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Because a wide range of disorders incorporate dissociative symptoms, evaluators should be familiar with evidence‐based approaches to evaluating dissociation claims in the clinical and forensic context. This article provides specific guidelines for practitioners when conducting a forensic assessment of individuals who report dissociative symptoms. We review the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition disorders that include dissociation as a symptom, highlight how to distinguish genuine versus atypical symptoms of dissociative identity disorder, and summarize strengths and weaknesses of structured assessments in the evaluation of dissociative claims. [ABSTRACT FROM AUTHOR]

Survivors of Adverse Childhood Experiences (ACEs) can experience dissociation because of their trauma. Those survivors can also experience stigma stemming from their traumatic experiences, which may encourage disidentification from the stigmatized group (i.e., other survivors of ACEs). However, the relationships between disidentification and dissociation have not been empirically tested. Using a social identity framework, we examined whether stigmatized trauma perceptions (the degree to which a trauma is perceived as a stigmatized experience) predicted dissociative symptoms and disidentification using cross‐sectional survey data. An online community sample of ACEs survivors (N = 181) completed measures of disidentification and dissociation. Stigmatized trauma perceptions were measured by respondents rating the extent to which they perceived ACEs are a stigmatizing experience. Path analysis revealed higher stigmatized trauma perceptions predicted more disidentification which resulted in greater dissociative symptoms, after controlling for ACEs and gender. The results show that survivors are more likely to disidentify from people with similar experiences when they feel their trauma is stigmatized. This disidentification was associated with greater dissociation. The findings demonstrate a link between social disidentification and personal dissociation. Further research can explore this link in other types of stigmatized traumas (e.g., suicide). [ABSTRACT FROM AUTHOR]

ObjectiveTo develop a Dissociative Seizures Likelihood Score (DSLS), which is a comprehensive, evidence-based tool using information available during the first outpatient visit to identify patients with "probable" dissociative seizures (DS) to allow early triage to more extensive diagnostic assessment.MethodsBased on data from 1616 patients with video-electroencephalography (vEEG) confirmed diagnoses, we compared the clinical history from a single neurology interview of patients in five mutually exclusive groups: epileptic seizures (ES), DS, physiologic nonepileptic seizure-like events (PSLE), mixed DS plus ES, and inconclusive monitoring. We used data-driven methods to determine the diagnostic utility of 76 features from retrospective chart review and applied this model to prospective interviews.ResultsThe DSLS using recursive feature elimination (RFE) correctly identified 77% (95% confidence interval (CI), 74-80%) of prospective patients with either ES or DS, with a sensitivity of 74% and specificity of 84%. This accuracy was not significantly inferior than neurologists' impression (84%, 95% CI: 80-88%) and the kappa between neurologists' and the DSLS was 21% (95% CI: 1-41%). Only 3% of patients with DS were missed by both the fellows and our score (95% CI 0-11%).SignificanceThe evidence-based DSLS establishes one method to reliably identify some patients with probable DS using clinical history. The DSLS supports and does not replace clinical decision making. While not all patients with DS can be identified by clinical history alone, these methods combined with clinical judgement could be used to identify patients who warrant further diagnostic assessment at a comprehensive epilepsy center.

Negative symptoms of schizophrenia remain clinically and theoretically understudied and represent an unmet psychiatric need. Negative symptoms are assumed to be related to other psychiatric disorders, but their association with dissociative symptoms is yet to be explored, particularly in light of depression and anxiety symptoms. We examined the five domains of negative symptoms (anhedonia, asociality, avolition, blunted affect and alogia) in an Israeli national sample of 1930 participants of whom 645 (33.4%) were with increased risk for dissociative disorder. The results show that anhedonia, blunted affect and alogia significantly associated with risk for dissociative disorder, above and beyond depression and anxiety. When assessing for negative symptoms it may be worth screening for dissociation and vice versa and thus make a more accurate clinical picture of the interplay between them. • Negative symptoms of schizophrenia remain clinically and theoretically understudied. • The association between negative symptoms of schizophrenia and dissociative symptoms is understudied. • We report data collected from 1930 participants in an Israeli national sample. • Anhedonia, blunted affect, and alogia associated with risk for dissociative disorders, considering depression and anxiety. [ABSTRACT FROM AUTHOR]

Richard Saville-Smith's book, "Acute Religious Experiences: Madness, Psychosis and Religious Studies," offers a critique of twentieth-century theorists who distanced religious and psychopathological experiences. Saville-Smith argues that there is a significant overlap between nonclinical religious experiences and psychotic and dissociative disorders. He introduces the DREAD model, which provides criteria for identifying acute religious experiences. The book challenges the traditional focus on mystical experiences in religion and highlights the importance of visions, voices, and possession. Overall, Saville-Smith's work aims to bridge the gap between religious studies and psychiatry by exploring the intersection of extreme experiences and madness. [Extracted from the article]

