Dissociative Disorders Among Inpatients With Drug or Alcohol Dependency

Department of Psychiatry, Istanbul University, İstanbul, Istanbul, Turkey
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 11/2005; 66(10):1247-53. DOI: 10.4088/JCP.v66n1007
Source: PubMed


To determine the prevalence of dissociative disorders among inpatients with alcohol or drug dependency.
The Dissociative Experiences Scale was used to screen 215 consecutive inpatients admitted to the dependency treatment center of a large mental hospital over a 1-year period (March 1, 2003, to March 31, 2004). Patients who had scores of 30.0 or above were compared with patients who scored below 10.0 on the scale. The patients in both groups were then evaluated using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. The interviewers were blind to the Dissociative Experiences Scale scores.
Of the patients, 36.7% had a Dissociative Experiences Scale score of 30.0 or above. The prevalence of DSM-IV dissociative disorders was 17.2% (N = 37). On average, 64.9% of these patients' dissociative experiences had started 3.6 years (SD = 2.9; range, 1.0-11.0 years) before onset of the substance use. Patients with dissociative disorders were younger, and the mean duration of their remission periods was shorter. Dissociative disorder patients tended to use more than 1 substance, and drugs were used more frequently than alcohol in this group. The frequency of borderline personality disorder, somatization disorder, history of suicide attempt, and childhood abuse and neglect occurred more frequently in the dissociative disorder group than in the nondissociative disorder group. History of suicide attempt (p = .005), female sex (p = .050), and childhood emotional abuse (p = .010) were significant predictors of a dissociative disorder diagnosis. Significantly more patients with dissociative disorders stopped their treatment prematurely (p < .001).
Impact of dissociative disorders on development and treatment of substance dependency requires further study.

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    • "(DSM–IV ) dissociative disorders among women in the community have yielded a 12-month prevalence of 8.6% (Johnson, Cohen, Kasen, & Brook, 2006) and a lifetime prevalence of 18.3% (Sar, Akyüz, & Dogan, 2007). Besides constituting clinical conditions on their own, dissociative disorders co-occur with several psychiatric disorders, such as borderline personality disorder (Sar, Akyuz, Kugu, Ozturk, & Ertem-Vehid, 2006; Sar et al., 2003), conversion disorder (Sar, Akyuz, Kundakci, Kiziltan, & Dogan, 2004), obsessive-compulsive disorder (Belli, Ural, Vardar, Yesilyurt, & Oncu, 2012), and substance use disorder (Karadag et al., 2005). Dissociative subtypes of posttraumatic stress disorder (PTSD) and schizophrenic disorder are increasingly understood by clinicians and researchers as valid constructs (Lanius et al., 2010; Ross, 1997; Sar et al., 2010). "
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    ABSTRACT: This study screened the prevalence and correlates of dissociative disorders among depressive women in the general population. The Dissociative Disorders Interview Schedule and the posttraumatic stress disorder (PTSD) and borderline personality disorder sections of the Structured Clinical Interview for DSM-IV were administered to 628 women in 500 homes. The prevalence of current major depressive episode was 10.0%. Of the women, 26 (40.6%) had the lifetime diagnosis of a DSM-IV, dissociative disorder, yielding a prevalence of 4.1% for dissociative depression. This group was younger (mean age = 30.7 years) than the nondissociative depression women (mean age = 39.6 years). There was no difference between the 2 groups on comorbid somatization disorder, PTSD, or borderline personality disorder. Besides suicide attempts, the dissociative group was characterized by secondary features of dissociative identity disorder; Schneiderian symptoms; borderline personality disorder criteria; and extrasensory perceptions, including possession experiences. They reported suicidality, thoughts of guilt and worthlessness, diminished concentration and indecisiveness, and appetite and weight changes more frequently than the nondissociative group. Early cessation of school education and childhood sexual abuse were frequently reported by the dissociative depression group. With its distinct features, the concept of dissociative depression may facilitate understanding of treatment resistance in, development of better psychotherapy strategies for, and new thinking on the neurobiology and pharmacotherapy of depressive disorders.
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    • "Childhood trauma has been put forward as one of the main predictors of dissociation in community as well as clinical samples [21] [22] [23]. As dissociation [13], rates and severity of childhood trauma are higher in patients with SUDs [24], and there has been increasing interest in the clinical consequences of childhood trauma in this population [25]. Association of childhood trauma and dissociation among patients with SUDs also has been investigated [1] [15] [25] [26] [27]. "
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    • "This can become burdensome for institutions and their staff. Clients with co-occurring disorders are often described as challenging and their drug use is often severe (Najavits et al., 1998) and complex, with many substances used (Karadag et al., 2005). Integrated treatment has the advantage of incorporating techniques such as motivational interviewing and cognitive–behavioral interventions that take into account the tendency for PTSD symptoms to worsen during early abstinence while emphasizing clients' need for safety and empowerment (Najavits, 2004; Ouimette et al., 1998) and addressing risks common to both disorders such as self-injurious behavior, suicidality , revictimization, and sexual promiscuity (Amaro, Chernoff et al., 2007; Amaro, Larson et al., 2007). "
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