study of the phenomenological differences within specific dissociative symptoms and their differential relationship to specific dissociative disorders.

Portuguese Validation of the Dissociative Experiences Scale (DES)

Objective: The Dissociative Experiences Scale (DES) is a widely used screening tool for dissociative symptoms. The aim of the present study was to evaluate the validity and internal consistency of a Portuguese version and determine if it accurately identified dissociative pathology. Method: The original DES underwent a “forward–backward” translation process. The translated form was used on 570 participants divided into 3 subgroups: 113 patients with dissociative symptoms, 233 psychiatric patients with various psychopathological disorders, and 224 normal individuals. Results: A principal components analysis with all of the participants yielded 4 factors that accounted for 56.3% of the variance. Reliability as measured by Cronbach's alpha was .94. The receiver operating characteristic curve applied to the cutoff analysis revealed a value of 30 comparing the 2 clinical groups and contrasting the dissociative-based group with the nonclinical group. The ability of the DES to correctly classify those with and without the disease was very good. Sensitivity was 65.0% and specificity was 86.0% with the cutoff score of 30 from the comparison between dissociative symptomatic disorders and the other psychopathological disorders. Comparing the dissociative symptomatic group with the nonclinical group, we found that sensitivity was 65.0% and specificity was 100%. The mean DES scores for the 3 subgroups were significantly different. Conclusion: These findings are in some degree analogous to those in other studies and suggest that the DES is a reliable and valid screen for the Portuguese population.

Dissociative Experiences in the Peoples' Republic of China

Abstract This paper discusses the qualitative differences in dissociative experiences among normal college-age subjects in China and Japan. The paper first describes the process used to prepare the Mandarin version of the Dissociative Experiences Scale (DES). Baseline statistics comparing the two populations of interest are then presented. These results show fundamental differences across these two Asian cultures in terms of the mean DES scores obtained as well as the shape of the overall distribution of these scores. The results of a factor analysis of the DES responses corroborate both gender and cultural differences across the Japanese and Chinese data. Interestingly, the structure of the factors derived shows little relationship to factors from analyses of normal college-age subjects in North America. These contrasting results suggest that the DES can be a useful addition to other instruments and methods for exploring cross-cultural psychological differences, and that prior to clinical use baseline DES norms for each culture need to be established.

Trauma and dissociation in treatment-seeking alcoholics: towards a resolution of inconsistent findings.

There is consistent empirical evidence for a trauma-dissociation relation in general population samples and in psychiatric patients. However, contradictory findings have been reported on this relation among substance abusers. The present study attempts to resolve these inconsistencies by testing a series of hypotheses related to problems regarding the measurement of childhood abuse, the measurement of psychological dissociation, and the potential existence of substance abuse as a form of chemical dissociation. Alcoholic patients (N = 155) were administered the Dissociative Experiences Scale (DES), the Structured Trauma Interview (STI), the European Addiction Severity Index (EuropASI), and the Posttraumatic Stress Disorder (PTSD) section of the Composite International Diagnostic Interview (CIDI). The DES showed good psychometric properties. Substantial rates of traumatization and PTSD were observed, as well as a significant trauma-PTSD relation. However, the mean DES score was low (11.4) and dissociation was not related to trauma (childhood or lifetime) or to PTSD. Years of lifetime regular medicine use, however, was significantly correlated with the severity of dissociative symptoms and PTSD, particularly in males. Overall, these findings suggest that absence of a trauma-dissociation relation in alcoholics may not be due to measurement problems of childhood abuse and/or dissociation. Rather, a trauma-dissociation link may not exist, particularly in male alcoholics, because these individuals may abuse substances to achieve dissociative-like states. Additional research is needed to further evaluate the utility of the DES in alcoholic samples and to examine the notion of chemical dissociation.

Dissociation and Posttraumatic Stress Symptoms in Patients With Chronic Pain

The present study examined the number and frequency of dissociative experiences reported by patients with chronic pain and the association between dissociation and emotional distress in this population. The mean Dissociative Experiences Scale (DES) score obtained by patients with chronic pain was comparable to mean DES scores obtained by persons diagnosed with affective disorders, eating disorders, personality disorders, and schizophrenia. Based on their median DES score, patients with chronic pain reported more frequent dissociation than did normal adults and persons diagnosed with alcohol use disorders, specific phobias, and agoraphobic avoidance. Traumatized patients with chronic pain evidenced significantly more frequent dissociation than did nontraumatized patients, the traumatized group reporting dissociative experiences as occurring 17% of the time and the nontraumatized group reporting dissociative experiences as occurring 11% of the time. DES absorption, depersonalization, and amnesia scores accounted for 21% of the variance in posttraumatic stress symptoms reported by patients with chronic pain. Findings are discussed in terms of their implications for assessment and cognitive–behavioral management of traumatic stress responding in persons with chronic pain.

Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients.

