MEDLINE Abstracts: Diagnosis of Dissociative Disorder
MEDLINE Abstracts: Diagnosis of Dissociative Disorder
Armstrong JG, Putnam FW, Carlson EB, Libero DZ, Smith SR
J Nerv Ment Dis 185(8):491-497, 1997
This study describes the initial reliability and validity data on the Adolescent Dissociative Experiences Scale (A-DES), a screening measure for pathological dissociation during adolescence. The A-DES showed good scale and subscale reliability, and, as hypothesized, increased scores were associated with reported trauma in a patient population. A-DES scores were able to distinguish dissociative disordered adolescents from a normal sample and from a patient sample with a variety of diagnoses.
Steinberg M, Hall P
Bull Menninger Clin 61(1):108-120, 1997
With the development of reliable diagnostic tools for the dissociative disorders, earlier implementation of appropriate therapy is now possible. The Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D) (Steinberg, 1994b), an extensively field-tested semistructured interview, can assist clinicians with treatment planning as well as diagnosis. This article discusses the diagnostic interview process, the importance of feedback interviews, specific questions regarding consultation and referral, and the use of hypnosis. The final section correlates the five dissociative symptoms assessed by the SCID-D with different phases of treatment planning.
Alexander PJ, Joseph S, Das A
Acta Psychiatr Scand 95(3):177-182, 1997
Studies of psychiatric out-patients from India have found that diagnosis of some of the subcategories of the dissociative and conversion disorders of the ICD and DSM classificatory systems are rarely made in this setting. Moreover, it was found that a significant percentage of patients seen in psychiatric practice may not fit into the defined subcategories of dissociative (conversion) disorders of these systems of classification. We studied the prevalence of various ICD-10 and DSM-IV categories of dissociative (conversion) disorders and our own proposed category of `brief dissociative stupor' (BDS), among all the in-patients of a psychiatric unit in a general teaching hospital, over a 2-year period. There were 18 patients who fulfilled our criteria for BDS and 18 patients in the second group which included all of the remaining subjects with a diagnosis of any other subcategory of dissociative disorder according to ICD-10. Our analysis revealed that there were no patients with a diagnosis of dissociative amnesia, fugue, stupor, trance and possession disorders or identity disorders. There were significantly more female patients in the BDS group, and they also had significantly more comorbid Axis-I diagnoses and panic attacks. Since 50% of our patients fulfilled the criteria for BDS, there is clearly a need for further studies to establish the prevalence of this subcategory in patients from other centres. The classification of these patients with this phenomenology is problematic. Inclusion of a subcategory of dissociative non-epileptic seizures, instead of dissociative convulsions, should improve the classification of dissociative (conversion) disorders.
Glover H, Lader W, Walker-O'Keefe J, Goodnick P
Psychiatry Res 70(2):115-123, 1997
Female inpatients engaged in self-injurious behavior (SIB) and females diagnosed with Dissociative Identity Disorder (DID) scored higher on the Glover Numbing Scale (GNS) than female inpatients diagnosed with Major Depressive Disorder (MDD). The DID sample showed a multi-modal distribution of scores, and the MDD sample showed a bimodal distribution with a significant difference between the means of the two subgroups. An additional subsample of outpatient males diagnosed with MDD also evidenced a bimodal distribution of scores with a similar spread between the two means. Scores on the Beck Depression Inventory did not discriminate the latter two subgroups.
Griffin MG, Resick PA, Mechanic MB
Am J Psychiatry 154(8):1081-1088, 1997
Objective: The aims of this study were to investigate psychophysiological changes associated with peritraumatic dissociation in female victims of recent rape and to assess the relation between these changes and symptoms of posttraumatic stress disorder (PTSD).
Method: Eighty-five rape victims were examined in a laboratory setting within 2 weeks after the rape, and measures of heart rate, skin conductance, and nonspecific movement were collected. Self-report indexes of reactions to the trauma and interviews to assess PTSD symptoms and peritraumatic dissociation were also completed. On the basis of their scores on the Peritraumatic Dissociation Index, the subjects were classified as having low or high levels of dissociation.
Results: Items from the index exhibited good internal consistency, and scores were approximately normally distributed. Individuals in the high peritraumatic dissociation group showed a significantly different pattern of physiological responses from those of the low dissociation group. In general, there was a suppression of autonomic physiological responses in the high dissociation group. This group also contained a larger proportion of subjects (94%) identified as meeting PTSD symptom criteria. Also, among the high dissociation subjects there was a discrepancy between self-reports of distress and objective physiological indicators of distress in the laboratory setting.
Conclusions: The results provide preliminary support for the idea that there is a dissociative subtype of persons with PTSD symptoms who exhibit diminished physiological reactivity. The results also underscore the importance of assessing dissociative symptoms in trauma survivors.
