No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Pathological Dissociation in The National Comorbidity Survey Replication (NCS-R): Prevalence, Morbidity, Comorbidity, and Childhood Maltreatment
Abstract
Our aim was to examine U.S. national prevalence of pathological dissociation (PD) likely indicative of dissociative disorder, and associated morbidity, comorbidity, and childhood maltreatment. PD was assessed in 6,644 participants in the National Comorbidity Survey Replication, a nationally representative adult survey. Seven of the eight pathological dissociation taxon items were inquired about over the past month and scored on a 4-point scale. A conservative PD cutoff score was applied, with 100% specificity against healthy individuals and 84% sensitivity for Depersonalization Disorder which lies at the less severe end of the dissociative disorder spectrum; it yielded a national PD prevalence of 4.1%. The PD group had diminished physical and mental health, marked comorbidity with most major psychiatric disorders, and high likelihood of psychiatric hospitalization. Over half of PD members had attempted suicide, significantly more than individuals with lifetime major depression. Childhood maltreatment was quantified for physical abuse, witnessing domestic violence, physical neglect, emotional abuse, and emotional neglect. Total childhood trauma significantly positively predicted PD severity, as well as severity of all three pathological dissociative experiences (amnesia, depersonalization / derealization, identity alteration). Furthermore, each childhood trauma category significantly predicted PD severity uniquely and additively. Childhood maltreatment in the PD group was significantly greater than in lifetime major depression, except for similar emotional neglect, and was comparable to lifetime PTSD. The study reinforces the validity of prior PD findings across clinical and community samples, and highlights the need for increased attention toward diagnosing and treating these quite common and highly morbid disorders and their traumatic antecedents.
... Severe dissociation is common. In a representative sample of 6,644 adults in the United States National Comorbidity Survey Replication, the 1-month prevalence of a severe DD was 4.1%, with a 1.5% 1month prevalence of DID (Simeon & Putnam, 2022). In a study of 25,018 individuals from 16 low-, medium-, and high-income countries, the 12-month prevalence of PTSD was 1.9%, with 14.4% of those with PTSD meeting criteria for DPTSD (Stein et al., 2013). ...
... Individuals with severe dissociation commonly experience physical and mental health challenges, extensive comorbidity (e.g., PTSD and major depressive disorder), and high rates of psychiatric hospitalization (Simeon & Putnam, 2022). Dissociative symptoms are linked with functional impairment (Tanner et al., 2019) and role impairment (Stein et al., 2013). ...
Objective: Evidence-based treatments are urgently needed for individuals with trauma-related dissociation (TRD), including severe dissociative disorders, the dissociative posttraumatic stress disorder (PTSD) subtype, and complex PTSD (International Classification of Diseases-10). TRD is strongly associated with severe trauma, a more refractory treatment course, and high suicidality and nonsuicidal self-injury. We evaluated changes in symptoms and adaptive capacities in individuals with high TRD through participation in an adjunctive online program based on the Finding Solid Ground (FSG) psychoeducational program. Method: We provide an interim report on an ongoing, randomized controlled trial of FSG on an international sample of 291 outpatients with dissociative identity disorder, dissociative PTSD, other specified dissociative disorders, complex PTSD, or dissociative disorder, unspecified (International Classification of Diseases-10). Outpatient therapists continued to provide psychotherapy. Participants were randomly assigned to either receive immediate access to FSG or be on a 6-month waitlist before accessing FSG. We did not exclude for suicidality, nonsuicidal self-injury, recent or concurrent hospitalization, or substance abuse. Results: Although initially comparable on outcome measures, at 6 months into the study, the Immediate FSG group showed significant improvement in emotion regulation, PTSD symptoms, self-compassion, and adaptive capacities in comparison to the Waitlist group. At 12 months, the Immediate group showed large effect size changes in these areas compared to study entry (|g|s = 0.95–1.32). The Waitlist group showed comparable improvements after accessing the FSG program for 6 months. Conclusions: This randomized controlled trial demonstrates that adding FSG to psychotherapy of individuals with TRD results in improvements in emotion regulation, PTSD symptoms, self-compassion, and adaptive functioning.
... dissociative identity disorder [DID] and other specified dissociative disorder [OSDD]) are known as complex DDs (CDDs) and research suggests they are associated with antecedent trauma exposure, particularly childhood complex trauma (Dalenberg et al., 2012;Dorahy et al., 2014). The prevalence rate of pathological dissociation was 4.1% in the National Comorbidity Survey Replication study with a U.S. representative sample (Simeon & Putnam, 2022); the prevalence of DID was 1.5%. People with CDDs often experience comorbid disorders including posttraumatic stress, mood, substance use, and eating disorders (APA, 2022;Brand et al., 2009;Loewenstein, 2018;Simeon & Putnam, 2022), suicidal ideation and attempts (Foote et al., 2008), non-suicidal self-injury (NSSI; Webermann et al., 2016), and emotion dysregulation (Brand et al., 2019). ...
... The prevalence rate of pathological dissociation was 4.1% in the National Comorbidity Survey Replication study with a U.S. representative sample (Simeon & Putnam, 2022); the prevalence of DID was 1.5%. People with CDDs often experience comorbid disorders including posttraumatic stress, mood, substance use, and eating disorders (APA, 2022;Brand et al., 2009;Loewenstein, 2018;Simeon & Putnam, 2022), suicidal ideation and attempts (Foote et al., 2008), non-suicidal self-injury (NSSI; Webermann et al., 2016), and emotion dysregulation (Brand et al., 2019). Individuals with CDDs use psychiatric care at high rates, including frequent inpatient hospitalizations (Myrick et al., 2017). ...
Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs.
Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses.
Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure.
Conclusion: Clients and therapists in the TOP DD Network programme described the programme’s components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs.
... DID is more prevalent than many people realise, especially in psychotherapy clients. The one-year prevalence rate of DID in the US was 1.5% (Simeon and Putnam 2022). By contrast, schizophrenia is thought to impact 0.3%-0.7% of the population (American Psychiatric Association [APA] 2022). ...
