Severity Of Dissociative Symptoms Research Articles

Dialectical behavioral therapy for complex posttraumatic stress disorder (DBT-PTSD): an evidence-based disorder-specific treatment program

Dialectical behavioral therapy for complex posttraumatic stress disorders (DBT-PTSD) is amodular treatment program that was developed at the Central Institute for Mental Health at the University of Heidelberg, Germany in 2005-2021. DBT-PTSD is designed to meet the needs of patients with complex PTSD related to sexual or physical trauma in childhood and adolescence. It is specifically designed for patients suffering from severe emotional dysregulation, persistent self-injury, chronic suicidal ideation, severe dissociative symptoms and amarkedly negative self-concept with a high level of guilt, shame, self-loathing and interpersonal problems. To address these different core symptoms, DBT-PTSD combines evidence-based therapeutic strategies: principles, rules, and skills of DBT, trauma-specific cognitive and exposure-based techniques, imaginative interventions and procedures for behavioral change. The treatment program is designed to be carried out in an outpatient (45weeks) or residential (12weeks) setting. The results from two randomized controlled trials showed large effect sizes across very different symptom domains and a significant superiority of DBT-PTSD over Cognitive Processing Therapy (CPT). Based on these results, DBT-PTSD is currently a promising evidence-based treatment program for all features of a complex PTSD after sexual abuse in childhood and adolescence.

Predictors and moderators of treatment outcomes in phase-based treatment and trauma-focused treatments in patients with childhood abuse-related post-traumatic stress disorder

ABSTRACT Background: Knowledge of treatment predictors and moderators is important for improving the effectiveness of treatment for PTSD due to childhood abuse. Objective: The first aim of this study was to test the potential predictive value of variables commonly associated with PTSD resulting from a history of repeated childhood abuse, in relation to treatment outcomes. The second aim was to examine if complex PTSD symptoms act as potential moderators between treatment conditions and outcomes. Method: Data were obtained from a randomized controlled trial comparing a phase-based treatment (Skills Training in Affect and Interpersonal Regulation [STAIR] followed by Eye Movement Desensitization and Reprocessing [EMDR] therapy; n = 57) with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with PTSD due to childhood abuse. The possible predictive effects of the presence of borderline personality disorder, dissociative symptoms, and suicidal and self-injurious behaviours were examined. In addition, it was determined whether symptoms of emotion regulation difficulties, self-esteem, and interpersonal problems moderated the relation between the treatment condition and PTSD post-treatment, corrected for pre-treatment PTSD severity. Results: Pre-treatment PTSD severity proved to be a significant predictor of less profitable PTSD treatment outcomes. The same was true for the severity of dissociative symptoms, but only post-treatment, and not when corrected for false positives. Complex PTSD symptoms did not moderate the relationship between the treatment conditions and PTSD treatment outcomes. Conclusions: The current findings suggest that regardless of the common comorbid symptoms studied, immediate trauma-focused treatment is a safe and effective option for individuals with childhood-related PTSD. However, individuals experiencing severe symptoms of PTSD may benefit from additional treatment sessions or the addition of other evidence-based PTSD treatment approaches. The predictive influence of dissociative sequelae needs further research. The study design was registered in The Dutch trial register (https://www.trialregister.nl/trialreg/admin/rctview.asp?TC = 5991) NTR5991 and was approved by the medical ethics committee of Twente NL 56641.044.16 CCMO.

Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and currentcontroversies.

Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.

Do Emotion Regulation Difficulties and Insecure Attachment Increase the Severity of Dissociative Symptoms in Panic Disorder?

Giriş ve Amaç: Panik bozukluğu hastalarında kaygılı bağlanma örüntüsü yoğunlaştıkça duyguların düzenlenmesinde yaşanan zorluklar ve dissosiyatif belirtilerin şiddeti hastalık yükünü artırmaktadır. Bu çalışmanın amacı panik bozukluğu hastalarında duygu düzenleme, bağlanma örüntüleri ve dissosiyatif belirtiler arasındaki ilişkiyi aydınlatmaktır.
 Gereç ve Yöntemler: Çalışmamıza psikiyatri polikliniğinde panik bozukluğu tanısıyla takip edilen, yaşları 18 – 65 arasında değişen 85 hasta dahil edildi. Araştırmaya dahil edilen hastalara DSM-V Eksen Bozukluklarına Yönelik Yapılandırılmış Klinik Görüşme (SCID - I), sosyodemografik veri formu, Panik Bozukluğu Şiddet Ölçeği (PDSS), Duygu Düzenleme Güçlükleri Ölçeği (DERS), Dissosiyatif Deneyimler Ölçeği (DES), Yakın İlişki Deneyimleri Ölçeği (ECR – RS) uygulandı.
 Bulgular: Panik bozukluğunun şiddeti ile dissosiyatif belirtilerin şiddeti arasında anlamlı bir ilişki bulundu (p=0,030). DERS toplam puanları ile DES puanları arasında istatistiksel olarak anlamlı korelasyon bulundu (p=0,005). DES puanı ile DERS alt ölçekleri arasındaki ilişkinin değerlendirilmesinde DERS dürtüsellik (p

