Research from 2012

Marcusson-Clavertz, D., Terhune, D. B., & Cardeña, E. (2012). Individual differences and state effects on mind-wandering : Hypnotizability, dissociation, and sensory homogenization Consciousness and Cognition: An International Journal, 21(3), 1097-1108.

Abstract

Consciousness alterations can be experienced during unstructured, monotonous stimuli. These effects have not been linked to particular cognitive operations; individual differences in response to such stimulation remain poorly understood. We examined the role of hypnotizability and dissociative tendencies in mind-wandering (MW) during a sensory homogenization procedure (ganzfeld). We expected that the influence of ganzfeld on MW would be more pronounced among highly hypnotizable individuals (highs), particularly those high in dissociative tendencies. High and low hypnotizables, also stratified by dissociation, completed the sustained attention to response task during ganzfeld and control conditions. High dissociative highs made more commission errors during ganzfeld, suggesting increased MW, whereas the other groups displayed the opposite pattern. Increases in commission errors from the control condition to ganzfeld were associated with more alterations in consciousness and negative affect, but only among highs. Sensory homogenization had opposite effects on MW depending on the interaction of hypnotizability and dissociation.

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Brand, B. L., Myrick, A. C., Loewenstein, R. J., Classen, C. C., Lanius, R., McNary, S. W., Pain, C., & Putnam, F. W. (2012). A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 490-500

Abstract

Little empirical evidence exists about the treatment of dissociative identity disorder and dissociative disorder not otherwise specified. Thus, we must rely on the clinical literature, which advocates a staged course of treatment. A survey of 36 international experts in the treatment of dissociative disorder (DD) was conducted to learn what treatment interventions they recommended at each stage of treatment. These highly experienced therapists recommended a carefully staged treatment consisting of three phases. In the initial phase, they advocated emphasizing skill building in development and maintenance of safety from dangerousness to self or others and other high-risk behaviors, as well as emotion regulation, impulse control, interpersonal effectiveness, grounding, and containment of intrusive material. In addition, they recommended specific trauma-focused cognitive therapy to address trauma-based cognitive distortions. They uniformly recommended identifying and working with dissociated self states beginning early in treatment. They advised the use of exposure or abreaction techniques—albeit modified to not overwhelm these complex dissociative patients—balanced with core, foundational interventions for the middle stage. The last stage of treatment is less clearly delineated and more individualized. Unification of self states appears to occur in only a minority of patients with DD. This study provides directions to pursue for future training and research on DD.

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Perona Garcelán, S., Carrascoso López, F., García Montes, J. M., Ductor Recuerda, M. J., Jiménez, A. M., Vallina Fernández, O., Pérez Álvarez, M., Gómez Gómez, M. T. v(2012). Dissociative experiences as mediators between childhood trauma and auditory hal­lucinations. Journal of Traumatic Stress, 25, 323-329.

Abstract

The purpose of this work was to study the relationship between reported traumatic experiences in childhood and posi­tive psychotic symptoms. We hypothesized that dissociative experiences were potential mediators between childhood trauma and hallucinations, but not delusions. The sample comprised 71 patients diagnosed with psychoses. They were assessed with the Dissociative Experiences Scale (DES‐II; Carlson & Putnam, 1993), a questionnaire on trauma (TQ; Davidson, Hughes, & Blazer, 1990), and the Positive and Negative Syndrome Scale (PANSS; Kay, Opler, & Linden­mayer, 1988) delusions and hallucinations items. The results showed that childhood trauma was positively associated with the dissociation scale scores (r = .40) and also the hallucination (r = .36) and delusions scale scores (r = .32). Furthermore, it was demonstrated that the dissociation variable was a potential mediator between childhood trauma and hallucinations, but not between childhood trauma and delusions. Of the 3 DES‐II factors, only depersonalization showed a mediating relationship between childhood trauma and hallucinations. The main conclusion is that the impact of childhood trauma on hallucinations may not simply be direct, but mediated by dissociative experiences, especially depersonalization. Clinical implications are also briefly discussed.

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Reinders, A.A.T.S., Willemsen, A.T.M., Vos, H.P.J., Den Boer, J.A., Nijenhuis, E.R.S. (2012). Fact or factitious? A psychobiological study of authentic and simulated dissocia­tive identity states. PLoS ONE 7(6), e39279. doi:10.1371/journal.pone.0039279.

Abstract

Background: Dissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and dis­rupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion.

Methodology/Principal Findings: DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysi­ological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation.

Conclusions/Significance: The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin.

