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Abstract

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.

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... One significant consequence often associated with emotional abuse concerns dissociative experiences (Kate et al., 2021). Featured by an adaptive nature, dissociation is characterised by identity alteration, depersonalisation and derealisation (Steinberg & Schnall, 2001) and is significantly related to some emotional constructs such as low consciousness and tolerance of one's emotions (Michal et al., 2007;Simeon et al., 2001). Dissociation is often associated with traumatic events and adversities, especially when beginning in childhood (Kate et al., 2021). ...
... Studies on trait mindfulness and dissociation, linked to stress and trauma, show that high levels of mindfulness facilitate the concentration of attention on present events, while dissociation, which is related to traumatic experiences, decreases the level of awareness of the present moment (Michal et al., 2007). Traumatised individuals may often resort to dissociation as a way to protect themselves from negative experiences (Michal et al., 2007). ...
... Studies on trait mindfulness and dissociation, linked to stress and trauma, show that high levels of mindfulness facilitate the concentration of attention on present events, while dissociation, which is related to traumatic experiences, decreases the level of awareness of the present moment (Michal et al., 2007). Traumatised individuals may often resort to dissociation as a way to protect themselves from negative experiences (Michal et al., 2007). Similarly, emotional awareness and acceptance issues stemming from significant childhood abuse may substantially hinder the normal development of mindfulness skills (Marszał & Górska, 2015). ...
Article
There is clear evidence linking trauma, mindfulness, dissociation and problematic internet use (PIU). Nonetheless, little is known about the role trait mindfulness and dissociative experiences may have in the relationship between childhood emotional abuse (CEA) and PIU, as well as the role that gender may have in such relationships. In the current research, self-report questionnaires on CEA, trait mindfulness, dissociative experiences and PIU were administered to 1074 Italian adolescents (50% females) aged 14–17 years old, to test whether trait mindfulness and dissociative experiences mediated the relationship between CEA and PIU, and whether the proposed mediation was invariant across genders. Furthermore, the main analyses were controlled for background variables. The findings highlighted significant associations between all direct and indirect paths and invariance of the mediation model across boys and girls. The results of this study highlight that emotionally abused boys and girls with high levels of dissociation and inadequate mindful skills may be more exposed to dysfunctional online activities. Hence, developing dissociation-focused and mindfulness-based interventions for emotionally abused adolescents may be clinically effective when building tailored approaches for the prevention and management of PIU. Further implications are discussed.
... For instance, Ryan et al. (2007) reported different attachment types and experiences of infants as one of the reasons that result in different trait mindfulness between individuals [14]. Conversely, researchers traced individuals with low-level trait mindfulness and his/her childhood experiences and have discovered they frequently experienced insecure parentchild attachments, such as emotional neglect or abuse [15]. Research on adolescents found that a warm attachment was positively associated with trait mindfulness, while an insecure attachment was negatively associated with low adolescent trait mindfulness [13]. ...
... SES has an impact on parenting style [15,17]. Individuals with lower SES experience a disproportionate distribution of social stress. ...
... In addition, parents with low SES typically experience more financial stress, family conflict, domestic violence, and discrimination [18]. These negative events are more likely to lead to negative parenting and predispose them to form insecure attachments [15], leading to low trait mindfulness. ...
Article
Full-text available
The present study was conducted twice over one year during the COVID-19 pandemic with Chinese adolescents (n = 1582) to investigate the relationships among family socioeconomic status (SES), adolescent mental health problems, trait mindfulness, and perceived stress using self-reported measures. We administered the Mindful Attention Awareness Scale (MAAS), the Perceived Stress Scale (PPS), the Self-rating Anxiety Scale (SAS), the Epidemiologic Studies Depression Scale (CES-D), and Conduct Problem Tendency Inventory (CPTDI) to a sample of Chinese adolescents. The results prove that (1) there were significant correlations among socioeconomic status, trait mindfulness, perceived stress, and adolescent mental health problems, and the (2) serial mediation analysis indicated that trait mindfulness and perceived stress performed as mediators on the path from SES to anxiety, depression, and externalizing problems. Our findings provide a contribution by showing the connection between socioeconomic position and adolescent mental health problems and by offering a reference for the treatment of psychological issues affecting adolescents.
... The symptoms of depersonalization and derealization (see Michal, Chapter 23 , this volume) are common among the dissociative disorders. DDD is often linked to childhood trauma (Michal et al., 2007;Simeon et al., 2001 ). However, it is not always so, especially when it occurs independently of other dissociative phenomena, Other triggers for depersonalization/ derealization include panic attacks, intoxication with mind-altering drugs, periods of stress (not necessarily traumatic stress) and periods of depression ( Simeon & Abugel, 2008 ). ...
... However, it is not always so, especially when it occurs independently of other dissociative phenomena, Other triggers for depersonalization/ derealization include panic attacks, intoxication with mind-altering drugs, periods of stress (not necessarily traumatic stress) and periods of depression ( Simeon & Abugel, 2008 ). Michal et al. (2007) demonstrated that the detached state of consciousness in DDD contrasts with certain aspects of mindfulness, a state of consciousness characterized by being in touch with the present moment. The relationships between being out of touch with one's feelings (alexithymia), body (depersonalization) and the environment (derealization) require further study ( Michal et al., 2007 ). ...
... Michal et al. (2007) demonstrated that the detached state of consciousness in DDD contrasts with certain aspects of mindfulness, a state of consciousness characterized by being in touch with the present moment. The relationships between being out of touch with one's feelings (alexithymia), body (depersonalization) and the environment (derealization) require further study ( Michal et al., 2007 ). In a self-report screening study on a large group of college students, Ş ar et al. (2017 a ) identifi ed four dimensions of depersonalization-derealization: cognitive-emotional self-detachment, perceptual detachment, bodily self-detachment, and detachment from reality. ...
... The factors that moderate this association remain unclear, with mindfulness and imagery as two potential candidates. Previous research suggests reduced mindfulness or metacognition in highly suggestible individuals (Grover et al., 2018;Lush et al., 2016;Pick et al., 2020;Semmens-Wheeler and Dienes, 2012;Terhune and Hedman, 2017) and in the dissociative disorders (Pick et al., 2020;Butler et al., 2019;Michal et al., 2007), as well as a subjective impairment in one's ability to generate visual images in DDD, particularly those in relation to the self or others (Lambert et al., 2001). This research points towards the importance of examining both of these factors in the context of suggestibility in DDD. ...
... However, there were weak trends for responsiveness to suggestions to be associated with severity of depersonalization-derealization symptoms, particularly anomalous bodily experiences. In accordance with reports of attenuated mindfulness in high dissociation (Michal et al., 2007;Nestler et al., 2015) patients with DDD also displayed lower mindfulness (FFMQ) than controls. These results indicate that DDD is not characterized by elevated direct verbal suggestibility and provide further insights into the aetiology and mechanisms of this condition and its status within the taxonomy of the dissociative disorders. ...
... Previous research has demonstrated negative associations between mindfulness or metacognition and suggestibility (Grover et al., 2018;Lush et al., 2016;Semmens-Wheeler and Dienes, 2012;Terhune and Hedman, 2017) implying that responsiveness to suggestion is supported by, or related to, aberrant metacognition pertaining to one's intentions and the factors influencing their sense of agency (Kirsch and Lynn, 1998;Dienes and Perner, 2007). Similarly, preliminary research points to attenuated mindfulness in highly dissociative individuals (Pick et al., 2020;Butler et al., 2019;Michal et al., 2007;Nestler et al., 2015) and to attenuated intention awareness in germane populations (Jungilligens et al., 2019;Baek et al., 2017). On the basis of this research, we examined whether suggestibility in DDD patients would be associated with, or moderated by, levels of mindfulness. ...
Article
Full-text available
The dissociative disorders and germane conditions are reliably characterized by elevated responsiveness to direct verbal suggestions. However, it remains unclear whether atypical responsiveness to suggestion is similarly present in depersonalization-derealization disorder (DDD). 55 DDD patients and 36 healthy controls completed a standardised behavioural measure of direct verbal suggestibility that includes a correction for compliant responding (BSS-C), and psychometric measures of depersonalization-derealization (CDS), mindfulness (FFMQ), imagery vividness (VVIQ), and anxiety (GAD-7). Relative to controls, patients did not exhibit elevated suggestibility (g = 0.26, BF10 = .11) but displayed significantly lower mindfulness (g = 1.38), and imagery vividness (g = 0.63), and significantly greater anxiety (g = 1.39). Although suggestibility did not correlate with severity of depersonalization-derealization symptoms in controls, r=-.03 [95% CI: -.36, .30], there was a weak tendency for a positive association in patients, r=.25, [95% CI: -.03, .48]. Exploratory analyses revealed that patients with more severe anomalous bodily experiences were also more responsive to suggestion, an effect not seen in controls. This study demonstrates that DDD is not characterized by elevated responsiveness to direct verbal suggestions. These results have implications for the aetiology and treatment of this condition, as well as its classification as a dissociative disorder in psychiatric nosology.
... The symptoms of depersonalization and derealization (see Michal, Chapter 23 , this volume) are common among the dissociative disorders. DDD is often linked to childhood trauma (Michal et al., 2007;Simeon et al., 2001 ). However, it is not always so, especially when it occurs independently of other dissociative phenomena, Other triggers for depersonalization/ derealization include panic attacks, intoxication with mind-altering drugs, periods of stress (not necessarily traumatic stress) and periods of depression ( Simeon & Abugel, 2008 ). ...
... However, it is not always so, especially when it occurs independently of other dissociative phenomena, Other triggers for depersonalization/ derealization include panic attacks, intoxication with mind-altering drugs, periods of stress (not necessarily traumatic stress) and periods of depression ( Simeon & Abugel, 2008 ). Michal et al. (2007) demonstrated that the detached state of consciousness in DDD contrasts with certain aspects of mindfulness, a state of consciousness characterized by being in touch with the present moment. The relationships between being out of touch with one's feelings (alexithymia), body (depersonalization) and the environment (derealization) require further study ( Michal et al., 2007 ). ...
... Michal et al. (2007) demonstrated that the detached state of consciousness in DDD contrasts with certain aspects of mindfulness, a state of consciousness characterized by being in touch with the present moment. The relationships between being out of touch with one's feelings (alexithymia), body (depersonalization) and the environment (derealization) require further study ( Michal et al., 2007 ). In a self-report screening study on a large group of college students, Ş ar et al. (2017 a ) identifi ed four dimensions of depersonalization-derealization: cognitive-emotional self-detachment, perceptual detachment, bodily self-detachment, and detachment from reality. ...
Chapter
This chapter explores the most pertinent research questions to understand and advance the study of dissociation. Drawing on specifi c themes, recommendations for future work are outlined at the end of each section. Our chapter in the fi rst edition of this book still contains questions empirically unanswered (e.g., genetics and neurobiology of dissociative disorders, dissociation in other psychiatric disorders). We will focus in this chapter on the most pressing questions that currently need to inform the scientifi c understanding of dissociation.
