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Diagnostic Evaluation of the Child With Dissociative Identity Disorder/Multiple Personality Disorder.

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Abstract

Reviews the diagnoses with which dissociative identity disorder/multiple personality disorder (DID/MPD) is often confused, including attention-deficit hyperactivity disorder, schizophrenia, mood disorders, seizure disorders and narcolepsy, borderline states, and conduct disorder/antisocial personality and suggests techniques for tapping dissociative symptoms in children. Figures are provided to illustrate the way writing samples and drawings produced prior to evaluations can be used to confirm the diagnosis of DID/MPD. It is concluded that the clinician must look beneath the mishmash of different signs, symptoms, and behaviors to uncover the 3 basic underlying psychological phenomena from which the rest of the symptomatology of DID/MPD derives: trance states, amnesias, and the tendency to switch from one identity or awareness state to another. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

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... Diagnostic obstacles. Other obstacles to diagnosing DID accurately in both adults and children are the seemingly baffling symptom complex: signs of DID can frequently be confused with other psychiatric diagnoses; the polymorphous symptom presentation or the presence of a coexisting disorder frequently makes the diagnosis of other psychiatric disorders the norm (Kluft, 1986;Lewis, 1996; 996). The oiagnosis of DID in children and adolescents is further complicated by a variety of factors: the need to differentiate between normal childhood fantasy involving imaginary companions and the alter personality states inherent in DID; the differentiation between normal childhood dissociation and pathological dissociation; the consideration of the less fixed symptomotology in children; the identification of childhood trauma and responses to the trauma; and the realization that abused children often move from one geographic place to another geographic place, thus, a complete data base of the child's history may be Skepticism, DID, Adolescents lacking; in addition, abused children are likely to present denying problems (Lewis, 1996;Steinberg, 1996). ...
... Other obstacles to diagnosing DID accurately in both adults and children are the seemingly baffling symptom complex: signs of DID can frequently be confused with other psychiatric diagnoses; the polymorphous symptom presentation or the presence of a coexisting disorder frequently makes the diagnosis of other psychiatric disorders the norm (Kluft, 1986;Lewis, 1996; 996). The oiagnosis of DID in children and adolescents is further complicated by a variety of factors: the need to differentiate between normal childhood fantasy involving imaginary companions and the alter personality states inherent in DID; the differentiation between normal childhood dissociation and pathological dissociation; the consideration of the less fixed symptomotology in children; the identification of childhood trauma and responses to the trauma; and the realization that abused children often move from one geographic place to another geographic place, thus, a complete data base of the child's history may be Skepticism, DID, Adolescents lacking; in addition, abused children are likely to present denying problems (Lewis, 1996;Steinberg, 1996). ...
... While the consensus addresses adult memories of childhood sexual abuse, the achieved consensus may be equally applicable to children and adolescents who often present denying even corroborated sexual abuse events (Lewis, 1996;Steinberg, 1996) despite the proximity in time of the abusive events. The AP A (1996) consensus conclusions are: ...
Article
Professional skepticism about DID and lack of knowledge about DID has been documented in the adult literature on dissociative pathology (Hayes and Mitchell, 1994). Although 100% of adult DID cases are thought to have originated in childhood as sequelae of trauma, to date no studies about professional skepticism of and knowledge about DID have been done with psychologists who specialize in assessing children and adolescents. This study was designed to investigate the beliefs about DID and knowledge of DID that has been garnered by psychologists who specialize in assessing and treating adolescents. This study consisted of a convenience sample of 34 participants recruited from the American Psychological Association's Division 53 and from participants surveyed via the Internet. This research replicates the study done by Hayes and Mitchell (1994) utilizing the Skepticism and Knowledge Scale designed by them. The abysmal response rate of 2.7% allowed for descriptive analysis but reduced power in calculating correlations between variables. Results indicated an inverse correlation between the Skepticism and the Knowledge variables. Unlike similar studies in the adult literature about dissociative pathology, participants lacked skepticism about DID and were knowledgeable about DID. Yet only 17.6% of the sample accurately diagnosed the DID vignette. The findings of this study reinforce other research findings (Putnam, 1991) that DID, the paradigmatic Dissociative Disorder, is seldom diagnosed in childhood and adolescence. The limitations of this study suggest that findings should be regarded as exploratory rather than conclusive as those who chose not to participate may have done so because of extreme skepticism as well as lack of knowledge about DID.
... CM has been proposed as a causal factor in IPV perpetration due to the high rates of CM reported by interpersonally violent offenders. This includes domestic violence (DV) offenders in a battering intervention program (Dutton, 1995;Simoneti, Scott, & Murphy, 2000); sex offenders in prison (Hulnick, 1997) and treatment (Becker-Blease & Freyd, 2007;; male undergraduates (Lisak, Hopper, & Song, 1996); incarcerated violent offenders (Swica, Lewis, & Lewis, 1996); and incarcerated homicide defendants (Lewis, Yeager, Swica, Pincus, & Lewis, 1997). While most CM survivors do not become IPV perpetrators (Lisak et al., 1996), it is feasible that much IPV is perpetrated by CM survivors. ...
