Erdinc Ozturk

Childhood Trauma and Dissociation in Schizophrenia

Background: This study is concerned with relationships between childhood trauma history, dissociative experiences, and the clinical phenomenology of chronic schizophrenia. Sampling and Methods: Seventy patients with a schizophrenic disorder were evaluated using the Structured Clinical Interview for DSM-IV, Dissociative Experiences Scale, Dissociative Disorders Interview Schedule, Positive and Negative Symptoms Scales, and Childhood Trauma Questionnaire. Results: Childhood trauma scores were correlated with dissociation scale scores and dissociative symptom clusters, but not with core symptoms of the schizophrenic disorder. Cluster analysis identified a subgroup of patients with high dissociation and childhood trauma history. The dissociative subgroup was characterized by higher numbers of general psychiatric comorbidities, secondary features of dissociative identity disorder, Schneiderian symptoms, somatic complaints, and extrasensory perceptions. A significant majority of the dissociative subgroup fit the diagnostic criteria of DSM-IV borderline personality disorder concurrently. Among childhood trauma types, only physical abuse and physical neglect predicted dissociation. Conclusions: A trauma-related dissociative subtype of schizophrenia is supported. Childhood trauma is related to concurrent dissociation among patients with schizophrenic disorder. A duality model based on the interaction of 2 qualitatively distinct psychopathologies and a dimensional approach are proposed as possible explanations for the complex relationship between these 2 psychopathologies and childhood trauma.

Frontal and occipital perfusion changes in dissociative identity disorder

The aim of the study was to investigate if there were any characteristics of regional cerebral blood flow (rCBF) in dissociative identity disorder. Twenty-one drug-free patients with dissociative identity disorder and nine healthy volunteers participated in the study. In addition to a clinical evaluation, dissociative psychopathology was assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders, the Dissociative Experiences Scale and the Clinician-Administered Dissociative States Scale. A semi-structured interview for borderline personality disorder, the Hamilton Depression Rating Scale, and the Childhood Trauma Questionnaire were also administered to all patients. Normal controls had to be without a history of childhood trauma and without any depressive or dissociative disorder. Regional cerebral blood flow (rCBF) was studied with single photon emission computed tomography (SPECT) with Tc99m-hexamethylpropylenamine (HMPAO) as a tracer. Compared with findings in the control group, the rCBF ratio was decreased among patients with dissociative identity disorder in the orbitofrontal region bilaterally. It was increased in median and superior frontal regions and occipital regions bilaterally. There was no significant correlation between rCBF ratios of the regions of interest and any of the psychopathology scale scores. An explanation for the neurophysiology of dissociative psychopathology has to invoke a comprehensive model of interaction between anterior and posterior brain regions.

HMPAO SPECT Study of Regional Cerebral Blood Flow in Dissociative Identity Disorder

Abstract The aim of the study was to in ves ti gate if there were any char ac ter is tics of re gional c e re bral blood flow (rCBF) in dissociative iden tity dis or der. Fif teen pa tients with dissociative iden tity dis or der and eight healthy vol un teers par tic i pated in the study. The clin i cal di ag no sis of dissociative iden tity dis or der was con firmed us ing the Struc tured Clin i cal In ter view for DSM-IV Dissociative Dis or ders. The Struc tured Clin i cal In ter view for DSM-III-R was also ad min is tered to all pa tients in or der to screen comorbid psy chi at ric con di tions. Re gional ce re bral blood flow was stud ied us ing a SPECT sys tem with Tc99m-hexamethyl -propylenamine (HMPAO) as a tracer. The rCBF ra tio was de creased in orbito-fron tal re gion bi lat er ally and in creased in left (dom i nant hemisphere) lat eral tem po ral re gion among pa tients with dissociative iden tity dis or der when com pared to the con trol group. The struc tured in ter view di ag no ses of con cur rent or life time ma jor de pres sion, PTSD, psy chotic dis or der, or on go ing drug treat ment were not sig nif i cantly re lated to perfu sion in these re gions. There was no sta tis ti cally mean ing ful dif fer ence in rCBF ra tios be tween host and al ter per son al ity states. Our find ings sug gest that orbitofron tal and left (dom i nant hemi sphere) lat eral tem poral re gions are af fected in dissociative iden tity dis or der. A rep li ca tion of this study on a larger group of drugfree dissociative pa tients and var i ous psy chi at ric con trol groups would lead to more de fin i tive find ings.

Childhood emotional abuse and dissociation in patients with conversion symptoms

Aim:  The aim of the present study was to evaluate the relationship between reported childhood trauma and dissociation in patients who have a conversion symptom.

