Prevalence of Dissociative Disorders in Psychiatric Outpatients

Klau-1 Psychiatric Outpatient Department, Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 05/2006; 163(4):623-9. DOI: 10.1176/appi.ajp.163.4.623
Source: PubMed


The purpose of the study was to assess the prevalence of DSM-IV dissociative disorders in an inner-city outpatient psychiatric population.
Subjects were 231 consecutive admissions (84 men and 147 women, mean age=37 years) to an inner-city, hospital-based outpatient psychiatric clinic. The subjects completed self-report measures of dissociation (Dissociative Experiences Scale) and trauma history (Traumatic Experiences Questionnaire). Eighty-two patients (35%) completed a structured interview for dissociative disorders (Dissociative Disorders Interview Schedule).
The 82 patients who were interviewed did not differ significantly on any demographic measure or on the self-report measures of trauma and dissociation from the 149 patients who were not interviewed. Twenty-four (29%) of the 82 interviewed patients received a diagnosis of a dissociative disorder. Dissociative identity disorder was diagnosed in five (6%) patients. Compared to the patients without a dissociative disorder diagnosis, patients with a dissociative disorder were significantly more likely to report childhood physical abuse (71% versus 27%) and childhood sexual abuse (74% versus 29%), but the two groups did not differ significantly on any demographic measure, including gender. Chart review revealed that only four (5%) patients in whom a dissociative disorder was identified during the study had previously received a dissociative disorder diagnosis.
Dissociative disorders were highly prevalent in this clinical population and typically had not been previously diagnosed clinically. The high prevalence of dissociative disorders found in this study may be related to methodological factors (all patients were offered an interview rather than only those who had scored high on a screening self-report measure) and epidemiological factors (extremely high prevalence rates for childhood physical and sexual abuse were present in the overall study population).

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    • "Previous work comparing abuse profiles across psychiatric groups has suggested that dissociative patients tend to have more physical, sexual and emotional maltreatment than those with schizophrenia, anxiety disorders and mixed non-dissociative disorders, more sexual abuse than those with complex partial seizures, and an earlier onset of sexual abuse than BPD (e.g., Fink and Golinkoff, 1990; Foote et al., 2006; Yargiç et al., 1998). The current findings add further detail to this developing picture, with the DD sample having more severe maltreatment on all physical, sexual and emotional markers than those with anxiety and mood disorders who reported an abuse/neglect history in childhood, and more severe sexual abuse than those with child abuse-related chronic PTSD. "
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    ABSTRACT: Only a select number of studies have examined different forms of child maltreatment in complex dissociative disorders in comparison to other groups. Few of these have used child abuse-related chronic PTSD and mixed psychiatric patients with maltreatment as comparison groups. This study examined child sexual, physical and emotional abuse, as well as physical and emotional neglect in dissociative disorder (DD; n = 39), chronic PTSD (C-PTSD; n = 13) and mixed psychiatric (MP; n = 21) samples, all with abuse and neglect histories. The predictive capacity of these different forms of maltreatment across the 3 groups were assessed for pathological dissociation, shame, guilt, relationship esteem, relationship anxiety, relationship depression and fear of relationships. All forms of maltreatment differentiated the DD from the MP group, while sexual abuse differentiated the DD sample from the C-PTSD group. Childhood sexual abuse was the only predictor of pathological dissociation. Emotional abuse predicted shame, guilt, relationship anxiety and fear of relationships. Emotional neglect predicted relationship anxiety and relationship depression. Physical neglect was associated with less relationship anxiety. Different forms of abuse and neglect are associated with different symptom clusters in psychiatric patients with maltreatment histories.
    Journal of Trauma & Dissociation 08/2015; DOI:10.1080/15299732.2015.1077916 · 1.72 Impact Factor
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    • "Studies within the general population have found that a majority of individuals espouse having had at least some degree of minor dissociative experience (Ross, Joshi, & Currie, 1991), whereas other research found an approximately 1%–5% prevalence for clinical dissociation at levels that would fulfill criteria for a dissociative disorder (Johnson, Cohen, Kasen, & Brook, 2006; Maarenan et al., 2004; Vanderlinden, Van der Hart, & Varga, 1996). Meanwhile, prevalence rates within psychiatric settings appear to range much higher, estimated at 4%–29% for dissociative disorders overall (Foote et al., 2006; Saxe et al., 1993). However, debate continues within the field as to the correct parameters for defining dissociation. "
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    ABSTRACT: Extant research indicates that dissociation may act as a risk factor for non-suicidal self-injury (NSSI), but the data are mixed. In this study, 75 university and community females, aged 18-35, were assessed for rates of normative, clinical, and severely clinical dissociation, as well as for NSSI. Significant differences in normative dissociation were found between the control group and the group reporting a history of NSSI. Additionally, normative dissociation - but not clinical or severely clinical dissociation - was found to be significantly associated with NSSI in this sample. Considering this finding in the context of existing literature, the authors propose a quartile risk model of dissociation and NSSI as a new approach to the influences of levels of dissociation on NSSI risk.
    Journal of Trauma & Dissociation 03/2015; 16(3). DOI:10.1080/15299732.2015.989645 · 1.72 Impact Factor
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    • "To date, there is no agreed-upon conceptualization of the taxonomy and aetiology of dissociative symptoms [2]. Epidemiological studies among psychiatric inpatients and outpatients have yielded prevalence estimates of severe dissociative symptoms, with rates usually exceeding 10% [3], while a recent epidemiological study in the UK general population found a prevalence rate of 0.95% [4]. Dissociative symptoms are not restricted to the dissociative disorders. "
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    ABSTRACT: Llewellyn has written a fascinating article about rapid eye movement (REM) dreams and how they promote the elaborative encoding of recent memories. The main message of her article is that hyperassociative and fluid cognitive processes during REM dreaming facilitate consolidation. We consider one potential implication of this analysis: the possibility that excessive or out-of-phase REM sleep fuels dissociative symptomatology. Further research is warranted to explore the psychopathological ramifications of Llewellyn's theory.
    Behavioral and Brain Sciences 12/2013; 36(6):630-1. DOI:10.1017/S0140525X13001453 · 20.77 Impact Factor
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