... It may allow a perpetrator to emotionally distance from the offense and maintain minimal empathy for their victim, especially for survivors of violence who perpetrate acts similar to abuse they experienced (Egeland & Susman-Stillman, 1996;Moskowitz, 2004;Ross, 2008). Research on interpersonally violent offenders has demonstrated elevated trait dissociation, increased rates of DD, and higher retrospectively reported peritraumatic dissociation (i.e., acute dissociative responses as traumatic events unfold; Marmar, Metzler, & Otte, 2004) for their own CM experiences and while perpetrating abuse toward others (Becker-Blease & Freyd, 2007;Hulnick, 1997;Leibowitz, 2007;Lewis et al., 1997;Ross, 2008;Simoneti et al., 2000;Swica et al., 1996). ...
... As discussed, the current findings could be enhanced in future research by including patient self-reported data on IPV victimization and perpetration. Self-reported data on IPV, obtained through IPV measures such as the Revised Conflict Tactics Scale (CTS2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996), Dissociative Violence Questionnaire (Simoneti et al., 2000), or through clinician and researcher interviews, has been successfully obtained in samples of highly dissociative violent offenders (Becker-Blease & Freyd, 2007;Dutton, 1995;Leibowitz, 2007;Lewis et al., 1997;Simoneti et al., 2000;Swica et al., 1996). A well-validated and short IPV measure, such as the Revised Conflict Tactics Scale-Short Form (CTS2S; Straus & Douglas, 2004) could be given as an optional measure. ...
Article
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Background: Childhood maltreatment (CM) is a risk factor for subsequent intimate partner violence (IPV) in adulthood, with high rates of retrospectively reported CM among IPV victims and perpetrators. A theorized mechanism of the link between CM and IPV is dissociation. Dissociation may allow perpetrators of violence to remain emotionally distant from their behavior and minimize empathy toward those they victimize, enabling them to commit acts of violence similar to their own experiences. Indeed, elevated rates of dissociation and dissociative disorders (DD) have been found among IPV survivors and perpetrators. In addition, in pilot studies, DD clinicians have reported high levels of violent behavior among DD patients. Objective: The present study investigates IPV among DD patients with Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified, a group with CM rates of 80-95% and severe dissociative symptoms. Methods: DD clinicians reported on rates of CM and IPV among 275 DD patients in outpatient treatment. DD patients also completed a self-report measure of dissociation. Analyses assessed the associations between CM typologies and IPV, as well as trait dissociation and IPV. Results: Physical and emotional child abuse were associated with physical IPV, and childhood witnessing of domestic violence (DV) and childhood neglect were associated with emotional IPV. Conclusions: The present study is the first to provide empirical support for a possible CM to adult IPV developmental trajectory among DD patients. Future research is needed to better understand the link between CM and IPV among those with trauma and DD.
... The Bellevue Dissociative Disorders Interview for Children (BDDI-C; D. O. Lewis, 1996) can be administered in a semistructured format and probes several areas: states of consciousness, memory, mood, imagination, hearing, visual and sensory experiences, temperament (aggression), discipline, medical conditions, sexual behaviors, references to oneself as a third person, and personal abilities. The interview can be administered in the context of play therapy (Coons, 1996). ...
... Certain themes, such as disruptions of memory, perception and identity, and inconsistency of the parents, have been found to be highly correlated with observations of children's dissociative behavior (Macfie, Cicchetti, & Toth, 2001). In a similar vein, D. O. Lewis (1996) recommended evaluating drawings and writing from school or personal diaries. Silberg (1998) described her test battery for children with possible DDs. ...
Article
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In the past 20 years, the study of dissociation has flourished partly because of the research on the links between traumatic events and dissociation. Epidemiological studies have shown that dissociative symptoms and disorders are not uncommon. The nonspecialist in this area needs a guide to the extensive literature on the evaluation of dissociation across the lifespan to choose the most appropriate form of evaluation. The authors provide summaries of various types of assessment for dissociation in infants, children, teens, and adults. The techniques they review include structured interviews, specialized questionnaires, and scales on more general instruments, along with their psychometric properties. A good evaluation of dissociation can guide diagnosis, help focus treatment, and provide a measure of treatment efficacy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The low index of suspicion among clinicians due to the lack of a dissociative disorder category among childhood psychiatric disorders in the DSM-IV, atypical clinical presentations, a smaller " window of diagnosability " among children than adults, and unawareness of children about their dissociative symptoms and trauma-related memories makes a diagnosis difficult. Given the fact that treatment is much more successful in childhood (Coons, 1996; Kluft, 1985; Kluft, 1991; Lewis, 1996; Putnam, 1997 ), early recognition of the disorder has vital importance . Various symptom checklists and screening instruments have been developed to aid the clinician in eliciting childhood dissociative symptomatology. ...
... In three studies (Hornstein & Putnam, 1992; Putnam, Helmers, & Trickett, 1993; Putnam & Peterson, 1994, Helmers, & Trickett, 1993 ). In addition, the mean CDC score for the children with DDNOS was 23 (Coons, 1996), and for the children with dissociative disorders (DID and DDNOS mixed group) 17.4 (Lewis, 1996). In our study, children with DID had mean and median scores of 24.9 (SD = 4.9) and 25, whereas children with DDNOS had 16.4 (SD = 6.1) and 16.5, respectively. ...
