Nel Draijer

Nel Draijer
Amsterdam University Medical Center | VUmc · Department of Psychiatry

PhD

About

80
Publications
65,734
Reads
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4,254
Citations
Additional affiliations
June 1990 - present
Amsterdam University Medical Center
Position
  • Professor (Associate)
January 1999 - December 2015
Vrije Universiteit Amsterdam
Position
  • Professor (Associate)
January 1995 - December 2015
GGZ inGeest
Position
  • Associate Professor - Clinical Psychologist - Psychotherapist - Senior researcher - Trainer / supervisor for Clinical Psychologists and Psychotherapists and Psychiatric Residents

Publications

Publications (80)
Article
Background and objectives: This study tested the prognostic value of a two-dimensional trauma-neglect model by determining clinically relevant change in symptomatology of patients with (comorbid) trauma-related disorders, dissociative disorders and personality disorders after 2-year follow-up Methods: Our cohort consisted of 150 patients who were r...
Article
Full-text available
Introduction Dissociative identity disorder (DID) is characterized by, among others, amnesic episodes and the recurrence of different dissociative identity states. While consistently observed in clinical settings, to our knowledge, no controlled research study has shown the degree to which different identity states report autobiographical knowledge...
Article
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Background Memory function is at the core of the psychopathology of dissociative identity disorder (DID), but little is known about its psychobiological correlates. Aims This study aims to investigate whether memory function in DID differs between dissociative identity states Method Behavioural data and neural activation patterns were assessed in...
Article
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Background: Two aetiology models for dissociative identity disorder (DID) have been proposed, namely a childhood Trauma Model and an iatrogenic or Fantasy model. A recent study indicated that sleep disturbances underlie dissociative symptomatology. Objective: Our current study aims to test whether this finding can be replicated in an independent sa...
Article
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Background: There is substantial comorbidity between trauma-related disorders (TRDs), dissociative disorders (DDs) and personality disorders (PDs), especially in patients who report childhood trauma and emotional neglect. However, little is known about the course of these comorbid disorders, despite the fact that this could be of great clinical imp...
Article
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Attachment (mal)functioning and a history of childhood trauma (CT) are both considered psychological determinants of personality disorders (PDs). Their interaction, however, remains largely uninvestigated. In this study, the authors assessed adult and childhood attachment style in a sample of patients with diverse PDs (N = 75) and determined the re...
Article
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Purpose of Review In this article, we describe the goals of transference-focused psychotherapy (TFP), its indications, underlying theory, and its broad structure and techniques. We summarize the current empirical support for TFP in regard to symptom and personality change. Lastly, we discuss recent developments and applications in TFP. Recent Find...
Article
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Introduction: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) introduced a dissociative subtype for patients with posttraumatic stress disorder (PTSD) and depersonalization and/or derealization symptoms. Despite high comorbidity rates between PTSD and dissociative disorders (D...
Article
Are personality disorders (PDs) associated with emotional neglect? Draijer (2003) developed a dimensional model of trauma-related disorders and PD. The first dimension consists of the severity of the trauma endured. The second dimension consists of emotional neglect, which is assumed to be related primarily to personality pathology. In this article...
Article
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Objective: Profiling patients who report early childhood trauma and emotional neglect may be useful for treatment planning. This study attempts to quantify a two-dimensional "trauma-neglect model" (Draijer, 2003) proposed to distinguish clinical profiles in terms of trauma-related, dissociative, and personality pathology. Method: A sample of pat...
Article
mhfmjournal.com/.../clinical-profiles-of-survivors-of-childhood-trauma-and- neglect-personality-or-trauma-oriented.pdf
Article
Psychotherapie dient aangetoond werkzaam te zijn. Zorginstituut Nederland (ZN) heeft eisen opgesteld voor het wetenschappelijk bewijs dat daarvoor nodig is. Welke psychodynamische of psychoanalytische behandelingen voldoen daaraan? Dit artikel geeft een overzicht van de huidige bewijskracht voor psychodynamische psychotherapie als een effectieve be...
Conference Paper
Background and objective: In patients with comorbid complex Posttraumatic Stress Disorder (complex PTSD) and psychotic disorder, trauma focused therapy may be difficult to endure. Phase-based treatment including (1) stabilization, (2) trauma focused therapy, and (3) integration of personality with recovery of connection, appears to be the treatment...