... A few studies have observed a negative correlation between mindfulness and symptoms of depersonalization in nonclinical individuals (Michal et al., 2007), patients with clinically diagnosed DPD (Nestler et al., 2015), patients with auditory hallucinations (Escudero-Pérez et al., 2016), and individuals prone to hallucinations (Perona-Garcelán et al., 2014). These findings have been taken to suggest that individuals who suffer from depersonalization exhibit deficits in dispositional mindfulness. ...
... The current findings suggest that the relationship between dispositional mindfulness and experiences of depersonalization is more nuanced than previously thought. A small body of prior research has consistently reported a negative overall correlation between mindfulness and depersonalization symptoms (Michal et al., 2007;Nestler et al., 2015). Based on these findings, researchers have suggested that those who suffer from depersonalization symptoms exhibit deficits in mindfulness and have described depersonalization as the antithesis of a mindful state of being (Michal et al., 2007(Michal et al., , 2013. ...
... A small body of prior research has consistently reported a negative overall correlation between mindfulness and depersonalization symptoms (Michal et al., 2007;Nestler et al., 2015). Based on these findings, researchers have suggested that those who suffer from depersonalization symptoms exhibit deficits in mindfulness and have described depersonalization as the antithesis of a mindful state of being (Michal et al., 2007(Michal et al., , 2013. However, previous research has relied on a unidimensional conceptualization and measurement of mindfulness, and has not controlled for general distress, which may confound relationships between mindfulness and depersonalization symptoms. ...
Article
Full-text available
Objectives Although depersonalization has been described as the antithesis of mindfulness, few studies have empirically examined this relationship, and none have considered how it may differ across various facets of mindfulness, either alone or in interaction. The present study examined the relationship between symptoms of depersonalization and facets of dispositional mindfulness in a general population sample. Methods A total of 296 adult participants (139 male, 155 female, 2 other) were recruited online via Qualtrics and completed the Cambridge Depersonalisation Scale; Depression, Anxiety, and Stress Scale; and Five Facet Mindfulness Questionnaire. Results Controlling for general distress, depersonalization symptoms were positively associated with Observe, Describe, and Nonreactivity facets and negatively associated with Acting with Awareness and Nonjudgment facets. After controlling for intercorrelations among the facets, depersonalization symptoms remained significantly associated with higher Nonreactivity and lower Acting with Awareness. The overall positive relationship between depersonalization symptoms and the Observe facet was moderated by both Nonjudgment and Nonreactivity. Specifically, higher Observing was related to increased depersonalization symptoms at low levels of Nonjudgment and to decreased symptoms at low levels of Nonreactivity. Conclusions The current study provides novel insight into the relationship between depersonalization symptoms and various aspects of mindfulness. Experiences of depersonalization demonstrated divergent relationships with mindfulness facets, alone and in interaction. The results may inform theoretical models of depersonalization and mindfulness-based interventions for depersonalization.
... 24,33 The factors that moderate this association remain unclear, with mindfulness and imagery as two potential candidates. Previous research suggests reduced mindfulness or metacognition in highly suggestible individuals [34][35][36][37][38] and in dissociative disorders, 36,39,40 as well as an impaired ability to generate visual images in DDD. 41 This research points towards the importance of examining both of these factors in the context of suggestibility in DDD. ...
... However, there were weak trends for responsiveness to suggestions to be associated with severity of depersonalization-derealization symptoms, particularly anomalous bodily experiences. In accordance with reports of attenuated mindfulness in high dissociation, 40,54 patients with DDD also displayed lower mindfulness (FFMQ) than controls. These results indicate that DDD is not characterized by elevated direct verbal suggestibility and provide further insights into the aetiology and mechanisms of this condition and its status within the taxonomy of the dissociative disorders. ...
... Previous research has demonstrated negative associations between mindfulness or metacognition and suggestibility 34,35,37,38 implying that responsiveness to suggestion is supported by, or related to, aberrant metacognition pertaining to one's intentions and the factors influencing their sense of agency. 65,66 Similarly, preliminary research points to attenuated mindfulness in highly dissociative individuals 36,39,40,54 and to attenuated intention awareness in germane populations. 67,68 On the basis of this research, we examined whether suggestibility in DDD patients would be associated with, or moderated by, levels of mindfulness. ...
Preprint
Full-text available
The dissociative disorders and germane conditions are reliably characterized by elevated responsiveness to direct verbal suggestions. However, it remains unclear whether atypical responsiveness to suggestion is similarly present in depersonalization-derealization disorder (DDD). 55 DDD patients and 36 healthy controls completed a standardised behavioural measure of direct verbal suggestibility that includes a correction for compliant responding (BSS-C), and psychometric measures of depersonalization-derealization (CDS), mindfulness (FFMQ), imagery vividness (VVIQ), and anxiety (GAD-7). Patients displayed nonsignificantly lower suggestibility than controls, (g = 0.26) but significantly lower mindfulness (g = 1.38), and imagery vividness (g = 0.63), and significantly greater anxiety (g = 1.39). Although suggestibility did not correlate with severity of depersonalization-derealization symptoms in controls, r=-.03 [95% CI: -.36, .30], there was a weak tendency for a positive association in patients, r=.25, [95% CI: -.03, .48]. Exploratory analyses revealed that patients with more severe anomalous bodily experiences were also more responsive to suggestion, an effect not seen in controls. This study demonstrates that DDD is not characterized by elevated responsiveness to direct verbal suggestions. These results have implications for the aetiology and treatment of this condition, as well as its classification as a dissociative disorder in psychiatric nosology.
... Evidence suggests that traumatic and abusive experiences are related to depersonalization experiences. Various types of traumatic events such as emotional abuse, negligence, physical abuse, and being a witness to interpersonal violence are found to increase risk for distressing depersonalization phenomena (Michal, et al., 2016;Michal, Beutel & Jordan, 2007;Simeon, Guralnik, Schmeidler, Sirof & Knutelska, 2001). For instance, Simeon et al (2001) found that patients with a depersonalization disorder reported more emotional abuse than their control group. ...
... This suggests that with more repeated abuse in the life of an individual, depersonalization-type experiences occur with a higher frequency. These marked differences support the notion that dissociative experiences are intricately related to abuse, victimization and trauma (Dalenberg, et al., 2012;Dalenberg & Palesh, 2004; Francia-Martínez, Roca, Alvarado, Martínez-Taboas & Sayers, 2003;Littlewood, 2002;Michal, Beutel, & Jordan, 2007;Schafer, et al., 2010;Simeon, 2004). The review by Lewis-Fernández, Martínez-Taboas, Sar, Patel and Boatin (2007), in which dissociative symptoms were assessed cross-culturally, indicates that dissociation is reliably related to a variety of traumatic experiences. ...
... They found that patients with a depersonalization disorder obtained higher scores on the Childhood Trauma Interview. Similarly, Michal, Beutel and Jordan (2007) found a significant correlation between emotional victimization and depersonalization severity. More recently, Michal, et al., (2016) found that in a group of 223 patients with depersonalization-derealization syndrome, 44.7% reported emotional abuse, 12.3% physical abuse and 6.1% sexual abuse. ...
Article
Full-text available
Depersonalization is a common psychiatric symptom that remains understudied amongst Latino/Hispanic populations. There is evidence that depersonalization is relatively common among persons with a history of psychological trauma and interpersonal abuse. In this study we compared the frequency of depersonalization experiences in two group of adults: 40 patients with a history of interpersonal abuse (HIA), and a control community group (CCG) of 40 adults without HIA. Results indicated that the patients with HIA showed significantly higher scores on the Cambridge Depersonalization Scale (CDS). Moreover, 25% of the HIA group (vs. none of the CCG) obtained a score (>70) in the CDS that suggests the presence of a Depersonalization Disorder. Furthermore, as the frequency of abusive experiences increased, the scores on the CDS concomitantly increased, in many cases to clinical levels. Consistent with other international studies, we found a significant correlation between depersonalization and depressive symptoms as measured with the Patient Health Questionnaire-9. Results are consistent with the assertion that interpersonal abuse is intricately related with depersonalization and dissociative symptoms. RESUMEN La despersonalización es un síntoma psiquiátrico común que sigue sin estudiarse entre las poblaciones de latinos/hispanas. Existe evidencia de que la despersonalización es relativamente común entre personas con antecedentes de trauma psicológico y abuso interpersonal. En este estudio comparamos la frecuencia de experiencias de despersonalización en dos grupos de adultos: 40 pacientes con historial de abuso interpersonal (HAI) y un grupo de control comunitario (GCC) de 40 adultos sin HAI. Los resultados indicaron que los pacientes con HAI obtuvieron puntajes significativamente más altos en la Escala de Despersonalización de Cambridge (CDS). Además el 25% del grupo HAI (frente a ninguno de los GCC) obtuvo una puntuación (> 70) en el CDS lo que sugiere la presencia de un trastorno de despersonalización. Encontramos que a medida que aumentaba la frecuencia de experiencias abusivas, los puntajes en el CDS aumentaban concomitantemente, en muchos casos a niveles clínicos. De acuerdo con otros estudios internacionales, encontramos una correlación significativa entre la despersonalización y los síntomas depresivos medidos con el Cuestionario de Salud del Paciente (PHQ-9). Los resultados son consistentes con la afirmación de que el abuso interpersonal está íntimamente relacionado con la despersonalización y los síntomas disociativos.
... Individuals who are securely attached to their parents or have a close parent-child relationship generally report high levels of mindfulness (Goodall, Trejnowska, & Darling, 2012;Shaver, Lavy, Saron, & Mikulincer, 2007). However, when people develop insecure relationships with attachment figures (Stevenson, Emerson, & Millings, 2017) or experience emotional maltreatment or neglect in childhood (Michal et al., 2007), they may confront difficulties in developing mindfulness. Empirical evidence further showed that parental warmth was positively associated with mindfulness in adolescents (Pepping & Duvenage, 2016) and college students (Li, Zhang, Jiao, & Yang, 2019), whereas parental rejection was negatively associated with adolescent mindfulness (Pepping & Duvenage, 2016). ...
... The correlation analysis revealed that parental warmth was positively associated with mindfulness, while parental rejection was negatively associated with mindfulness. The results confirm the view that individual differences in mindfulness can be ascribed to the childhood experience and attachment processes (Michal et al., 2007;Ryan et al., 2007;Shaver et al., 2007). However, when parental warmth and parental rejection entered together in the regression model of mindfulness, the relationship between parental warmth and mindfulness became non-significant. ...
