Article

Dissociative Depression Among Women in the Community

a Department of Psychiatry, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
Journal of Trauma & Dissociation (Impact Factor: 1.72). 07/2013; 14(4):423-438. DOI: 10.1080/15299732.2012.753654
Source: PubMed

ABSTRACT

This study screened the prevalence and correlates of dissociative disorders among depressive women in the general population. The Dissociative Disorders Interview Schedule and the posttraumatic stress disorder (PTSD) and borderline personality disorder sections of the Structured Clinical Interview for DSM-IV were administered to 628 women in 500 homes. The prevalence of current major depressive episode was 10.0%. Of the women, 26 (40.6%) had the lifetime diagnosis of a DSM-IV, dissociative disorder, yielding a prevalence of 4.1% for dissociative depression. This group was younger (mean age = 30.7 years) than the nondissociative depression women (mean age = 39.6 years). There was no difference between the 2 groups on comorbid somatization disorder, PTSD, or borderline personality disorder. Besides suicide attempts, the dissociative group was characterized by secondary features of dissociative identity disorder; Schneiderian symptoms; borderline personality disorder criteria; and extrasensory perceptions, including possession experiences. They reported suicidality, thoughts of guilt and worthlessness, diminished concentration and indecisiveness, and appetite and weight changes more frequently than the nondissociative group. Early cessation of school education and childhood sexual abuse were frequently reported by the dissociative depression group. With its distinct features, the concept of dissociative depression may facilitate understanding of treatment resistance in, development of better psychotherapy strategies for, and new thinking on the neurobiology and pharmacotherapy of depressive disorders.

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    ABSTRACT: Abstract The aim of this study was to inquiry the possible relations of childhood trauma, anger, and dissociation to depression among women with fibromyalgia or rheumatoid arthritis. Fifty female patients diagnosed as having fibromyalgia (N=30) or rheumatoid arthritis (N=20) participated in the study. Childhood Trauma Questionnaire (CTQ-28), Somatoform Dissociation Questionnaire (SDQ-20), Dissociation Questionnaire (DIS-Q), Beck Depression Inventory (BDI), Spielberger State-Trait Anger Expression Inventory (STAXI), and Dissociative Disorders Interview Schedule (DDIS) were administered to all participants. Women with a lifetime diagnosis of depressive disorder had higher scores of somatoform and psychoform dissociation than the non-depressive patients. However, childhood trauma scores did not differ between two groups. In regression analysis, current severity of depression (BDI) was predicted by psychoform dissociation (DIS-Q) and lower education, and the lifetime diagnosis of major depression was predicted by somatoform dissociation (SDQ). While childhood emotional neglect predicted somatoform dissociation, psychoform dissociation was predicted by childhood sexual abuse. Mental processing of anger seems to be one of the dimensions of psychodynamics in trauma-related depressive conditions. In context of the perceived threat of loss of control due to expressed anger and mental dysintegration, somatoform dissociation seems to contribute to overmodulation of emotions in dissociative depression. Among patients suffering from physical illness with possible psychosomatic dimensions, assessment of somatoform dissociation in addition to psychoform dissociation may be helpful to understand diverse psychopathological trajectories emerging in the aftermath of childhood adversities. The recently proposed category of dissociative depression seems to be a promising concept for future research on psychosomatic aspects of traumatic stress.
    Full-text · Article · Nov 2013 · Journal of Trauma & Dissociation
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    ABSTRACT: ABSTRACT The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. Hundred-sixteen consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the first time were evaluated using Adolescent Dissociative Experiences Scale, Adolescent Version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by two senior psychiatrists in a blind fashion. There was excellent inter-rater reliability between two clinicians on SCID-D diagnoses and scores. Among 73 participants, thirty-three (45.2 %) had a dissociative disorder, twelve (16.4%) having DID and 21 (28.8%) dissociative disorder not otherwise specified. There was no difference on gender distribution, childhood trauma, and family dysfunction scores between dissociative and non-dissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than controls. While SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rating dissociation, and lack of relationship between diagnosis ande childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults require to be replicated. Introduction of diagnostic criteria for adolescent DID in revised versions of DSM-5 would refine the assessment of dissociative disorders in this age group.
    Full-text · Article · Nov 2013 · Journal of Trauma & Dissociation
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    ABSTRACT: Although a plethora of studies have delineated the relationship between childhood trauma and onset, symptom severity, and course of depression and anxiety disorders, there has been little evidence that childhood trauma may lead to interpersonal problems among adult patients with depression and anxiety disorders. Given the lack of prior research in this area, we aimed to investigate characteristics of interpersonal problems in adult patients who had suffered various types of abuse and neglect in childhood. A total of 325 outpatients diagnosed with depression and anxiety disorders completed questionnaires on socio-demographic variables, different forms of childhood trauma, and current interpersonal problems. The Childhood Trauma Questionnaire (CTQ) was used to measure five different forms of childhood trauma (emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and the short form of the Korean-Inventory of Interpersonal Problems Circumplex Scale (KIIP-SC) was used to assess current interpersonal problems. We dichotomized patients into two groups (abused and non-abused groups) based on CTQ score and investigated the relationship of five different types of childhood trauma and interpersonal problems in adult patients with depression and anxiety disorders using multiple regression analysis. Different types of childhood abuse and neglect appeared to have a significant influence on distinct symptom dimensions such as depression, state-trait anxiety, and anxiety sensitivity. In the final regression model, emotional abuse, emotional neglect, and sexual abuse during childhood were significantly associated with general interpersonal distress and several specific areas of interpersonal problems in adulthood. No association was found between childhood physical neglect and current general interpersonal distress. Childhood emotional trauma has more influence on interpersonal problems in adult patients with depression and anxiety disorders than childhood physical trauma. A history of childhood physical abuse is related to dominant interpersonal patterns rather than submissive interpersonal patterns in adulthood. These findings provide preliminary evidence that childhood trauma might substantially contribute to interpersonal problems in adulthood.
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Questions & Answers about this publication

