Article

Dissociative disorders among inpatients with drug or alcohol dependency.

Research, Treatment and Training Center for Alcohol and Substance Dependency (AMATEM) and Neurosis Clinic, Bakirkoy State Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 11/2005; 66(10):1247-53. DOI: 10.4088/JCP.v66n1007
Source: PubMed

ABSTRACT To determine the prevalence of dissociative disorders among inpatients with alcohol or drug dependency.
The Dissociative Experiences Scale was used to screen 215 consecutive inpatients admitted to the dependency treatment center of a large mental hospital over a 1-year period (March 1, 2003, to March 31, 2004). Patients who had scores of 30.0 or above were compared with patients who scored below 10.0 on the scale. The patients in both groups were then evaluated using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. The interviewers were blind to the Dissociative Experiences Scale scores.
Of the patients, 36.7% had a Dissociative Experiences Scale score of 30.0 or above. The prevalence of DSM-IV dissociative disorders was 17.2% (N = 37). On average, 64.9% of these patients' dissociative experiences had started 3.6 years (SD = 2.9; range, 1.0-11.0 years) before onset of the substance use. Patients with dissociative disorders were younger, and the mean duration of their remission periods was shorter. Dissociative disorder patients tended to use more than 1 substance, and drugs were used more frequently than alcohol in this group. The frequency of borderline personality disorder, somatization disorder, history of suicide attempt, and childhood abuse and neglect occurred more frequently in the dissociative disorder group than in the nondissociative disorder group. History of suicide attempt (p = .005), female sex (p = .050), and childhood emotional abuse (p = .010) were significant predictors of a dissociative disorder diagnosis. Significantly more patients with dissociative disorders stopped their treatment prematurely (p < .001).
Impact of dissociative disorders on development and treatment of substance dependency requires further study.

Download full-text

Full-text

Available from: Vedat Sar, Jun 30, 2015
0 Followers
 · 
106 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to investigate the mediator roles of negative affect, aggression, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients. In addition, the effect of some variables that may be related with childhood trauma and dissociation among treatment-seeking substance dependents, such as substance of choice (alcohol/drug), mean of current age, and age at regular substance use was controlled. Participants were consecutively admitted 200 male substance-dependent inpatients. Patients were investigated with the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, the Barratt Impulsiveness Scale, the Buss-Perry Aggression Questionnaire, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory. Seventy-seven patients (38.5%) with pathologic dissociation were compared with 123 nondissociative patients (61.5%) classified by dissociative taxon membership. The dissociative group had lower age, age at regular substance use, duration of education, and higher rate of drug dependency rather than alcohol dependency. Beside higher scores on anxiety, depression, childhood trauma, aggression, and impulsivity, a larger proportion of dissociative group reported suicide attempts and self-mutilation than did the nondissociative group. Results of regression analyses suggest that severity of chronic anxiety, aggression (particularly hostility), and impulsivity were found to be mediators of association between childhood trauma and dissociation. Results suggest that, to reduce the risk of dissociation and related behavior such as suicide attempt and self-mutilation among substance dependents, chronic anxiety together with the feelings of hostility and impulsivity must be the targets of evaluation and treatment among those with history of childhood trauma.
    Comprehensive psychiatry 08/2012; 54(2). DOI:10.1016/j.comppsych.2012.06.013 · 2.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is consensus that an integrated approach which addresses the clinical needs of individuals who have histories of substance abuse and psychological trauma concurrently is an acceptable and preferred approach to treatment. Several integrated models have emerged in recent years. In this paper we first define the concepts of substance abuse and psychological trauma, investigate the relationship between both and proceed to discuss why an integrated approach is most compelling. Finally, we review and critically examine the different integrated models that have been developed in terms of efficacy, effectiveness and empirical evidence. The paper concludes with suggestions on how the field can be improved.
    Trauma Violence & Abuse 10/2010; 11(4):202-13. DOI:10.1177/1524838010381252 · 3.27 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although early trauma is a well-recognized risk factor for both dissociation and substance abuse, there are inconsistent reports on the association between substance abuse and dissociation. This inconsistency may be resolved by the "chemical dissociation" hypothesis that suggests that some substance abuse patients may not exhibit high levels of dissociation, despite their trauma history, because they may achieve dissociative-like states through chemicals consumption. This article describes 2 studies aimed to (a) assess the incidence of dissociative psychopathology among recovering opioid use disorder (OUD) patients and (b) examine the chemical dissociation hypothesis. One hundred forty-nine patients receiving treatment in a heroin recovery program and 46 controls were administered self-report measures of dissociation and childhood maltreatment in study 1. A similar battery and an assessment of addiction severity were completed by 50 methadone maintenance treatment (MMT) patients and 30 detoxified OUD patients in study 2. In addition, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Dissociative Disorders-Revised was administered to a subsample of MMT and detoxified OUD patients. Patients with OUD reported higher levels of child maltreatment and dissociation than controls. Although MMT and detoxified patients did not differ in severity of addiction and child maltreatment, detoxified outpatients had higher levels of dissociation than MMT outpatients: 23% of the detoxified patients and 12% of the MMT patients were diagnosed with a dissociative disorder. These findings support the chemical dissociation hypothesis of OUD and suggest that detoxification programs should take into consideration the high incidence of comorbid dissociative disorders among their recovering OUD patients.
    Comprehensive psychiatry 07/2010; 51(4):419-25. DOI:10.1016/j.comppsych.2009.09.007 · 2.26 Impact Factor