Article
Background Sleep quality plays a crucial role in children’s physical and mental health. Prior research has documented that parenting styles are closely associated with children’s sleep quality. However, the psychological processes underlying this relationship are less investigated. Objective Based on parental acceptance-rejection theory and the psychobiological inhibition model of insomnia, the current study aimed to examine the mediating roles of mindfulness and loneliness in the associations between parenting styles (i.e., parental warmth and parental rejection) and children’s sleep quality. Methods A questionnaire survey regarding parenting styles, mindfulness, loneliness, and sleep quality was administered to 475 Chinese children (Mage = 10.68 years, SDage = 1.15). Results Parental warmth was negatively associated with poor sleep quality, and parental rejection was positively associated with poor sleep quality. Structural equation modeling (SEM) analysis indicated that (a) loneliness, but not mindfulness, mediated the association between parental warmth and children’s sleep quality, and (b) mindfulness and loneliness exerted both unique and sequential mediating effects on the association between parental rejection and children’s sleep quality. Conclusion These findings shed light on possible mechanisms that can account for the associations between parenting styles and children’s sleep quality, and have implications for intervention strategies aimed at improving children’s sleep quality.
... However, especially in contrast with no significant results revealing that dream type per se was associated with changes in waking reflective awareness, our finding has substantially supported the possibility that a reflective component during dreaming might be carried forward into wakefulness and could have a significant effect on waking reflective awareness as well. According to a recent empirical study on depersonalization, mindfulness, and childhood trauma (Michal et al., 2007), although their measures only involved daily waking life, the severity of depersonalization was found to be negatively associated with mindfulness. ...
... There has been substantial research indicating that depersonalization (considered to be a major dissociative symptom) after loss and trauma was related to psychopathology (Giesbrecht, Merckelbach, Kater, & Sluis, 2007;Harvey & Bryant, 1998;Moskowitz, Schafer, & Dorahy, 2008;Simeon & Abugel, 2006;Sims & Sims, 1998;Watson, 2001). There is also evidence that, depersonalization during the waking state is not only associated with decreased mindfulness (Michal et al., 2007), but also related to rumination (Simeon & Abugel, 2006;Wolfradt & Engelmann, 1999), and impaired abilities to direct the focus of attention (Guralnik, Schmeidler, & Simeon, 2000) Third, the development of our measures of dream reflective awareness is still in its preliminary stage. Although our five factors (i.e., lucid mindfulness, dual perspectives, depersonalization, intra-dream self-awareness, and willed appearances) were replicated across two studies (Lee et al. (2007) and the present study), further revision might still be necessary. ...
Thesis
Full-text available
The objectives of this study were to explore (a) the relationships between dream reflective awareness and different types of impactful dreams, (b) the relationships between waking reflective awareness and dream reflective awareness following loss and trauma, and (c) the self-transformative potential of reflective awareness within dreams. We conducted a 2 (loss/trauma experiences) X 3 (timeframe: within the preceding 6 months, within the preceding 6-24 months, within the preceding 3-7 years) cross-sectional study to examine reflective awareness within impactful dreams and the changes in subsequent waking reflective awareness. The major results suggested that (a) only transcendent dreams were highly related to explicit dream lucidity (i.e., lucid mindfulness); (b) a continuity between pre-dream waking mindfulness and intra-dream self-awareness was specific to mundane dreams; (c) the experiences of loss or trauma and the timeframe of such experiences both predicted depersonalization within dreams; and (d) depersonalization within dreams was predictive of subsequent decreases in waking mindfulness. In sum, the present study replicated prior studies of the self-transformative effects of impactful dreams, demonstrated the continuity between dreaming and waking reflective awareness, and clarified the ways in which reflective awareness within dreams may affect post-traumatic growth.
... Jedyną próbę jego zbadania podjął Hunter [25], który wykazał jego skuteczność, ale badana grupa była zbyt mała, żeby móc uogólniać wyniki. Należy podkreślić, że działania opisane wyżej, czyli trening koncentracji na zadaniu, którego pokrewną formą jest medytacja mindfulness, może się okazać pomocny w leczeniu DP/ /DR, bo, jak pokazują dane korelacyjne [26], istnieje negatywna korelacja pomiędzy mindfulness (stopniem uważności danej osoby) a depersonalizacją. Dodatkowo, wyniki badań nad skutecznością terapii poznawczej fobii społecznej (posiadającej elementy wspólne z opisywanym wyżej modelem) pokazały, że skutecznie redukuje nasilenie depersonalizacji [27]. ...
... Autorzy modelu [53] podejmowali próbę jego sprawdzenia, jednak była ona przeprowadzona wśród zbyt małej liczby pacjentów, aby móc mówić o jakichkolwiek uogólnieniach. Istotne w nakreślaniu obrazu zaburzenia DP/DR są jego korelaty, wśród których warto wymienić wykorzystywanie emocjonalne [26], indywidualizm w sensie kulturowym, lęk przed utratą kontroli [54], zagrożone Ja [55] oraz ujemną korelację ze stopniem uważności (mindfulness). Warto tu zwrócić uwagę na dane płynące z analiz i wywiadów obszernych grup pacjentów zmagających się z zaburzeniem DP/DR. ...
Article
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Depersonalization is often characterized as a sense of unreality of self and the state of emotional numbing. Derealization, on the other hand, is defined as a sense of unreality of the environment and the alteration in its experience. This article discusses the current state of knowledge about the treatment and neurobiological/psychological aspects of this condition. In addition, the authors describe the problems which have to be faced by professionals who are dealing with these disorders. The difficulties which are discussed include: co-occurrence with other disorders, insufficient knowledge of patients and physicians, difficulty in describing symptoms, lack of clear treatment guidelines and unknown psychological and neurobiological background. The authors underline the need to take decisive steps towards better understanding and helping people with depersonalization/derealization disorder. As authors highlight, there is a clear expectation from patients to get a disorder-specific treatment, so that we should continuously widen our understanding in this field. In spite of the difficulties encountered, the authors note that the level of knowledge is constantly increasing, and depersonalization and derealization are becoming increasingly popular among professionals. This results in emerging new hopeful treatment methods such as rTMS, cognitive-behavioural therapy, of depersonalization and opioid antagonists, but they require further research.
... More specifically, mindfulness can be defined as Bthe state of being attentive to and aware of what is taking place in the present^ (Brown and Ryan 2003, p. 822). Survivors of childhood maltreatment, and potentially even more those who have experienced CCT, are likely to show lower levels of mindfulness (Michal et al. 2007). In the face of a traumatic event, the survivor is typically in a state of alarm, with his/her biological systems hyper activated as in survival mode, and traumatic memories (e.g., thoughts and feelings) tend to be embodied in the survivor's experience (Follette et al. 2004). ...
... Results support our main hypotheses that mindfulness and dissociation act as two distinct mediators of the association between CCT and depressive symptoms in adulthood. These findings are in line with Michal et al.'s (2007) postulate suggesting that dissociation and mindfulness are not simply opposite constructs, but distinct phenomena. Overall, our results showed that adults who experienced multiple forms of childhood traumas are more likely to avoid internal states that could be painful or upsetting, as reflected by lower mindfulness capacities and higher levels of dissociation. ...
Article
Full-text available
Considering the heightened risk of adults who have experienced childhood cumulative trauma (CCT) to suffer from depressive symptoms, the present study aimed to investigate mindfulness and dissociation as possible mechanisms implicated in this relationship. A total of 234 clients seeking psychotherapy for sexual and/or relational difficulties completed self-reported questionnaires as part of the evaluation phase within their treatment. The assessment tools evaluated the experience of childhood trauma, depressive symptoms, mindfulness levels, and dissociative symptoms. Results of structural equation modeling indicated that the link between CCT and depressive symptoms was fully mediated by both mindfulness and dissociation. In light of our results, it is recommended to assess systematically the presence of CCT, depressive symptoms, and dissociation in clients seeking help for sexual and/or relational issues, even though their primary motive may seem unrelated. Findings suggest that treatments focusing on fostering mindfulness might be beneficial in reducing depressive symptoms for individuals who experienced CCT.
... Psychological theories of DPD etiology have emphasized the role of mental escape from trauma during childhood [4,7]. However, empirical studies [42][43][44] are more consistent in suggesting noteworthy associations between childhood adversities and the severity of DPD symptoms. For example, depersonalized symptoms may play a mediating role between childhood trauma and psychological distress [44]. ...
Article
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Depersonalization/derealization disorder (DPD) is a prevalent yet inadequately understood clinical condition characterized by a recurrent or persistent sense of unreality. This study aims to provide insight into DPD through descriptive and comparative analyses involving a large group of Chinese participants. The socio-demographic details (age, gender proportion, education, occupational status, marital status), depersonalized and dissociative symptom characteristics (symptomatic factors or subscales of the Cambridge Depersonalization Scale and the Dissociative Experiences Scale), development trajectory (age of onset, potential precipitating factors, course characteristics), treatment history (duration of delayed healthcare attendance, duration of delayed diagnosis, previous diagnoses), and adverse childhood experiences of the DPD patients are presented. Comparisons of anxiety and depressive symptoms, alongside psychosocial functioning, between DPD participants and those diagnosed with generalized anxiety disorder, bipolar disorders, and major depressive disorder were conducted. The analysis highlights a higher male preponderance and early onset of DPD, symptomatology marked by derealization, notable impairment in psychosocial functioning, and prolonged periods of delayed healthcare attendance and diagnosis associated with symptom severity. Furthermore, noteworthy relationships between adverse childhood experiences and symptom levels were identified. The findings substantiate the view that DPD is a serious but neglected mental disorder, urging initiatives to improve the current condition of DPD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12888-024-06028-z.
... There are findings suggesting that decreased capacity for mindfulness is a mechanism through which trauma exposure mediates trauma symptoms and dissociation (Boughner et al., 2016;Michal et al., 2007;Thompson et al., 2011), and that increased mindfulness decreases the avoidance of trauma exposure and increases the efficacy of trauma exposure therapies (Lang et al., 2012;Thompson et al., 2011). ...
... Baer et al. (2006) found negative correlations between five mindfulness questionnaires (rs ranged from −.30 to −.53) and the Scale of Dissociative Activities (Mayer & Farmer, 2003). Relatedly, Michal et al. (2007) found a strong negative correlation (r = −.56) between the MAAS (Brown & Ryan, 2003), and depersonalization, as measured by the Cambridge Depersonalization Scale (Michal et al., 2004). Further research is needed to further clarify the relationships between fantasy proneness, mindfulness, and dissociation. ...