The article discusses the challenges that modern psychiatry faces in defining and understanding delusions in the context of the internet and social media. It highlights the emergence of internet subcultures, such as "reality shifting," where individuals alter their subjective experience of reality. The article suggests that these subcultures may have implications for mental health, but further research is needed to determine their significance. The authors propose using thematic analysis and big data approaches to monitor and classify internet subcultures, with the goal of improving clinical outcomes and understanding the subjective experiences of patients. They emphasize the need for collaboration between mental health clinicians and computer science experts in this endeavor. [Extracted from the article]

Pesticides are chemicals used in agricultural fields for the prevention or destruction of pests. Inappropriate use of these substances, as well as handling them without using personal protective equipment, may result in serious health problems such as neurodegenerative diseases and mental disorders. Previous studies have demonstrated the adverse effects of pesticides on brain function. However, some researchers have associated pesticide poisoning with the development of disorders such as dissociative amnesia, multiple personality disorders, and depersonalization disorder. The objective of this work was to perform a bibliographic review of the relationship between pesticide poisoning and the development of dissociative disorders. Previous studies suggest that the duration of pesticide exposure is a major determinant in the development of dissociative diseases and disorders. The information obtained in this review suggests that there is no specific relationship between dissociative disorders and pesticide poisoning. However, these results point to associating the most representative symptoms of dissociative disorder (such as amnesia and memory loss) with pesticide exposure. Based on the bibliographic search, possible mechanisms of action were suggested in an attempt to explain a possible association between exposure to pesticides and the appearance of dissociative disorders. [ABSTRACT FROM AUTHOR]

The article discusses the Mental Healthcare Act of India, enacted in 2017, which addresses mental health and capacity provisions within the country. The authors suggest that due to cultural diversity, certain revisions and amendments are needed in the mental capacity provisions of the act. They compare the Indian Mental Healthcare Act 2017 with similar legislations in the U.K.'s devolved nations, highlighting the challenges and cultural considerations associated with assessing mental capacity.

Contemporary Developments in the Area of Non-recent Child Sexual Abuse: Moving from What Is Wrong with You and What Happened to You, to What Are We Going To Do About It Now? It found that one in 13 adults reported experiencing CSA, with 9% in total reporting contact CSA and 3% non-contact CSA. The knowledge of child sexual abuse (CSA) - the recognition of its prevalence and the reality of its impact - has been lost and found in repeated cycles within society and perhaps particularly within the field of mental health. [Extracted from the article]

The author discusses the psychoanalytic interrelationship between traumatic experiences and dissociative phenomena. It is understood that dynamic constitution among various parts of the self is significantly impeded as a result of traumatic experiences. Working from this perspective, and based on clinical practice and references from other authors who work with dissociative disorders, including identity disorders, the main objectives are: 1) to understand dissociative phenomena; 2) to understand how a fragmented mind develops from traumatic experiences; and 3) to offer some psychoanalytic approaches that may favor, in patients and analysts, a greater integration between states of self. [ABSTRACT FROM AUTHOR]

Objectives Negative age stereotypes have negative, assimilative effects on the subjective aging experience due to internalization processes, but sometimes positive contrast effects are reported as well, reflecting dissociation and downward comparisons. Our aim was thus to compare short-term and long-term consequences of age stereotypes on the subjective aging experience, to test the hypothesis that contrast effects are visible cross-sectionally, whereas internalization processes are observed when considering long-term changes. Methods We assessed age stereotypes and subjective age in a core sample of N = 459 participants (initial age range 30–80 years) from the Ageing as Future project across 3 consecutive measurement occasions spanning a longitudinal interval of 10 years. Short-term and long-term effects were estimated with latent growth models by assessing the effects of age stereotypes on the intercepts (cross-sectional) and on the slopes (longitudinal) of subjective age, respectively, while controlling for current self-views. Results Age stereotypes had opposite effects on subjective age depending on the time frame. A cross-sectional contrast effect was found, whereas longitudinal effects were assimilative in nature. Discussion Our findings support the time-dependent nature of the effects of age stereotypes on the subjective aging experience. Negative age stereotypes temporarily lead to a significantly younger subjective age, indicating dissociation from one's age group and downward comparison. In the long run, however, negative (positive) age stereotypes become internalized into the self-views of older people and are linked to a relatively older (younger) subjective age. [ABSTRACT FROM AUTHOR]