Background
Psychotherapists who treat clients with dissociative identity disorder (DID), a trauma‐related condition, have unique experiences and challenges. There is a dearth of literature investigating the experiences and perspectives of therapists who treat clients with DID.
Methodology
We conducted in‐depth semi‐structured interviews with 15 DID‐treating therapists. We used reflexive thematic analysis, drawing upon constructivist and critical paradigms, to generate an understanding of how these therapists experience, relate to, and make sense of their work with clients with DID.
Analysis
We created four primary themes: (1) ‘Here and Now’: Working in the Present to Facilitate Healing for Clients with DID; (2) ‘I Was Made To Do This’: Finding Meaning in the Calling to Work with Clients with DID; (3) ‘Churning my Stomach Up’: From Holding Trauma and Dissociation to Vicarious Traumatisation; and (4) ‘Pulling Back the Veil’: Working with DID as Social Justice Practice.
Conclusions
We recommend therapists work to leverage their experiences and perspectives in positive ways, such as embracing a here and now stance and what is meaningful about the work, while caring for themselves to manage potential vicarious traumatisation. Supervisors and/or consultants of these therapists must support them in this work.
... Both the fourth and the fth edition of the Diagnostic and Statistical Manual for Mental Disorders (American Psychiatric Association, 1994; American Psychiatric Association, 2013) specify that in order for a DDD diagnosis to be made, dpdr episodes must not only be persistent or recurrent, and associated with distress or impairment, but must also have a separate standing of their own, predating, extending past, and not limited to episodes of other psychiatric disorders, the most common ones being anxiety disorders, mood disorders, posttraumatic stress disorder, and other dissociative disorders. The overarching purpose of this report was to examine the relationship of dpdr to mood and anxiety disorders in a nationally representative U.S. sample; the relationship of dpdr to posttraumatic stress disorder and to pathological dissociation/dissociative disorders has been examined elsewhere (Stein et al., 2013;Simeon & Putnam, 2022). ...
Depersonalization/derealization (dpdr) is known to occur across mood and anxiety disorders (MAD) and has been proposed as a marker of worse illness. However, despite the well-known clinical association, there are no epidemiological data on the relationship between dpdr and MAD. In this NCS-R analysis clinically significant dpdr (DPDR-C) was defined as “sometimes” or “often” past-month endorsement of depersonalization and/or derealization in the absence of other pathological dissociation. Six past-month MAD diagnoses were examined: DSM-IV generalized anxiety disorder, panic disorder, social phobia, major depression, bipolar I, and bipolar II. National DPDR-C one-month prevalence was 0.9%. After excluding all cases with past-month posttraumatic stress disorder or non-dpdr pathological dissociation, 21.2% of DPDR-C cases were accounted for by MAD while 3.0% of MAD cases endorsed DPDR-C, ranging from 0% (generalized anxiety disorder) to 11.8% (comorbid mood and anxiety disorder). DPDR-C was not uniquely related to any MAD disorder, and was not associated with MAD age of onset, chronicity, or impairment. Rather, DPDR-C was significantly associated with number of comorbid MAD disorders and with mood/anxiety comorbidity. In conclusion, at the epidemiologic level DPDR-C was uncommon in MAD but was more likely to occur in the presence of combined mood and anxiety disturbance, which may cause greater disruption to the usual sense of self and thus trigger unreality experiences.
... They also suffer from higher dissociation. Walling et al. (1998) administered the Dissociative Experience Scale (DES; Bernstein & Putnam, 1986) to 64 transexuals and 10% had scores of 30 or more, suggestive of a dissociative disorder, higher than the 4% prevalence of pathological dissociation in a national sample (Simeon & Putnam, 2022). M. Colizzi et al. (2015) reported a 30% prevalence of probably dissociative disorders among transpeople after sex reassignment, but this was based on the Dissociative Disorders Interview Schedule (DDIS; Ross et al., 1989) and the mean scores in the DES for the whole sample was 13.54 (SD = 10.78), ...
... International, general population epidemiological studies show that the 1-year prevalence of DID is 1.5%, with a lifetime prevalence possibly as high as 3.5% (Loewenstein, 2018). The US National Comorbidity Study Replication (NCS-R) found that the one-month prevalence of pathological dissociation (PD), severe dissociative symptoms consistent with diagnoses of DID, dissociative amnesia (DA), and severe forms of depersonalization/derealization disorder (DDD), was about 4.8%; this is consistent with a large, prospective Finnish general population study that found about 3.5% prevalence for PD both at baseline and 3 year follow-up (Simeon & Putnam, 2022). In the NCS-R study of PD, multiple forms of childhood maltreatment (physical, sexual, and emotional abuse, neglect), suicidality, and psychiatric hospitalizations strongly correlated with PD, but not with other diagnoses in the NCS-R. ...
Discuss dissociative identity disorder (DID) and the importance of psychodynamic concepts in its conceptualization and treatment. help the psychodynamically oriented clinician make sense of DID. DID as a disorder of self-systems, not identity or personality; DID has a unique psychological (personality) organization as shown in data on psychological assessment.
... Dissociative disorders (DDs) and their symptoms are related to overwhelming traumatic experiences, especially during childhood, and include derealization, depersonalization, time distortions, cognitive and memory alterations (including amnesia), identity alterations, and somatic sensations (American Psychiatric Association, 2022;Dorahy et al., 2015;Ogawa et al., 1997;Simeon & Putnam, 2022). Child maltreatment (CM) of all types is highly associated with eating disorders (EDs), particularly those characterized by earlier ED onset, more binge-purge symptoms, and greater suicidality and psychiatric comorbidity (Brewerton, 2022;Molendijk et al., 2017). ...
Objective
Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co‐occurrence generally is associated with greater morbidity, self‐harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder.
Method
We report our experience with a case series of 18 patients with DSM‐5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state–trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma‐focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence‐based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t ‐tests.