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The study explored relationships between fantasy proneness, dissociation, mindfulness, and anomalous sleep experiences in a sample (N = 306) of comic book convention attendees. Women (N = 60) reported significantly higher fantasy proneness, measured by the Inventory of Childhood Memories and Imaginings, compared to men (N = 246). Fantasizers (N = 35) reported lower mindfulness, measured by the Mindful Attention Awareness Scale, and higher dissociation, measured by the Dissociative Experiences Scale, compared to both medium (N = 33) and low (N = 36) fantasy prone groups. Fantasizers reported a higher frequency of anomalous sleep experiences, measured by the Iowa Sleep Experiences Survey (ISES), compared to the low group. Fantasy proneness was not correlated to mindfulness when controlling for shared variance with dissociation and absorption. A high fantasy proneness high mindfulness group reported approximately half the percentage of dissociative experiences compared to a high fantasy proneness low mindfulness group. Dissociation strongly correlated with fantasy proneness (r = .55) and inversely with mindfulness (r = −.55). Fantasy proneness and mindfulness combined accounted for 44% of variance in dissociation. When shared variance was removed, both variables contributed equivalent unique variance. Fantasy proneness, dissociation, and mindfulness combined accounted for 46% of variance in general sleep experiences and 9% of variance in lucid dreaming. When shared variance was removed, fantasy proneness was the strongest predictor of anomalous sleep experiences. Regressions on each ISES item found that fantasy proneness was the strongest contributor of unique variance for most items, followed by dissociation.
... Some studies have focused on the relationship between mindfulness and dissociation. A negative association between the two concepts was found in the general population (Baer et al., 2004;Perona-Garcelán et al., 2014;Vancappel et al., 2021;Walach et al., 2006), in patients suffering from auditory and verbal hallucinations (Escudero-Pérez et al., 2016), in patients suffering from PTSD (Kratzer et al., 2018;Vancappel, Reveillere, & El-Hage, submitted), and in patients suffering chronic pain (Michal et al., 2007). In accordance with our model, Vancappel et al. (2021, accepted) also found a mediating role of both emotional acceptance and attention-concentration in the relationship between mindfulness and dissociation. ...
... Im trudniejsze były to doświadczenia, tym większe nasilenie depersonalizacji. W innych badaniach uzyskano podobne wyniki: nasilenie DP w grupie nieklinicznej było powiązane z ogólnym wskaźnikiem traumy dziecięcej, ale przede wszystkim z emocjonalnym nadużyciem i zaniedbaniem (Aponte-Soto et al., 2019;Michal et al., 2007;Ó Laoide et al., 2018). W pracy Sara i wsp. ...
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The concepts of depersonalisation and derealisation refer to alteration in how an affected individual feels about oneself and their environment. Both these experiences may range from mild and episodic to severe and chronic. When clinically severe, these symptoms can be the basis for the diagnosis of depersonalisation-derealisation disorder; however, they are viewed as transdiagnostic, as they accompany various mental disorders. Literature emphasises the heterogeneous nature of the discussed construct, which includes several dimensions such as derealisation, somatopsychic depersonalisation, autopsychic depersonalisation and affective depersonalisation. This phenomenological complexity is reflected in the complex neurobiological mechanisms responsible for depersonalisation experiences, of which the theory of cortico-limbic inhibition is best described. Symptoms of depersonalisation and derealisation can be triggered by a variety of factors, such as physiological states (fatigue, stress, etc.), central nervous system abnormalities or psychoactive substances. In many cases, however, traumatic experiences are crucial, with most empirical evidence pointing to the role of emotional abuse and neglect. Trauma can alter responses of the autonomic nervous system, which mediates the symptoms of depersonalisation and derealisation (e.g. freeze response). The attachment style may be another mediator. Although depersonalisation and derealisation were conventionally assigned to the category of detachment, it has been suggested that they also bear features of compartmentalisation under certain circumstances. The analysis of the impact of various developmental processes on the formation of the complex phenomenon of depersonalisation sheds new light on the understanding of dissociative disorders and the importance of dissociation in psychopathology.
... In DSM-5, diagnostic criteria include experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (American Psychiatric Association 2013), p. 531-532. DDS has been characterized as a syndrome including feelings of being detached from one's own mental processes or body, or as a form of mental escape from the full experience of reality, i.e., to avoid intense unpleasant feelings like anxiety (Michal et al. 2007). In line, DDS has repeatedly been linked to anxiety spectrum disorders, especially social anxiety (Michal et al. 2005). ...
Article
3,4-methylenedioxymethamphetamine (MDMA/“ecstasy”) is widespread in the electronic club scene, but MDMA has also been suggested for the treatment of anxiety spectrum disorders like posttraumatic stress disorder (PTSD) and social anxiety in autistic adults. Here, we report a case of a high functioning 24-old student with a sporadic recreational use of ecstasy, and a history of a single episode of obsessive-compulsive disorder (OCD). A few days after using ecstasy during a period of stressful life events, he developed a complex depersonalization/derealization syndrome (DDS) including intermittent distortions of time and very short intermittent episodes of misidentification of persons. Furthermore, obsessive thoughts reappeared and he suffered a panic attack for the first time in his life. Under combined pharmacological treatment and psychotherapy, symptoms gradually subsided until full remission after 14 months. Some months after discontinuation of escitalopram, however, panic attacks recurred, evolving into a regular pattern. Even if MDMA is a promising tool for the treatment of some anxiety spectrum disorders in the framework of substance-assisted psychotherapy, the use of ecstasy might be also harmful for some patients with a history of anxiety or dissociative symptoms, when used recreationally or as a self-medication outside of a controlled clinical setting.
... DPD has a prevalence of about 1-2% of the population (Hunter et al., 2004;Lee et al., 2012;Michal et al., 2007), which is comparable to that of schizophrenia and obsessivecompulsive disorder, with an equal gender ratio and an average onset age in early adulthood Michal et al., 2016;Simeon, 2004;Simeon et al., 2003). Nevertheless, DPD is one of the most prevalent but under-diagnosed psychiatric disorders (Hunter et al., 2017;Michal et al., 2010). ...
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Depersonalisation/derealisation disorder (DPD) refers to frequent and persistent detachment from bodily self and disengagement from the outside world. As a dissociative disorder, DPD affects 1-2% of the population, but takes 7-12 years on average to be accurately diagnosed. In this systematic review, we comprehensively describe research targeting the neural correlates of core DPD symptoms, covering publications between 1992 and 2020 that have used electrophysiological techniques. The aim was to investigate the diagnostic potential of these relatively inexpensive and convenient neuroimaging tools. We review the EEG power spectrum, components of the event-related potential (ERP), as well as vestibular and heartbeat evoked potentials as likely electrophysiological biomarkers to study DPD symptoms. We argue that acute anxiety- or trauma-related impairments in the integration of interoceptive and exteroceptive signals play a key role in the formation of DPD symptoms, and that future research needs analysis methods that can take this integration into account. We suggest tools for prospective studies of electrophysiological DPD biomarkers, which are urgently needed to fully develop their diagnostic potential.
... Some authors suggest that mindfulness-based interventions could be appropriate for treating dissociative symptoms (Cloitre, Petkova, Wang & Lu Lassell, 2012;Forner, 2018;Frewen, Lanius, van der Kolk & Spiegel, 2015;Zerubavel & Messman-Moore, 2015). To date, only a few studies have been conducted on the links between dissociation and mindfulness; a negative correlation has been found between mindfulness and dissociation in the general population (Baer, Smith & Allen, 2004;Perona-Garcel an et al., 2014;Walach, Buchheld, But-tenm€ uller, Kleinknecht & Schmidt, 2006), among patients suffering from auditory and verbal hallucinations (Escudero-P erez et al., 2016), among patients suffering from Post-Traumatic Stress Disorder (Kratzer et al., 2018), and among patients suffering chronic pain Michal et al., (2007). Those results suggest that the more patients have mindfulness abilities, the less they have dissociative symptoms. ...
Article
Background Dissociation can be defined as a disruption in the usually integrated functions of consciousness, memory, identity, and perception of the environment. Previous studies have reported the negative correlation between mindfulness and dissociation. Some authors have also suggested that mindfulness-based interventions may be relevant psychotherapeutic tools to treat dissociative symptoms. According to Bishop et al.’s model of mindfulness, two processes are involved in mindfulness-based interventions: self-regulation of attention, and acceptance of internal experiences. The aim of this study was to identify which of these mechanisms mediate the link between mindfulness and dissociation in a non-clinical sample. Method We recruited 312 healthy volunteers (269 women, mean age 29.5±12.8, mean years of higher education 3.37±2.48) who completed online questionnaires to assess history of childhood trauma, dissociative experiences, emotion regulation abilities, cognitive difficulties, attention control, and mindfulness abilities. Results We found significant negative correlations between mindfulness and dissociation, and positive correlations between dissociation, attention and emotional acceptance. We also found significant correlations between mindfulness, attention and emotional acceptance. The causal steps approach revealed a reduction of the variance of dissociation explained by mindfulness when attention and emotional acceptance were added. The bootstrapping analysis confirmed the mediating role of attention and emotional acceptance in the link between mindfulness and dissociation. Discussion The results suggest that the link between dissociation and mindfulness may be mediated by attention and emotional acceptance. This is consistent with the model proposed by Bishop et al. (2004). Specific exercises targeting attentional control and emotional acceptance are indicated to treat dissociative symptoms.
... With regard to evidence of divergent validity, negative correlations were found between the scores on the DCI subscales and the MAAS mindfulness scale, which measure opposite constructs. This result is coherent with other studies done both in general and psychiatric populations (more specifically with other studies in psychosis) in which a negative correlation was found between mindfulness and dissociation in general, 35 mindfulness and depersonalization 36 and mindfulness and depersonalization and absorption. 37 Similarly, for evidence of construct validity, on one hand, we found no differences in the strength of the association between the two DCI subscales and the total score on the DES-II, but on the other, there were differences in the association with the DES-Taxon and the SDQ-20. ...
Article
Introduction Dissociative symptoms are a type of phenomenon which is present in a wide variety of psychopathological disorders. It is therefore necessary to develop scales that measure this type of experience for therapy and research. Starting out from the bipartite model of dissociation, this study intended to adapt and validate the Detachment and Compartmentalization Inventory (DCI) in Spanish. Material and methods For this, 308 participants (268 from the community population and 40 with psychiatric pathology) completed the DCI, the Dissociative Experiences Scale (DES-II), the Somatoform Dissociation Questionnaire (SDQ20) and the Mindfulness Attention Awareness Scale (MAAS). Results The results showed that the Spanish version has a two-factor structure similar to the original version and was invariant across participants. The reliability of DCI scores was adequate and acquired evidence of validity related to other instruments. Conclusions It is concluded that the DCI is a valid scale for detecting detachment and compartmentalization dissociative experiences, both in the clinic and research.
... For instance, one dominant theory to explain emotional numbing in DPD defines a threshold for the level of anxiety (or any unpleasant salient stimuli) in which the emotional processing units, including anterior insula and amygdala, stop translating emotions into perceived feelings, and DPD is associated with abnormalities in triggering that threshold [3,21]. Nevertheless, there is no laboratory method to diagnose dissociative disorders at the moment, and due to the considerable circulation of DPD (1-2% [13,22,23]), it is believed to be one of the most prevalent yet under-diagnosed psychological disorders [9,24]. Since there are also overlaps between DPD and other psychological disorders such as depression and post-traumatic stress Detachment of the self from its surroundings Other symptoms and processing differences Impaired attentional functioning and processing speed or perceptual organisation disorder (PTSD) [25], it currently takes seven to 12 years for DPD to be correctly diagnosed [9]. ...
