Prevalence of Dissociative Disorders in Psychiatric Outpatients

Klau-1 Psychiatric Outpatient Department, Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 05/2006; 163(4):623-9. DOI: 10.1176/appi.ajp.163.4.623
Source: PubMed


The purpose of the study was to assess the prevalence of DSM-IV dissociative disorders in an inner-city outpatient psychiatric population.
Subjects were 231 consecutive admissions (84 men and 147 women, mean age=37 years) to an inner-city, hospital-based outpatient psychiatric clinic. The subjects completed self-report measures of dissociation (Dissociative Experiences Scale) and trauma history (Traumatic Experiences Questionnaire). Eighty-two patients (35%) completed a structured interview for dissociative disorders (Dissociative Disorders Interview Schedule).
The 82 patients who were interviewed did not differ significantly on any demographic measure or on the self-report measures of trauma and dissociation from the 149 patients who were not interviewed. Twenty-four (29%) of the 82 interviewed patients received a diagnosis of a dissociative disorder. Dissociative identity disorder was diagnosed in five (6%) patients. Compared to the patients without a dissociative disorder diagnosis, patients with a dissociative disorder were significantly more likely to report childhood physical abuse (71% versus 27%) and childhood sexual abuse (74% versus 29%), but the two groups did not differ significantly on any demographic measure, including gender. Chart review revealed that only four (5%) patients in whom a dissociative disorder was identified during the study had previously received a dissociative disorder diagnosis.
Dissociative disorders were highly prevalent in this clinical population and typically had not been previously diagnosed clinically. The high prevalence of dissociative disorders found in this study may be related to methodological factors (all patients were offered an interview rather than only those who had scored high on a screening self-report measure) and epidemiological factors (extremely high prevalence rates for childhood physical and sexual abuse were present in the overall study population).

Full-text preview

Available from:
    • "This study aims to resolve three issues regarding the relationship between trauma and dissociation that emerge from clinical (Saxe et al., 1993;Modestin et al., 1996;Tutkun et al., 1998;Şar et al., 2000;Foote et al., 2006) and prospective studies (Ogawa et al., 1997;Dutra et al., 2009;Trickett et al., 2011) and to verify a hypothesis that cumulative traumatization accounts for pathological dissociation. The results showed that dissociation significantly correlated with traumatizing events, parental dysfunctions , and general psychopathology. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinical studies of patients with dissociative disorders and prospective studies of childhood trauma survivors show inconsistent findings regarding the relationship between childhood trauma and dissociation. This study aims to resolve this inconsistency by investigating how dissociation is related to parental dysfunctions, general psychopathology, childhood trauma, and adulthood trauma. Specifically, we focus on the role of cumulative traumatization in pathological and non-taxon dissociation. Eighty acute psychiatric inpatients were administrated standardized measures on dissociation, perceived parental dysfunctions, traumatizing events, and general psychopathology. Parental dysfunctions and trauma correlated with both types of dissociation and general psychopathology. When general psychopathology and parental dysfunctions were controlled, a unique link between trauma and dissociation remained significant. Moreover, the pattern of relationships differed for non-taxon and pathological dissociations. The effect of childhood but not adulthood trauma was significant on non-taxon dissociation. In contrast, an interactive model incorporating both childhood and adulthood trauma was the best model for explaining pathological dissociation. Childhood trauma is important for developing non-taxon dissociation, and adulthood trauma exacerbates its effects on the emergence of pathological dissociation. Cumulative traumatization from childhood to adulthood should be incorporated into the trauma hypothesis of pathological dissociation.
    No preview · Article · Oct 2015 · Psychiatry Research
    • "Previous work comparing abuse profiles across psychiatric groups has suggested that dissociative patients tend to have more physical, sexual and emotional maltreatment than those with schizophrenia, anxiety disorders and mixed non-dissociative disorders, more sexual abuse than those with complex partial seizures, and an earlier onset of sexual abuse than BPD (e.g., Fink and Golinkoff, 1990; Foote et al., 2006; Yargiç et al., 1998). The current findings add further detail to this developing picture, with the DD sample having more severe maltreatment on all physical, sexual and emotional markers than those with anxiety and mood disorders who reported an abuse/neglect history in childhood, and more severe sexual abuse than those with child abuse-related chronic PTSD. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Only a select number of studies have examined different forms of child maltreatment in complex dissociative disorders in comparison to other groups. Few of these have used child abuse-related chronic PTSD and mixed psychiatric patients with maltreatment as comparison groups. This study examined child sexual, physical and emotional abuse, as well as physical and emotional neglect in dissociative disorder (DD; n = 39), chronic PTSD (C-PTSD; n = 13) and mixed psychiatric (MP; n = 21) samples, all with abuse and neglect histories. The predictive capacity of these different forms of maltreatment across the 3 groups were assessed for pathological dissociation, shame, guilt, relationship esteem, relationship anxiety, relationship depression and fear of relationships. All forms of maltreatment differentiated the DD from the MP group, while sexual abuse differentiated the DD sample from the C-PTSD group. Childhood sexual abuse was the only predictor of pathological dissociation. Emotional abuse predicted shame, guilt, relationship anxiety and fear of relationships. Emotional neglect predicted relationship anxiety and relationship depression. Physical neglect was associated with less relationship anxiety. Different forms of abuse and neglect are associated with different symptom clusters in psychiatric patients with maltreatment histories.
    No preview · Article · Aug 2015 · Journal of Trauma & Dissociation
  • Source
    • "Studies within the general population have found that a majority of individuals espouse having had at least some degree of minor dissociative experience (Ross, Joshi, & Currie, 1991), whereas other research found an approximately 1%–5% prevalence for clinical dissociation at levels that would fulfill criteria for a dissociative disorder (Johnson, Cohen, Kasen, & Brook, 2006; Maarenan et al., 2004; Vanderlinden, Van der Hart, & Varga, 1996). Meanwhile, prevalence rates within psychiatric settings appear to range much higher, estimated at 4%–29% for dissociative disorders overall (Foote et al., 2006; Saxe et al., 1993). However, debate continues within the field as to the correct parameters for defining dissociation. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Extant research indicates that dissociation may act as a risk factor for non-suicidal self-injury (NSSI), but the data are mixed. In this study, 75 university and community females, aged 18-35, were assessed for rates of normative, clinical, and severely clinical dissociation, as well as for NSSI. Significant differences in normative dissociation were found between the control group and the group reporting a history of NSSI. Additionally, normative dissociation - but not clinical or severely clinical dissociation - was found to be significantly associated with NSSI in this sample. Considering this finding in the context of existing literature, the authors propose a quartile risk model of dissociation and NSSI as a new approach to the influences of levels of dissociation on NSSI risk.
    Full-text · Article · Mar 2015 · Journal of Trauma & Dissociation
Show more