Results
Following integrated, trauma‐focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes.
Discussion
These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma‐focused ED program at higher levels of care.
Public Significance
EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma‐focused ED program.
... The three most common and well-known dissociative disorders are Dissociative Identity Disorder, Depersonalization Disorder (DDD; renamed Depersonalization / Derealization Disorder in the DSM-5 without substantive changes in diagnostic criteria), and Dissociative Amnesia (Simeon & Putnam, 2022). Dissociative symptoms have the potential to give rise to marked psychopathology and to disrupt every area of psychological functioning. ...
The Flash Technique (FT) is a low-intensity individual or group intervention, which was shown to reduce the distress of disturbing and traumatic memories rapidly. For this reason, the purpose of the study was to examine the effect of the Flash Technique on childhood trauma, dissociation, and Post-Traumatic Stress Symptoms. The Quantitative Study Method was used in the study with the single-group pre-test post-test control group design, which is one of the semi-experimental designs. The childhood Traumas Scale, PTSD Checklist Scale, and Dissociation Questionnaire (DIS-Q) were used in the study. The study is an individual intervention application that consisted of six case series. The duration of the intervention for memories varies according to the intensity of the client's problem. But in general, interventions for memories lasted an average of 35-55 minutes. Compared to other therapies, this is shorter in terms of time. The Non-parametric Friedman Test was used for the difference between the measurements because the study group was very small. These repeated measurements are the equivalent of the One-Way Analysis of Variance. As a result of the data obtained in the study, the dissociation levels of university students (χ 2 (2) = 10.33; p < .05), childhood trauma symptoms (χ 2 (2) = 12.00; p < .05), and post-traumatic stress symptoms (χ 2 (2) = 12.00; p < .05).It was determined that the Flash Technique is an effective technique for reducing and/or improving the dissociation levels, childhood trauma symptoms, and post-traumatic stress symptoms of university students.
... However, dissociative disorders are not rare. A recent health survey conducted in the United States estimated that 4.1% of adults met criteria for a dissociative disorder by their report of symptoms experienced in the previous month (Simeon & Putnam, 2022). Meta-analyses of prevalence studies indicate that the worldwide prevalence of DID is 1.2% in the general community and 3.7% in university students (Kate et al., 2020) with the lifetime prevalence of all dissociative disorders estimated to be near 10% (Brand et al., 2016;Şar, 2011). ...
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and its Text Revision (DSM-5-TR) include experiences of diabolical possession and human relationships with spirits as a cultural variation of dissociative identity disorder (DID). Consideration of potential cultural factors is essential to making an accurate diagnosis and employing ethical treatment. However, the DSM and existing literature offer little to assist professionals making a differential diagnosis when these “cultural factors” may be present and someone does not otherwise meet criteria for DID. A Catholic Christian perspective allows for instances of possession and dissociative disorders to be distinct or to coincide. Each diocese/bishop is required to appoint a priest to function in the role of exorcist and to minister to people who are seeking spiritual help, including for possession. When the Roman Catholic Church concludes that the rite of exorcism may be warranted, mental health professionals are appropriately tasked to assess whether the symptoms experienced by the person can be explained and treated psychologically. Given the current DSM criteria, mental health professionals in this role must be equipped to rule in or rule out a diagnosis of a dissociative disorder. This article discusses relevant history, current literature, diagnostic criteria, and assessment tools for dissociative disorders, and DID in particular, from a Catholic lens.
... As the facticity of DID becomes ever more concrete through neurobiological (Reinders & Veltman, 2021) and epidemiological (Kate et al., 2020) research, this editorial reflects on the tension between the facts and fantasies of dissociation, and how we might navigate through the conflicted epistemic terrain of dissociation and responses to it. There is no doubt that DID is coming "out of the shadows at last" (Reinders & Veltman, 2021), and so too are the dynamics of neglect, abuse and exploitation that give rise to it (Simeon & Putnam, 2022). Recognition of the prevalence, severity and diversity of child maltreatment and its impacts into adulthood have expanded considerably. ...
Objective: Dissociation is thought to be traumagenic, though this conceptualization is not without misunderstanding and stigma. There is little research regarding people’s conceptualizations of their dissociative experiences and client–clinician discrepancies in understanding dissociation. Method: An online survey assessed 208 self-reported dissociative participants’ understandings of their dissociation and their beliefs about their clinicians’ understanding of dissociation via two open-ended questions. Template analysis, a codebook thematic analysis approach, was employed to explore and compare the ways people understand their dissociation and their perceptions of their clinicians’ conceptualizations. Results: Four themes were developed to capture participants’ perspectives: (1) Dissociation as Stigmatized and Underexplored (n = 83; 39.90%); (2) Dissociation as Individualized and Normalized Lived Experience (n = 173; 83.17%); (3) Dissociation as Clinical and/or Pathological (n = 112; 53.85%); and (4) Dissociation Through Etiological Frameworks (n = 67; 32.21%). Overall, 73.48% of participants indicated discrepancies between their understandings of their dissociation and those of their clinicians. Participants understood their dissociation through a lens of individualized and normalized lived experiences (100.00%) more often than their clinicians (23.12%). They believed their clinicians held more clinical understandings of dissociation (81.25%) than themselves (69.64%). Conclusions: Given the perceived discrepancies between clients’ and clinicians’ understandings of dissociation, clinicians should engage in discussions with their clients about their dissociation-related lived experiences with awareness that they may have been misunderstood by previous providers. Client–clinician discrepancies should be addressed, as failure to do so could lead to misunderstandings and ruptures in the therapeutic relationship.
There is a lack of research about dissociative experiences in young non-clinical population, especially in children. Considering this and the association of anxiety and depression symptoms along with rumination, this study aimed to explore the relationship between those transdiagnostic variables
and dissociation in children. Children (N= 588, 46.4% were boys) aged between 9 and 12 years (Mage = 11.04 years, SD = .76) filled out the
Patient Reported Outcomes Measure Information System, the Brief State Rumination Inventory, and the Adolescent Dissociative Experiences Scale.