Moral injury appraisals and dissociation: Associations in a sample of trauma-exposed community members

ABSTRACT Appraisal of trauma is a critical factor in the development of impairing post-traumatic stress symptoms, such as dissociation. Individuals may appraise trauma as morally injurious (i.e., moral injury exposure [MIE]) and experience subsequent moral distress related to this exposure (i.e., moral injury distress [MID]). To date, however, investigation into the relations between moral injury appraisals and dissociation has been limited, particularly within community populations. This study investigated MIE and MID in relation to six facets of dissociation (disengagement, depersonalization, derealization, memory disturbances, emotional constriction, identity dissociation) in a sample of trauma-exposed community members (n = 177, 58.2% Black, 89.3% female) recruited from a public hospital and/or community advertisements. Participants completed measures assessing trauma exposure, MIE, MID, dissociation, and posttraumatic stress disorder (PTSD) symptoms. Partial correlation analyses revealed that after controlling for PTSD symptoms, MIE was correlated with disengagement, r = .23, p ≤ .025, and depersonalization, r = .25, p ≤ .001, and MID was correlated with depersonalization, r = .19, p ≤ .025. Sex moderated each association, with stronger associations observed for female participants. Findings suggest that moral injury appraisals are linked to more severe dissociative symptoms among female civilians, and as such, may need to be specifically targeted in empirically supported treatments.

Dissociative experiences of adolescents with borderline personality disorder: description and prediction

AimsThe first purpose of this study was to assess the severity of dissociative experiences reported by adolescent inpatients with borderline personality disorder (BPD). The second purpose was to compare the severity of their dissociative symptoms to those reported by a sample of adult inpatients with BPD. The third purpose of this study was to assess a range of clinically meaningful predictors of the severity of dissociation in adolescents and adults with BPD.MethodsThe Dissociative Experiences Scale (DES) was administered to a total of 89 hospitalized girls and boys aged 13–17 with BPD and 290 adult inpatients with BPD. Predictors of the severity of dissociation in adolescents and adults with BPD were assessed using the Revised Childhood Experiences Questionnaire (a semi-structured interview), the NEO, and the SCID I.ResultsBorderline adolescents and adults had non-significant differences on their overall DES scores and subscale scores. They also had a non-significant distribution of low, moderate, and high scores. In terms of multivariate predictors, neither temperament nor childhood adversity was a significant predictor of the severity of dissociative symptoms in adolescents. However, co-occurring eating disorders were found in multivariate analyses to be the only bivariate predictor to significantly predict this outcome. In adults with BPD, however, both the severity of childhood sexual abuse and co-occurring PTSD were significantly related to the severity of dissociative symptoms in multivariate analyses.ConclusionsTaken together, the results of this study suggest that the severity of dissociation is not significantly different in adolescents and adults with BPD. However, the etiological factors differ substantially.

The longitudinal relationship between dissociative symptoms and self-harm in adolescents: a population-based cohort study.