Research on the etiology of dissociation in adults has focused primarily on childhood sexual abuse. The role of co-occurring childhood stressors and of more chronic adverse conditions such as neglect is less clear. This study examined the level of dissociation in relation to childhood trauma (sexual/physical abuse, witnessing interparental violence), early separation from a parent, and perceived parental dysfunction. One hundred sixty inpatients consecutively admitted to a general psychiatric hospital were administered the Dissociative Experiences Scale and the Structured Trauma Interview. The mean Dissociative Experiences Scale score was 17.4; 18.0% of the patients scored beyond 30. Early separation was reported by 26.4% of the patients; 30.1% had witnessed interparental violence; 23.6% reported physical abuse; 34.6% reported sexual abuse; 11.7% reported rape before age 16; and 42.1% reported sexual and/or physical abuse. The level of dissociation was primarily related to reported overwhelming childhood experiences (sexual and physical abuse). When sexual abuse was severe (involving penetration, several perpetrators, lasting more than 1 year), dissociative symptoms were even more prominent. Highest dissociation levels were found in patients reporting cumulative sexual trauma (intrafamilial and extrafamilial) or both sexual and physical abuse. In particular, maternal dysfunction was related to the level of dissociation. With control for gender and age, stepwise multiple regression analysis indicated that the severity of dissociative symptoms was best predicted by reported sexual abuse, physical abuse, and maternal dysfunction. These findings indicate that dissociation, although trauma-related, is neglect-related as well. This implies the importance of object relations and attachment in the diagnosis and treatment of patients with dissociative disorders.

Frequency of dissociative identity disorder in the general population in Turkey

This study attempted to determine the prevalence of dissociative identity disorder in the general population. The Dissociative Experiences Scale (DES) was administered to 994 subjects in 500 homes who constituted a representative sample of the population of Sivas City, Turkey. The mean DES score was 6.7 ± 6.1 (mean ± SD). Of the 62 respondents who scored above 17 on the DES, 32 (51.6%) could be contacted during the second phase of the study. They were matched for age and gender with a group of respondents who scored below 10 on the scale, and the Dissociative Disorders Interview Schedule (DDIS) was then administered to both groups. Seventeen subjects (1.7%) received a diagnosis of dissociative disorder according to the structured interview. In the third phase, eight of 17 subjects who had a dissociative disorder on the structured interview could be contacted for a clinical evaluation. They were matched with a nondissociative control group and interviewed by a clinician blind to the structured interview diagnosis. Four of eight subjects were diagnosed clinically with dissociative identity disorder, yielding a minimum prevalence of 0.4%. Dissociative identity disorder is not rare in the general population. Self-rating instruments and structured interviews can be used successfully for screening these cases. Our data, derived from a population with no public awareness about dissociative identity disorder and no exposure to systematic psychotherapy, suggest that dissociative identity disorder cannot be considered simply an iatrogenic artifact, a culture-bound syndrome, or a phenomenon induced by media influences.

Structured interview data on 35 cases of dissociative identity disorder in Turkey

The aim of this study was to describe the clinical features of dissociative identity disorder in a group of Turkish patients as assessed with a structured interview. Thirty-five consecutive patients at the dissociative disorders program of a university psychiatric clinic who met the DSM-IV criteria for dissociative identity disorder were included in this study. The subjects were assessed with the Turkish versions of the Dissociative Disorders Interview Schedule and the Dissociative Experiences Scale. A descriptive analysis of the clinical features was carried out. Most (88.6%) of the patients were women. The mean age of the group was 22.8 years. Childhood physical or sexual abuse was reported by 77.1% of the patients. The mean Dissociative Experiences Scale score was 49.1. The patients reported an average of 12.5 somatic symptoms, 6.2 Schneiderian symptoms, 10.0 secondary features of the disorder, 3.8 borderline personality disorder criteria, and 4.1 extrasensory experiences. Dissociative identity disorder has a stable, consistent set of features throughout North America, in the Netherlands, and in Turkey. Cross-cultural research using standardized assessment measures will be invaluable in further illumination of the validity of this widely neglected psychiatric category.

Psychodynamics and psychiatric diagnoses of pseudoseizure subjects

The goal of this study was to determine current and lifetime rates of DSM-III-R disorders in patients with pseudoseizures and to ascertain whether trauma is associated with the occurrence of pseudoseizures. Adult pseudoseizure patients (N = 45) were interviewed regarding seizure course and life events, and they were given the Structured Clinical Interview for DSM-III-R--Patient Version, the Structured Clinical Interview for DSM-III-R Dissociative Disorders, the Dissociative Experiences Scale, and the Personality Diagnostic Questionnaire--Revised. The pseudoseizures were diagnosed in a tertiary-care video-EEG facility. Most of the subjects (78%) were female, and the mean age of the overall patient group was 37.5 years (SD = 9.7). The mean duration of the subjects' seizure history was 8.3 years (SD = 8.0). Common current psychiatric diagnoses included somatoform disorders (89%), dissociative disorders (91%), affective disorders (64%), personality disorders (62%), posttraumatic stress disorder (PTSD) (49%), and other anxiety disorders (47%). The lifetime occurrence of nonseizure conversion disorders was 82%. The mean Dissociative Experiences Scale score was 20.2 (SD = 18.2). Trauma was reported by 84% of the subjects: sexual abuse by 67%, physical abuse by 67%, and other traumas by 73%. Pseudoseizure subjects have high rates of the psychiatric disorders found in traumatized groups; they closely resemble patients with dissociative disorders. Reclassification of conversion seizures with the dissociative disorders should be considered. Pseudoseizures often appear to express distress related to abuse reports. Clinicians should screen pseudoseizure patients for adult and childhood trauma, dissociative disorders, depression, and PTSD.