Article
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Objective: This paper investigated the psychometric characteristics of the Turkish Version of the Child Dissociative Checklist (CDC).Method: The CDC was translated by the authors and discrepancies were resolved by consensus. It was administered to a sample consisting of 9 DID, 28 DDNOS, 35 anxiety disorder, 22 mood disorder, 22 ADHD, and 88 non-psychiatric comparison children and adolescents (N = 204, age range 6-17 years). Parents or caretakers completed the measure at the hospital for patient groups. Controls were recruited through school. A 5-month test-retest was performed on a mixed patient and control group (N = 34).Results: The test-retest coefficient was 0.59. The split-half was 0.85. For the whole sample (N = 204), Cronbach's alpha coefficient was 0.89. Spearman rank-order correlations were calculated between each item and item-corrected score totals and were all significant at p < 0.001 except for item 17. A Kruskal-Wallis comparison across the different groups with pair-wise comparisons was highly significant. The median score of CDC was 25.0 in DID, 16.5 in DDNOS, 4.0 in anxiety disorder, 5.0 in mood disorder, 5.5 in ADHD groups and 2.0 in non-clinical controls.Conclusion: This paper establishes the validity and reliability of the Turkish translation of the CDC as well as providing cross-cultural documentation of significant dissociation occurring in children and adolescents in Turkey.
... ccording to the Guidelines for Treating Dissociative Identity Disorder (Multiple Personality Disorder) in Adults (1997), the following symptoms may be present and should be explored: episodes of amnesia, fugue, depersonalization, derealization, identity confusion, identity alteration, age regressions, autohypnotic experiences, and hearing voices. Lewis (1996) notes: ...
... There are a whole range of symptoms and behaviours that may only become evident when a sufficient level of trust and relationship is established with the therapist. Lewis (1996) identifies a long list of symptoms including the following: command hallucinations, voices arguing with each other, headaches, rapid mood changes, trance-like states, unpredictability, restlessness, difficulty concentrating, impaired memory for learning material, suicidal behaviours, apparently lying, and apparently stealing. DID is often confused with other conditions. ...
Chapter
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I am privileged to be part of a group of educators who are exploring the place of inner work in our pedagogical practice. Different threads connect me to the members of the group—interests in the arts, creativity, and exceptional human accomplishments, dedication to students and to teaching, and longstanding respect. Our paths have converged in different ways, at different times, always with pleasure in the convergence. One shared belief is that inner work is different for all of us but especially for educators.
... According to the Guidelines for Treating Dissociative Identity Disorder (Multiple Personality Disorder) in Adults (1997) the following symptoms may be present and should be explored: episodes of amnesia, fugue, depersonalization, derealization, identity confusion, identity alteration, age regressions, auto-hypnotic experiences, and hearing voices. Lewis (1996) notes: ...
... There are a whole range of symptoms and behavior which may only become evident when a sufficient level of trust and relationship is established with the therapist. Lewis (1996) identifies a long list of symptoms including the following: Lewis writes from the diagnostic paradigm. He refers to DID as a condition. ...
Article
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My dissertation is a selection of essays that reflect upon human potential, particularly but not exclusively, within educational environments. I offer theory and practices that suggest that under the right conditions educators and students will move towards the far reaches of their own creative capacities. I offer my own experience and practice as an exemplar of possibilities. I make proposals about educators and education of educators that represent a paradigm shift from centralizing curriculum and content to focusing on care, nurturance, subjective and inter-subjective understanding, and development of educators. The reader is invited to see educators as central, and is encouraged towards the possibility that educators must be supported, encouraged, and cared for in order to support emergence of their vitality, first for themselves and subsequently for students. I outline an approach that puts human beings in educational environments first in practical and specific ways. Integration of personal experience and curriculum material is explicated. The importance of personal inner work for educators is highlighted. Inner Work is characterized as a personal and spiritual process. The claim that educators need to have group facilitation skills is made and evidence offered. Philosophical and theoretical background from education, eastern and western philosophy, humanistic and transpersonal psychology, process-oriented methods, and counselling psychology are drawn upon. The approach is holistic and systemic. The human is viewed as important but not separate from other living beings or the environment. The values of presence, care, and deep democracy underlie the ideas. The importance of relationality and I-Thou connection are explicated. The writing and research draws on a variety of qualitative approaches, including, living inquiry, autobiography, and self-study, as well as conceptual, narrative, poetic, auto-ethnographic, heuristic, and analytic methods. The material, personal, and ephemeral are investigated as integrated parts of the Dao-Field of education and life.
... ccording to the Guidelines for Treating Dissociative Identity Disorder (Multiple Personality Disorder) in Adults (1997), the following symptoms may be present and should be explored: episodes of amnesia, fugue, depersonalization, derealization, identity confusion, identity alteration, age regressions, autohypnotic experiences, and hearing voices. Lewis (1996) notes: ...
... There are a whole range of symptoms and behaviours that may only become evident when a sufficient level of trust and relationship is established with the therapist. Lewis (1996) identifies a long list of symptoms including the following: command hallucinations, voices arguing with each other, headaches, rapid mood changes, trance-like states, unpredictability, restlessness, difficulty concentrating, impaired memory for learning material, suicidal behaviours, apparently lying, and apparently stealing. DID is often confused with other conditions. ...