Previous studies have reported that dissociative symptoms (DIS) are associated with self-harm (SH) in adolescents. However, most of these studies were cross-sectional, which limits the understanding of their theoretical relationship. We aimed to investigate the longitudinal relationship between DIS and SH in the general adolescent population. We used data from the Tokyo Teen Cohort study (N = 3007). DIS and SH were assessed at times 1 and 2 (T1 and T2) (12years of age and 14years of age, respectively). DIS were assessed using the parent-report Child Behavior Checklist (CBCL), and severe dissociative symptoms (SDIS) were defined as a score above the top 10th percentile. The experience of SH within 1year was assessed by a self-report questionnaire. The longitudinal relationship between DIS and SH was examined using regression analyses. Using logistic regression analyses, we further investigated the risk for SH at T2 due to persistent SDIS and vice versa. DIS at T1 tended to predict SH at T2 (odds ratio (OR) 1.11, 95% CI 0.99 to 1.25, p = 0.08), while SH at T1 did not predict DIS at T2 (B = -0.03, 95% CI -0.26 to 0.20, p = 0.81). Compared with adolescents without SDIS, those with persistent SDIS had an increased risk of SH at T2 (OR 2.61, 95% CI 1.28 to 5.33, p = 0.01). DIS tended to predict future SH, but SH did not predict future DIS. DIS may be a target to prevent SH in adolescents. Intensive attention should be given to adolescents with SDIS due to their increased risk of SH.

DISSOCIATIVE PHENOMENOLOGY, STRESSFUL LIFE EVENTS AND SUBJECTIVE MENTAL HEALTH AMONG YOUNG ADULTS IN HARYANA, INDIA

Background: Now a day's stress has been known as a significant health issue, which is also related to morbidity as well as mortality. Because everyone is experienced so many stressful life situations in their life which are more likely to, later on, have many succeeding psychological problems. Objective: To assess the relationship and severity between stressful life events, dissociative phenomenology and subjective mental health rating in the general population.Method: A group of 100 healthy participants from Medical College, Rohtak (Haryana), India was selected on the basis of convenience and snowball sampling techniques. Tools: Socio-demographic datasheet, General Health Questionnaire-12, Dissociative Experience Scale-28 and Presumptive Stressful Life Events Scale were used in the present study for obtained the objectives.Results: There is a significant relationship has been seen between depersonalization and education (r=-0.233, p<0.005), absorption and education (r=-0.315, p<0.001), age (r=-0.232, p<0.005). On stressful life experience, marital and sexual problem and mental health (r=-0.246, p<0.005), education-related with depersonalization and absorption (r=0.203 & r=0.235, p<0.005) respectively. Chi-Square value showedthat there is a significant difference between gender in term of mentalhealth (χ²= 5.76, p=0.01), the severity of dissociative symptoms (χ²= 9.00, p=0.003) and stressful life events (χ²= 49.52, p=0.01). Conclusion: Male participants reported more dissociative symptoms than female. Female participants reported a more mild level of traumatic events in comparison to male.

Dissociation and its biological and clinical associations in functional neurological disorder: systematic review and meta-analysis.

Studies have reported elevated rates of dissociative symptoms and comorbid dissociative disorders in functional neurological disorder (FND); however, a comprehensive review is lacking. To systematically review the severity of dissociative symptoms and prevalence of comorbid dissociative disorders in FND and summarise their biological and clinical associations. We searched Embase, PsycInfo and MEDLINE up to June 2021, combining terms for FND and dissociation. Studies were eligible if reporting dissociative symptom scores or rates of comorbid dissociative disorder in FND samples. Risk of bias was appraised using modified Newcastle-Ottawa criteria. The findings were synthesised qualitatively and dissociative symptom scores were included in a meta-analysis (PROSPERO CRD42020173263). Seventy-five studies were eligible (FND n = 3940; control n = 3073), most commonly prospective case-control studies (k = 54). Dissociative disorders were frequently comorbid in FND. Psychoform dissociation was elevated in FND compared with healthy (g = 0.90, 95% CI 0.66-1.14, I2 = 70%) and neurological controls (g = 0.56, 95% CI 0.19-0.92, I2 = 67%). Greater psychoform dissociation was observed in FND samples with seizure symptoms versus healthy controls (g = 0.94, 95% CI 0.65-1.22, I2 = 42%) and FND samples with motor symptoms (g = 0.40, 95% CI -0.18 to 1.00, I2 = 54%). Somatoform dissociation was elevated in FND versus healthy controls (g = 1.80, 95% CI 1.25-2.34, I2 = 75%). Dissociation in FND was associated with more severe functional symptoms, worse quality of life and brain alterations. Our findings highlight the potential clinical utility of assessing patients with FND for dissociative symptomatology. However, fewer studies investigated FND samples with motor symptoms and heterogeneity between studies and risk of bias were high. Rigorous investigation of the prevalence, features and mechanistic relevance of dissociation in FND is needed.