... Other correlations with trauma-related disorders as well as depersonalization were also noted. Levels of mindfulness attention and awareness were significantly negatively associated with the symptom severity levels of posttraumatic stress disorder (PTSD), psychiatric comorbidity, arousal of anxiety, and anhedonia depression symptoms (Bernstein et al. 2011;Michal et al. 2007). Additionally, mindfulness as a trait was also inversely correlated with anxiety and depression in healthy individuals (Antonova et al. 2016). ...
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We aimed to evaluate the mindfulness trait, its relations to perceived stress, and whether they change as a result of outpatient psychiatric non-mindfulness treatment among 21 patients with psychiatric disorders. Perceived stress (Perceived Stress Scale, PSS) and mindfulness trait (Five Facet Mindfulness Questionnaire, FFMQ) questionnaires were administered to patients with psychiatric disorders on admission and following 6 weeks of treatment. The Clinical Global Impression Severity scale (CGI-S) was also assessed. Repeated measures were used to assess variables that related to changes in the PSS and FFMQ scores over time. On admission, the PSS score was inversely correlated with the FFMQ score, and it was higher among patients with current pain and a CGI-S score ≥ 5. The PSS score declined, and the "non-judge" domain of the five sub-scores of the FFMQ score increased after 6 weeks of treatment. An interaction between change in "non-judge" scores and the CGI-S score at baseline showed that scores improved among the severe (CGI-S ≥ 5) group only, achieving comparable scores after 6 weeks. Stress lowered following treatment but the mindfulness trait remained unchanged and probably needs specific intervention.
... Identifying DPD, as well as its risks and neuroprotective factors, at early stages should thus be a 6 critical endeavour for clinical practice and research. 7 DPD has a prevalence of about 1-2% of the population (Hunter et al., 2004;Lee et al., 8 2012;Michal et al., 2007), which is comparable to that of schizophrenia and obsessive-9 compulsive disorder, with an equal gender ratio and an average onset age in early adulthood 10 Michal et al., 2016;Simeon, 2004;Simeon et al., 2003). Nevertheless, DPD 11 is one of the most prevalent but under-diagnosed psychiatric disorders (Hunter et al., 2017;12 Michal et al., 2010). ...
Article
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Depersonalisation/derealisation disorder (DPD) refers to frequent and persistent detachment from bodily self and disengagement from the outside world. As a dissociative disorder, DPD affects 1-2% of the population, but takes 7- 12 years on average to be accurately diagnosed. In this systematic review, we comprehensively describe research targeting the neural correlates of core DPD symptoms, covering publications between 1992 and 2020 that have used electrophysiological techniques. The aim was to investigate the diagnostic potential of these relatively inexpensive and convenient neuroimaging tools. We review the EEG power spectrum, components of the event-related potential (ERP), as well as vestibular and heartbeat evoked potentials as likely electrophysiological biomarkers to study DPD symptoms. We argue that acute anxiety- or trauma-related impairments in the integration of interoceptive and exteroceptive signals play a key role in the formation of DPD symptoms, and that future research needs analysis methods that can take this integration into account. We suggest tools for prospective studies of electrophysiological DPD biomarkers, which are urgently needed to fully develop their diagnostic potential.
... (Sierra, 2009, p. 125) Such a third-person viewpoint would engender a significant constriction in the field of conscious awareness and a decrease in the intensity of self-experiencing (Lowen, 2004;Milrod, 2002). Indeed, patients suffering with chronic depersonalization exhibit an increased tendency to become absorbed in mental images (Humpston et al., 2016;Levin, Sirof, Simeon, & Guralnick, 2004) and to be less aware of bodily states and surroundings (Michal et al., 2007). Another finding compatible with the idea that in depersonalization self-related imagery is experienced predominantly in the third person, is that patients with chronic depersonalization experience difficulties imagining themselves carrying out a series of bodily actions (e.g., walking, jumping), but not when imagining somebody else carrying out the behavior in question (Lambert et al., 2001). ...
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Identification, in Western psychology, refers to an unconscious tendency to create a relationship of identity between oneself and significant others and is thought to be crucial for healthy psychological development. Within Eastern traditions, however, identification is viewed as a wider encompassing phenomenon, capable of occurring with any mental content and as an obstacle toward experiencing the true nature of the self. We developed the Self-with-Mind Identification Scale (SMIS) to measure a person’s tendency to identify with both external objects as well as mental images, thoughts and emotions. We administered the scale to university students (N � 260) alongside measures of well-being, attentive awareness, dissociation, and depersonalization. As predicted, a comparison of low versus high identification scorers revealed the former to score significantly higher on well-being and attentive awareness, but significantly lower on dissociation and depersonalization. To further examine the construct validity of the SMIS, we conducted an exploratory factor analysis on an extended sample (N � 430). A 5-factor solution provided evidence for construct validity as well as the importance of emotional feelings in identification. Our findings support the validity of a more encompassing concept of identification and implicate further research regarding identification as a way to better understand self-awareness and its anomalies. Keywords: identification, depersonalization, dissociation, self-awareness, self-objectification
... Thompson and Waltz also found that components of mindfulness (i.e., nonjudgment of experiences, describing experiences, acting with awareness, and nonreactivity) were significantly negatively associated with experiential avoidance. Regarding dissociation, there is evidence of a significant inverse relationship between mindfulness and depersonalization, a form of dissociation [40,43]. ...
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Objectives: The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population. Method: Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness. Results: Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = -.70, p < .001, 95% CI [-.58, -79], and SLEs were significantly positively related to PTSD symptom severity, r(86) = .29, p = .003, 95% CI [.09, .47]. Mindfulness was an independent predictor of PTSD symptom severity after accounting for SLEs, B = -1.16, t(84) = -9.06, p < .001, 95% CI [-1.41, -0.90], and SLEs were an independent predictor of PTSD symptom severity after accounting for mindfulness, B = 0.49, t(84) = 2.92, p = .004, 95% CI [0.16, 0.82]. Mindfulness did not moderate the relation between SLEs and PTSD symptom severity, B = -.003, t(84) = -0.15, p = .89, 95% CI [-.04, .03]. Implications: This study has implications for both mindfulness as a potential protective factor against PTSD symptom severity and SLEs as a potential risk factor for increased PTSD symptom severity in African-American urban adolescents.
... Depending on such experiences, it is stated that children develop behavioral patterns such as rapid response to trauma, avoidance, helplessness, and destructive behaviors and transfer these patterns to future developmental stages through cognitive schemas (Glaser, Van Os, Portegijs, Myin-Germeys, 2006).Childhoodadolescent traumas may cause various psychiatric problems both in the short term and in adulthood (Ellason, Ross, 1997). It is stated that the research results showing the relationship between childhood neglect and abuse and the occurrence of psychiatric disorder throughout the life of the individual are increasing (Michal, Beutel, Jordan, Zimmermann, Wolters, Heidenreich, 2007). Studies emphasize that traumas may increase the risk of neurobiological changes and psychiatric disorders in adulthood (Alvarez, Roura, Osés, Foguet, Sola, Arrufat, 2011). ...
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Foreign language textbook, intercultural approach
... Most experiences of dissociation entail symptoms of depersonalization, which refers to self-related alterations including emotion processing, perception, and body experience. Dissociation in the form of depersonalization correlates significantly with the levels of reported childhood trauma (Michal et al., 2007;Simeon, Guralnik, Schmeidler, Sirof, & Knutelska, 2001). However, the causal relationships underlying this association have been widely debated (see Dalenberg et al., 2012;Lynn et al., 2014). ...
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Background: Childhood trauma severity is associated with the level of subsequent substance use as well as with the self-reported severity of dissociation. Classic psychedelics and dissociatives target neurotransmitter systems thought to be involved in the onset of dissociative symptoms and may evoke severe and long-lasting symptoms of depersonalization in some users. However, it is currently unclear whether drug use puts people with a history of childhood trauma at higher risk of developing dissociative symptoms. Objectives: The current study investigates whether the one-year prevalence of substance use significantly moderates the link between childhood trauma and the severity of depersonalization. Methods: Participants (n = 297, of which 80.2% were active users) filled out an online self-report questionnaire including the Childhood Trauma Questionnaire (CTQ), the Cambridge Depersonalisation Scale (CDS), and information about their substance use. Results: Results indicate that childhood trauma and substance use are significant individual predictors of dissociation scores in this sample, but no moderation of substance use on the link between childhood trauma and depersonalization was established. Conclusions: It is hypothesized that the quality (particularly the context) of the experience of substance use rather than the sheer quantity may be responsible for the manifestation of depersonalization.
... On the other side, some researchers argued that childhood abuse and neglect have also indirect effects on psychological problems through disrupting certain processes (Barlow, 2002;Wright et al., 2009). These variables, which mediate the relationship between childhood traumatic experiences and psychological problems, are emotion regulation difficulties (Gratz et al., 2007;Soenke et al., 2010), dissociation (Michal et al., 2007), cognitive distortions (Gibb et al., 2001;Wright et al., 2009) and experiential avoidance that can be conceptualized as unwillingness to experience emotions, and finally thoughts and body sensations (Polusny et al., 2004;Tull et al., 2004). ...
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Mindfulness is a recent interesting concept that is known to be a protective trait in terms of psychological well-being (Bränström et al., 2011) and it is being used as a psychological intervention method (Kimbrough et al., 2010). The main purpose of this study was to examine the direct effect of childhood traumatic experiences on trait anxiety as well as its indirect (mediated) effect through mindfulness. The sample of the study consisted of 467 participants; 264 female (56.5%) and 203 male (43.5%). The average age of the sample was 22.89 (SD = 3.34). Demographic Information Form, Childhood Trauma Questionnaire, Mindful Attention Awareness Scale and Trait Anxiety Inventory were used to collect data. The mediator role of the mindfulness was examined with PROCESS macro by Hayes (2013). Results indciated that mindfulness plays a mediating role between childhood abuse and neglect experiences and trait anxiety. Consequently, studying childhood traumatic experiences and trait anxiety with mindfulness is thought to provide a comprehensive explanation on this issue. It could also provide valuable knowledge and insights on intervention and prevention studies. Key words: Mindfulness, trait anxiety, childhood traumatic experiences
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This study explores the relationship between depersonalization symptoms, social touch seeking and acceptance, self-concept clarity, and psychological factors in a large sample of Argentinian participants (N = 273). In this online study, we assessed participants' acceptance of (or willingness to receive) touch from strangers, friends/family, and intimate partners. Replicating previous studies, we found a higher acceptance of touch from closer social bonds. Touch acceptance from intimate partners showed weak links with self-concept clarity and lower depersonalization symptoms. However, no definitive link between depersonalization symptoms and touch seeking or acceptance was found. Higher depersonalization symptoms were associated with increased social touch avoidance and decreased self-concept clarity. Mediation analyses indicated that social touch avoidance partially mediates the relationship between depersonalization and self-concept clarity. Additionally, depersonalization was associated with higher levels of anxiety, depression, and negative affect, and lower levels of positive affect and life satisfaction. Our results underscore the importance of considering touch in creating therapeutic interventions for depersonalization.