Children who exhibited higher scores in dissociative experiences were more likely to score higher in depressive symptoms, anxious symptoms, and
rumination. Rumination, depression, and anxiety were significantly associated with dissociation considering gender and age as control factors. Our
results showed the presence of dissociative experiences in children, and its association with other important variables that seem to predispose the
detonation of this symptomatology. These outcomes highlight the undoubted necessity of an early prevention of dissociation where we should considerate the key role of rumination, depression, and anxiety.
Introduction:
Dissociative identity disorder (DID) is a treatable mental health condition that is associated with a range of psychobiological manifestations. However, historical controversy, modern day misunderstanding, and lack of professional education have prevented accurate treatment information from reaching most clinicians and patients. These obstacles also have slowed empirical efforts to improve treatment outcomes for people with DID. Emerging neurobiological findings in DID provide essential information that can be used to improve treatment outcomes.
Areas covered:
In this narrative review, the authors discuss symptom characteristics of DID, including dissociative self-states. Current treatment approaches are described, focusing on empirically supported psychotherapeutic interventions for DID and pharmacological agents targeting dissociative symptoms in other conditions. Neurobiological correlates of DID are reviewed, including recent research aimed at identifying a neural signature of DID.
Expert opinion:
Now is the time to move beyond historical controversy and focus on improving DID treatment availability and efficacy. Neurobiological findings could optimize treatment by reducing shame, aiding assessment, providing novel interventional brain targets and guiding novel pharmacologic and psychotherapeutic interventions. The inclusion of those with lived experience in the design, planning and interpretation of research investigations is another powerful way to improve health outcomes for those with DID.
This systematic review and meta-analysis aimed to investigate the relationship between dissociation and obsessive-compulsive symptoms (OCS) and disorder (OCD). Specifically, the study aimed to (a) estimate the pooled prevalence of dissociative disorders among individuals with OCD; (b) systematically review the prevalence of OCD among individuals with dissociative disorders; (c) compare the severity of dissociative symptoms between individuals with OCD and non-clinical controls; (d) estimate the association between OCS and dissociative symptoms in the clinical and non-clinical populations. A systematic search was carried out in biomedical databases from inception to January 2022 according to PRISMA guidelines. A total of 41 studies met inclusion criteria (n = 9,438, 34.3% males). The pooled prevalence of dissociative disorders in adult samples with OCD was 8% (95% CI [3, 15], k = 5). Studies on adolescent and adult patients with dissociative disorders found that 17-32% reported comorbid OCD, while a prospective study of patients with early-onset dissociative disorders found no evidence of association with OCD. Individuals affected by OCD reported more dissociative symptoms than non-clinical controls (g = .67, 95% CI [.18, 1.16], k = 9). A moderate correlation between dissociative symptoms and OCS was detected (r = .43, 95% CI [.36, .51], k = 18). Sensitivity analyses showed small/moderate correlations between dissociative experiences and specific types of obsessions and compulsions. Findings suggest that dissociative symptoms are moderately related to OCS in both clinical and non-clinical populations. Interventions aimed to reduce dissociation might improve treatment response of patients suffering from OCD.
Controversy about dissociation and the Dissociative Disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence support a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and DD are artefactual conditions produced by iatrogenesis and/or socio-cultural factors. Almost no research or clinical data support this view. DD are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior. Prospective treatment outcome studies of severely ill DD patients show significant improvement in symptoms including suicidal/self-destructive behaviors, with reductions in treatment cost. A major public health effort is needed to raise awareness about dissociation/DD including educational efforts in all mental health training programs and increased funding for research.
Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine the relationship between ACEs and adult mental health outcomes adjusting for sociodemographic covariates. Results indicated a graded dose-response relationship between the expanded ACE score and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood. In the adjusted models, being spanked as a child was significantly associated with all self-reported mental health outcomes. Over 80% of the sample reported exposure to at least one ACE, signifying the potential to capture experiences not previously considered by traditional ACE indices. The findings highlight the importance of examining both cumulative ACE scores and individual ACEs on adult health outcomes to better understand key risk and protective factors for future prevention efforts.
The present study investigates whether symptom severity can distinguish patients diagnosed with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) with a recent history of non-suicidal self-injury (NSSI) and suicide attempts from those without recent self-harm. Two hundred forty one clinicians reported on recent history of patient NSSI and suicide attempts. Two hundred twenty-one of these clinicians' patients completed dissociative, depressive, and posttraumatic stress disorder symptomatology measures. Baseline cross-sectional data from a naturalistic and prospective study of dissociative disorder (DD) patients receiving community treatment was utilized. Analyses evaluated dissociative, depressive, and PTSD symptom severity as methods of classifying patients into NSSI and suicide attempt groupings. Results indicated that dissociation severity accurately classified patients into NSSI and suicidality groups, while depression severity accurately classified patients into NSSI groups. These findings point to dissociation and depression severity as important correlates of NSSI and suicidality in patients with DDs, and have implications for self-harm prevention and treatment.
This article examined evidence for dimensional and typological models of dissociation. The authors reviewed previous research with the Dissociative Experiences Scale (DES; E. B. Bernstein-Carlson & F. W. Putnam; see record
1987-14407-001) and note that this scale, like other dissociation questionnaires, was developed to measure that so called dissociative continuum. Next, recently developed taxometric methods for distinguishing typological from dimensional constructs are described and applied to DES item-response data from 228 adults with diagnosed multiple personality disorder and 228 normal controls. The taxometric findings empirically justify the distinction between two types of dissociative experiences. Nonpathological dissociative experiences are manifestations of a dissociative trait, whereas pathological dissociative experiences are manifestations of a latent class variable. The taxometric findings also indicate that there are two types of dissociators. Individuals in the pathological dissociative class (taxon) can be identified with a brief, 8-item questionnaire called the DES-T. Scores on the DES-T and DES are compared in 11 clinical and nonclinical samples. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reviews studies that relate to the norms, reliability, and validity of the Dissociative Experiences Scale (DES). Appropriate clinical and research use of the scale are discussed together with factor analytic studies and fruitful statistical analysis methods. Research reported for 1989–1992 with the DES is described, and promising new research questions are highlighted. Suggestions are made for translating and using the DES in other cultures. A 2nd version of the DES, which is easier to score, is included as an appendix. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.