Introduction: Functional dissociative seizures (FDS) are episodes that resemble epileptic seizures, but are caused by different biopsychosocial factors. The way in which these patients cope with the challenges of their condition has been considered an important maintaining factor. The aim of this systematic review is to identify the coping strategies used by adult patients with FDS, and the measures used to assess them. Methods: The review was conducted following the PRISMA guidelines. A search was conducted in Pubmed, Cochrane Library, Scielo, Science Direct and Lilacs databases. Results: Eleven articles met the inclusion criteria and were integrated into a narrative synthesis. FDS patients use more avoidance and emotion-focused strategies than the general population. Their excessive use has been related to greater psychopathology, poorer quality of life and greater distress in the face of stress. On the other hand, the diversity of coping assessment instruments reflects the heterogeneity of the field. Conclusions: More research is needed to understand the coping strategies of FDS patients and to offer more personalized and effective treatment. [ABSTRACT FROM AUTHOR]

Hostilities and discrimination against refugees are continuous traumatic stressors (type III trauma) different from single past trauma. The goal was to measure their potential effects longitudinally. Recruiting 190 Syrian refugees in Turkey, we measured, two times, depression, complex PTSD, PTSD, anxiety, executive function, cumulative stressors, resilience, identity salience and the will to exist, live, survive and fight (WTELS‐F). We measured changes between times one and two. Using the structural equation, we tested two models. The first included latent variables 'changes between times 1 and 2 in discrimination, community violence, and poverty (DCVP)', 'mental health,' and 'executive function deficits'. The second included identity salience, WTELS‐F, PTG and resilience. Results indicated that the increase in DCVP led to a significant increase in mental health symptoms and cognitive deficits. There was a parallel increase in WTELS‐F and PTG. Identity salience seems to lead to this increase in WTELS‐F and PTG. We examined the clinical and conceptual significance of the results. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Dissociation in child sexual abuse (CSA) survivors remains under-recognized and diagnosed, partly because of the difficulties involved in identifying dissociative symptoms. Qualitative research can contribute to a better understanding of the lived experiences of dissociation. This study focused on the experiences of dissociation in the context of CSA. In all, 22 female incest survivors, all diagnosed with different dissociative disorders, provided narratives about their experiences of dissociation. The narratives were analyzed using interpretative phenomenological analysis. The narrative analysis revealed four central themes. The first theme deals with reliving the experience of the abuse. The second theme refers to the experience of disconnection from the body, the self, and the surroundings. The third theme covers the lack of coherence in the narrative, and the fourth theme describes the bridge between voluntary controlled and nonvoluntary uncontrolled use of dissociation. The data are discussed in light of several traumagenic constructs, including a lack of self-sense, being entrapped in a victim–aggressor relationship, and distorted time perception. It is suggested that the extent to which participants can control their dissociation and the coherency of their narratives reflects the severity of their dissociation. Clinicians can consider helping clients use dissociation as an adaptive defense mechanism. [ABSTRACT FROM AUTHOR]

Dissociative disorders (DD) are mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions, and identity. Transient dissociative episodes are a common phenomenon during childhood that generally decrease during adolescence to relatively low levels in adults. There is strong evidence that traumatic events play a key role in the development of dissociation, but non-abusive and genetic factors are also considered. In the article, we discuss a few complementary theoretical models of the origin of DD that view them from attachment theory, affect theory, or developmental perspectives. Diagnosing DD among children is especially hard because of their frequent co-occurrence with other disorders, their broad differential diagnosis spectrum, and the fact that symptoms may be unnoticed for a long time. Treatment guidelines are mainly based on experts' opinions, so appropriate studies on children are necessary. [ABSTRACT FROM AUTHOR]

Interest in dissociative identity disorder (DID) in psychiatry has increased rapidly although epidemiologically the cases of patients with DID are still rare, several studies exist trying to understand how DID might occur and the best therapeutic approach. Some of the symptoms of DID can also be found in non-clinical populations even though they are not directly related to the disorder. The findings of DID are often associated with other psychiatric disorders and can complicate the diagnosis. Various studies have tried to understand the case of DID either objectively or subjectively. Diagnosis of DID must be diagnosed by carefully experienced clinicians with clinical interviews with some proper tests that could help to identify various identities. Current DID therapy may be able to strengthen the identity of the patient's control and prevent impaired social functioning of the patient. Many pharmacological and non-pharmacological treatments have been developed to improve symptoms of the disorder, but none of them have been effective due to the quality of the studies conducted. Further research is still needed on DID as a whole to assist in the correct diagnosis and therapy for DID patients. [ABSTRACT FROM AUTHOR]