A Pilot Randomized Controlled Trial of Goal Management Training in Canadian Military Members, Veterans, and Public Safety Personnel Experiencing Post-Traumatic Stress Symptoms.

Post-traumatic stress disorder (PTSD) is a severe psychiatric illness that disproportionately affects military personnel, veterans, and public safety personnel (PSP). Evidence demonstrates that PTSD is significantly associated with difficulties with emotion regulation (ER) and difficulties with cognitive functioning, including difficulties with attention, working memory, and executive functioning. A wide body of evidence suggests a dynamic interplay among cognitive dysfunction, difficulties with ER, and symptoms of PTSD, where numerous studies have identified overlapping patterns of alterations in activation among neuroanatomical regions and neural circuitry. Little work has examined interventions that may target these symptoms collectively. The primary objective of this pilot randomized controlled trial (RCT) with a parallel experimental design was to assess the effectiveness of goal management training (GMT), a cognitive remediation intervention, in reducing difficulties with cognitive functioning, and to determine its effects on PTSD symptoms and symptoms associated with PTSD, including difficulties with ER, dissociation, and functioning among military personnel, veterans, and PSP. Forty-two military personnel, veterans, and PSP between the ages of 18 and 70 with symptoms of PTSD were recruited across Ontario, Canada between October 2017 and August 2019. Participants were randomized to either the waitlist (WL) (n = 18) or the GMT (n = 22) condition. Participants in both conditions received self-report measures and a comprehensive neuropsychological assessment at baseline, post-intervention, and 3-month follow-up. Following their completion of the 3-month follow-up, participants in the WL condition were given the opportunity to participate in GMT. Assessors and participants were blind to intervention allocation during the initial assessment. A series of 2 (time) × 2 (group) ANOVAs were conducted to assess the differences between the WL and GMT conditions from pre- to post-intervention for the self-report and neuropsychological measures. The results demonstrated significant improvements in measures of executive functioning (e.g., verbal fluency, planning, impulsivity, cognitive shifting, and discrimination of targets) and trending improvements in short-term declarative memory for participants in the GMT condition. Participants in the GMT condition also demonstrated significant improvements from pre- to post-testing in measures of subjective cognition, functioning, PTSD symptom severity, difficulties with ER, dissociative symptom severity, and depression and anxiety symptoms. No adverse effects were reported as a result of participating in GMT. The results of this pilot RCT show promise that GMT may be a useful intervention to improve symptoms of cognitive dysfunction, symptoms of PTSD, and symptoms associated with PTSD within military personnel, veterans, and PSP. Future work is needed to address the small sample size and the durability of these findings.

Impact of dissociative phenomena on treatment outcome of inpatient psychotherapy of patients with borderline personality disorder

Impact of dissociative phenomena on treatment outcome of inpatient psychotherapy of patients with borderline personality disorder Objectives: Although dissociative phenomena belong to the diagnostic criteria of borderline personality disorder (BPD) and are of high clinical relevance, their predictive significance with regard to the treatment outcome has hardly been investigated. Because some therapeutic and experimental studies suggest that dissociation can impede emotional learning and thus adversely affect the response to psychotherapy, we examined this issue in patients with BPD. Methods: In this naturalistic psychotherapy study we assessed 342 patients with BPD at the beginning and end of inpatient dialectical behavioural therapy (DBT) with self-report measures for dissociation (Questionnaire on dissociative symptoms, FDS, as German version of the Dissociative Experiences Scale, DES) as well as general and borderline specific pathology (Brief Symptom Inventory, BSI; Borderline Symptom List, BSL) and quality of life (SF-12). Results: Both the general mental distress (BSI) and the borderline-specific pathology (BSL) as well as the psychosocial quality of life improved less in patients with initially severe dissociative symptoms than in those with less pronounced symptoms; this effect was mainly driven by the subscale derealisation of the Dissociative Experience Scale (DES), and was found particularly in women. Conclusion: Consistent with earlier findings, dissociative phenomena proved to be negative predictors of the therapeutic outcome in BPD women completing inpatient DBT. Whether this also applies to outpatient and other evidence-based treatment approaches for BPD remains to be clarified. Our results indicate the necessity to identify and treat dissociative symptoms as early as possible for a successful psychotherapy.