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Brand, B. L., McNary, S. W., Myrick, A. C., Classen, C. C., Lanius, R., Loewenstein, R. J., Pain, C., & Putnam, F. W. (2012, April 2). A longitudinal naturalistic study of patients with dissociative disorders treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. doi: 10.1037/a0027654

Abstract

Severe dissociative disorders (DD) are associated with high levels of impairment, treatment utilization, and treatment costs, yet relatively little systematic research has focused on treatment for these challenging patients. The goal of this naturalistic observational 30-month follow-up study of an international sample of patients with dissociative disorders was to determine if treatment provided by community providers was associated with improvements in symptoms and adaptive functioning. The patients were diagnosed with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). The patients and their therapists completed surveys at study entry and at 6-, 18-, and 30-month follow-up. At the 30-month follow-up, 119 of the original 226 patients completed the surveys. Accord­ing to patients’ reports, they showed decreased levels of dissociation, post-traumatic stress disorder symptoms, gen­eral distress, drug use, physical pain, and depression over the course of treatment. As treatment progressed, patients reported increased socializing, attending school or volunteering, and feeling good. According to therapists’ reports, patients engaged in less self-injurious behavior and had fewer hospitalizations as well as increased global assessment of functioning scores (American Psychiatric Association, 2000) and adaptive capacities over time. These results sug­gest that treatment provided by therapists who have training in treating DID/DDNOS appears to be beneficial across a number of clinical domains. Additional research into the treatment of DD is warranted.

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Somer, E., Ginzburg, K., & Kramer, L. (2012). The role of impulsivity in the association between childhood trauma and dissociative psychopathology: Mediation versus moderation. Psychiatry Research, 196, 133-137.

Abstract

Previous studies on survivors of childhood trauma documented associations between psychological dysregulation, im­pulsivity, and both behavioral and emotional manifestations of distress. Yet, the mechanism that links these variables remains unclear. The current study aims to examine the pattern of relations between a history of child abuse, impul­sivity and dissociation. More specifically, it examines whether impulsivity serves as a moderator or mediator in the association between childhood trauma and dissociation. Eighty-one inpatients from the acute wards of two psychiatric hospitals participated in this study. Data were collected by clinician-administered questionnaires. A highly significant linear hierarchical regression analysis revealed that both psychiatric comorbidity and childhood trauma made unique contributions to the variance of dissociation. Yet, the significant association between childhood trauma and dissocia­tion decreased when impulsivity was entered into the regression model. Our findings suggest that impulsivity medi­ates the association between childhood trauma and dissociative psychopathology and imply that the identification and treatment of impulsivity could be a potentially valuable clinical target in individuals with dissociative disorders.

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Majohr, K-L., Leenen, K., Grabe, H. J., Jenewein, J., Nuñez, D. G., & Rufer, M., (2011). Alexithymia and its relationship to dissociation in patients with panic disorder. Journal of Nervous and Mental Disease, 199(10), 773-777.

Abstract:

Conditions that impede the regulation of emotional arousal, such as alexithymia and dissociation, may underlie panic attacks. This study aimed to evaluate the relationship between alexithymia and dissociation in patients with panic disorder (PD). We assessed 95 PD outpatients with regard to alexithymia (20-item Toronto Alexithymia Scale), dissociation (Dissociation Experi­ence Scale), and overall psychological distress (Symptom Checklist 90-Revised, Global Severity Index). Regression analyses revealed a positive correlation between alexithymia and dissociation, even when the Global Severity Index was controlled for. A specific link was observed between “difficulty in identifying feelings” and “depersonalization/derealization.” Patients who showed the pathological form of dissociation had higher levels of alexithymia, with particular regard to “difficulty in identify­ing feelings” and, to a smaller extent, “difficulty in describing feelings.” These results support a strong relationship between alexithymia and dissociation in patients with PD. Assessing alexithymia and dissociation at the outset of therapy may be helpful for individualized therapy planning.

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Fan, Q., Yu, J., Ross, C. A., Keyes, B. B., Dai, Y., Zhang, T., Wang, L., & Xiao, Z. (2011). Teaching Chinese psychiatrists to make reliable dissociative disorder diagnoses. Transcultural Psychiatry, 48(4), 473-483.

Abstract:

The aim of the study was to assess the outcome of an educational effort by two North American experts in dissociative disorders to teach Chinese psychiatrists to make reliable dissociative disorder diagnoses. In the final phase of the educational effort, 569 patients at Shanghai Mental Health Center completed the Chinese version of the Dissociative Experiences Scale (DES). Patients were then randomly selected in different proportions according to their DES scores: 96 selected patients were then assessed with the Dissociative Disorders Interview Schedule (DDIS) and clinical diagnostic interviews based on DSM-IV criteria. According to the clinical diagnostic interviews, 28 (4.9%) patients were diagnosed as having dissociative disorders.