Background: Dissociative disorder is a stress-related disorder usually present in adolescents and younger age groups. It is also accompanied by significant impairment in activity of daily living and family relations. Family environment and use of dysfunctional coping strategies play important roles in the initiation and maintenance of symptoms and this puts a considerable burden on the family. Objectives: This study aims to study the presence of stressors, the role of family environment, the role of family burden, and the use of coping mechanisms in persons with dissociative disorder. Materials and Method: This was a descriptive cross-sectional study in which 100 persons with a dissociative disorder were included after fulfilling inclusion and exclusion criteria from the outpatient department (OPD) of psychiatry. Results: In this study, the major part of the sample were women (87%), most were educated up to 12th standard or less than 12 years of formal education. According to stressors, 44% had family stress/problems. 77% (mostly women) had dissociative stupor. The dissociative disorder caused a considerable degree of burden on the other family members. There was a significant difference in financial burden among caregivers of persons who were married, belonging to rural areas, joint families, and from lower socio-economic classes. There was a significant difference in disruption of routine family activities, and burden in persons having a longer duration of illness. There was a significant difference found in conflict, achievement orientation, and dimensions of family environment between males and females. A significant difference in the venting of emotions, behavioral disengagement, and restraint as a coping strategy between males and females was found. Conclusion: Present study showed dissociative disorder patients cause a considerable degree of burden on family members in terms of leisure, physical, mental, financial, and routine family interrelationship domains. In personal growth and relationship dimensions, the use of dysfunctional coping strategies in the family environment has a causal effect on the symptoms of dissociative disorder patients. [ABSTRACT FROM AUTHOR]

Background: Dissociation is a ubiquitous clinical phenomenon. Dissociative disorders (DD) are primarily characterized by dissociation, and dissociative states are also a criterion for borderline personality disorder (BPD) and the dissociative subtype of post-traumatic stress disorder (PTSD). Dissociative reactions (e.g., depersonalization/derealization or gaps in awareness/memory) across diagnostic categories are believed to be affect contingent and theorized to serve affect regulation functions. What is not clear, however, is how self-reported affect and physiological reactivity unfold within dissociative episodes. To address this issue, the present project aims to investigate the hypothesis (1) whether self-reported distress (as indicated by arousal, e.g., feeling tense/agitated, and/or valence, e.g., feeling discontent/unwell) and physiological reactivity increase before dissociative episodes and (2) whether self-reported distress and physiological reactivity decrease during and after dissociative episodes in a transdiagnostic sample of patients with DD, BPD, and/or PTSD. Methods: We will use a smartphone application to assess affect and dissociation 12 times per day over the course of one week in everyday life. During this time, heart and respiratory rates will be remotely monitored. Afterwards, participants will report affect and dissociative states eight times in the laboratory before, during, and after the Trier Social Stress Test. During the laboratory task, we will continuously record heart rate, electrodermal activity, and respiratory rate, as well as measure blood pressure and take salivary samples to determine cortisol levels. Our hypotheses will be tested using multilevel structural equation models. Power analyses determined a sample size of 85. Discussion: The project will test key predictions of a transdiagnostic model of dissociation based on the idea that dissociative reactions are affect contingent and serve affect regulation functions. This project will not include non-clinical control participants. In addition, the assessment of dissociation is limited to pathological phenomena. [ABSTRACT FROM AUTHOR]

The Generalised Anxiety Disorder Dimensional Scale is a new measure of generalised anxiety disorder developed to assist clinicians in the dimensional assessment of generalised anxiety disorder by the Diagnostic and Statistical Manual (Fifth Edition) Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorder Work Group. This study aims to evaluate the psychometric properties of the scale in an Australian community sample. A sample of 293 Australians (72.7% female) aged between 18 and 73 (M = 28.31 years; SD = 12.11 years) was recruited. Participants completed the Generalised Anxiety Disorder Dimensional Scale, as well as related measures used to assess convergent and discriminant validity. A small proportion of the sample (n = 21) completed the scale a second time to assess test-retest reliability. The scale demonstrated a unidimensional factor structure, good internal consistency (Cronbach's α =.94), good test-retest reliability (ICC =.85), good convergent validity with the Generalised Anxiety Disorder– 7 item (rs =.77), and discriminant validity with the Panic Disorder Severity Scale–Self Report (rs =.63). The scale appears to be a reliable and valid measure of generalised anxiety disorder symptomology for use in the Australian population. [ABSTRACT FROM AUTHOR]