Article
Full-text available
Objective: The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two mo...
Article
Estimates of the extent of childhood sexual abuse (CSA) within in the Roman Catholic Church (RCC) in the general population are difficult to find. The independent Commission of Inquiry into sexual abuse of minors in the RCC in the Netherlands collected population-based data to estimate its prevalence. A large random online population sample was sur...
Article
Full-text available
Background: Posttraumatic stress disorder (PTSD) symptoms in individuals who have experienced repeated trauma (sexual and/or physical) in early childhood can lead to problems associated with emotion regulation, interpersonal functioning and self-image.This so-called complex ptsd is often accompanied by a comorbid personality disorder. Although ptsd...
Article
Neuroanatomical evidence on the relationship between posttraumatic stress disorder (PTSD) and dissociative disorders is still lacking. We acquired brain structural magnetic resonance imaging (MRI) scans from 17 patients with dissociative identity disorder (DID) and co-morbid PTSD (DID-PTSD) and 16 patients with PTSD but without DID (PTSD-only), and...
Article
Smaller hippocampal volume has been reported in individuals with post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID), but the regional specificity of hippocampal volume reductions and the association with severity of dissociative symptoms and/or childhood traumatization are still unclear. Brain structural magnetic resonan...
Article
Full-text available
Purpose Epidemiological research on childhood sexual abuse (CSA) and its consequences in adult life mainly relies on retrospective reports. This study explores their consistency and the correlates of inconsistent CSA self-reports in a random population sample. Method A stratified subsample of 2,462 subjects (selected from a large-scale (N = 34,267)...
Article
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Effective first-line treatments for posttraumatic stress disorder (PTSD) are well established, but their generalizability to child abuse (CA)-related Complex PTSD is largely unknown. A quantitative review of the literature was performed, identifying seven studies, with treatments specifically targeting CA-related PTSD or Complex PTSD, which were me...
Article
Abstract Background: In patients with co-morbid Complex Posttraumatic Stress Disorder (Complex PTSD) and psychotic disorder, trauma focused therapy may be difficult to endure. Phase-based treatment including (1) stabilization, (2) trauma focused therapy, and (3) integration of personality with recovery of connection, appears to be the treatment of...
Article
Full-text available
Background Bipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders. Both disorders have overlapping symptoms, and current research shows that the presence of a BPD has an adverse effect on the course of BD. The limited research available shows an unfavorable illness course, a worse prognosis...
Article
In dit artikel beschrijven wij de toepassing van Transference-Focused Psychotherapy (TFP) bij de behandeling van voormalige kindsoldaten met een dissociatieve identiteitsstoornis (DIS). Het richt zich vooral op de agressieproblemen, zoals die in psychotherapie naar voren komen. TFP biedt een psychodynamisch, objectrelationeel model om deze agressie...
Article
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A two-dimensional diagnostic model for (complex) trauma-related and personality disorders has been proposed to assess the severity and prognosis of the impact of early childhood trauma and emotional neglect. An important question that awaits empirical examination is whether a distinction between trauma-related disorders and personality disorders re...
Article
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While there is evidence of clinical improvement of posttraumatic stress disorder (PTSD) with treatment, its neural underpinnings are insufficiently clear. Moreover, it is unknown whether similar neurophysiological changes occur in PTSD specifically after child abuse, given its enduring nature and the developmental vulnerability of the brain during...
Article
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In the empirical and clinical literature, complex posttraumatic stress disorder (PTSD) and personality disorders (PDs) are suggested to be predictive of drop-out or reduced treatment effectiveness in trauma-focused PTSD treatment. In this study, we aimed to investigate if personality characteristics would predict treatment compliance and effectiven...
Article
Full-text available
Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. We conducted a systematic review of four databases (1980-2010) and then described and an...
Poster
Full-text available
Background and objective: In patients with comorbid complex Posttraumatic Stress Disorder (complex PTSD) and psychotic disorder, trauma focused therapy may be difficult to endure. Phase-based treatment including (1) stabilization, (2) trauma focused therapy, and (3) integration of personality with recovery of connection, appears to be the treatment...
Poster
Full-text available
Background: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness are often not recognized in clinical practice. Objective: The aim of this study was to substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with severe mental illness.