  • Vedat Sar added an answer in Depression:
    Why depression is so common nowadays?
    • Is it because we are in the information age?
    • Why?
    Vedat Sar

    What we call depression is a final common pathway and, if you consider only the symptoms, many conditions which look like depression are actually not depression.

    For instance, patients with PTSD usually have depressive symptoms but their condition is different in the course, pathogenesis, and treatment response. You may check my work on dissociative depression (the few papers have been uploaded in Researchgate), a concept I have proposed to address the heterogeneity despite overlap in phenomenology.

    • [Show abstract] [Hide abstract]
      ABSTRACT: This study screened the prevalence and correlates of dissociative disorders among depressive women in the general population. The Dissociative Disorders Interview Schedule and the posttraumatic stress disorder (PTSD) and borderline personality disorder sections of the Structured Clinical Interview for DSM-IV were administered to 628 women in 500 homes. The prevalence of current major depressive episode was 10.0%. Of the women, 26 (40.6%) had the lifetime diagnosis of a DSM-IV, dissociative disorder, yielding a prevalence of 4.1% for dissociative depression. This group was younger (mean age = 30.7 years) than the nondissociative depression women (mean age = 39.6 years). There was no difference between the 2 groups on comorbid somatization disorder, PTSD, or borderline personality disorder. Besides suicide attempts, the dissociative group was characterized by secondary features of dissociative identity disorder; Schneiderian symptoms; borderline personality disorder criteria; and extrasensory perceptions, including possession experiences. They reported suicidality, thoughts of guilt and worthlessness, diminished concentration and indecisiveness, and appetite and weight changes more frequently than the nondissociative group. Early cessation of school education and childhood sexual abuse were frequently reported by the dissociative depression group. With its distinct features, the concept of dissociative depression may facilitate understanding of treatment resistance in, development of better psychotherapy strategies for, and new thinking on the neurobiology and pharmacotherapy of depressive disorders.
      No preview · Article · Jul 2013 · Journal of Trauma & Dissociation