The current meta-analytic study examined the differential impact of maltreatment and various socioeconomic risks on attachment security and disorganization. Fifty-five studies with 4,792 children were traced, yielding 59 samples with nonmaltreated high-risk children (n = 4,336) and 10 samples with maltreated children (n = 456). We tested whether proportions of secure versus insecure (avoidant, resistant, and disorganized) and organized versus disorganized attachments varied as a function of risks. Results showed that children living under high-risk conditions (including maltreatment studies) showed fewer secure (d = 0.67) and more disorganized (d = 0.77) attachments than children living in low-risk families. Large effects sizes were found for the set of maltreatment studies: maltreated children were less secure (d = 2.10) and more disorganized (d = 2.19) than other high-risk children (d = 0.48 and d = 0.48, respectively). However, children exposed to five socioeconomic risks (k = 8 studies, d = 1.20) were not significantly less likely to be disorganized than maltreated children. Overall, these meta-analyses show the destructive impact of maltreatment for attachment security as well as disorganization, but the accumulation of socioeconomic risks appears to have a similar impact on attachment disorganization.
In contrast to trauma's relationship with the other dissociative disorders, the relationship of trauma to depersonalization disorder is unknown. The purpose of this study was to systematically investigate the role of childhood interpersonal trauma in depersonalization disorder.
Forty-nine subjects with DSM-IV depersonalization disorder and 26 healthy comparison subjects who were free of lifetime axis I and II disorders and of comparable age and gender were administered the Dissociative Experiences Scale and the Childhood Trauma Interview, which measures separation or loss, physical neglect, emotional abuse, physical abuse, witnessing of violence, and sexual abuse.
Childhood interpersonal trauma as a whole was highly predictive of both a diagnosis of depersonalization disorder and of scores denoting dissociation, pathological dissociation, and depersonalization. Emotional abuse, both in total score and in maximum severity, emerged as the most significant predictor both of a diagnosis of depersonalization disorder and of scores denoting depersonalization but not of general dissociation scores, which were better predicted by combined emotional and sexual abuse. The majority of the perpetrators of emotional abuse were either or both parents. Although different types of trauma were modestly correlated, only a few of these relationships were statistically significant, underscoring the importance of comprehensively considering different types of trauma in research studies.
Childhood interpersonal trauma and, in particular, emotional abuse may play a role in the pathogenesis of depersonalization disorder. Compared to other types of childhood trauma, emotional maltreatment is a relatively neglected entity in psychiatric research and merits more attention.
This study sought to determine the prevalence of dissociative disorders among women in the general population, as assessed in a representative sample of a city in central Turkey. The Dissociative Disorders Interview Schedule (DDIS), the Borderline Personality Disorder section of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), and the PTSD-Module of the Structured Clinical Interview for DSM-III-R (SCID) were administered to 628 women in 500 homes. The mean age of participants was 34.8 (S.D.=11.5, range: 18-65); 18.3% of participants (n=115) had a lifetime diagnosis of a dissociative disorder. Dissociative disorder not otherwise specified (DDNOS) was the most prevalent diagnosis (8.3%); 1.1% of the population was diagnosed as having dissociative identity disorder (DID). Participants with a dissociative disorder had borderline personality disorder, somatization disorder, major depression, PTSD, and history of suicide attempt more frequently than did participants without a dissociative disorder. Childhood sexual abuse, physical neglect, and emotional abuse were significant predictors of a dissociative disorder diagnosis. Only 28.7% of the dissociative participants had received psychiatric treatment previously. Because dissociative disorders are trauma-related, significant part of the adult clinical consequences of childhood trauma remains obscure in the minds of mental health professionals and of the overall community. Revisions in diagnostic criteria of dissociative disorders in the DSM-IV are recommended.
A large body of evidence has demonstrated that exposure to childhood maltreatment at any stage of development can have long-lasting consequences. It is associated with a marked increase in risk for psychiatric and medical disorders. This review summarizes the literature investigating the effects of childhood maltreatment on disease vulnerability for mood disorders, specifically summarizing cross-sectional and more recent longitudinal studies demonstrating that childhood maltreatment is more prevalent and is associated with increased risk for first mood episode, episode recurrence, greater comorbidities, and increased risk for suicidal ideation and attempts in individuals with mood disorders. It summarizes the persistent alterations associated with childhood maltreatment, including alterations in the hypothalamic-pituitary-adrenal axis and inflammatory cytokines, which may contribute to disease vulnerability and a more pernicious disease course. The authors discuss several candidate genes and environmental factors (for example, substance use) that may alter disease vulnerability and illness course and neurobiological associations that may mediate these relationships following childhood maltreatment. Studies provide insight into modifiable mechanisms and provide direction to improve both treatment and prevention strategies.
This meta-analysis of 31,905 college students includes 12 studies diagnosing Dissociative Disorders (DD) and 92 studies measuring dissociation with the Dissociative Experiences Scale (DES). Prevalence rates were used to separately test the plausibility of the Trauma Model (TM) and the Fantasy Model (FM) of dissociation. Results show 11.4% of students sampled meet criteria for DD, which is consistent with the prevalence of experiencing multiple (types of) trauma during childhood (12%), but is not consistent with the very low prevalence expected from the role of fantasy-proneness proposed in the FM. DES scores varied significantly across the 16 countries and were not higher in North America, but in countries that were comparatively unsafe. The least well-known DD was the most common, which is inconsistent with the FM which holds that the diagnosed person is enacting a familiar social role. There was no evidence that DES scores had decreased over recent decades, which does not support FM assertions that DD were a fad of the 1990s. Three of the five hypotheses tested provided clear support for the TM and a fourth hypothesis provided partial support for the TM. None of the five hypotheses tested supported the FM. The finding that DD were slightly more common in college populations than the general population did not support predictions of either model. The theoretical perspective of the authors moderated DES scores, although this is unlikely due to experimenter bias as studies led by FM theorists had significantly higher DES scores than those led by TM theorists.