The challenge of being present with yourself: Exploring the lived experience of individuals with complex dissociative disorders

AimThe objective of this study was to explore how clients with severe dissociative symptoms describe their experiences of being present in their everyday life. The data in this study stems from a large study conducted at a trauma–outpatient clinic in Oslo, Norway. Method16 participants underwent in-depth interviews six months after a twenty- week group treatment based on psychoeducational stabilization for dissociative disorders. These interviews and participants were part of a larger study, and the interviews in this article are the first 16 of many interviews. Hermeneutic-phenomenological thematic analysis was used to analyze the transcripts. ResultsFour themes were identified: (1) “Being present: To be here and now, and remember it afterward,” (2) “To not be present: avoiding challenges but challenged by their inner life,” (3) “Being present in a Fragmented Sense of Self,” and (4) “Bearing the consequences of not being present in your own life.” DiscussionThe findings are discussed in relation to existing theory and research, and reflexivity in the process and limitations of the study are considered. ConclusionThe results indicate that the experience of being present is an important part of the struggles the participants describe in their everyday lives, as well as a part of the challenges of living with a dissociative disorder. ImplicationsThe findings indicate that focusing on the ability of staying present could be an important part of treatment of and how we meet and understand dissociative disorders.

Reliability and validity study of the French-language version of the SCID-D semi-structured clinical interview for diagnosing DSM-5 and ICD-11 dissociative disorders

This paper presents the validation and inter-rater reliability study of the French translation of the new edition of the SCID-D, a semi-structured clinical interview for evaluating dissociative symptoms and diagnosing dissociative disorders based upon DSM-5 and ICD-11 criteria. The SCID-D evaluates five core dimensions of dissociation: amnesia, depersonalization, derealization, identity confusion and identity alteration. The SCID-D was administered to 20 subjects with a dissociative disorder, 19 subjects with a nondissociative psychiatric disorder, and 10 healthy control subjects. Results indicate that there was 96% agreement among raters on the SCID-D's ability to differentiate subjects with a dissociative disorder from subject with no dissociative disorder. The statistical analysis indicates that the overall diagnosis, the scores for each of the five dimensions, and the total SCID-D scores were homogenous amongst raters. The results indicate good to excellent inter-rater reliability. The SCID-D could efficiently discriminate dissociative subjects from nondissociative ones. Convergent validity was tested with the use of the Somatoform Dissociation Questionnaire SDQ-20 and the Dissociation Questionnaire DIS-Q. Correlation between the scores from these questionnaires and the SCID-D total score is high. The French translation of the SCID-D has good to excellent reliability, discriminant and convergent validity, and is similar to previous research of DSM-III and DSM-IV versions of the SCID-D in different languages. The SCID-D is a useful instrument for the assessment of dissociative symptom severity and the diagnosis of DSM-5 and ICD-11 dissociative disorders.

Dissociative Phenomenology and General Health in Normal Population

Background: Dissociative symptoms are most commonly found in females and adolescents, and when discussing their background, they can be from lower socio-economic backgrounds and rural areas. They are always preceded by psychosocial stressors. Dissociative disorders previously known as “hysteria” have been described since antiquity and Hippocrates even hypothesised “wandering uterus” to be the cause for dissociation in females. With the advances in science, there has been shift from these religious and spiritual concepts to a scientific basis for dissociation. Aim: To assess the dissociative phenomenology in normal population and to assess the subjective health in normal population. Methods: A group of 100 (50 females & 50 males) were selected from the community using a snowball sampling technique. Tools: Socio-demographic data sheet, General Health Questionnaire-12 and Dissociative Experience Scale-II were used. Results: The study found that females differ from males in the reporting of subjective health rating (X2=5.76, p=0.01) and similar results shown in terms of dissociative phenomenology (X2=67.76, p=0.001). Discussion: It has been found that only 4% from the female group and 2% from the male group rated their health under the “normal” category. 52% of females and 64% of males were categorised under “mild ill health” and 24% to 26% were in “moderate ill health”, whereas 20% of female participants and 8% of male participants rated their health as “severely ill”. In another domain of the study, dissociative phenomenology, 32% of female participants reported severe dissociative symptoms and 38% of male participants also showed similar results. Conclusion: Dissociative disorder significantly affects the population but it is hard to diagnose due to factors such as; cultural factors, socio-economic factors etc. The study shows clearly that dissociative symptoms are found in the general population also.