Book
The Promise of Education for Living Well art of the unspoken promise of education currently is that those who are successfully educated will have access to the most resources and the best chance for survival and living well. This is at odds with my idea of living well. It seems that the contemporary idea of living well is associated with material wealth, possessions, and status. We do have evidence of some sort based on the too early demise of celebrities such as Marilyn Monroe, Michael Jackson, and Junior Seau, to name a few. Survival orientation itself is problematic. It promotes competition and a lack of care for others and the planet, and negates thriving by failing to address it or even mention it. Positioning on either side of this polarity is problematic. Both survival and thriving are very human. The crucial distinction is the development of consciousness that can see the possibilities in both sides of apparently opposing positions. Skilful practice that sheds light on the identity these dichotomies represent depends on the ability to metacommunicate about them, and the ability and willingness to provide facilitation to bring out the message of both and support their potential integration. While the meaning of success needs to be redefined, uncritical derision of those who are successful in material ways is also problematic. Many of these prosperous people are leaders in creating the institutions that will further the nurturance of healers, lovers, artists, poets, educators, and others, and who in fact are almost invariably creative in their own fields. Refocusing the idea of success to mean being a humane human being, with material success being seen as a potential accompaniment to this human beingness, seems to be a worthy undertaking. Working to develop the consciousness that can see both sides of polarized positions inclusively is a value and practice that has great potential. It can start with educators who are developing this inner awareness and who are consequently modelling and teaching this.
... Putnam & Helmers, 1993;Putnam 8z Peterson, 1994) indicate adequate reliability and validity for children aged 3-19: the scale is capable of discriminating 'between children diagnosed as having Multiple Personality Disorder and Dissociative Disorder Not Otherwise Specified' (Putnam & Peterson, 1994: 204). Preliminary indications, then, from clinical applications of this instrument (Lewis, 1996) suggest that the CDC 'is a useful, reliable, and valid screening tool for the detection of pathological dissociation in children' (Putnam & Peterson, 1994: 204). ...
... Indeed, some aspects of dissociation are a common expression of the child's evolving ability to use fantasy creatively, subserving the development of their imaginative capacities, as well as being able to use dissociation as a means of defense (against, for example, perceived threats in interpersonal relationships). However, Lewis (1996) reminds us that 'dissociation functions as an automatic, primitive, protective, psychological defense against excruciating physical and mental pain' (p. 303). ...
Article
Personality and mental ability measures were administered to 27 pairs of children in Sri Lanka who did, or did not, claim memories of a previous life. Questionnaires about their behavior, development, and family environment were administered to their parents. Children claiming previous-life memories performed better in school than did their peers and they were not more suggestible. The Child Behavior Checklist revealed that they exhibited more behavioral problems, including oppositional traits, and obsessional and perfectionistic characteristics. The Child Dissociation Checklist showed them to have dissociative tendencies (e.g. rapid changes in personality and frequent daydreaming). The structure of their family environment did not differ measurably from that of comparison children.
... La Bellevue Dissociative Disorders Interview for Children (BDDI-C; Lewis, 1996) se administra en una forma semi-estructurada e incluye varias áreas a investigar: estados de consciencia, memoria, estados de ánimo, imaginación, audición, experiencias visuales y sensoriales, temperamento (agresividad), disciplina, aspectos médicos, conducta sexual, referencias a sí mismo como si fuera otra persona, y cambios abruptos en las habilidades personales. Se puede utilizar la terapia de juego para enmarcar la entrevista (Coons, 1996). ...
... Macfie, Ciccheti, y Toth (2001) han planteado que las narrativas que muestran ciertos temas como disrupciones de la memoria, percepción e identidad, y la inconsistencia de los padres, están altamente relacionadas con observaciones de conducta disociativa en los niños. Aparte de estas formas sistemáticas de evaluación, Lewis (1996) recomienda utilizar dibujos y escritura relacionada con la escuela o con diarios personales. Silberg (1998) describe la utilización de una batería de pruebas para niños con posibles TD, que incluye la prueba de inteligencia de Wechsler, el Rorschach, el TAT, una prueba de completar frases, y dibujos. ...
Article
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Este artículo está enfocado en la evaluación de trastornos disociativos en menores y adultos. La evaluación de los trastor-nos disociativos (TD)incluye objetivos clínicos y de investigación. En este último campo se in-cluyen áreas como la epidemiología de los TD en muestras clínicas y no clínicas, su presencia y manifestación en diversas eda-des, la comorbilidad de los TD con otros trastornos, y el efecto de las variables culturales. Se hace una reseña de diversos instrumentos tales como entrevistas estructuradas, cuestionarios y otras formas de evaluación más especializadas.
... In interviews of the child, the family, and of other third parties, pay attention to the following: a. Imaginary friends and other transitional objects, auditory and visual hallucinations, perplexing forgetfulness, intrusive thoughts and feelings, numbing, anxiety, nightmares, self-injury, flashbacks, somatic concerns, sexual concerns, depersonalization and derealization, and identity alteration and confusion (see Symptom Assessment below). Fairly structured interviews have been described (Hornstein, 1998;Lewis, 1996), as have cautions in interviewing (Silberg, 1998c). b. ...
... The evaluator must rule out general medical disorders that may mimic dissociative symptoms. These include seizure disorders, other neurological conditions, allergy, exposure to toxins, or legal or illegal drug effects (Graham, 1998;Lewis, 1996). 7. Pharmacological and hypnotic diagnostic probes a. Sodium amobarbital or other pharmacological interventions are not recommended in the assessment of children and adolescents. ...
... One area that has also received some attention is related to the association between abuse and childhood dissociative symptoms or disorders (Coons, 1996;Hornstein, 1996;Kisiel & Lyons, 2001;Putnam, 1997;Zoroglu, et al., 1996Zoroglu, et al., , 2003. The research and clinical data indicate that children abused in a variety of ways, especially in a severe and persistent manner, are at risk of demonstrating dissociative symptoms or disorders (Goodwin & Sachs, 1996;Dell & Eisenhower, 1990;Kluft, 1984;Lewis, 1996;Macfie, Cicchetti, & Toth, 2001;Pearson, 1997). Authors such as Alexander and Anderson (1997) have suggested that abuse that is repetitive and severe contributes to the child's subsequent dissociation due to his/her attempts to provide self-soothing in the face of overwhelming pain and fear. ...