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We present novel research on the cortical dynamics of atypical perceptual and emotional processing in people with symptoms of depersonalization–derealization disorder (DP-DR). We used electroencephalography (EEG)/event-related potentials (ERPs) to delineate the early perceptual mechanisms underlying emotional face recognition and mirror touch in adults with low and high levels of DP-DR symptoms (low-DP and high-DP groups). Face-sensitive visual N170 showed markedly less differentiation for emotional versus neutral face–voice stimuli in the high- than in the low-DP group. This effect was related to self-reported bodily symptoms like disembodiment. Emotional face–voice primes altered mirror touch at somatosensory cortical components P45 and P100 differently in the two groups. In the high-DP group, mirror touch occurred only when seeing touch after being confronted with angry face–voice primes. Mirror touch in the low-DP group, however, was unaffected by preceding emotions. Modulation of mirror touch following angry others was related to symptoms of self–other confusion. Results suggest that others’ negative emotions affect somatosensory processes in those with an altered sense of bodily self. Our findings are in line with the idea that disconnecting from one's body and self (core symptom of DP-DR) may be a defence mechanism to protect from the threat of negative feelings, which may be exacerbated through self–other confusion. This article is part of the theme issue ‘Sensing and feeling: an integrative approach to sensory processing and emotional experience’.
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Introduction: A number of studies have investigated the relationship between mindfulness and dissociation and suggested that mindfulness-based interventions could be effective in the treatment of dissociative symptoms. A recent study in healthy volunteers found that attention and emotional acceptance mediates this relationship. However, no study has yet been performed among a clinical sample to assess this association. Method: We recruited 90 patients (76 women) suffering from Posttraumatic Stress Disorder (PTSD). They completed self-report questionnaires to measure PTSD, dissociation, emotion regulation difficulties, childhood trauma, mindfulness abilities and cognitive abilities. Results: We found that mindfulness abilities, emotional difficulties, dissociation and attention-concentration were all related to each other. Using a step-by-step approach and bootstrapping techniques, we found a significant indirect effect of mindfulness abilities on dissociation through non-acceptance (confidence interval 95%=-.14 to -.01) and attentional difficulties (confidence interval 95%=-.23 to -.05). Conclusion: Patients with higher levels of dissociative symptoms have less capacity for mindfulness. Our results support Bishop et al.'s model proposing that attention and emotional acceptance are the two active components of mindfulness. To extend our findings, clinical trials are required to evaluate a causal relationship and the effectiveness of mindfulness-based interventions for patients suffering from dissociation.
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Our ability to regulate our emotions plays a key protective role against psychological distress and somatic symptoms, with most of the literature focusing on the role of cognitive reappraisal in interventions such as cognitive behavioral therapy (CBT). This study seeks to examine the relationship between emotion dysregulation and psychological and physical distress in university students through the role of depersonalization (DP) and insecure attachment. This study will try to explain the deployment of DP as a defense mechanism to insecure attachment fears and overwhelming stress, developing a maladaptive emotion responding strategy, which affects wellbeing later in life. A cross-sectional design was used on a sample (N = 313) of university students over the age of 18 which consisted of an online survey of 7 questionnaires. Hierarchical multiple regression and mediation analysis were conducted on the results. The results showed that emotion dysregulation and DP predicted each variable of psychological distress and somatic symptoms. Both insecure attachment styles were found to predict psychological distress and somatization, mediated through higher levels of DP, whereby DP may be deployed as a defense mechanism to insecure attachment fears and overwhelming stress, which affects our wellbeing. Clinical implications of these findings highlight the importance of screening for DP in young adults and university students.
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This article summarises research into mindfulness and the benefits it has for wellbeing. This is evaluated in the context of secure children’s homes (SCHs), drawing upon personal experiences of leading mindfulness sessions to discuss whether mindfulness could be useful in these settings.
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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.
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This study's goal was to systematically investigate attachment styles in Depersonalization Disorder (DDD), and their relationship to dissociation severity and childhood trauma history. Forty-two participants with DSM-IV DDD and 53 healthy controls (HC) without lifetime Axis I and II disorders were administered the Relationships Questionnaire and the Relationship Scales Questionnaire, based on Bartholomew's anxiety-avoidance orthogonal model of secure, dismissive, preoccupied, and fearful attachment; the Dissociative Experiences Scale; and the Childhood Trauma Questionnaire. DDD was characterized by a significantly higher prevalence of insecure attachment (66.7%) compared to controls (34.0%), largely accounted for by fearful attachment (45.2% of all DDD participants). In the DDD group, of the four attachment styles only fearful was predictive of both normative and pathological dissociation, accounting for 17% - 18% of the variance. Childhood trauma made a significant hierarchical contribution to the prediction of dissociation beyond fearful attachment, and the effect of fearful attachment on dissociation was indirectly mediated by childhood trauma. In the control group, dissociation was predicted by fearful attachment but was not associated with childhood trauma. Implications of the findings are discussed, highlighting the potentially important role of trauma-based relational fear in this dissociative disorder.
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From a behavioral perspective, dissociation is an avoidant behavior precipitated by difficult life events such as abuse or neglect in childhood. Psychological inflexibility has been proposed as a mechanism carrying the relationship between adverse childhood experiences (ACEs) and their negative consequences. Using cloud source data collected from Amazon's Mechanical Turk (MTurk), this project examined whether psychological inflexibility mediated the relationship between ACEs and dissociation. Psychological inflexibility had a mediational effect on the positive association between ACEs and dissociation. Post hoc analyses, using a parallel mediation model, revealed cognitive fusion mediated the relationship between ACEs and dissociation, whereas experiential avoidance did not. These results provide preliminary evidence suggesting cognitive fusion uniquely contributes to the development of psychological dissociation, even when controlling for experiential avoidance. Implications are discussed.
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Aim The objective of this study was to explore how clients with severe dissociative symptoms describe their experiences of being present in their everyday life. The data in this study stems from a large study conducted at a trauma–outpatient clinic in (LOCATION REMOVED FOR PEER REVIEW). Method 16 participants underwent in-depth interviews six months after a twenty- week group treatment based on psychoeducational stabilization for dissociative disorders. These interviews and participants were part of a larger study, and the interviews in this article are the first 16 of many interviews. Hermeneutic-phenomenological thematic analysis was used to analyze the transcripts. Results Four themes were identified: 1)“Being present: To be here and now, and remember it afterward,” 2)“ To not be present: avoiding challenges but challenged by their inner life,” 3)“Being present in a Fragmented Sense of Self,” and 4)“Bearing the consequences of not being present in your own life.” Discussion The findings are discussed in relation to existing theory and research, and reflexivity in the process and limitations of the study are considered. Conclusion The results indicate that the experience of being present is an important part of the struggles the participants describe in their everyday lives, as well as a part of the challenges of living with a dissociative disorder. Implications The findings indicate that focusing on the ability of staying present could be an important part of treatment of and how we meet and understand dissociative disorders.
Article
Childhood maltreatment has been consistently associated with adult symptoms of depression, anxiety, and dissociation, and attachment has been proposed as one mediator. Attachment, however, tends to only partially mediate the association, and mindfulness may be another explanatory pathway. The current study examined mindfulness and attachment in a multiple mediator model linking maltreatment to adult symptoms of depression, anxiety, and dissociation. A sample of 232 adults were recruited from two universities and an online sample who completed an online survey. Using structural equation modeling, childhood maltreatment was indirectly associated to symptoms of depression (ß = .104; 95% CI [.015, .193]), anxiety (ß = .090; 95% CI [.014, .166]), and dissociation (ß = .088; 95% CI [.006, .170]) through mindfulness. Additionally, childhood maltreatment was associated with symptoms of depression (ß = .062; 95% CI [.007, .118]), anxiety (ß = .074; 95% CI [.009, .139]), and dissociation (ß = .069; 95% CI [.017, .121]) through attachment avoidance. No significant indirect effects were found through attachment anxiety. These findings indicate that both mindfulness and attachment may be explanatory pathways linking childhood maltreatment. Inclusion of both attachment and mindfulness provides a more robust theoretical understanding of how maltreatment is associated with adult mental health.
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This article reports on mixed methods research into intimate partner violence (IPV) and women’s mental health. Using an online national survey and life history interviews, quantitative and qualitative data analysis demonstrates how IPV negatively impacts women’s sense of self, with other multiple losses in relation to income, work, housing, and social participation further undermining recovery into the long term. The feminist concept of sexual politics is used to critically examine current responses to mental health problems after IPV, and a feminist-informed response is outlined that addresses the gender inequalities underpinning IPV and the psychological distress it produces.
Article
Body ownership, i.e., the certainty that own body parts belongs to oneself, is a fundamental feature of self-consciousness. Patients with borderline personality disorder (BPD) often show symptoms of dissociation, describing a state of detachment from reality including their own body. However, up to now, there is no study that a) quantifies body ownership experiences in BPD, b) compares these experiences between the current and the remitted state of the disorder, and c) relates this kind of experience specifically to dissociation. In the present study, we assessed ownership for 25 body areas in current BPD patients (cBPD) and compared their ratings with those of remitted BPD patients (rBPD) and healthy controls (HC). We further related body ownership to dissociation and other relevant BPD markers on body area and subject level by applying multi-level analyses in the cBPD group. We found significantly reduced body ownership experiences in cBPD compared to HC, while there were no significant differences between these groups and rBPD. In cBPD, reduced body ownership was significantly related to dissociation when controlled for other BPD core features. Reduced body ownership might thus constitute a relevant marker for dissociation in current BPD which could further represent a target for therapeutic approaches.
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Claims of amnesia and dissociative experiences in association with a violent crime are not uncommon. Research has shown that dissociation is a risk factor for violence and is seen most often in crimes of extreme violence. The subject matter is most relevant to forensic psychiatry. Peritraumatic dissociation for instance, with or without a history of dissociative disorder, is quite frequently reported by offenders presenting for a forensic psychiatric examination. Dissociation or dissociative amnesia for serious offenses can have legal repercussions stemming from their relevance to the legal constructs of fitness to stand trial, criminal responsibility, and diminished capacity. The complexity in forensic psychiatric assessments often lies in the difficulty of connecting clinical symptomatology reported by violent offenders to a specific condition included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This article provides a review of diagnostic considerations with regard to dissociation across the DSM nomenclature, with a focus on the main clinical constructs related to dissociation. Forensic implications are discussed, along with some guides for the forensic evaluator of offenders presenting with dissociation.