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Majohr, K-L., Leenen, K., Grabe, H. J., Jenewein, J., Nuñez, D. G., & Rufer, M., (2011). Alexithymia and its relationship to dissociation in patients with panic disorder. Journal of Nervous and Mental Disease, 199(10), 773-777.

Abstract:

Conditions that impede the regulation of emotional arousal, such as alexithymia and dissociation, may underlie panic attacks. This study aimed to evaluate the relationship between alexithymia and dissociation in patients with panic disorder (PD). We assessed 95 PD outpatients with regard to alexithymia (20-item Toronto Alexithymia Scale), dissociation (Dissociation Experi­ence Scale), and overall psychological distress (Symptom Checklist 90-Revised, Global Severity Index). Regression analyses revealed a positive correlation between alexithymia and dissociation, even when the Global Severity Index was controlled for. A specific link was observed between “difficulty in identifying feelings” and “depersonalization/derealization.” Patients who showed the pathological form of dissociation had higher levels of alexithymia, with particular regard to “difficulty in identify­ing feelings” and, to a smaller extent, “difficulty in describing feelings.” These results support a strong relationship between alexithymia and dissociation in patients with PD. Assessing alexithymia and dissociation at the outset of therapy may be helpful for individualized therapy planning.

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Fan, Q., Yu, J., Ross, C. A., Keyes, B. B., Dai, Y., Zhang, T., Wang, L., & Xiao, Z. (2011). Teaching Chinese psychiatrists to make reliable dissociative disorder diagnoses. Transcultural Psychiatry, 48(4), 473-483.

Abstract:

The aim of the study was to assess the outcome of an educational effort by two North American experts in dissociative disorders to teach Chinese psychiatrists to make reliable dissociative disorder diagnoses. In the final phase of the educational effort, 569 patients at Shanghai Mental Health Center completed the Chinese version of the Dissociative Experiences Scale (DES). Patients were then randomly selected in different proportions according to their DES scores: 96 selected patients were then assessed with the Dissociative Disorders Interview Schedule (DDIS) and clinical diagnostic interviews based on DSM-IV criteria. According to the clinical diagnostic interviews, 28 (4.9%) patients were diagnosed as having dissociative disorders.

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Majohr, K-L., Leenen, K., Grabe, H. J., Jenewein, J., Nuñez, D. G., & Rufer, M., (2011). Alexithymia and its relationship to dissociation in patients with panic disorder. Journal of Nervous and Mental Disease, 199(10), 773-777.

Abstract:

Conditions that impede the regulation of emotional arousal, such as alexithymia and dissociation, may underlie panic attacks. This study aimed to evaluate the relationship between alexithymia and dissociation in patients with panic disorder (PD). We assessed 95 PD outpatients with regard to alexithymia (20-item Toronto Alexithymia Scale), dissociation (Dissociation Experi­ence Scale), and overall psychological distress (Symptom Checklist 90-Revised, Global Severity Index). Regression analyses revealed a positive correlation between alexithymia and dissociation, even when the Global Severity Index was controlled for. A specific link was observed between “difficulty in identifying feelings” and “depersonalization/derealization.” Patients who showed the pathological form of dissociation had higher levels of alexithymia, with particular regard to “difficulty in identify­ing feelings” and, to a smaller extent, “difficulty in describing feelings.” These results support a strong relationship between alexithymia and dissociation in patients with PD. Assessing alexithymia and dissociation at the outset of therapy may be helpful for individualized therapy planning.

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Fan, Q., Yu, J., Ross, C. A., Keyes, B. B., Dai, Y., Zhang, T., Wang, L., & Xiao, Z. (2011). Teaching Chinese psychiatrists to make reliable dissociative disorder diagnoses. Transcultural Psychiatry, 48(4), 473-483.

Abstract:

The aim of the study was to assess the outcome of an educational effort by two North American experts in dissociative disorders to teach Chinese psychiatrists to make reliable dissociative disorder diagnoses. In the final phase of the educational effort, 569 patients at Shanghai Mental Health Center completed the Chinese version of the Dissociative Experiences Scale (DES). Patients were then randomly selected in different proportions according to their DES scores: 96 selected patients were then assessed with the Dissociative Disorders Interview Schedule (DDIS) and clinical diagnostic interviews based on DSM-IV criteria. According to the clinical diagnostic interviews, 28 (4.9%) patients were diagnosed as having dissociative disorders.