Article
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This study examined the use of a Spanish version of the Child Dissociative Checklist (CDC) in Puerto Rico. The CDC was administered to the primary caretakers of three groups of children: 31 with documented abuse histories, 30 with Attention Deficit Hyperactivity Disorder (ADHD), 33 with no abuse or psychiatric record. Results confirmed the reliability and validity of the CDC and revealed that Puerto Rican children with abuse histories showed significantly higher levels of dissociation than the children in the other two groups. Moreover, more than half of the abused children had a score above the usual cut-off point of 12 in the CDC, while only a handful of the ADHD children and none in the control group evidenced such a pattern. The results also showed that there were significant correlations between the CDC and the duration of the abusive experiences. Implications of our findings and subsequent clinical recommendations are offered.
... 14 Briefly, it consisted of a semistructured interview based on the Bellevue Adolescent Interview Schedule and the Dissociative Disorders Interview Schedule. [15][16][17] Topics included histories of neuropsychiatric symptoms, psychiatric treatment, medical history, characteristics of temper, family mental health histories, and histories of child physical and sexual abuse and family violence. An examination of scars on the face, head, and body was also performed. ...
Article
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Eighteen males condemned to death in Texas for homicides committed prior to the defendants' 18th birthdays received systematic psychiatric, neurologic, neuropsychological, and educational assessments, and all available medical, psychological, educational, social, and family data were reviewed. Six subjects began life with potentially compromised central nervous system (CNS) function (e.g., prematurity, respiratory distress syndrome). All but one experienced serious head traumas in childhood and adolescence. All subjects evaluated neurologically and neuropsychologically had signs of prefrontal cortical dysfunction. Neuropsychological testing was more sensitive to executive dysfunction than neurologic examination. Fifteen (83%) had signs, symptoms, and histories consistent with bipolar spectrum, schizoaffective spectrum, or hypomanic disorders. Two subjects were intellectually limited, and one suffered from parasomnias and dissociation. All but one came from extremely violent and/or abusive families in which mental illness was prevalent in multiple generations. Implications regarding the ethics involved in matters of culpability and mitigation are considered.
... Many have acquired multiple comorbid diagnoses over repeated evaluations, including depression, conduct disorder, borderline personality disorder, attention deficit-hyperactivity disorder, and post-traumatic stress disorder. [1][2][3][4][5][6] Although DD usually begins in childhood, less than 3% of the diagnoses of the disorder are made in children under 12, and less than 8% are made in adolescents between the ages of 12 and 19. 7 Differential diagnosis of DD is complicated in child and adolescent population because of a number of reasons. ...
Article
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The Adolescent Dissociative Experiences Scale (A-DES) is designed to measure dissociation in adolescents. The present study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the A-DES. The Turkish version of the A-DES was administered to 20 patients with a dissociative disorder, 24 patients with post-traumatic stress disorder (PTSD), 31 patients with anxiety disorder, 31 patients with mood disorder, 24 patients with attention deficit-hyperactivity disorder (ADHD), and 201 non-clinical participants. The internal consistency and the test-retest correlation of the A-DES were excellent. The mean total score of A-DES was 6.2 in dissociative disorder, 3.9 in PTSD, 2.1 in anxiety disorder, 2.4 in mood disorder, 2.5 in ADHD groups and 2.4 in non-clinical participants. There was a statistically significant difference between dissociative patients and other diagnostic groups on the A-DES total score. The good psychometric characteristics of the A-DES among Turkish participants support its cross-cultural validity.
... In the same case, the symptom of reading and writing from the opposite direction is an uncommon dissociative phenomenon. Related but not similar changes in handwriting and using the left hand instead of the usual right have been described in dissociative identity disorder in children (Lewis and Yeager, 1996). In the second case, the recurrence of Ganser symptom with every subsequent episode of bipolar disorder was noticeable. ...
Article
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Ganser's syndrome is a rare and controversial entity in psychiatric nosology. We report two cases ofGS, one developing in a 12-year-old boy, which had their onset during an episode of mania. After recovery from Ganser's syndrome, these cases were followed-up for two and five years, respectively. Interestingly both these patients evolved into bipolar disorder with one patient showing recurrence of Ganser symptoms with each subsequent episode. The importance of following-up and relevance of affective symptoms in GS is discussed.
... If this cycle persists, dissociation can cause impairment in the emotional processing of the traumatic experience, leading to psychosocial reactions like post-traumatic stress disorder (PTSD) or dissociative disorders (Jaycox, Foa, & Morrall, 1998; Marmar, Weiss, & Metzler, 1997). Other researchers working with children and adolescents with a diverse array of traumatic reactions have reported that dissociative defenses can be identified in this population (Coons, 1996; Lewis, 1996; Macfie et al., 2001a, 2001b; Putnam, 1995). Despite the finding that dissociative symptoms and disorders are repeatedly recognized in youngsters with traumatic experiences, at present there are few instruments to assess dissociative processes for this age range (Ohan, Myers, & Collett, 2002; Putnam, 1997). ...