Article
This article describes the application of transference-focused psychotherapy (TFP) to the treatment of former child soldiers suffering from dissociative identity disorder. It focuses on the problems with aggression faced in psychotherapy. TFP provides a psychodynamic, object relations model to understand the aggression arising in psychotherapy, foc...
Article
Full-text available
Objective: This study aimed to evaluate the criterion validity and the diagnostic accuracy of the Four-Dimensional Symptom Questionnaire (4DSQ) regarding the identification of depressive and anxiety disorders in an insurance medicine setting. Participants: Our sample consisted of 230 individuals who applied for a work disability benefit due to m...
Article
Full-text available
Evidence-based treatments for complex posttraumatic stress disorder (PTSD) related to childhood abuse are scarce. This is the first randomized controlled trial to test the efficacy of psycho-educational and cognitive behavioural stabilizing group treatment in terms of both PTSD and complex PTSD symptom severity. Seventy-one patients with complex PT...
Article
Full-text available
Complex posttraumatic stress disorder (PTSD) involves a variety of personality disturbances presumed to result from repeated interpersonal trauma such as child abuse. As Complex PTSD patients are a heterogeneous population, we searched for clinically relevant personality-based subtypes. This study used a cluster analysis of Diagnostic and Statistic...
Article
Full-text available
Background: Functional neuroimaging studies have shown increased Stroop interference coupled with altered anterior cingulate cortex (ACC) and insula activation in post-traumatic stress disorder (PTSD). These brain areas are associated with error detection and emotional arousal. There is some evidence that treatment can normalize these activation p...
Article
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Post-traumatic stress disorder (PTSD) is associated with impaired memory performance coupled with functional changes in brain areas involved in declarative memory and emotion regulation. It is not yet clear how symptom severity and comorbidity affect neurocognitive functioning in PTSD. We performed a functional magnetic resonance imaging (fMRI) stu...
Article
Full-text available
The purpose of this study was to develop an expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). We developed a survey in 2 rounds: In the first round we surveyed 42 experienced therapists (22 DID and 20 complex PTSD therapists), and in the second round we surve...
Article
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SAMENVATTING Er zijn weinig betrouwbare gegevens over de prevalentie, aard en ernst van psychiatrische aandoeningen in de WAO/WIA. Dit artikel beschrijft een onderzoek dat is verricht onder een cohort psychisch arbeidsongeschikten dat een arbeidsongeschiktheidsbeoordeling voor de WAO/WIA kreeg. Met behulp van het Composite International Diagnostic...
Article
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Handelseditie van het eindrapport van de Onderzoekscommissie seksueel misbruik van minderjarigen binnen de Rooms-Katholieke Kerk, zonder verwijzingen naar de aan het onderzoek ten grondslag liggende nadere informatie en documentatie Onafhankelijk onderzoek gedaan van medio 2010 tot december 2011 naar seksueel misbruik van minderjarigen in de Rooms...
Article
Full-text available
Classic posttraumatic stress disorder (PTSD) is associated with smaller hippocampus, amygdala, and anterior cingulate cortex (ACC) volumes. We investigated whether child abuse-related complex PTSD--a severe form of PTSD with affect dysregulation and high comorbidity--showed similar brain volume reductions. We used voxel-based morphometry to measure...
Article
Full-text available
This study tests a Stabilizing Group Treatment protocol, designed for the management of the long-term sequelae of child abuse, that is, Complex Posttraumatic Stress Disorder (Complex PTSD). Evidence-based treatment for this subgroup of PTSD patients is largely lacking. This stabilizing treatment aims at improving Complex PTSD using psycho-education...
Article
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To gain insight into memory disturbances in Complex Posttraumatic Stress Disorder (Complex PTSD), we investigated declarative memory function and medial temporal lobe activity in patients and healthy non-traumatized controls. A case-control study was performed in nine patients with Complex PTSD and nine controls. All respondents performed a declara...
Article
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One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their st...
Article
In 1980 werden de dissociatieve stoornissen voor het eerst opgenomen in de DSM-III. Deze stoornissen en met name de dissociatieve identiteitsstoornis (DIS) waren toen en deels nu nog omstreden. Sommige clinici beweerden dat DIS helemaal niet bestond, maar het resultaat was van iatrogenese, namelijk beïnvloeding van suggestieve patiënten door overij...
Article
In the present article potential gender differences in the co-occurrence of dissociation and alcohol use disorders are evaluated. Based on a review of the nature of the co-morbidity patterns of these two phenomena in clinical and non-clinical samples it is suggested that psychological dissociation as a response to childhood trauma is more common in...