Safety and tolerability of IV ketamine in adults with major depressive or bipolar disorder: results from the Canadian rapid treatment center of excellence

ABSTRACT Objectives Rigorous clinical trials suggest ketamine is safe and well-tolerated in patients with treatment-resistant depression (TRD). There is a paucity of data on the safety and tolerability of ketamine in community-based clinics treating patients with TRD. Methods Retrospective data was analyzed from 203 patients with TRD who received repeat-dose IV ketamine. Safety was operationalized as hemodynamic changes. Tolerability was evaluated through the reporting of adverse events and dissociation symptom severity, as measured by the Clinician-Administered Dissociative States Scale. Results Ketamine was well-tolerated, with less than 5% of patients withdrawing due to tolerability concerns. Blood pressure significantly increased during infusion, with 44.3% meeting criteria for treatment-emergent hypertension (i.e., blood pressure ≥ 165/100 mmHg). 12% of patients exhibiting hypertension required pharmacological intervention. The most frequently reported adverse events included drowsiness (56.4%), dizziness (45.2%), dissociation (35.6%), and nausea (13.3%). Dissociation severity significantly attenuated after the first infusion, but plateaued for subsequent infusions. Conclusion Intravenous ketamine was safe and well-tolerated. Hypertension was commonly observed and was often transient. Dissociation was most frequently reported after the first infusion but remained a consistent but not treatment-limiting adverse event thereafter. No patients exhibited psychosis, mania, or new onset suicidality with IV ketamine.

The dissociative subtype of posttraumatic stress disorder is associated with subcortical white matter network alterations

Posttraumatic stress disorder (PTSD) is characterized by intrusions, avoidance, and hyperarousal while patients of the dissociative subtype (PTSD-D) experience additional dissociative symptoms. A neurobiological model proposes hyper-inhibition of limbic structures mediated by prefrontal cortices to underlie dissociation in PTSD. Here, we tested whether functional alterations in fronto-limbic circuits are underpinned by white matter network abnormalities on a network level. 23 women with PTSD-D and 19 women with classic PTSD participated. We employed deterministic diffusion tractography and graph theoretical analyses. Mean fractional anisotropy (FA) was chosen as a network weight and group differences assessed using network-based statistics. No significant white matter network alterations comprising both frontal and limbic structures in PTSD-D relative to classic PTSD were found. A subsequent whole brain exploratory analysis revealed relative FA alterations in PTSD-D in two subcortical networks, comprising connections between the left amygdala, hippocampus, and thalamus as well as links between the left ventral diencephalon, putamen, and pallidum, respectively. Dissociative symptom severity in the PTSD-D group correlated with FA values within both networks. Our findings suggest fronto-limbic inhibition in PTSD-D may present a dynamic neural process, which is not hard-wired via white matter tracts. Our exploratory results point towards altered fiber tract communication in a limbic-thalamic circuit, which may underlie (a) an initial strong emotional reaction to trauma reminders before conscious regulatory processes are enabled and (b) deficits in early sensory processing. In addition, aberrant structural connectivity in low-level motor regions may present neural correlates for dissociation as a passive threat-response.

Psychoform and somatoform dissociation among individuals with eating disorders

Objective: This study analyzed the prevalence of psychoform and somatoform dissociation among individuals with the whole spectrum of eating disorder diagnoses and compared it with ratings from a non-clinical group. The relationship between dissociation and severity of eating disturbance was examined as well as differences between the eating disorder diagnosis groups in extent of dissociation. The validity of a new structural dissociation interview suitable for eating disorder patients was analyzed.Method: Sixty individuals with eating disorder completed three self-report questionnaires: Dissociation Questionnaire Sweden, Somatoform Dissociation Questionnaire and Eating Disorder Examination Questionnaire. The ratings were compared with the scores in a female non-clinical group (N = 245). Twenty patients with eating disorder diagnoses were interviewed with the Interview for Dissociative Disorders and Trauma Related Symptoms. The validity of the interview was tested by comparing the ratings on the interview subscales with the scores on the Dissociation questionnaires and the Somatoform Dissociation Questionnaire.Results: Participants with eating disorders reported a higher extent of both psychoform and somatoform dissociation compared with the non-clinical individuals. Analyses also showed a correlation between degree of dissociation and severity of eating disorder symptoms. No differences in dissociation were found between the ED subgroups. Participants reporting more dissociation got higher ratings on the interview, indicating convergent validity.Discussion: Eating disorders seem to be associated with presence and severity of dissociative symptoms. The extent of dissociation needs to be assessed for these individuals as treatment may benefit from a focus on such symptoms in order to increase its effect.