Aim: Departing from existing neurobiological models of dissociation, the current study aims at conducting a quantitative meta‐analytic review of neural responses to emotional stimuli among individuals ascribed to the dissociative spectrum (DS). Accordingly, the study explored common and specific brain mechanisms across borderline personality disorder, conversion/somatoform disorders, posttraumatic stress disorder, posttraumatic stress disorder related to repeated interpersonal traumatic experiences, and dissociative disorders. Methods: The meta‐analysis included studies that administered emotional stimuli during functional magnetic resonance imaging acquisition among individuals included in the DS. There were two conducted meta‐analytic procedures: (i) a Bayesian network meta‐analysis for a region‐of‐interest–based approach; and (ii) robust voxel‐based approach. Results: Forty‐four independent studies were included for a total of 1384 individuals (DS = 741 patients). The network meta‐analysis showed specific patterns of neural activity considering an extended brain network involved in emotion regulation for each condition ascribed to the DS. The voxel‐based meta‐analysis highlighted an increased activity of dorsal anterior cingulate cortex as a common neurological signature of the DS. Conclusion: The common neural feature of the DS captures an implicit appraisal of emotion‐eliciting stimuli as threatening and/or noxious for mental and physical integrity of the individual together with painful subjective experiences associated with physiological emotional reactions. Specific brain responses across the DS suggested the engagement in different mechanisms to address emotional stimuli, including implicit avoidance reactions and attempts to overcontrol of affective states together with a disruption of integrative processes of emotional mind–body features. [ABSTRACT FROM AUTHOR]

Prior to 2020, pain management in the Washtenaw/Livingston County Medical Control Authority (W/L MCA) Emergency Medical Service (EMS) system in Southeast Michigan was limited to morphine, fentanyl, ketorolac, and acetaminophen. Based on the increasing evidence describing its safety and efficacy, ketamine was added to local protocols for pain management. This study aimed to evaluate differences in pain management and adverse effects of ketamine and opioid administration. Data from pediatric patients who received ketamine or an opioid in the W/L MCA EMS system from October 2019 to March 2021 were analyzed. The primary outcome was the difference in pain score, and the secondary outcome was adverse effects observed after analgesic administration. The decrease in pain scores was greater among ketamine patients (mean: 5.2) compared to opioid patients (mean: 2.9), p < 0.001. The prevalence of adverse effects was higher among patients in the ketamine group (28.6%) compared to patients in the opioid group (2.4%, p < 0.001). Of 14 patients who received ketamine, one 17-year-old male experienced mild anxiety (7.1%), two teenage females experienced mild dissociation (14.3%), and one 20-year-old female experienced mild nausea (7.1%). Overall, ketamine is a safe and effective option compared to opioids for pediatric patients experiencing moderate to severe prehospital pain. [ABSTRACT FROM AUTHOR]

Advanced imaging methods now allow cell-type-specific recording of neural activity across the mammalian brain, potentially enabling the exploration of how brain-wide dynamical patterns give rise to complex behavioural states1-12. Dissociation is an altered behavioural state in which the integrity of experience is disrupted, resulting in reproducible cognitive phenomena including the dissociation of stimulus detection from stimulus-related affective responses. Dissociation can occur as a result of trauma, epilepsy or dissociative drug use13,14, but despite its substantial basic and clinical importance, the underlying neurophysiology of this state is unknown. Here we establish such a dissociation-like state in mice, induced by precisely-dosed administration of ketamine or phencyclidine. Large-scale imaging of neural activity revealed that these dissociative agents elicited a 1-3-Hz rhythm in layer 5 neurons of the retrosplenial cortex. Electrophysiological recording with four simultaneously deployed high-density probes revealed rhythmic coupling of the retrosplenial cortex with anatomically connected components of thalamus circuitry, but uncoupling from most other brain regions was observed-including a notable inverse correlation with frontally projecting thalamic nuclei. In testing for causal significance, we found that rhythmic optogenetic activation of retrosplenial cortex layer 5 neurons recapitulated dissociation-like behavioural effects. Local retrosplenial hyperpolarization-activated cyclic-nucleotide-gated potassium channel 1 (HCN1) pacemakers were required for systemic ketamine to induce this rhythm and to elicit dissociation-like behavioural effects. In a patient with focal epilepsy, simultaneous intracranial stereoencephalography recordings from across the brain revealed a similarly localized rhythm in the homologous deep posteromedial cortex that was temporally correlated with pre-seizure self-reported dissociation, and local brief electrical stimulation of this region elicited dissociative experiences. These results identify the molecular, cellular and physiological properties of a conserved deep posteromedial cortical rhythm that underlies states of dissociation.