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Depersonalization disorder is characterized by a detachment from one's sense of self and one's surroundings that leads to considerable distress and impairment yet an intact testing of reality. Depersonalized individuals often report difficulties in perception, concentration, and memory; however, data on their cognitive profiles are lacking. Fifteen patients with depersonalization disorder were compared to 15 matched normal comparison subjects on a comprehensive neuropsychological test battery that assessed cognitive function. The subjects with depersonalization disorder showed a distinct cognitive profile. They performed significantly worse than the comparison subjects on certain measures of attention, short-term visual and verbal memory, and spatial reasoning within the context of comparable intellectual abilities. The authors propose that depersonalization involves alterations in the attentional and perceptual systems, specifically in the ability to effortfully control the focus of attention. These early encoding deficits are hypothesized to have a deleterious effect on the short-term memory system; they manifest as deficits in the ability to take in new information but not in the ability to conceptualize and manipulate previously encoded information.
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From a review of the literature on meditation and depersonalization and interviews conducted with six meditators, this study concludes that: 1) meditation can cause depersonalization and derealization; 2) the meanings in the mind of the meditator regarding the experience of depersonalization will determine to a great extent whether anxiety is present as part of the experience; 3) there need not be any significant anxiety or impairment in social or occupational functioning as a result of depersonalization; 4) a depersonalized state can become an apparently permanent mode of functioning; 5) patients with Depersonalization Disorder may be treated through a process of symbolic healing--that is, changing the meanings associated with depersonalization in the mind of the patient, thereby reducing anxiety and functional impairment; 6) panic/anxiety may be caused by depersonalization if catastrophic interpretations of depersonalization are present.
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Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. Scale items were developed using clinical data and interviews, scales involving memory loss, and consultations with experts in dissociation. Pilot testing was performed to refine the wording and format of the scale. The scale is a 28-item self-report questionnaire. Subjects were asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. In addition, demographic information (age, sex, occupation, and level of education) was collected so that the connection between these variables and scale scores could be examined. The mean of all item scores ranges from 0 to 100 and is called the DES score. The scale was administered to between 10 and 39 subjects in each of the following populations: normal adults, late adolescent college students, and persons suffering from alcoholism, agoraphobia, phobic-anxious disorders, posttraumatic stress disorder, schizophrenia, and multiple personality disorder. Reliability testing of the scale showed that the scale had good test-retest and good split-half reliability. Item-scale score correlations were all significant, indicating good internal consistency and construct validity. A Kruskal-Wallis test and post hoc comparisons of the scores of the eight populations provided evidence of the scale's criterion-referenced validity.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.
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Mindfulness is an attribute of consciousness long believed to promote well-being. This research provides a theoretical and empirical examination of the role of mindfulness in psychological well-being. The development and psychometric properties of the dispositional Mindful Attention Awareness Scale (MAAS) are described. Correlational, quasi-experimental, and laboratory studies then show that the MAAS measures a unique quality of consciousness that is related to a variety of well-being constructs, that differentiates mindfulness practitioners from others, and that is associated with enhanced self-awareness. An experience-sampling study shows that both dispositional and state mindfulness predict self-regulated behavior and positive emotional states. Finally, a clinical intervention study with cancer patients demonstrates that increases in mindfulness over time relate to declines in mood disturbance and stress.
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A self-report inventory for the assessment of mindfulness skills was developed, and its psychometric characteristics and relationships with other constructs were examined. Participants included three samples of undergraduate students and a sample of outpatients with borderline personality disorder. Based on discussions of mindfulness in the current literature, four mindfulness skills were specified: observing, describing, acting with awareness, and accepting without judgment. Scales designed to measure each skill were developed and evaluated. Results showed good internal consistency and test-retest reliability and a clear factor structure. Most expected relationships with other constructs were significant. Findings suggest that mindfulness skills are differentially related to aspects of personality and mental health, including neuroticism, psychological symptoms, emotional intelligence, alexithymia, experiential avoidance, dissociation, and absorption.
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Psychoanalytical theories coincide in understanding depersonalization (DP) as a disorder of narcissistic self-regulation. DP is described as an ego defense against overwhelming shame resulting in a splitting of an observing ego detached from the experiencing self. In contrast to a behavioral-cognitive theory on DP, which suggests that the catastrophic appraisal of normal transient DP maintains the disorder, psychodynamic approaches stress that DP is an important defensive function for the individual. We examine this psychodynamic aspect more closely as it relates to narcissistic self-regulation and interpersonal behavior in depersonalized patients. Thirty-five patients with pathological DP are compared with 28 patient controls concerning their narcissistic self-regulation and interpersonal behavior. For the assessment, we used the German Narcissism Inventory and the Inventory of Interpersonal Problems. The two groups were controlled for sociodemographic data, comorbidity with a personality disorder, and the General Severity Index of the Symptom Check List-90-R. Bonferroni-corrected group comparison showed that the depersonalized patients are characterized by perceiving themselves as helpless, hopeless, socially isolated and worthless, perceiving others as bad and disappointing, and that they avoid interpersonal relations and reality significantly more than other patients with equal symptom severity. Treatment approaches on DP should take the issue of low self-esteem, pervasive shame and the related defensive social avoidance into account. Further empirical research on psychodynamic concepts of DP is warranted also for the sake of linking modern neurobiological findings with clinical experience.
Article
Objectives: This study examined the construct and criterion validity of the Mindful Attention Awareness Scale (MAAS) in cancer outpatients, using matched community members as controls. Methods: Cancer outpatients (n = 122) applying for enrollment in a mindfulness-based stress reduction (MBSR) program completed the MAAS and measures of mood disturbance and stress. Local community members (n = 122) matched to the patients on gender, age, and education level completed the same measures. Results: The single-factor structure of the MAAS was invariant across the groups. Higher MAAS scores were associated with lower mood disturbance and stress symptoms in cancer patients, and the structure of these relations was invariant across groups. Conclusions: The MAAS appears to have appropriate application in research examining the role of mindfulness in the psychological well-being of cancer patients, with or without comparisons to nonclinical controls. (c) 2005 Elsevier Inc. All rights reserved.
Article
Depersonalisation disorder is characterised by prominent depersonalisation and often derealisation, without clinically notable memory or identity disturbances. The disorder has an approximately 1: 1 gender ratio with onset at around 16 years of age. The course of the disorder is typically long term and often continuous. Mood, anxiety and personality disorders are often comorbid with depersonalisation disorder but none predict symptom severity. The most common immediate precipitants of the disorder are severe stress, depression and panic, and marijuana and hallucinogen ingestion. Depersonalisation disorder has also been associated with childhood interpersonal trauma, in particular emotional maltreatment. Neurochemical findings have suggested possible involvement of serotonergic, endogenous opioid and glutamatergic NMDA pathways. Brain imaging studies in depersonalisation disorder have revealed widespread alterations in metabolic activity in the sensory association cortex, as well as prefrontal hyperactivation and limbic inhibition in response to aversive stimuli. Depersonalisation disorder has also been associated with autonomic blunting and hypothalamic-pituitary-adrenal axis dysregulation. To date, treatment recommendations and guidelines for depersonalisation disorder have not been established. There are few studies assessing the use of pharmacotherapy in this disorder. Medication options that have been reported include clomipramine, fluoxetine, lamotrigine and opioid antagonists. However, it does not appear that any of these agents have a potent anti-dissociative effect. A variety of psychotherapeutic techniques has been used to treat depersonalisation disorder (including trauma-focused therapy and cognitive-behavioural techniques), although again none of these have established efficacy to date. Overall, novel therapeutic approaches are clearly needed to help individuals experiencing this refractory disorder.
Article
Selbstauskunftsinstrumente haben sich in der Erforschung des klinisch noch zu wenig beachteten Depersonalisations-Derealisations-Syndroms als unverzichtbare Hilfsmittel erwiesen. In neueren Untersuchungen hat sich die Cambridge Depersonalisation Scale (CDS) dabei als sinnvolles Instrument hervorgetan. Mit der vorliegenden Arbeit wird die Validierung der autorisierten deutschen Version der Cambridge Depersonalisation Scale (CDS) an einer Stichprobe von 91 stationären Patienten, 43 mit pathologischer Depersonalisation und 48 ohne pathologische Depersonalisation, vorgestellt. Als Goldstandard dienen die entsprechenden Kapitel des Strukturierten Klinischen Interviews für DSM-IV Dissoziative Störungen (SKID-D). Als weiteres Kriterium der externen Validität wird der Fragebogen zu Dissoziativen Symptomen verwendet. Die deutsche Version der CDS zeigt eine gute interne Konsistenz (α = 0,95 und Guttman Split-half = 0,95) und konnte Patienten mit pathologischer Depersonalisation von Patienten ohne solche sehr gut differenzieren. Die deutsche Version der CDS kann deshalb als reliables und valides Instrument angesehen werden.
Article
Translated and edited by David Rapaport, "Schilder's Medizinische Psychologie is presented here in translation, three decades after it was written, both for its value as a historical document and its inherent value, which the decades have not dissipated." The section on "Affect and experience" is omitted here. There is a foreword by the translator. Rapaport's "Paul Schilder's contribution to the theory of thought-processes" is reprinted in an appendix from Int. J. Psycho-Anal. (see 26: 4433). 905-item bibliography. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A study of the body-image—"the picture of our own body which we form in our mind"—in its physiological, libidinous, and sociological aspects. In the section on the physiological basis of the image such subjects as postural and tactile impressions, localization, imperceptions of various kinds, synesthesia, apraxia, agnosia, the phantom, muscle-tone, and pain in their relation to the postural model of the body are discussed. In the section on the libidinous structure narcissism, erogenic zones, neurasthenia, depresonalization, hypochondria, hysteria, and conversion are some of the fields which are considered in their relation to the body-image. The sociology of the body-image considers curiosity, the expression of emotions, imitation, identification, beauty, and other social aspects of the body-image. An appendix giving case histories of organic brain lesions and another giving an elementary discussion of the anatomy and physiology of the nervous system are included. Bibliography and index. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Mindfulness, a concept originally derived from Buddhist psychology, is essential for some well-known clinical interventions. Therefore an instrument for measuring mindfulness is useful. We report here on two studies constructing and validating the Freiburg Mindfulness Inventory (FMI) including a short form. A preliminary questionnaire was constructed through expert interviews and extensive literature analysis and tested in 115 subjects attending mindfulness meditation retreats. This psychometrically sound 30-item scale with an internal consistency of Cronbach alpha = .93 was able to significantly demonstrate the increase in mindfulness after the retreat and to discriminate between experienced and novice meditators. In a second study we broadened the scope of the concept to 86 subjects without meditation experience, 117 subjects with clinical problems, and 54 participants from retreats. Reducing the scale to a short form with 14 items resulted in a semantically robust and psychometrically stable (alpha = .86) form. Correlation with other relevant constructs (self-awareness, dissociation, global severity index, meditation experience in years) was significant in the medium to low range of correlations and lends construct validity to the scale. Principal Component Analysis suggests one common factor. This short scale is sensitive to change and can be used also with subjects without previous meditation experience.
