Dissociation, Childhood Interpersonal Trauma, and Family Functioning in Patients With Somatization Disorder

The University of Manchester, Manchester, England, United Kingdom
American Journal of Psychiatry (Impact Factor: 12.3). 06/2005; 162(5):899-905. DOI: 10.1176/appi.ajp.162.5.899
Source: PubMed


The goals of this study were to determine 1) the occurrence of various dissociative phenomena in patients with somatization disorder, 2) the occurrence of six different types of childhood interpersonal trauma in these patients, and 3) the nature of these patients' early family environment.
Twenty-two patients with somatization disorder and 19 medical comparison subjects completed the Structured Clinical Interview for DSM-IV Dissociative Disorders, the Childhood Trauma Interview, and the Family Functioning Scale.
The somatization disorder patients reported significantly higher level of dissociative amnesia than the comparison subjects. The two groups reported similar levels of depersonalization, derealization, identity confusion, and identity alteration. Somatization disorder patients reported significantly greater childhood emotional abuse and more severe forms of physical abuse, relative to the comparison subjects, with chronic emotional abuse being the best predictor of unexplained symptoms. Childhood sexual abuse, separation/loss, and witnessing violence were equally common in the two groups. The somatization disorder group reported significantly more family conflict and less family cohesion.
Only some types of dissociation are more severe in patients with somatization disorder, relative to medical comparison subjects. Many patients with somatization disorder are raised in an emotionally cold, distant, and unsupportive family environment characterized by chronic emotional and physical abuse. Sexual abuse is not a necessary prerequisite for the disorder.

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    • "Dissociative symptoms are often observed in conversion disorder [2] [26]. Also, dissociative phenomena are associated with early childhood trauma [2] [27]. Furthermore, a recent study [28] showed that number of aversive life events (in a non-clinical sample of students) was a predictor of postural freezing. "
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    Journal of Psychosomatic Research 11/2014; 78(3). DOI:10.1016/j.jpsychores.2014.11.009 · 2.74 Impact Factor
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    • "Studies aimed at explaining the origin of SD have shown that dissociation also plays an important role in the process and there has been a link between these constructs [23] [25] [26]. A number of studies indicated that SD and dissociation were significantly associated [23] [26]. In a study on 924 non-clinical subjects, somatization, dissociation, depression and alexithymia were reported to be distinct constructs. "
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    ABSTRACT: Objective: This study sought to determine the trauma-related psychiatric comorbidity of somatization disorder among women who applied to an outpatient psychiatric unit of a general hospital in eastern Turkey. Methods: Forty women with somatization disorder and 40 non-clinical controls recruited from the same geographic region participated in the study. Somatization disorder and posttraumatic stress disorder (PTSD) sections of the Structured Clinical Interview for DSM-IV (including its criterion A traumatic events checklist), Dissociative Disorders Interview Schedule, Dissociative Experiences Scale (Taxon), Hamilton Depression Rating Scale, and Childhood Abuse and Neglect Questionnaire were administered to all participants. Results: A significant proportion of the women with somatization disorder had the concurrent diagnoses of major depression, PTSD, dissociative disorder, and borderline personality disorder. Women with somatization disorder reported traumatic experiences of childhood and/or adulthood more frequently than the comparison group. A significant proportion of these patients reported possession and/or paranormal experiences. Binary logistic regression analysis demonstrated that current major depression, being married, total number of traumatic events in adulthood, and reports of possession and/or paranormal experiences were independent risk factors for somatization disorder diagnosis. Conclusions: Among women with endemically high exposition to traumatic stress, multiple somatic complaints were in a significant relationship with major depressive disorder and lifelong cumulative traumatization. While accompanying experiences of possession and paranormal phenomena may lead to seeking help by paramedical healers, the challenge of differential diagnosis may also limit effective service to this group of somatizing women with traumatic antecedents and related psychiatric comorbidities.
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