Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder
ABSTRACT 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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ABSTRACT: Ms. V, a 10-year-old girl was referred to Child Psychiatry Department with complaints of bleeding from eyes for last 3 months. Bleeding was spontaneous, recurrent, painless, and self-limited. History revealed significant Psychological stressors, Temperamental Difficulties and Conflicts with Mother. Mental status examination revealed Depression in Ms. V. During hospital stay, Ms. V developed repeated bleeding episodes. The presence of hemoglobin is confirmed in the bleeding sample. Hematologic investigations and computed tomography brain were normal. Ms. V was started on Sertraline, Propranolol, and Clonazepam. Both Ms. V and her Mother were psycho-educated about the nature of the illness. Ms. V was discharged and under follow-up. This case is reported for the rarity of presentation (bleeding from Eyes) of a childhood Depression.Indian Journal of Psychiatry 01/2015; 57(1):88-90. DOI:10.4103/0019-5545.148533
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ABSTRACT: Current theories of conversion disorder (CD) propose that motor symptoms are related to heightened self-monitoring and excessive cognitive control of movements. We tested this hypothesis using quantification of performance on a continuous perceptuo-motor task involving quiet standing. Twelve CD patients and matched controls maintained static balance on a force platform under various attention conditions: (1) with eyes open; (2) with eyes closed (requiring enhanced attention to proprioceptive information to regulate posture); and (3) while performing an attention demanding cognitive task. Compared to controls, CD patients displayed a greater decrease in postural stability in the 'eyes-closed' versus 'eyes-open' condition. In contrast, cognitive distraction led to a normalization of balance in CD. Moreover, sensitivity to the balance interventions correlated significantly with trauma reports and dissociative symptoms. These results indicate that attention plays a crucial role in postural control in CD. More specifically, patients seem to inadvertently use deliberate control of posture (i.e., cognitive investment) of an otherwise nearly automatized perceptuo-motor task. Attentional distraction resulted in a temporary normalization of balance, which may be used to train individuals with CD to guide their attention in a more effective way. Copyright © 2014 Elsevier Inc. All rights reserved.