Ülker Atilan Fedai,&ast; Mehmet Aso&gbreve;lu&ast; Department of Psychiatry, Harran University Faculty of Medicine, &Scedil;anl&inodot;urfa, Turkey&ast;These authors contributed equally to this workCorrespondence: Ülker Atilan Fedai, Department of Psychiatry, Harran University Faculty of Medicine, Osmanbey Campus, &Scedil;anl&inodot;urfa, Turkey, Tel +90 4143183031, Fax +90 4143183192, Email uatilan@hotmail.comPurpose: The prevalence of dissociative identity disorder (DID) is 1%. However, the diagnosis can be made less frequently. This rate is similar to that of schizophrenia, and it is a public health problem that should receive attention. In the wake of the research results and clinical experiences, it was determined that DID diagnosis was challenging. Despite prevalence rates being similar to those seen in schizophrenia, DID remains under-researched. This study aims to determine the sociodemographic features, complaints, aetiological traumas, comorbid psychiatric disorders, and previous psychiatric applications of patients who had DID diagnosis, as well as to increase the awareness and recognisability of DID.Patients and Methods: Seventy patients who were diagnosed with DID based on the DSM 5 criteria and admitted to the outpatient clinic of the Department of Psychiatry Harran University Faculty of Medicine agreed to participate in this study. Patients filled out dissociative experiences scale, dissociation scale, and sociodemographic data form.Results: Of the 70 patients, 47 (67.14%) were female, and 23 (32.85%) were male. The mean age was 26.5 ± 9.63, the age range was 18– 62. It was the first psychiatric application for 34 (48.57%) patients. Of the 70 patients, 27 (38.57%) had four or more applications. Only 17 patients (24.28%) had the sole diagnosis of DID, while 47 patients (67.14%) had comorbid depressive symptoms. Regarding the first complaints, 35 patients (50.00%) had dissociative symptoms; 49 patients (70.00%) had depressive symptoms. As for the trauma types, 45 patients (64.28%) had histories of physical abuse, while 34 patients (48.57%) had histories of chronic neglect.Conclusion: The symptoms of DID can be related to many psychiatric disorders. DID patients can be classified under many different symptom groups. Treatments for symptoms fail when the diagnosis of DID is neglected. Patients are generally misdiagnosed, as determined in this study and in previous studies. Dissociative symptoms should be checked regularly during psychiatric interviews to prevent misdiagnosis.Keywords: dissociative disorders, dissociation, psychiatry, demographics

Objective: dissociative disorders usually have a poor prognosis. Childhood trauma is one of the most important predisposing factors for it. This study aimed to investigate the relationship between dissociative experiences with childhood abuse, in nursing and midwifery students of Rafsanjan University Medical Science.Patients and methods. This cross-sectional study was carried out in nursing and midwifery students of Rafsanjan University of Medical Sciences. The students were asked to complete Dissociative Experience (DES) and Traumatic Life Events Questionnaires. Descriptive statistics, independent t-test, ANOVA, chi-square test and pearson correlation coefficient were used for statistical analysis.Results and discussion. The prevalence of moderate and severe dissociative experiences among the participated students was about 38%. Nearly 50% of the students reported to have moderate to severe childhood injuries. Significantly higher dissociative experiences scores were observed in men compare with women (P=0.015). Moderate correlations were detected between subscales of childhood traumatic life events questionnaire and dissociative experiences score (P˂ 0.05).Conclusion. The prevalence of dissociative experiences among the studied students was moderately high which revealed the necessity and importance of psychological counseling among health professional students. A positive correlation was detected between dissociative disorders and traumatic events. Therefore, in order to reduce the chance of dissociative disorder, childhood psychological counseling is necessary in children who have had traumatic events.

Dissociation is an old concept that is in common use replacing hysteria. Reviewing the history of the concept is essential to understand the changes that took place in mental health. There are trauma and socio-cognitive models offered to explain what is essentially a defence mechanism. The category of dissociative disorders in the new ICD-11 is detailed covering all aspects of dissociation. Dissociative disorders are not exclusive to mental health and managed in neurology under functional neurological disorders. Ten cases are presented illustrating medical and legal challenges. [ABSTRACT FROM AUTHOR]

Interactions between childhood trauma (CT) and dissociation can contribute to psychiatric disturbances. We explored this phenomenon in relation to behavioral addictions (BAs) in a sample (n = 633) of young adults (age: 18–34 years). Self-report measures investigating CT, dissociation, and symptoms related to gambling disorder, internet gaming disorder, problematic social media use, exercise dependence and compulsive buying were used. Scales related to BAs were summarized into a single measure ("Total Behavioral Addiction Index" – TBAI) for inferential analyses. A model analyzing the direct and indirect effects of CT on TBAI through the mediation of pathological dissociation was performed, controlling for confounding factors. Measures on CT, dissociation, and TBAI were significantly associated with each other (all p <.001). The total effect of CT on TBAI was significant (B = 0.063; CI: 0.045; 0.081); pathological dissociation significantly mediated such association (B = 0.023; CI: 0.013; 0.036). Our findings support the possibility that the interaction between CT and dissociation contributes to increase disturbances related to BAs. [ABSTRACT FROM AUTHOR]

An editorial is presented on the stigma associated with dissociative disorders (DD), particularly dissociative identity disorder (DID). It highlights the skepticism from professionals within the clinical community, which has led to missed diagnoses of DID. It also explains the different types of stigma related to mental and psychological disorders, including self-stigma, social stigma, professional stigma, and institutional stigma.