Dissociative depression among women in the community

This study screened the prevalence and correlates of dissociative disorders among depressive women in the general population. The Dissociative Disorders Interview Schedule and the posttraumatic stress disorder (PTSD) and borderline personality disorder sections of the Structured Clinical Interview for DSM–IV were administered to 628 women in 500 homes. The prevalence of current major depressive episode was 10.0%. Of the women, 26 (40.6%) had the lifetime diagnosis of a DSM-IV, dissociative disorder, yielding a prevalence of 4.1% for dissociative depression. This group was younger (mean age = 30.7 years) than the nondissociative depression women (mean age = 39.6 years). There was no difference between the 2 groups on comorbid somatization disorder, PTSD, or borderline personality disorder. Besides suicide attempts, the dissociative group was characterized by secondary features of dissociative identity disorder; Schneiderian symptoms; borderline personality disorder criteria; and extrasensory perceptions, including possession experiences. They reported suicidality, thoughts of guilt and worthlessness, diminished concentration and indecisiveness, and appetite and weight changes more frequently than the nondissociative group. Early cessation of school education and childhood sexual abuse were frequently reported by the dissociative depression group. With its distinct features, the concept of dissociative depression may facilitate understanding of treatment resistance in, development of better psychotherapy strategies for, and new thinking on the neurobiology and pharmacotherapy of depressive disorders.

Somatization as a predictor of suicidal ideation in dissociative disorders

Aim:  This study was concerned with correlates of suicidal ideation among patients with chronic complex dissociative disorders.

Functional Dissociation of the Self: A Sociocognitive Approach to Trauma and Dissociation

ABSTRACT A novel sociocognitive theory of dissociation and dissociative disorders is proposed. The model, which is both theoretical and clinical, is based on “functional dissociation of the self.” A new concept is introduced in this paper: the sociological self. While the sociological self may have cultural and societal dimensions, it is regarded here as a universal phenomenon rather than a culture-bound one; as an individual psychological instance rather than a sociological concept per se. It is proposed that the main sources of dissociation are trauma-related detachment of the sociological and psychological selves and the subsequent amplification of the sociological self. Thus, effective psychotherapy must curtail the enlargement of the sociological self and reactivate the psychological self. It is hoped that this conceptualization will contribute to efforts both toward understanding the everyday dissociation of the average contemporary individual and toward developing novel psychotherapeutic approaches which might shorten the length of treatment of dissociative disorders.

What Is Trauma and Dissociation

Abstract Although the official term of posttraumatic stress disorder implies the opposite, trauma is not identical with the noxious event itself. An adequate definition of trauma would require the inclusion of both the objective and subjective components of a traumatic experience. Moreover, trauma is not limited solely to the traumatic situation, but is better defined as a socio-psychological process which can be completed in the course of time, if at all. The superposition of multiple trauma processes throughout a persons life span can make this task even more complex. We propose that what turns an experience to be traumatic is not only the interruption of information processing, but the activation of a maladaptive process, i.e., trauma is a threatening experience which turns an adaptive process to a maladaptive one. The six concepts of traumatic double-bind, traumatic turning point, completion expectancy, traumatic time perception, traumatic obsessions, and traumatic whirlpool are presented to better clarify this maladaptive process. Traumatic experiences and the consequently altered self-perceptions contribute to the impairment of the mutuality between internal world and external reality of the affected person. This is accompanied by a renewed perception of the self in context of a different reality accompanied by an alteration in vigilance, awareness, control, and sense of concentration. De-personalization is the core clinical element of this resulting condition which is called dissociation.

The “Apparently Normal” Family

Abstract Fifty first-degree relatives of 24 Turkish dissociative patients and 50 Turkish non-clinical controls were screened for childhood traumas, dissociative experiences/disorders, and borderline personality disorder/criteria. The Dissociative Experiences Scale, the borderline personality disorder section of the Structured Clinical Interview for DSM-IV Personality Disorders, the Childhood Trauma Questionnaire, and a structured history form were admistered to all participants. Family members had dissociative experiences, borderline personality disorder criteria (subtreshold scores included), and childhood traumas more frequently than the normal control group. Family members with a Dissociative Experiences Scale score 25 and above (N = 3) were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders. None of the family members were diagnosed as having a dissociative disorder and/or borderline personality disorder on a clinical level. Our findings suggest that these apparently normal families of dissociative patients need to be evaluated for trauma-related family dynamics overall and for hidden subclinical psychopathology.

Stimulus Deprivation and Overstimulation as Dissociogenic Agents in Postmodern Oppressive Societies

Societal conditions associated with overstimulation or understimulation may precipitate and maintain oppression among individuals and communities by inducing dissociation. Distortion of reality and the flooding of everyday awareness with irrelevant information by mass media is a type of community-wide overstimulation. Alternatively, stimulus deprivation enables single-minded thinking to be narrowly preoccupied with rigid religious ideas, traditional rituals, and postmodern thought and behavior patterns. Provoked sex is utilized as a soothing tool for those who live in overstimulation and as an opportunity for transient enjoyment and rejuvenation for those who live in stimulus deprivation. Chronic exposure to disproportionate stimuli resurrects the trauma-based developmental detachment between the sociological and psychological selves of the individual at the cost of the latter. The enlarged sociological self of the individual is misused to induce a conforming identity transformation of individuals and entire communities that is a prerequisite to setting and maintaining an oppressive system. Constituting overstimulation itself, the enduring fear of chaos in a world akin to crisis enables deliberate acceptance of oppression to restore a sense of control. In fact, the expectancy of crisis triggers the trauma-related dissociative fears of individual internal chaos, which are misused, in turn, to aggravate fears of external chaos again. By facilitating the denial of internal fears rather than integrating them, psychological theories and practices of the past century have failed in addressing the problem of individual and societal oppression.