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Majohr, K-L., Leenen, K., Grabe, H. J., Jenewein, J., Nuñez, D. G., & Rufer, M., (2011). Alexithymia and its relationship to dissociation in patients with panic disorder. Journal of Nervous and Mental Disease, 199(10), 773-777.

Abstract:

Conditions that impede the regulation of emotional arousal, such as alexithymia and dissociation, may underlie panic attacks. This study aimed to evaluate the relationship between alexithymia and dissociation in patients with panic disorder (PD). We assessed 95 PD outpatients with regard to alexithymia (20-item Toronto Alexithymia Scale), dissociation (Dissociation Experi­ence Scale), and overall psychological distress (Symptom Checklist 90-Revised, Global Severity Index). Regression analyses revealed a positive correlation between alexithymia and dissociation, even when the Global Severity Index was controlled for. A specific link was observed between “difficulty in identifying feelings” and “depersonalization/derealization.” Patients who showed the pathological form of dissociation had higher levels of alexithymia, with particular regard to “difficulty in identify­ing feelings” and, to a smaller extent, “difficulty in describing feelings.” These results support a strong relationship between alexithymia and dissociation in patients with PD. Assessing alexithymia and dissociation at the outset of therapy may be helpful for individualized therapy planning.

___________________________________________________________________________________________________________________________________________________________________

Fan, Q., Yu, J., Ross, C. A., Keyes, B. B., Dai, Y., Zhang, T., Wang, L., & Xiao, Z. (2011). Teaching Chinese psychiatrists to make reliable dissociative disorder diagnoses. Transcultural Psychiatry, 48(4), 473-483.

Abstract:

The aim of the study was to assess the outcome of an educational effort by two North American experts in dissociative disorders to teach Chinese psychiatrists to make reliable dissociative disorder diagnoses. In the final phase of the educational effort, 569 patients at Shanghai Mental Health Center completed the Chinese version of the Dissociative Experiences Scale (DES). Patients were then randomly selected in different proportions according to their DES scores: 96 selected patients were then assessed with the Dissociative Disorders Interview Schedule (DDIS) and clinical diagnostic interviews based on DSM-IV criteria. According to the clinical diagnostic interviews, 28 (4.9%) patients were diagnosed as having dissociative disorders.

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Majohr, K-L., Leenen, K., Grabe, H. J., Jenewein, J., Nuñez, D. G., & Rufer, M., (2011). Alexithymia and its relationship to dissociation in patients with panic disorder. Journal of Nervous and Mental Disease, 199(10), 773-777.

Abstract:

Conditions that impede the regulation of emotional arousal, such as alexithymia and dissociation, may underlie panic attacks. This study aimed to evaluate the relationship between alexithymia and dissociation in patients with panic disorder (PD). We assessed 95 PD outpatients with regard to alexithymia (20-item Toronto Alexithymia Scale), dissociation (Dissociation Experi­ence Scale), and overall psychological distress (Symptom Checklist 90-Revised, Global Severity Index). Regression analyses revealed a positive correlation between alexithymia and dissociation, even when the Global Severity Index was controlled for. A specific link was observed between “difficulty in identifying feelings” and “depersonalization/derealization.” Patients who showed the pathological form of dissociation had higher levels of alexithymia, with particular regard to “difficulty in identify­ing feelings” and, to a smaller extent, “difficulty in describing feelings.” These results support a strong relationship between alexithymia and dissociation in patients with PD. Assessing alexithymia and dissociation at the outset of therapy may be helpful for individualized therapy planning.

___________________________________________________________________________________________________________________________________________________________________

Fan, Q., Yu, J., Ross, C. A., Keyes, B. B., Dai, Y., Zhang, T., Wang, L., & Xiao, Z. (2011). Teaching Chinese psychiatrists to make reliable dissociative disorder diagnoses. Transcultural Psychiatry, 48(4), 473-483.

Abstract:

The aim of the study was to assess the outcome of an educational effort by two North American experts in dissociative disorders to teach Chinese psychiatrists to make reliable dissociative disorder diagnoses. In the final phase of the educational effort, 569 patients at Shanghai Mental Health Center completed the Chinese version of the Dissociative Experiences Scale (DES). Patients were then randomly selected in different proportions according to their DES scores: 96 selected patients were then assessed with the Dissociative Disorders Interview Schedule (DDIS) and clinical diagnostic interviews based on DSM-IV criteria. According to the clinical diagnostic interviews, 28 (4.9%) patients were diagnosed as having dissociative disorders.