Armstrong JG, Putnam FW, Carlson EB, Libero DZ, Smith SR
J Nerv Ment Dis 185(8):491-497, 1997
This study describes the initial reliability and validity data on the Adolescent Dissociative Experiences Scale (A-DES), a screening measure for pathological dissociation during adolescence. The A-DES showed good scale and subscale reliability, and, as hypothesized, increased scores were associated with reported trauma in a patient population. A-DES scores were able to distinguish dissociative disordered adolescents from a normal sample and from a patient sample with a variety of diagnoses.
Steinberg M, Hall P
Bull Menninger Clin 61(1):108-120, 1997
With the development of reliable diagnostic tools for the dissociative disorders, earlier implementation of appropriate therapy is now possible. The Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D) (Steinberg, 1994b), an extensively field-tested semistructured interview, can assist clinicians with treatment planning as well as diagnosis. This article discusses the diagnostic interview process, the importance of feedback interviews, specific questions regarding consultation and referral, and the use of hypnosis. The final section correlates the five dissociative symptoms assessed by the SCID-D with different phases of treatment planning.
Alexander PJ, Joseph S, Das A
Acta Psychiatr Scand 95(3):177-182, 1997
Studies of psychiatric out-patients from India have found that diagnosis of some of the subcategories of the dissociative and conversion disorders of the ICD and DSM classificatory systems are rarely made in this setting. Moreover, it was found that a significant percentage of patients seen in psychiatric practice may not fit into the defined subcategories of dissociative (conversion) disorders of these systems of classification. We studied the prevalence of various ICD-10 and DSM-IV categories of dissociative (conversion) disorders and our own proposed category of `brief dissociative stupor' (BDS), among all the in-patients of a psychiatric unit in a general teaching hospital, over a 2-year period. There were 18 patients who fulfilled our criteria for BDS and 18 patients in the second group which included all of the remaining subjects with a diagnosis of any other subcategory of dissociative disorder according to ICD-10. Our analysis revealed that there were no patients with a diagnosis of dissociative amnesia, fugue, stupor, trance and possession disorders or identity disorders. There were significantly more female patients in the BDS group, and they also had significantly more comorbid Axis-I diagnoses and panic attacks. Since 50% of our patients fulfilled the criteria for BDS, there is clearly a need for further studies to establish the prevalence of this subcategory in patients from other centres. The classification of these patients with this phenomenology is problematic. Inclusion of a subcategory of dissociative non-epileptic seizures, instead of dissociative convulsions, should improve the classification of dissociative (conversion) disorders.
Glover H, Lader W, Walker-O'Keefe J, Goodnick P
Psychiatry Res 70(2):115-123, 1997
Female inpatients engaged in self-injurious behavior (SIB) and females diagnosed with Dissociative Identity Disorder (DID) scored higher on the Glover Numbing Scale (GNS) than female inpatients diagnosed with Major Depressive Disorder (MDD). The DID sample showed a multi-modal distribution of scores, and the MDD sample showed a bimodal distribution with a significant difference between the means of the two subgroups. An additional subsample of outpatient males diagnosed with MDD also evidenced a bimodal distribution of scores with a similar spread between the two means. Scores on the Beck Depression Inventory did not discriminate the latter two subgroups.
Griffin MG, Resick PA, Mechanic MB
Am J Psychiatry 154(8):1081-1088, 1997
Objective: The aims of this study were to investigate psychophysiological changes associated with peritraumatic dissociation in female victims of recent rape and to assess the relation between these changes and symptoms of posttraumatic stress disorder (PTSD).
Method: Eighty-five rape victims were examined in a laboratory setting within 2 weeks after the rape, and measures of heart rate, skin conductance, and nonspecific movement were collected. Self-report indexes of reactions to the trauma and interviews to assess PTSD symptoms and peritraumatic dissociation were also completed. On the basis of their scores on the Peritraumatic Dissociation Index, the subjects were classified as having low or high levels of dissociation.
Results: Items from the index exhibited good internal consistency, and scores were approximately normally distributed. Individuals in the high peritraumatic dissociation group showed a significantly different pattern of physiological responses from those of the low dissociation group. In general, there was a suppression of autonomic physiological responses in the high dissociation group. This group also contained a larger proportion of subjects (94%) identified as meeting PTSD symptom criteria. Also, among the high dissociation subjects there was a discrepancy between self-reports of distress and objective physiological indicators of distress in the laboratory setting.
Conclusions: The results provide preliminary support for the idea that there is a dissociative subtype of persons with PTSD symptoms who exhibit diminished physiological reactivity. The results also underscore the importance of assessing dissociative symptoms in trauma survivors.
