Frauke Rodewald

Prevalence of Dissociative disorders among psychiatric inpatients in a German University Clinic

The aim of the study was to determine the frequency of dissociative disorders among psychiatric inpatients in Germany and to investigate the relationship between childhood trauma and dissociation. The German version of the Dissociative Experiences Scale (DES), the Fragebogen für Dissoziative Symptome (FDS), was used to screen 115 consecutive inpatients admitted to the psychiatric clinic of a university hospital. Patients with FDS scores higher than 20 were interviewed by a trained clinician, using the German translation of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). The German version of the Childhood Trauma Questionnaire (CTQ) was administered to investigate prevalence of childhood trauma and relations between childhood trauma and dissociation in adult life. Twenty-five of the 115 patients (21.7%) had a score higher than 20 on the FDS. Of these, 15 patients were interviewed with the SCID-D-R. One patient was diagnosed with a dissociative identity disorder, three with dissociative disorders not otherwise specified, and one patient with depersonalization disorder. All diagnoses were confirmed clinically. A significant positive relationship was found between the severity of childhood trauma and dissociation. Dissociative disorders are common among German psychiatric inpatients. Clinicians who work in psychiatric inpatient units should be mindful of these disorders.

Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified.

The aim of this study was to investigate axis-I comorbidity in patients with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). Using the Diagnostic Interview for Psychiatric Disorders, results from patients with DID (n = 44) and DDNOS (n = 22) were compared with those of patients with posttraumatic stress disorder (PTSD) (n = 13), other anxiety disorders (n = 14), depression (n = 17), and nonclinical controls (n = 30). No comorbid disorders were found in nonclinical controls. The average number of comorbid disorders in patients with depression or anxiety was 0 to 2. Patients with dissociative disorders averagely suffered from 5 comorbid disorders. The most prevalent comorbidity in DDNOS and DID was PTSD. Comorbidity profiles of patients with DID and DDNOS were very similar to those in PTSD (high prevalence of anxiety, somatoform disorders, and depression), but differed significantly from those of patients with depression and anxiety disorders. These findings confirm the hypothesis that PTSD, DID, and DDNOS are phenomenologically related syndromes that should be summarized within a new diagnostic category.

Borderline-Persönlichkeitsstörung (BPS) und Dissoziative Identitätsstörung (DIS)

Patienten mit einer Vorgeschichte mit komplexen (Kindheits-) Traumatisierungen und daraus resultierenden posttraumatischen Störungsbildern wie z.B. der komplexen posttraumatischen Belastungsstörung, der Borderline-Persönlichkeitsstörung (BPS) und/oder komplexen dissoziativen Störungen (Dissoziative Identitätsstörung, DIS und DIS-ähnliche Formen der Nicht näher bezeichneten dissoziativen Störung, engl. dissociative disorder not otherwise specified, DDNOS) stellen in der klinischen Praxis häufig eine besondere Herausforderung für psychotherapeuten, Ärzten bzw. Stationsteams dar. Sowohl die klinische Erfahrung als auch empirische Forschungsergebnisse zeigen, dass betroffene Patienten häufig unter sehr komplexen Störungsbildern mit oft vielen Komorbiditäten leiden (Kessler, 1995), dass viele Patienten zu wiederholten Krisen und Dekompensationen neigen und dass es ohne eine traumaspezifische Psychotherapie häufig zu einem chronischen Störungsverlauf mit oft intensivem psychiatrischem Behandlungsbedarf und entsprechend hohen Krankheitskosten kommt.