Etzel Cardeña

Disintegrated experience : The dissociative disorders revisited

We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.

Evaluation of the Evidence for the Trauma and Fantasy Models of Dissociation

The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.

Dissociative Disorders in DSM-5

Background: We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM‐5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria. Methods: This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up‐to‐date, evidence‐based set of DD diagnoses and diagnostic criteria for DSM‐5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM‐IV‐TR and the ICD‐10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM‐5 and discuss the implications of this definition for understanding dissociative symptoms and disorders. Results: We make the following recommendations for DSM‐5: 1. Depersonalization Disorder (DPD) should derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Should Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category.

Psychometric properties of the Stanford Acute Stress Reaction Questionnaire (SASRQ): A valid and reliable measure of acute stress

A reliable and valid measure is needed for assessing the psychological symptoms experienced in the aftermath of a traumatic event. Previous research suggests that trauma victims typically experience dissociative, anxiety and other symptoms, during or shortly after a traumatic event. Although some of these symptoms may protect the trauma victim from pain, they may also lead to acute stress, posttraumatic stress, or other disorders. The Stanford Acute Stress Reaction Questionnaire (SASRQ) was developed to evaluate anxiety and dissociation symptoms in the aftermath of traumatic events, following DSM-IV criteria for acute stress disorder. We present data from multiple datasets and analyses supporting the reliability and construct, convergent, discriminant, and predictive validity of the SASRQ.

When disaster strikes, acute stress disorder may follow

During and immediately following a traumatic event, people may manifest a pattern of dissociative and anxiety symptoms and other reactions, referred to as Acute Stress Disorder. A review of the empirical literature on psychological reactions to trauma suggest that this pattern of symptoms has often been identified across different kinds of traumatic events. It is likely to constitute a psychological adaptation to a stressful event, limiting painful thoughts and feelings associated with the event and allowing the person to function at least minimally. Continuation of these symptoms, however, may impair the persons quality of life and disrupt social and other functioning. If symptoms last beyond a month following the traumatic event, Post Traumatic Stress Disorder (PTSD) may ensue, continuing for months or even years after the precipitating event. Hence, it is important to be able to identify this pattern of reactions that may be manifested in reaction to trauma, so that appropriate intervention can be provided. Although it was not officially recognized in the 3rd edition Diagnostic and Statistical Manual (DSM-III-R), Acute Stress Disorder is included as a separate diagnosis in the DSM-IV.

Guidelines for treating dissociative identity disorder in adults, third revision

Abstract in Undetermined The International Society for the Study of Dissociation (ISSD), the former name of the International Society for the Study of Trauma and Dissociation (ISSTD), adopted the Guidelines for Treating Dissociative Identity Disorder (Multiple Personality Disorder) in Adults in 1994. However, the Guidelines must be responsive to developments in the field and require ongoing review. The first revision of the Guidelines was proposed by the ISSD’s Standards of Practice Committee1 and was adopted by the ISSD Executive Council in 1997 after substantial comment from the ISSD membership. The second revision of the Guidelines was requested and approved in 2005 based on the expertise of a task force of expert clinicians and researchers.2 The current revision was undertaken by a new task force3 in 2009 and 2010 after input from an open-ended survey of the membership. The current revision of the Guidelines focuses specifically on the treatment of dissociative identity disorder (DID) and those forms of disso- ciative disorder not otherwise specified (DDNOS) that are similar to DID. It is intended as a practical guide to the management of adult patients and represents a synthesis of current scientific knowledge and informed clinical practice. There is a separate Guidelines for the Evaluation and Treatment of Dissociative Symptoms in Children and Adolescents (ISSD, 2004) available through the ISSTD and published in the Journal of Trauma & Dissociation. The American Psychiatric Association (2004) has published Practice Guidelines for the Treatment of Patients with Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD), which may be relevant to the treatment of DID. (Less)