"Was it real or did I imagine it?" Perfectionistic beliefs are associated with dissociative absorption and imaginative involvement in obsessive-compulsive disorder.

Background and objectivesIn the literature there are inconsistent data regarding the role of dissociation in OCD. No study explored the association between obsessive beliefs and dissociative symptoms in OCD. It is important to understand which clinical factors are related to dissociation in OCD as more severe dissociative symptoms, particularly absorption, have been found to be predictors of treatment non-response. In the present short report we describe the results of an exploratory study aimed to investigate the role of the obsessive beliefs as predictors of the different dissociative symptoms controlling for anxiety and OCD severity in a group of OCD patients.MethodsSixty treatment-seeking patients consecutively referred to psychiatric services were included (mean age=31.17 years, 53.30% females). The Dissociative Experiences Scale-II, the Obsessive Beliefs Questionnaire-46, the Yale-Brown Obsessive-Compulsive Scale, and the Beck Anxiety Inventory were administered.ResultsHigher anxious symptoms predicted higher Dissociative Amnesia, Depersonalization/Derealization, and Absorption/Imaginative Involvement. Higher OCD severity predicted higher Dissociative Amnesia. More severe Perfectionism predicted higher Absorption/Imaginative Involvement.ConclusionPerfectionism in OCD patients may be associated with a higher tendency to absorption and imaginative involvement. Future research should explore whether a psychotherapeutic intervention on perfectionism might improve the outcomes of the OCD patients with higher absorption tendencies.

Autonomic responses to fear conditioning among women with PTSD and dissociation.

Individuals with posttraumatic stress disorder (PTSD) demonstrate alterations in autonomic responses to fear conditioning, such as exaggerated startle and poor fear inhibition. However, there is a paucity of research on fear conditioning among individuals with PTSD and dissociative symptoms, which represents 10-30% of those with PTSD. The current study used a fear-potentiated startle (FPS) conditioning paradigm to examine autonomic responses among women with PTSD and a range of dissociative symptoms. Participants included 39 women with PTSD and dissociation, and 53 women with PTSD with unknown levels of dissociation. The FPS paradigm consisted of conditioned stimuli associated and not associated with an aversive unconditioned stimulus. FPS response (eyeblink startle), electrocardiogram (ECG), and skin conductance response (SCR) were collected during the FPS paradigm. Compared to the PTSD-unknown dissociation sample, the PTSD-dissociation sample demonstrated significantly lower FPS during the last block of conditioning. Among the PTSD-dissociation sample, higher dissociation scores were associated with decreased FPS and SCR, and higher respiratory sinus arrhythmia (derived from ECG). Results suggest that autonomic responses to fear conditioning differ depending on the presence and severity of dissociative symptoms. Given that treatment response may differ depending on dissociative symptoms, it is important to understand the mechanisms that underlie different subtypes of PTSD and that may affect treatment response and outcome.

Gray Matter Alterations Associated With Dissociation in Female Survivors of Childhood Trauma.

ObjectiveAcross various axis-1 disorders, the severity of dissociative symptoms is significantly related to a history of childhood traumatization. Thus, the question arises if coping with childhood trauma leads to neural adaptations that enhance the frequency of dissociative processing during adulthood. The aim of the two reported studies therefore was to identify and replicate gray matter alterations associated with dissociation.Methods and ResultsIn a first study, whole-brain MRI data were acquired for 22 female in-patients with trauma-spectrum disorders and a history of severe childhood trauma. Voxel-based morphometry (VBM) was carried out to test for significant correlations between dissociation (depersonalization/derealization) severity and gray matter volume. Dissociation severity was positively associated with volume in the left angular gyrus. This result was diagnosis-invariant. The replication study involved 26 female in-patients with trauma-spectrum disorders and 25 healthy controls. No significant association between dissociation severity and brain volume in a left angular gyrus region of interest located at the peak identified in study 1 was identified and no significant group difference in this region could be established.ConclusionThe angular gyrus has previously been implicated in the processing of agency and vestibular integration as well as dissociative processing. The current attempt at a direct replication of brain volume alterations however, failed. The data thus only partially support the notion that dissociative processing is associated trans-diagnostically with structural brain alterations in the left angular gyrus and independent replication in a larger patient sample is essential.