Childhood abuse puts individuals at risk for psychopathology and psychiatric symptoms such as posttraumatic stress disorder (PTSD) and anxiety symptoms. At the same time, research has indicated that some survivors report positive transformations in the aftermath of their trauma, known as posttraumatic growth (PTG). Yet the essence of PTG reports is questionable, and some scholars claim that it may reflect maladaptive illusory qualities. Furthermore, according to a recent theoretical model, PTG might be dissociation-based and related to survivors' bonds with their perpetrators. This study aimed to explore these claims by assessing PTG, dissociation, and identification with the aggressor (IWA), as well as PTSD and anxiety symptoms. An online survey was conducted among 597 adult childhood abuse survivors. Study variables were assessed via self-report measures. Analyses indicated positive associations between PTG, dissociation, and IWA. Three distinct profiles were found, reflecting high, medium, and low scores on PTG, dissociation, and IWA. Profile type explained PTSD and anxiety symptoms above and beyond gender, age, and abuse severity. These findings suggest that whereas some childhood abuse survivors might experience a positive transformation subsequent to their trauma, others' PTG reports might reflect dissociative mechanisms and pathological attachments to their perpetrators, and thus might be maladaptive. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to investigate the relationship between dissociation and obsessive-compulsive symptoms (OCS) and disorder (OCD). Specifically, the study aimed to (a) estimate the pooled prevalence of dissociative disorders among individuals with OCD; (b) systematically review the prevalence of OCD among individuals with dissociative disorders; (c) compare the severity of dissociative symptoms between individuals with OCD and non-clinical controls; (d) estimate the association between OCS and dissociative symptoms in the clinical and non-clinical populations. A systematic search was carried out in biomedical databases from inception to January 2022 according to PRISMA guidelines. A total of 41 studies met inclusion criteria (n = 9,438, 34.3% males). The pooled prevalence of dissociative disorders in adult samples with OCD was 8% (95% CI [3, 15], k = 5). Studies on adolescent and adult patients with dissociative disorders found that 17–32% reported comorbid OCD, while a prospective study of patients with early-onset dissociative disorders found no evidence of association with OCD. Individuals affected by OCD reported more dissociative symptoms than non-clinical controls (g =.67, 95% CI [.18, 1.16], k = 9). A moderate correlation between dissociative symptoms and OCS was detected (r =.43, 95% CI [.36,.51], k = 18). Sensitivity analyses showed small/moderate correlations between dissociative experiences and specific types of obsessions and compulsions. Findings suggest that dissociative symptoms are moderately related to OCS in both clinical and non-clinical populations. Interventions aimed to reduce dissociation might improve treatment response of patients suffering from OCD. [ABSTRACT FROM AUTHOR]

Upto 86% of dissociative individuals engage in non-suicidal self-injury (NSSI). Research suggests that people who dissociate utilize NSSI to regulate posttraumatic and dissociative experiences, as well asrelated emotions. Despite high rates of NSSI, no quantitative study has examined the characteristics, methods, and functions of NSSIwithin a dissociative population. The present study examined thesedimensions of NSSI among dissociative individuals, as well aspotential predictors of intrapersonal functions of NSSI. The sample included 295 participants who indicated experiencing one or more dissociative symptoms and/or having been diagnosed with a trauma- or dissociation-related disorder. Participants were recruited through online trauma- and dissociation- related forums. Approximately 92% of participants endorsed a history of NSSI. The most common methods of NSSI were interfering with wound healing (67%), hitting oneself (66%), and cutting (63%). After controlling for age and gender, dissociation was uniquely associated with cutting, burning, carving, interfering with wound healing, rubbing skin against rough surfaces, swallowing dangerous substances, and other forms of NSSI. Dissociation was correlated with affect regulation, self-punishment,anti-dissociation, anti-suicide, and self-care functions of NSSI;however, after controlling for age, gender, depressive symptoms, emotion dysregulation, and PTSD symptoms, dissociation was no longer associated with any function of NSSI. Instead, only emotion dysregulation was associated with the self-punishment function ofNSSI and only PTSD symptoms were associated with the anti-dissociation function of NSSI. Understanding the unique properties of NSSI among dissociative individuals may improve the treatment of people who dissociate and engage in NSSI. [ABSTRACT FROM AUTHOR]