Acute Stress Disorder Revisited

Acute stress disorder (ASD) was introduced into the Diagnostic and Statistical Manual (DSM) taxonomy in 1994 to address the lack of a specific diagnosis for acute pathological reactions to trauma and the role that dissociative phenomena play both in the short- and long-term reactions to trauma. In this review, we discuss the history and goals of the diagnosis and compare it with the diagnoses of acute stress reaction, combat stress reaction, and posttraumatic stress disorder (PTSD). We also evaluate the research on the validity and limitations of ASD as a diagnosis, the relationship between peritraumatic dissociation and other symptomatology, the extent to which PTSD is predicted by previous ASD or peritraumatic dissociation, and other important issues such as impairment and risk factors related to ASD. We conclude with our recommendations for changes in DSM-5 criteria and the development of more sophisticated research that considers ASD as but one of two or possibly three common acute posttraumatic syndromes.

The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: Examination of comorbidity with anxiety and depression

Previous research has indicated a relationship between posttraumatic stress disorder (PTSD) and somatic complaints. We examined whether this relationship is a result of shared comorbidity with anxiety and depression. Local doctors interviewed a random, community sample of 526 tortured and 526 nontortured Bhutanese refugees living in U.N. refugee camps in Nepal. The interview covered demographics, torture, somatic complaints, and PTSD, depression, and anxiety measures. Number of PTSD symptoms, independent of depression and anxiety, predicted both number of reported somatic complaints and number of organ systems involving such complaints. Physicians need to screen for PTSD when survivors of extreme stressors present nonspecific somatic complaints.

THE PHENOMENOLOGY OF DEEP HYPNOSIS: QUiescent and Physically Active

Abstract To study the phenomenology of hypnotic virtuosos, the author employed a 2 (hypnosis vs. control) × 3 (quiescent, pedaling a stationary bike, having a motor pedal the bike) within-subjects design with quantitative and qualitative measures. In a “neutral hypnosis” context with the only suggestion being to go as deeply into hypnosis as possible, participants reported alterations in body image, time sense, perception and meaning, sense of being in an altered state of awareness, affect, attention, and imagery. They also mentioned less self-awareness, rationality, voluntary control, and memory. Analyses of the 3 physical conditions showed that hypnotic experiences were overall similar, although quiescence was more conducive to alterations of body image and reports of depth. These results suggest that hypnotic virtuosos have alterations of consciousness that can be better conceptualized as distinct states rather than being on a continuum. This study was supported in part by the American Psychological Association’s MFP and Doctoral Dissertation fellowships. An earlier version of this paper received the Crasilneck award from SCEH after being presented at the 39th Annual Meeting of the Society for Clinical and Experimental Hypnosis, Asheville, North Carolina. Thanks to Charles Tart, Ph.D., for his supervision; to Jaime Curts, Ph.D., for statistical consultation; and to Grant Benham, Ph.D., Dana Barth, and Lupita Weiner for editorial assistance.

A Snapshot of Terror: Acute Posttraumatic Responses to the September 11 Attack

SUMMARY This paper reports on acute posttraumatic reactions and forms of coping to the September 11 attack. We conducted a survey within three weeks of the attack on a nationwide, representative sample of individuals 13 years or older (N= 3,134). Measures included the Stanford Acute Stress Reaction Questionnaire (SASRQ), the brief version of the COPE, and questions about demographics and attitudes toward the attackers. Results show that residents of New York City-women, young adults (but not teens), and people recently immigrated into the country-experienced more distress about the attack. There was a positive linear association between hours of watching TV news related to the attack and distress, and a small positive association between hostility toward the perpetrators, TV watching, and distress. Income, religion, education, and ethnicity did not have an effect on distress. Maladaptive coping strategies and TV watching explained considerably more variance than did demographics. Reactions to acute trauma seem to depend on the lack of appropriate coping strategies. The curvilinear relationship between age and posttraumatic distress suggests caution when interpreting previous findings about age and posttraumatic reactions. The association between media exposure, coping styles, and acute distress among teens extends previous findings and deserves further investigation.