Article
Im Rahmen dieses Beitrags untersuchten wir mögliche Zusammenhänge zwischen traumatischen Erlebnissen in der Kindheit und komorbiden psychischen Störungen, wie sie üblicherweise bei männlichen Alkoholpatienten gefunden werden, die nicht zu Stichproben von Kriegsveteranen gehören. Es werden einerseits Ergebnisse bisheriger Studien im Überblick vorges...
Article
This study among treatment-seeking alcoholics examined the relationship between childhood abuse (sexual abuse only [CSA], physical abuse only [CPA], or dual abuse [CDA]) and the presence of comorbid affective disorders, anxiety disorders, and suicide attempts, controlling for the potential confounding effects of other childhood adversities (early p...
Article
Full-text available
Affect regulation is assumed to be a biologically based function that can become disrupted by inadequate parenting and by traumatic experiences. We studied the relation between the perceived parental parenting style, and sexual and physical abuse, with alexithymia, dissociation, anxiety and depression. In a cross-sectional study psychiatric outpati...
Article
We examined the validity of the Addiction Severity Index (ASI) regarding the identification of lifetime physical and sexual abuse histories using the Structured Trauma Interview (STI) as external criterion in alcohol-dependent patients (n=144). Compared to the STI, the ASI showed a lower incidence of lifetime physical abuse reports (51% vs. 24%) an...
Article
There is consistent empirical evidence for a trauma-dissociation relation in general population samples and in psychiatric patients. However, contradictory findings have been reported on this relation among substance abusers. The present study attempts to resolve these inconsistencies by testing a series of hypotheses related to problems regarding...
Article
Evaluation of the Addiction Severity Index (ASI) as a screen for identifying sexual and physical assault histories. The sensitivity and specificity of the ASI assault items were examined in 146 alcoholic patients with the assault questions of the Composite International Diagnostic Interview posttraumatic stress module as external criterion. The sen...
Article
Objective: Prevalence rates for dissociative disorders among psychiatric in-patients vary widely. The aim of this meta-analysis is to offer an explanation for these differences. Method: Prevalence studies using a clinical diagnostic interview among psychiatric in-patients were included. Hypotheses concerning the impact of blind versus not blind des...
Article
The goal of this study was to determine the frequency of dissociative disorders in Dutch psychiatric inpatients. During a period of 12 months, 122 consecutively admitted adult psychiatric patients were screened with the Dissociative Experiences Scale. Patients scoring 25 and higher and a random selection of patients scoring lower than 25 were blind...
Article
Since the late 1980s the authors have been confronted with cases of imitated dissociative identity disorder (DID) in Holland. Because DSM-IV defines 'factitious disorder' as intentional, the term 'imitation of DID' is used here for patients who, partly unconsciously motivated, simulate a DID profile. DID can be imitated due to contagion, to iatroge...
Article
Full-text available
Research on the etiology of dissociation in adults has focused primarily on childhood sexual abuse. The role of co-occurring childhood stressors and of more chronic adverse conditions such as neglect is less clear. This study examined the level of dissociation in relation to childhood trauma (sexual/physical abuse, witnessing interparental violence...
Article
This article addresses the following questions: (1) How to distinguish dissociative identity disorder (DID) from a variety of other mental disorders, including schizophrenia and other psychotic disorders, bipolar disorder, anxiety disorders and personality disorders?, and (2) How to distinguish DID from malingering and from factitious disorder? Sys...
Article
The aim of this study was to describe the phenomenology of multiple personality disorder as presented in a group of Dutch patients. Seventy-one patients with multiple personality disorder were interviewed with the Dutch version of the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D); following the SCID-D, the Structured T...
Article
Analyzed the utility of the Dissociative Experience Scale (DES) as a screener for dissociative disorders (DDs). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) Dissociative Disorders (SCID-D) was used as standard of comparison. 43 psychiatric patients with a DD and 36 control patie...
Article
Although clinical reports on MPD [Multiple Personality Disorder] and other dissociative disorders began to appear in the Dutch literature, there is still much controversy as to whether MPD can be considered as a valid diagnosis. Boon & Van der Hart (1988, 1991)—based on their clinical experience with MPD patients—suggested that MPD probably is un...
Article
To improve the ability to diagnose dissociative disorders in The Netherlands, the authors conducted a study using a Dutch version of the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) with additional questions on childhood trauma and symptoms of borderline and histrionic personality disorders. All interviews were audiot...

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