Article
Episodes of depersonalization function to keep disturbing preconscious thoughts from becoming conscious. The symptom is conceptualized as a compromise between the wish to be "only dreaming" and the need to maintain a waking state in contact with perceptual reality. Restriction of attention is identified as the central mechanism by which the compromise is effected. On this basis an explanation for the alteration in the sense of reality is suggested. Material from a case is given to support these ideas. The author speculates that early efforts to deal with traumatic experience at a time when the distinction between sleeping and waking states is not secure may lead to the symptom choice of depersonalization.
Article
To present initial findings on the validity of a recently developed maltreatment inventory, the Childhood Trauma Questionnaire (CTQ), in a sample of adolescent psychiatric patients. Three hundred ninety-eight male and female adolescents (aged 12 to 17 years) admitted to the inpatient service of a private psychiatric hospital were given the CTQ as part of a larger test battery. Structured interviews were also conducted with the primary therapists of 190 of the patients to obtain ratings of abuse and neglect based on all available data, including clinical interviews with patients and their relatives and information from referring clinicians and agencies. Principal-components analysis of the CTQ items yielded five rotated factors-emotional abuse, emotional neglect, sexual abuse, physical abuse, and physical neglect-closely replicating the factor structure in an earlier study of adult patients. The internal consistency of the CTQ factors was extremely high both in the entire sample and in every subgroup examined. When CTQ factor scores were compared with therapists' ratings in a series of logistic regression analyses, relationships between the two sets of variables were highly specific, supporting the convergent and discriminant validity of the CTQ. Finally, when therapists' ratings were used as the validity criterion, the CTQ exhibited good sensitivity for all forms of maltreatment, and satisfactory or better levels of specificity. These initial findings suggest that the CTQ is a sensitive and valid screening questionnaire for childhood trauma in an adolescent psychiatric inpatient setting.
Article
Existing self-rating scales to measure depersonalization either show dubious face validity or fail to address the phenomenological complexity of depersonalization. Based on a comprehensive study of the phenomenology of this condition, a new self-rating depersonalization questionnaire was constructed. The Cambridge Depersonalization Scale is meant to capture the frequency and duration of depersonalization symptoms over the 'last 6 months'. It has been tested on a sample of 35 patients with DSM-IV depersonalization disorder, 22 with anxiety disorders, and 20 with temporal lobe epilepsy. Scores were compared against clinical diagnoses (gold standard) and correlated with the depersonalization subscale of the Dissociation Experiences Scale (DES). The scale was able to differentiate patients with DSM-IV depersonalization disorder from the other groups, and showed specific correlations with the depersonalization subscale of the DES (r=0.80; P=0.0007). The scale also showed high internal consistency and good reliability (Cronbach alpha and split-half reliability were 0.89 and 0.92, respectively). The instrument can, therefore, be considered as valid and reliable, and can be profitably used in both clinical and neurobiological research.
Article
The aim of the study was to determine the frequency of dissociative disorders among psychiatric inpatients in Germany and to investigate the relationship between childhood trauma and dissociation. The German version of the Dissociative Experiences Scale (DES), the Fragebogen für Dissoziative Symptome (FDS), was used to screen 115 consecutive inpatients admitted to the psychiatric clinic of a university hospital. Patients with FDS scores higher than 20 were interviewed by a trained clinician, using the German translation of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). The German version of the Childhood Trauma Questionnaire (CTQ) was administered to investigate prevalence of childhood trauma and relations between childhood trauma and dissociation in adult life. Twenty-five of the 115 patients (21.7%) had a score higher than 20 on the FDS. Of these, 15 patients were interviewed with the SCID-D-R. One patient was diagnosed with a dissociative identity disorder, three with dissociative disorders not otherwise specified, and one patient with depersonalization disorder. All diagnoses were confirmed clinically. A significant positive relationship was found between the severity of childhood trauma and dissociation. Dissociative disorders are common among German psychiatric inpatients. Clinicians who work in psychiatric inpatient units should be mindful of these disorders.
Article
We constructed a short multidimensional screening instrument for chronic pain patients based on the items contained in the Symptom Check List-90-Revised (SCL-90-R). The proposed dimensional structure of the SCL-90-R was recently shown to be irreproducible in chronic pain patients. As a consequence, the use of the Global Severity Index (GSI) was recommended, although it did not capture all information contained in the many items of the SCL-90-R. Based on an exploratory factor analysis, a six-dimensional structure using 27 items from the SCL-90-R was explored utilizing the data of 2780 chronic pain patients. A short form was prospectively tested on 581 patients in the same setting. Criteria for item selection were high convergent and low discriminant correlations. The assessment of the dimensions was kept short, but a minimum of four items were retained. A questionnaire yielding the dimensions (I) depressive symptoms, (II) dysthymic symptoms, (III) vegetative symptoms, (IV) agoraphobic symptoms, (V) symptoms of social phobia, and (VI) symptoms of mistrust was obtained. Additionally, the GSI of the SCL-90-R could be estimated precisely (r =0.96). The SCL-27 can be used for screening psychopathology in chronic pain patients. The scoring algorithm of the SCL-27 can be used for the 90-item form as well.
Article
Depersonalisation (DP) and derealisation (DR) are subjective experiences of unreality in, respectively, one's sense of self and the outside world. These experiences occur on a continuum from transient episodes that are frequently reported in healthy individuals under certain situational conditions to a chronic psychiatric disorder that causes considerable distress (depersonalisation disorder, DPD). Despite the relatively high rates of reporting these symptoms, little research has been conducted into psychological treatments for this disorder. We suggest that there is compelling evidence to link DPD with the anxiety disorders, particularly panic. This paper proposes that it is the catastrophic appraisal of the normally transient symptoms of DP/DR that results in the development of a chronic disorder. We suggest that if DP/DR symptoms are misinterpreted as indicative of severe mental illness or brain dysfunction, a vicious cycle of increasing anxiety and consequently increased DP/DR symptoms will result. Moreover, cognitive and behavioural responses to symptoms such as specific avoidances, 'safety behaviours' and cognitive biases serve to maintain the disorder by increasing awareness of the symptoms, heightening the perceived threat and preventing disconfirmation of the catastrophic misinterpretations. A coherent model facilitates the development of potentially effective cognitive and behavioural interventions.
Article
Depersonalisation disorder is characterised by prominent depersonalisation and often derealisation, without clinically notable memory or identity disturbances. The disorder has an approximately 1 : 1 gender ratio with onset at around 16 years of age. The course of the disorder is typically long term and often continuous. Mood, anxiety and personality disorders are often comorbid with depersonalisation disorder but none predict symptom severity. The most common immediate precipitants of the disorder are severe stress, depression and panic, and marijuana and hallucinogen ingestion. Depersonalisation disorder has also been associated with childhood interpersonal trauma, in particular emotional maltreatment. Neurochemical findings have suggested possible involvement of serotonergic, endogenous opioid and glutamatergic NMDA pathways. Brain imaging studies in depersonalisation disorder have revealed widespread alterations in metabolic activity in the sensory association cortex, as well as prefrontal hyperactivation and limbic inhibition in response to aversive stimuli. Depersonalisation disorder has also been associated with autonomic blunting and hypothalamic-pituitary-adrenal axis dysregulation. To date, treatment recommendations and guidelines for depersonalisation disorder have not been established. There are few studies assessing the use of pharmacotherapy in this disorder. Medication options that have been reported include clomipramine, fluoxetine, lamotrigine and opioid antagonists. However, it does not appear that any of these agents have a potent anti-dissociative effect. A variety of psychotherapeutic techniques has been used to treat depersonalisation disorder (including trauma-focused therapy and cognitive-behavioural techniques), although again none of these have established efficacy to date. Overall, novel therapeutic approaches are clearly needed to help individuals experiencing this refractory disorder.
Article
Self-rating scales have proved to be essential in the study of depersonalisation, which regrettably, is still seldom recognised in clinical practice. In recent studies the Cambridge Depersonalisation Scale (CDS) has emerged as an useful instrument for the study of depersonalisation. Here we report a validation study of the authorised German version of the CDS in a sample of 91 inpatients, 43 of whom had pathological depersonalisation and 48 without pathological depersonalisation. The SCID-D Interview for depersonalisation and derealisation was used as the gold standard and the German version of the Dissociative Experiences Scale was used to test the external validity of the scale. The German version of the CDS was found to have high internal consistency and reliability (alpha = 0,95 and Guttman Split-half = 0,95) and could differentiate patients with pathological depersonalisation from the control group. We therefore conclude that the German version of the CDS can be considered as reliable and valid.
Article
This study examined the construct and criterion validity of the Mindful Attention Awareness Scale (MAAS) in cancer outpatients, using matched community members as controls. Cancer outpatients (n=122) applying for enrollment in a mindfulness-based stress reduction (MBSR) program completed the MAAS and measures of mood disturbance and stress. Local community members (n=122) matched to the patients on gender, age, and education level completed the same measures. The single-factor structure of the MAAS was invariant across the groups. Higher MAAS scores were associated with lower mood disturbance and stress symptoms in cancer patients, and the structure of these relations was invariant across groups. The MAAS appears to have appropriate application in research examining the role of mindfulness in the psychological well-being of cancer patients, with or without comparisons to nonclinical controls.
Article
It is assumed that the procedures of functional magnetic resonance imaging (fMRI) are able to provoke significant dissociative responses. Trait and state dissociation of 32 healthy subjects undergoing fMRI have been recorded. At least one-third of the subjects showed dissociative responses of very large effect size (d=4.10). The contributing causal factors for that dissociative response could not yet identified clearly. Considering the impact of dissociation on mental functions, we recommend controlling subjects undergoing fMRI studies for dissociative responses. Further studies on the actual phenomenological experience of subjects undergoing fMRI procedures are warranted.
Article
There is evidence suggesting that the prevalence of depersonalization in psychiatric patients can vary across cultures. To explore the possible influence of culture on the prevalence of depersonalization, we compared psychiatric inpatient samples from the United Kingdom (N = 31), Spain (N = 68), and Colombia (N = 41) on standardized and validated self-rating measures of dissociation and depersonalization: the Cambridge Depersonalization Scale and the Dissociative Experiences Scale (DES). Colombian patients were found to have lower global scores on the Cambridge Depersonalization Scale and the DES and all its subscales, with the exception of DES-Absorption. No differences were found for measures of depression or anxiety. These findings seem to support the view that depersonalization is susceptible to cultural influences. Attention is drawn to the potential relevance of the sociological dimension "individualism-collectivism" on the experience of the self, and it is proposed that cultures characterized by high individualism may confer vulnerability to depersonalization experiences.
Article
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.
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