Article
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The aim of this study was to examine the psychometric properties of a Spanish translation of an eight-item version of the Adolescent Dissociative Experiences Scale (ADES-8). The eight items were selected to assess pathological forms of dissociative experiences. The scale was administered to a representative sample of 459 medically indigent adolescents, ages 11 to 17, who received mental health services in Puerto Rico. Results indicated that the ADES-8 demonstrated satisfactory internal consistency and test-retest reliability. As expected, most adolescents evidenced very low scores, with nearly half (46%) scoring zero. The scale showed expected patterns of convergent validity with variables that are hypothesized to be related to dissociative disorders, such as psychiatric impairment, comorbidity, and abusive experiences. Logistic regression analyses suggested that a cutoff score of three on the ADES-8 was the best screening rule for identifying persons with higher values on the convergent validity variables. The findings provide support for the clinical and research promise of the ADES-8 as a screening instrument for dissociative disorders in referred youths.
... To a certain extent dissociation is a normative experience and is thought to be a coping strategy to manage difficult or painful events (e.g. Lewis, 1996). It is hypothesized that dissociation becomes problematic when the actual experience interferes with daily living as the individual has been unable to develop more effective coping strategies and consequently only learns to tolerate stress through dissociating (see . ...
Thesis
p>The dissertation explores post-traumatic stress (PTS) symptoms in bullied adolescents. The initial part of the literature review discusses prevalence, gender differences and developmental aspects of bullying. The risk factors of being bullied are explored as well as the subsequent sequelae. The second part of the review discusses the adolescent trauma literature, particularly focusing on the developmental issues and sequelae. Because only a small proportion of individuals experience PTS symptoms, the moderating and mediating factors of developing PTS symptoms are discussed. The final section of the review brings the two bodies of literature together and argues that some bullied adolescents may actually be experiencing PTS reactions. The empirical study tests the argument proposed in the literature review that bullied adolescents experience symptoms associated with PTS symptoms, exploring the moderating role of social support and mediating role of dissociation. The participants were members of a secondary school (n = 689) who filled in four questionnaires exploring bullying experiences, levels of dissociation and support, and PTS symptoms. The results indicated that those who reported being bullied experienced significantly more PTS and dissociation symptoms that those who reported not being bullied. Over half of those bullied more than once or twice had scores for the Impact of Events Scale which fell in the clinically significant range for PTS symptoms. Dissociation was found to be a mediator between bullying and PTS symptoms but social support was not identified as a moderator. The implications for clinical practice and future research are discussed.</p
... Pokud jde o vyšetřování dětí, je doporučeno v rámci klinického interview věnovat zvláštní pozornost především nerealistickým fantazijním konstruktům, například smyšleným kamarádům a podobně. Velice přehledné a důkladné interview vhodné pro vyšetřování uvedených stavů u dětí popsali například Lewis [28] nebo Hornstein [24]. ...
Article
The purpose of this paper is threefold: (a) to report an unusually high prevalence of encopresis in a sample of boys in psychiatric residential treatment; (b) to explore the possible relationship of sexual abuse to the development of encopresis in these cases; and (c) to discuss the diagnostic and treatment implications of our findings.ResumenObjetivo: Este trabajo tiene tres propósitos; (a) reporta una alta prevalencia de encopresis en una muestra de uchachos en tratamiento residencial; (b) describe la historia de abuso sexual por varones en la mayoría de estos casos; (c) explora las implicaciones de estos hallazgos para el diagnóstico y el tratmiento. Método: los sujetos eran 23 muchachos en tratamiento residencial (edad media 10.6 años). Los datos relacionados con la encopresis y el abuso sexual fueron recogidos en entrevistas clínicas y de informes extensos de estos casos. Hallazgo: Nueve (36%) de los 23 sujetos eran encopréticos. De los encopréticos, 7 (77%) tenian historias documentadas de abuso sexual por hombres y 1 (11%) sujeto adicional tenía una historia de probable abuso sexual por varones. Conclusiones: Los resultados de este estudio sugierenque la encopresis puede ser una señal del abuso sexual. Esto puede ofrecer una explicación de los signos, sintomas, conductas y características familiares reportadas en ninos con encopresis y en niños con historias de abuso sexual.
Article
Recent evidence regarding dissociation indicates that this concept is particularly useful for psychopathology, psychiatry and clinical diagnostics. According to clinical experience right and early diagnostics of dissociative symptoms presents important factor for treatment and unrecognizing of the symptoms may be a reason of treatment resistance. With respect to these findings the article reviews recent psychometric possibilities to assess dissociative symptoms with main focus to self-reported questionnaires, scales and structured interviews but other comprehensive methods useful for diagnostic practice are also shortly reviewed.
Article
This article describes an alternative descriptor, the history, etiology, DSM diagnostic criteria, symptoms, description, treatment, future research ideas, and alternative ideas related to the diagnostic category known as Dissociative Identity Disorder, and the importance of therapist alertness. It also discusses the implications of the diagnosis itself and outlines how the naming of the cluster of experiences that constitute the diagnosis is an inversion of reality and suggests some ideas about the therapy that focus on integration. Speculations about the nature of the experience and possible developmental and bonding ruptures that would contribute to the possibility of segregated personality experience occurrence are discussed as well.
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Controversies have centered on the prevalence of dissociative symptoms and disorders in children and adolescents, recommended treatment approaches, and the potential effects of suggestive interpersonal influences. Convergence among diverse practitioners describing dissociative children and adolescents with similar symptoms and maltreatment histories supports the occurrence of these symptom patterns. Although prevalence information has not been well studied, dissociative symptoms may be found in children from a variety of settings across a continuum of severity. There is not yet agreement on exact treatment protocols, but successful treatment outcomes have been reported. A challenge for future research is to develop assessment protocols that are derived from multiple sources of data, and to incorporate the latest developmental research findings into theory development that addresses psychobiological, family, and cultural factors. The study of dissociation in children and adolescents has the potential to clarify some puzzling child and adolescent presentations and to identify a process by which some children respond and adapt to traumatic environments.