Depersonalization (DP) is a dissociative phenomenon, characterised by feeling “unreal” or detached from one’s own emotions, thoughts and behaviour (APA, 2013). It is considered a defense mechanism, employed in response to overwhelming events, whereby thoughts and emotions are suppressed in order to enhance the individual’s’ capacity to function in traumatic environments. DP has been found to co-occur with anxiety and depressive disorders and childhood emotional maltreatment (EM) has been identified as an important predisposing factor. The study’s primary aim was to investigate the mediating role of DP in the relationship between childhood emotional maltreatment and psychological distress in young adults. Additionally it aimed to confirm that a history of childhood EM (emotional abuse and emotional neglect) predicted current levels of DP and to explore how both a person’s attitude towards experiencing and expressing emotions (with an emphasis on the affect phobia model) and their current attachment security are related to current DP. A cross-sectional design was employed, which included young adults (N = 761) aged between 18–25 years. Participants completed an online survey that comprised of several self-report measures. Regression and mediation analyses were conducted. The results indicated that: (1) DP significantly mediated the relationship between childhood EM and current psychological distress (2); that a history of EM, but no other forms of childhood abuse, significantly predicted current depersonalization experiences and (3); EM, attachment-related anxiety and negative attitudes towards emotions predicted clinical cut-off levels of DP. The results are discussed in detail, including clinical implications and direction for future research.
Dissociative disorders (DD) are frequently associated with suicidal behaviors. We performed the first meta-analysis of studies comparing rates of suicide attempts (SA) and non-suicidal self-injury (NSSI) in psychiatric individuals with and without DD. We included: 1) studies comparing SA and NSSI rates in psychiatric individuals with and without DD; 2) studies comparing Dissociative Experiences Scale (DES) scores in both SA and NSSI psychiatric patients versus non SA and non NSSI ones. Cochrane Collaboration Review Manager Software and STROBE statement were used. Nineteen studies were included in the analyses. DD patients were more likely to report both previous SA and NSSI in comparison to non DD patients. Importantly, results remained highly significant in both outcomes but with no more heterogeneity when including studies using a DSM-based method to diagnose DD. Both SA and NSSI patients reported higher DES scores in comparison to non SA and non NSSI patients. The presence of DD diagnosis or higher DES scores seems to be related to both SA and NSSI in psychiatric patients. Hence, it may be reasonable to hypothesize the presence of a dissociative subtype in a subset of these patients, which should be considered as a transdiagnostic factor and should be carefully assessed.
Dissociative disorders are frequent comorbid conditions of other mental disorders. Yet, there is controversy about their clinical relevance, and little systematic research has been done on how they influence global functioning. Outpatients and day care patients (N=160) of several psychiatric units in Switzerland were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV Axis I Disorders, Structured Clinical Interview for DSM-IV Dissociative Disorders, Global Assessment of Functioning Scale, and World Health Organization Disability Assessment Schedule-II. The association between subjects with a dissociative disorder (N=30) and functional impairment after accounting for non-dissociative axis I disorders was evaluated by linear regression models. We found a proportion of 18.8% dissociative disorders (dissociative amnesia=0%, dissociative fugue=0.6%, depersonalization disorder=4.4%, dissociative identity disorder=7.5%, dissociative disorder-not-otherwise-specified=6.3%) across treatment settings. Adjusted for other axis I disorders, subjects with a comorbid dissociative identity disorder or dissociative disorder-not-otherwise-specified had a median global assessment of functioning score that was 0.86 and 0.88 times, respectively, the score of subjects without a comorbid dissociative disorder. These findings support the hypothesis that complex dissociative disorders, i.e., dissociative identity disorder and dissociative disorder-not-otherwise-specified, contribute to functional impairment above and beyond the impact of co-existing non-dissociative axis I disorders, and that they qualify as "serious mental illness".
A recent survey of a large sample of the general population in the city of Winnipeg, Manitoba, showed that multiple personality disorder related to childhood abuse affects about 1% of the adult population. About 10% of the adult population has had a DSM-III-R dissociative disorder of some kind. Pathologic dissociation appears to be a major form of emotional disturbance in North America, and it appears to be about as common as anxiety, mood, and substance abuse disorders. The dissociative disorders can no longer be considered rare.
The clinical syndrome of multiple personality disorder (MPD) is an unusual dissociative condition that has been poorly characterized. In an attempt to better delineate the clinical phenomenology of MPD, 100 recent cases were collected on a 386-item questionnaire completed by clinicians involved in the treatment of MPD patients. This study documents the existence of a clinical syndrome characterized by a core of depressive and dissociative symptoms and a childhood history of significant trauma, primarily child abuse.
In recent years, the pathologic dissociation taxon developed by Waller, Putnam, and Carlson (Psychological Methods 1:300-321, 1996) from a Dissociative Identity Disorder (DID) sample has been increasingly used in studies of dissociation in general. However, the taxon's convergence with dissociative diagnoses other than DID, as well as the taxon's central premise that pathologic dissociation is a categorical rather than a dimensional construct, remain areas of exploration. This report examines the applicability of the pathologic dissociation taxon to Depersonalization Disorder (DPD). The Dissociative Experiences Scale was administered to 100 consecutively recruited DPD subjects diagnosed by semistructured clinical interview and by the SCID-D. Taxon membership probability was calculated using the recommended SAS scoring program. Approximately 2/3 of subjects (N = 64) had a very high probability (>.80) of belonging to the taxon, while 1/3 of subjects had a very low probability (<.10) of belonging to the taxon. A taxon cutoff score of 13 yielded an 81% sensitivity in detecting the presence of DPD. The modest convergence between taxonic membership and clinical dissociative disorder diagnosis suggests that the taxon may have important limitations in its use, at least when applied to DPD in its current form. As previously, we continue to recommend a low taxon cutoff score (13) for the sensitive detection of depersonalization disorder. The inference that pathologic dissociation is a unitary and categorical entity is also discussed.