This study examined the factor structure and psychometric properties of the Dissociative Symptoms Scale (DSS) among the Korean community adult population with adverse childhood experiences (ACE). Data were drawn from community sample data sets collected from an online panel investigating the impact of ACE and ultimately consisted of data from a total of 1304 participants. A confirmatory factor analysis revealed a bi-factor model with a general factor and four sub-factors such as depersonalization/derealization, gaps in awareness and memory, sensory misperceptions, and cognitive behavioral reexperiencing, which are the four factors that correspond to the original DSS. The DSS showed good internal consistency as well as convergent validity with clinical correlates such as posttraumatic stress disorder, somatoform dissociation, and emotion dysregulation. The high-risk group with more ACE was associated with increased DSS. These findings support the multidimensionality of dissociation and the validity of Korean DSS scores in a general population sample. [ABSTRACT FROM AUTHOR]

The Dissociative Experiences Measure, Oxford (DEMO) is a recently developed measure that reflects the current conceptualization of dissociation. However, psychometric investigations of the DEMO are still limited. The current study examined the factor structure and psychometric properties of the Hong Kong Chinese version of the DEMO (HKC-DEMO). Online survey data on 914 community-dwelling adults in Hong Kong was extracted from a primary preregistered study on sleep and dissociation. Confirmatory factor analyses revealed that a five-factor structure, identified as "unreality," "numbness and disconnectedness," "memory blanks," "zoned out," and "vivid internal world," fit the data adequately. The five-factor structure fit significantly better than a four-factor structure, which combined "zoned out" and "vivid internal world" as a single factor of "absorption." Furthermore, the HKC-DEMO demonstrated excellent reliability, and satisfactory convergent, and divergent validity. The current study was the first to translate the DEMO to other language and showed that the HKC-DEMO is reliable and valid for use in Hong Kong Chinese adults. Further validation of the HKC-DEMO with a clinical sample and samples with a wider age range would enhance the generalizability of the HKC-DEMO. [ABSTRACT FROM AUTHOR]

Item- and list-method directed forgetting paradigms have been used to study forgetting of emotionally toned items in clinical and control group populations for several decades. Meta-analysis of item-method studies found that clinical populations retained more remember- than forget-cued items of each valence. These effects were comparable to that shown by control populations for positive and negative items, but less than that shown by controls on neutral items. Encoding deficits may underlie clinical populations' item-method directed forgetting since those populations retained fewer remember-cued items of each valence compared to control populations. Moderator analysis indicated larger effect size variability for some clinical populations (e.g., anxiety disorders) than other populations (e.g., PTSD, schizophrenia). Meta-analysis of list-method directed forgetting among clinical populations revealed only List 1 forgetting or costs for neutral items; i.e., better memory for to-be-remembered than forgotten List 1 neutral items, but no List 2 enhancements or benefits; i.e., better memory for List 2 items among those told to forget than remember List 1 items, for any item valence. Control populations showed costs and benefits for all item valences. Results from both paradigms are discussed in terms of clinical-control population differences in executive processes. Limitations of the meta-analyses and suggestions for future research are presented. [ABSTRACT FROM AUTHOR]

Background and Objectives: Dissociative convulsions represent complex biopsychosocial etiopathogenesis and have semiological similarities with epilepsy, which leads to delays in definitive diagnosis as well as treatment. We explored the neurobiological underpinnings of dissociative convulsions using a functional magnetic resonance imaging (fMRI) design targeting cognitive, affective, and resting state characteristics in our subjects. Materials and Methods: Seventeen female patients with dissociative convulsions without any co‑morbid psychiatric or neurological illness and 17 matched healthy controls underwent standardized task‑based (affective and cognitive) and resting state fMRI. Blood oxygen level‑dependent (BOLD) activation results were compared across the groups, and correlation with the severity of dissociation was measured. Results: Patients with dissociative convulsions had lower activation in the left cingulate gyrus, left paracentral lobule, right middle and inferior frontal gyrus, right caudate nucleus, and right thalamus. There was increased resting state functional connectivity (FC) between the left posterior superior temporal gyrus and left superior parietal lobule; left amygdala and Default Mode Network (DMN) of right lateral parietal cortex; right supramarginal gyrus and left cuneus in the patient group. Patients also had decreased FC between the anterior cingulate cortex (ACC) and left thalamus; ACC and right central opercular cortex; DMN of PCC, posterior cingulate gyrus, and right middle temporal lobe. Conclusions: Patients with dissociative convulsions have significant deficits in the areas associated with the processing of emotional, cognitive, memory, and sensory‑motor functions. There is a significant correlation between dissociative severity and the functioning of areas involving the processing of emotions, cognition, and memory. [ABSTRACT FROM AUTHOR]