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The diagnostic evaluation of the violent child and adolescent is a collaborative exercise, requiring diverse expertise. Ironically, after systematic, comprehensive psychiatric, neurologic, psychologic, neuropsychologic, psychoeducational, family, and social evaluations have been completed, the clinician probably will not be able to make a hard and fast DSM-IV diagnosis; that is, unless the clinician is satisfied with fitting the behavioral pieces into the Conduct Disorder category and ignoring the rest of the clinical data. From time to time the clinician will be able to diagnose a bipolar mood disorder underlying a violent youngster's behavior. Occasionally the clinician will recognize paranoid schizophrenia motivating a particularly heinous or bizarre violent act. Most often the clinician will be faced with a variety of different kinds of psychiatric, neurologic, cognitive, and environmental vulnerabilities that have come together and created a violent child or adolescent. That's fine because almost invariably each discovered vulnerability has implications for treatment. The clinician evaluating a violent child or adolescent must overcome his or her initial disgust or anger at the youngster's behaviors and resist the impulse to dismiss the child as conduct disordered, as an incipient psychopath. That diagnosis leads nowhere. The identification of vulnerabilities leads to specific interventions and ultimately to the prevention of future violence.
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Symptom overlap, comorbidity, disagreement among informants, and the impact of development complicate psychiatric diagnoses in the adolescent patient. This review of frequently missed diagnoses includes anxiety disorders, ADD without hyperactivity, early-onset bipolar disorder, syndromes associated with trauma, and substance abuse.
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Psychosomatic symptoms in children may be frequent reasons for referral in pediatric practice. Recognition of these symptoms as psychosomatic may sometimes be difficult, leading to unnecessary hospitalization and invasive diagnostic procedures. Meanwhile hospitalization and invasive diagnostic procedures may themselves have a traumatic impact on child psychology and cause pathological dissociation. In this paper we report a 12-year-old boy who was admitted to hospital following a sudden onset of motor loss in his legs which led to his undergoing several invasive diagnostic procedures for the first time in his life. After comprehensive investigations no medical conditions were detected and he was eventually diagnosed with conversion disorder following psychiatric consultation. His condition returned almost to normal spontaneously after two days and he was discharged from hospital after 17 days of hospitalization. He then developed dissociative disorder following his discharge from hospital. We aim to discuss the clinical picture and the child’s perception of the traumatic nature of invasive medical procedures in this particular case, the traumatic impact of hospitalization and invasive medical procedures on child mental health, and the importance of early recognition of symptoms of conversion or dissociative disorders in children.
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Violence is multidetermined, the outcome of individual, family, and cultural factors. This article draws attention to the importance of some basic functions of the living organism that can lead to aggression and violence as well as to the processes of internalization, reenactment, poor problem solving, and societal narrative. It also presents an expanded conceptualization of discounting and passivity. Because early-onset violence has been shown to have a poorer prognosis than violence that begins later in life, emphasis is placed on early childhood. The article ends with a typology of prevention and control.
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A piece about the intersections of feminist politics and dissociation research, and about my work exploring intimate partner violence among patients with dissociative disorders. "I wondered, why is no one talking about dissociation and DD in the violence prevention world? And as I got more involved in the dissociation and DD world, I also found few discussions of [intimate partner violence]."
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The Adolescent Dissociative Experience Scale (A-DES) is a screening measure for dissociative experience in adolescents. The present study aimed to investigate the reliability, validity and psychometric properties of the Korean version of the Adolescent Dissociative Experience Scale. The Korean version of the A-DES was administered to a normative group of 371 adolescents aged 12 to 18 years and a traumatized group of 33 adolescents aged 12 to 18 years with known trauma. The internal consistency was excellent (Cronbach's alpha=0.91) and the test-retest correlation of the A-DES was high (r=0.99). Correlation between the A-DES and other measures of dissociation was moderate (r=0.48). There were no significant age differences in mean total A-DES scores for the normative sample, or for boys or girls separately. Nor were there any significant gender differences for any age group. The mean total score of the A-DES was significantly higher in the traumatized group than in the normative group. There was a statistically significant difference between adolescents with self-reported trauma and those without a trauma history in the normative group. This study demonstrated that the Korean version of the A-DES is a reliable measure with excellent internal consistency and good stability over a 4-week test-retest interval with single factor structure. It can be used to screen for dissociative symptoms in Korean adolescents between the ages 12 and 18.
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Dissociative identity disorder (DID) remains a controversial diagnosis due to conflicting views on its etiology. Some attribute DID to childhood trauma and others attribute it to iatrogenesis. The purpose of this article is to review the published cases of childhood DID in order to evaluate its scientific status, and to answer research questions related to the etiological models. I searched MEDLINE and PsycINFO records for studies published since 1980 on DID/multiple personality disorder in children. For each study I coded information regarding the origin of samples and diagnostic methods. The review produced a total of 255 cases of childhood DID reported as individual case studies (44) or aggregated into empirical studies (211). Nearly all cases (93%) emerged from samples of children in treatment, and multiple personalities was the presenting problem in 23% of the case studies. Four US research groups accounted for 65% of all 255 cases. Diagnostic methods typically included clinical evaluation based on Diagnostic and Statistical Manual of Mental Disorder criteria, but hypnosis, structured interviews, and multiple raters were rarely used in diagnoses. Despite continuing research on the related concepts of trauma and dissociation, childhood DID itself appears to be an extremely rare phenomenon that few researchers have studied in depth. Nearly all of the research that does exist on childhood DID is from the 1980s and 1990s and does not resolve the ongoing controversies surrounding the disorder.