Despite a surge of interest and literature on depersonalization disorder in recent years, a large series of individuals with the disorder has not been described to date. In this report, we systematically elucidate the phenomenology, precipitants, antecedents, comorbidity, and treatment history in such a series.
117 adult subjects with depersonalization disorder (DSM-III-R/DSM-IV criteria) consecutively recruited to a number of depersonalization disorder research studies were administered structured and semistructured diagnostic interviews and the Dissociative Experiences Scale. Data were gathered from 1994 to 2000.
The illness had an approximately 1:1 gender ratio with onset around 16 years of age. The course was typically chronic and often continuous. Illness characteristics such as onset, duration, and course were not associated with symptom severity. Mood, anxiety, and personality disorders were frequently comorbid, but none predicted depersonalization severity. The most common immediate precipitants of the disorder were severe stress, depression, panic, marijuana ingestion, and hallucinogen ingestion, and none of these predicted symptom severity. Negative affects, stress, perceived threatening social interaction, and unfamiliar environments were some of the more common factors leading to symptom exacerbation. Conversely, comforting interpersonal interactions, intense emotional or physical stimulation, and relaxation tended to diminish symptom intensity. There were no significant gender differences in the clinical features of the disorder. In this sample, depersonalization tended to be refractory to various medication and psychotherapy treatments.
The characteristics of depersonalization disorder found in this sample, the largest described to date, are in good accord with previous literature. The study highlights the need for novel therapeutic approaches to treat depersonalization disorder. Novel medication classes, as well as novel psychotherapeutic techniques that build on the reported symptom fluctuation factors, may prove helpful in the future.
The National Comorbidity Survey Replication (NCS-R) is a new nationally representative community household survey of the prevalence and correlates of mental disorders in the US. The NCS-R was carried out a decade after the original NCS. The NCS-R repeats many of the questions from the NCS and also expands the NCS questioning to include assessments based on the more recent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostics system (American Psychiatric Association, 1994). The NCS-R was designed to (1) investigate time trends and their correlates over the decade of the 1990s and (2) expand the assessment of the prevalence and correlates of mental disorders beyond the assessment in the baseline NCS in order to address a number of important substantive and methodological issues that were raised by the NCS. This paper presents a brief review of these aims.
To investigate the association of dissociative disorder (DD) with impaired functioning and co-occurring Axis I and personality disorders among adults in the community.
Psychiatric interviews were administered to a sample of 658 adult participants in the Children in the Community Study, a community-based longitudinal study.
Depersonalization disorder (prevalence: 0.8%), dissociative amnesia (prevalence: 1.8%), dissociative identity disorder (prevalence: 1.5%), and dissociative disorder not otherwise specified (prevalence: 4.4%), evident within the past year, were each associated with impaired functioning, as assessed by the clinician-administered Global Assessment of Functioning Scale. These associations remained significant after controlling for age, sex, and co-occurring disorders. Individuals with anxiety, mood, and personality disorders were significantly more likely than individuals without these disorders were to have DD, after the covariates were controlled. Individuals with Cluster A (DD prevalence: 58%), B (DD prevalence: 68%), and C (DD prevalence: 37%) personality disorders were substantially more likely than those without personality disorders were to have DD.
DD is associated with clinically significant impairment among adults in the community. DD may be particularly prevalent among individuals with personality disorders.
This study explored the relationships among a variety of victimization experiences and dissociative symptoms in a community probabilistic household sample (n=891) of youths (11-17 years old) in Puerto Rico. To measure dissociative symptoms, the authors selected eight items from the Adolescent Dissociative Experiences Scale (Armstrong, Putnam, Carlson, Liber, & Smith, 1997) that are indicative of pathological forms of dissociation. Victimization factors associated with dissociation were investigated with bivariate logistic regression followed by multiple logistic regression. The results indicated that 44 (4.9%) youths experienced pathological dissociative symptoms. Forty-three (98%) of those youths experienced victimization. Logistic regression analyses indicated that the risk of pathological dissociation was significant among those participants who reported severe forms of physical abuse and those who were exposed to violence.
This study investigated basal and stress-induced hypothalamic-pituitary-adrenal (HPA)-axis alterations in dissociative disorders (DDs).
Forty-six subjects with DD without lifetime post-traumatic stress disorder (PTSD), 35 subjects with PTSD, and 58 healthy comparison (HC) subjects, free of current major depression, were studied as inpatients. After a 24-hour urine collection and hourly blood sampling for ambient cortisol determination, a low-dose dexamethasone suppression test was administered, followed by the Trier Social Stress Test.
The DD group had significantly elevated urinary cortisol compared with the HC group, which was more pronounced in the absence of lifetime major depression, whereas the PTSD and HC groups did not differ. The DD group demonstrated significantly greater resistance to, and faster escape from, dexamethasone suppression compared with the HC group, whereas the PTSD and HC groups did not differ. The three groups did not differ in cortisol stress reactivity, but both psychiatric groups demonstrated a significant inverse correlation between dissociation severity and cortisol reactivity, after controlling for all other symptomatology. The PTSD subgroup with comorbid DD tended to have blunted stress reactivity compared with the HC group.
The study demonstrates a distinct pattern of HPA-axis dysregulation in DDs, emphasizing the importance of further study of stress-response systems in dissociative psychopathology.
Depersonalization (DP), i.e., feelings of being detached from one's own mental processes or body, can be considered as a form of mental escape from the full experience of reality. This mental escape is thought to be etiologically linked with maltreatment during childhood. The detached state of consciousness in DP contrasts with certain aspects of mindfulness, a state of consciousness characterized by being in touch with the present moment. Against this background, the present article investigates potential connections between DP severity, mindfulness, and childhood trauma in a mixed sample of nonpatients and chronic nonmalignant pain patients. We found a strong inverse correlation between DP severity and mindfulness in both samples, which persisted after partialing out general psychological distress. In the nonpatient sample, we additionally found significant correlations between emotional maltreatment on the one hand and DP severity (positive) and mindfulness (negative) on the other. We conclude that the results first argue for an antithetical relationship between DP and certain aspects of mindfulness and thus encourage future studies on mindfulness-based interventions for DP and second throw light on potential developmental factors contributing to mindfulness.
Although it is common for patients with dissociative disorders to report a history of suicide attempts, there is very little data systematically comparing suicidality in patients with dissociative disorders versus patients without these disorders. The subjects in our study were 231 patients consecutively admitted to an inner-city, hospital-based outpatient psychiatric clinic. Eighty-two of these patients completed structured interviews for dissociative disorders, borderline personality disorder, and trauma history (dissociative disorders interview schedule) and for posttraumatic stress disorder and substance abuse (Structured Clinical Interview for DSM-IV). Patients receiving a dissociative disorder diagnosis were compared with nondissociative patients on measures of self-harm and suicidality. Presence of a dissociative disorder was strongly associated with all measures of self-harm and suicidality. When we focused on patients with a history of multiple suicide attempts, significant associations were found between several diagnoses (dissociative disorder; borderline personality disorder; posttraumatic stress disorder; alcohol abuse/dependence) and multiple suicide attempter status. When these diagnoses were entered in a logistic regression, a highly significant association remained for dissociative diagnosis and multiple suicide attempter status (odds ratio, 15.09; 95% confidence interval, 2.67-85.32; p = 0.002). Dissociative disorders are commonly overlooked in studies of suicidality, but in this population they were the strongest predictor of multiple suicide attempter status.
There have been no previous general population studies on the stability of dissociative symptoms. The aim of this study was to examine the course of and the changes in dissociative symptoms and factors associated with these changes during a 3-year follow-up of a Finnish general population sample.
The general population sample included a cohort of 1497 subjects. Dissociative symptoms were assessed with the Dissociative Experiences Scale (DES) and the DES-taxon (DES-T). Depressive symptoms and suicidal ideation were measured with the Beck Depression Inventory (BDI). The sample was categorized into low dissociators with DES scores less than 20 and high dissociators with DES scores of 20 or more.
At baseline, 98 subjects were high dissociators. On follow-up, 28 of them were still high dissociators, whereas among 70 subjects, the DES score declined below the cutoff score. During the follow-up period, 28 of 1399 subjects became new high dissociators, and constantly low dissociators consisted of 1371 of 1399 subjects. Dissociative taxon membership was detected in 39 subjects either at baseline or at follow-up, but only 4 of them met the criteria at both assessments. Stable high dissociation was associated with an increase in the BDI score on follow-up, baseline suicidal ideation, a younger age, a reduced working ability, and smoking. Risk factors for becoming a new high dissociator were an increase in the BDI score, a younger age at baseline, and a reduced working ability. Among the baseline high dissociators, recovery from high dissociation was associated with a decline in the BDI score at follow-up and with no suicidal thoughts, older age, and a good working ability at baseline.
Only a small proportion of the general population had constantly high levels of dissociative symptoms. The stability of dissociative taxon membership was weaker than the stability of the continuous variables of dissociation. The dissociative experiences had a tendency to change, and these changes were associated with changes in the BDI scores. Further studies are needed to reveal the factors associated with the changes in dissociative symptoms.
Symptoms of depersonalisation (DP) and derealisation (DR) are increasingly recognised in both clinical and non-clinical settings, but their importance and underlying pathophysiology is only now being addressed.
This paper is a systematic review of the current state of knowledge about the prevalence of depersonalisation and derealisation using computerised databases and citation searches. All potential studies were examined and numerical data included. Three categories of study are reviewed: questionnaire and interview surveys of selected student and non-clinical samples; population-based community surveys using standardised diagnostic interviews; and clinical surveys of depersonalisation/derealisation symptoms occurring within inpatients with psychiatric disorders. In addition, we present newly analysed data of the prevalence of depersonalisation/derealisation from five large population-based studies.
Epidemiological surveys demonstrate that transient symptoms of depersonalisation/derealisation in the general population are common, with a lifetime prevalence rate of between 26 and 74% and between 31 and 66% at the time of a traumatic event. Community surveys employing standardised diagnostic interviews reveal rates of between 1.2 and 1.7 % for one month prevalence in a UK sample and a 2.4% current prevalence rate in a Canadian sample. Current prevalence rates in samples of consecutive inpatient admissions are reported between 1 and 16%, although screening measures employed may have resulted in these being an underestimate. Prevalence rates in clinical samples of specific psychiatric disorders vary between 30% of war veterans with PTSD and 60% of those with unipolar depression. There is a high prevalence within panic disorder with rates varying from 7.8 to 82.6%.
DP and DR symptoms are common in normal and psychiatric populations, but prevalence estimates are hampered by inconsistent definitions and the use of variable time-frames. Population-based surveys using diagnostic interviews yield prevalence rates of clinically significant DP/DR in the region of 1-2%. Surveys of clinical populations in which common screening and assessment instruments were used also yield consistently high prevalence rates. The use of reliable diagnostic assessments and rating scales is needed. The relationship between DP/DR and certain other psychiatric disorders (e. g. panic) suggests possible common pathophysiological or aetiological factors.
Factors associated with pathological dissociation in the general population
- P Maaranen
- A Tanskanen
- K Honkalampi
- K Haatainen
- J Hinktikka
- H Viinamaki