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This study explores dissociative symptoms in 3 different groups of Puerto Rican children. Data were collected on 40 children with documented sexual abuse history, 39 children with psychiatric disorders but without a history of sexual abuse, and 40 community control children. Dissociative symptoms were assessed with the child using the Trauma Symptom Checklist for Children (TSCC); a social worker answered the Child Dissociative Checklist (CDC). Results indicated that children with sexual abuse obtained significantly different scores on both the TSCC and the CDC. Further analysis indicated that child and social worker reports of dissociative symptoms were highly correlated (r = .73). Furthermore, 30% of the children in the sexual abuse group scored at or above the cutoff point of 12 on the CDC, which is indicative of a dissociative disorder. None of the children in the other 2 groups obtained such a score. The results suggest that children with documented sexual abuse victimization demonstrate a significant number of dissociative phenomena that not only are subjectively experienced but also can be observed by a non-family member. Finally, as nearly a third of the abused children obtained a score of 12 or higher on the CDC, the next step is to prepare clinicians to conduct a proper and formal diagnosis assessment of dissociative disorders.
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Psychoform dissociation has been researched more than somatoform dissociation. The Somatoform Dissociation Questionnaire (SDQ-20), a commonly used adult measure of somatoform dissociation, is increasingly being used with adolescents internationally. We compared psychoform and somatoform dissociation in a mixed clinical adolescent sample. A total of 71 adolescents (12-18 years old) attending Australian community mental health and counseling services completed the SDQ-20 and the Adolescent Dissociative Experiences Scale, a commonly used measure of adolescent psychoform dissociation. The participants' treating clinicians provided participants' demographic details and mental health diagnoses. We found that 41% of participants reported high levels of psychoform dissociation and 21% reported high levels of somatoform dissociation. Both dissociation types were positively correlated. Neither was significantly related to participants' age, gender, or mental health diagnoses. Participants with more than 1 Axis I mental health diagnosis had higher levels of somatoform dissociation than participants with only 1 or no Axis I mental health diagnosis. This study is the first to examine somatoform dissociation in Australian adolescents and enables initial international comparisons.
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This paper evaluates representation of clinical consequences of developmental psychological trauma in the current proposal of DSM-5. Despite intensive efforts by its proponents for two decades, it is not known yet if Complex PTSD will take a place in the final version of DSM-5. Recognition of dissociative character of several symptom dimensions and introduction of items about negative affects such as shame and guilt imply an indirect improvement toward better coverage of the consequences of developmental trauma in the existing category of PTSD. As disorders with highest prevalence of chronic traumatization in early years of life, dissociative disorders and personality disorder of borderline type are maintained as DSM-5 categories; however, recognition of a separate type of trauma-related personality disorder is unlikely. While a preschooler age variant of PTSD is under consideration, the proposed diagnosis of Developmental Trauma Disorder (child version of Complex PTSD) has not secured a place in the DSM-5 yet. We welcome considerations of subsuming Adjustment Disorders, Acute Stress Disorder, PTSD, and Dissociative Disorders under one rubric, i.e., Section of Trauma, Stress, or Event Related Disorders. Given the current conceptualization of DSM-5, this paper proposes Complex PTSD to be a subtype of the DSM-5 PTSD. Composition of a trauma-related disorders section would facilitate integration of knowledge and expertise about interrelated and overlapping consequences of trauma.
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A high proportion of patients in child and adolescent psychiatry with significant dissociative symptomatology after early childhood traumatization may go undiagnosed, be wrongly diagnosed and/or inappropriately treated. The diagnostics and treatment of dissociative disorders have been limited by lack of comprehensive, reliable and valid instruments and the ongoing polarization and fierce controversy regarding treatment. However, recent neurobiological findings of neurochemical, functional and structural cerebral consequences of early stressful childhood experiences point out a need for active, early and effective identification and treatment interventions. We present an update on assessment tools available in the Nordic countries, and an overview of different appropriate therapeutic intervention models for children and adolescents. A systematic overview of studies of dissociation in children and adolescent published over the last decade disclosed a total of 1019 references. The 465 papers describing aspects of assessment tools and/or treatment were studied in detail. Reliable and valid screening questionnaires and diagnostic interviews for children and adolescents now allow for effective early identification of dissociative disorders. A combination of individual psychotherapy, pharmacotherapy and family therapy are often required to handle dissociative disorders in children and adolescents. Cognitive-behavioural therapy, hypnotherapy, Eye-Movement Desensitization-Reprocessing (EMDR), psychodynamic therapy and an integrated approach are the main described psychotherapeutic approaches, but treatment of dissociation in children and adolescent does not require allegiance to any one particular treatment model. However, achievement of physical safety by providing a safe environment is a primary goal that supersedes any other therapeutic work. Assessments tools are now available, and appropriate therapeutic intervention models may hopefully contribute to reduce the risk of wrong diagnoses and inappropriate treatment of dissociative symptomatology in children and adolescents. However, controlled clinical trials of the various interventions and longitudinal outcome studies are needed.
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