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Dissociative Disorders

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Research articles:

Coons, P. M., Bowman, E. S., & Milstein, V. (1988). Multiple personality disorder: A clinical investigation of 50 cases. Journal of Nervous and Mental Disease, 176(9), 519-527. doi:10.1097/00005053-198809000-00001

Assessed 50 consecutive patients with multiple personality disorder (MPD), using clinical history, psychiatric interview, neurological examination, EEG, the Minnesota Multiphasic Personality Inventory (MMPI), intelligence testing, and a variety of psychiatric rating scales. Results reveal that Ss with MPD were usually women who presented with depression, suicide attempts, repeated amnesic episodes, and a history of childhood trauma, particularly sexual abuse. Also common were headaches, hysterical conversion, and sexual dysfunction. Intellectual level varied from borderline to superior. The MMPI reflected underlying character pathology in addition to depression and dissociation. Significant neurological or EEG abnormalities were infrequent. Data suggest that the etiology of MPD was strongly related to childhood trauma rather than to an underlying electrophysiological dysfunction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Foote, B., Smolin, Y., Neft, D., & Lipschitz, D. (2008). Dissociative disorders and suicidality in psychiatric outpatients. Journal of Nervous & Mental Disease, 196(1), 29-36. Retrieved from EBSCOhost.

Although it is common for patients with dissociative disorders to report a history of suicide attempts, there is very little data systematically comparing suicidality in patients with dissociative disorders versus patients without these disorders. The subjects in our study were 231 patients consecutively admitted to an inner-city, hospital-based outpatient psychiatric clinic. Eighty-two of these patients completed structured interviews for dissociative disorders, borderline personality disorder, and trauma history (dissociative disorders interview schedule) and for posttraumatic stress disorder and substance abuse (Structured Clinical Interview for DSM-IV). Patients receiving a dissociative disorder diagnosis were compared with nondissociative patients on measures of self-harm and suicidality. Presence of a dissociative disorder was strongly associated with all measures of self-harm and suicidality. When we focused on patients with a history of multiple suicide attempts, significant associations were found between several diagnoses (dissociative disorder; borderline personality disorder; posttraumatic stress disorder; alcohol abuse/dependence) and multiple suicide attempter status. When these diagnoses were entered in a logistic regression, a highly significant association remained for dissociative diagnosis and multiple suicide attempter status (odds ratio, 15.09; 95% confidence interval, 2.67-85.32; p = 0.002). Dissociative disorders are commonly overlooked in studies of suicidality, but in this population they were the strongest predictor of multiple suicide attempter status.

Kenny, D. T., Lennings, C. J., & Munn, O. A. (2008). Risk factors for self-harm and suicide in incarcerated young offenders: Implications for policy and practice. Journal of Forensic Psychology Practice, 8(4), 358-382. doi:10.1080/15228930802199317

This study identified common and unique risk factors for suicidal and self-harming (SSH) behavior in 242 incarcerated young offenders. Lifetime prevalence of suicidal ideation was 19.2% and was 18.2% for self-harm ideation; 8.4% had attempted suicide (44% in detention), and 9.1% had inflicted self-harm in the past 12 months (75% in detention). SSH young offenders reported more severe psychopathology, childhood trauma, and psychological distress than non-SSH young offenders. Past emotional abuse, current psychological distress, and depersonalization disorder were significant risk factors for suicidal ideation. Past physical abuse and current psychological distress were significant risk factors for self-harm ideation. Suicidality and self-harm co-occurred. Two approaches to the assessment of self-harm risk—past behavior and scores on a scale of self-harm risk—were compared. Some support for the equivalence of assessment methods was found; however, significant differences emerged that indicated that a multi-factorial approach to the assessment of self-harm risk is advised. Screening on entry to detention could identify young offenders at risk and direct them into treatment. The high rates of self-harm in detention suggest that the detention environment and management practices should be reviewed to identify structural elements that contribute to distress in some young offenders that for a significant minority is associated with SSH ideation and behavior. [ABSTRACT FROM AUTHOR]

Kluft, R. P. (1995). Six completed suicides in dissociative identity disorder patients: Clinical observations. Dissociation: Progress in the Dissociative Disorders, 8(2), 104-111. Retrieved from EBSCOhost.

Describes 6 cases of female dissociative identity disorder (DID) patients (aged 26–38 yrs), who succeeded in committing suicide. In 4 cases, suicide attempts were planned to evade detection. Major motivations for suicide appeared diverse; they included vindictiveness, overwhelming impact of flashbacks that could not be distinguished from reality, inner conflicts, anticipated object loss, guilt related to a parent's death, and pain and helplessness due to abandonment. 5 Ss used lying to attain goals, ready rationalizations for dishonest and inappropriate behavior, disrupted therapeutic alliances, and delusions. In most cases, there was a clash between objective and subjective realities before the fatal event. It is suggested that suicide may have provided the illusion of the omnipotent reestablishment of their desired construction of reality and precluded further painful confrontations, humiliations and narcissistic deflations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Ross, C. A., & Norton, G. (1989). Suicide and parasuicide in multiple personality disorder. Psychiatry: Journal for the Study of Interpersonal Processes, 52(3), 365-371. Retrieved from EBSCOhost.

Surveyed 227 Canadian clinicians to determine the features that differentiate multiple personality disorder (MPD) patients who attempt suicide from those who do not. Compared with 48 patients who did not attempt suicide, 167 patients who attempted suicide (1) reported more experiences of physical abuse and rape; (2) received more psychiatric diagnoses other than MPD, more inpatient treatment, and more psychotropic medications; (3) spent twice as long in the mental health system prior to diagnosis and had twice as many identifiable personalities; and (4) experienced more thought broadcasting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Ross, C. A., Norton, G., & Wozney, K. (1989). Multiple personality disorder: An analysis of 236 cases. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 34(5), 413-418. Retrieved from EBSCOhost.

Analysis of 236 cases of Multiple Personality Disorder (MPD) indicates that patients experienced extensive sexual (79.2%) and physical (74.9%) abuse as children. They had been in the health care system for an average of 6.7 yrs before being diagnosed with MPD and had an average of 15.7 personalities at the time of reporting. The most common alter personalities were a child personality (86.0%), a personality of a different age (84.5%), a protector personality (84.0%), and a persecutor personality (84.0%). Patients with MPD were highly suicidal with 72% attempting suicide and 2.1% being successful. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Sar, V., Akyüz, G., & Do?an, O. (2007). Prevalence of dissociative disorders among women in the general population. Psychiatry Research, 149(1-3), 169-176. doi:10.1016/j.psychres.2006.01.005

Abstract: This study sought to determine the prevalence of dissociative disorders among women in the general population, as assessed in a representative sample of a city in central Turkey. The Dissociative Disorders Interview Schedule (DDIS), the Borderline Personality Disorder section of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), and the PTSD-Module of the Structured Clinical Interview for DSM-III-R (SCID) were administered to 628 women in 500 homes. The mean age of participants was 34.8 (S.D.=11.5, range: 18–65); 18.3% of participants (n =115) had a lifetime diagnosis of a dissociative disorder. Dissociative disorder not otherwise specified (DDNOS) was the most prevalent diagnosis (8.3%); 1.1% of the population was diagnosed as having dissociative identity disorder (DID). Participants with a dissociative disorder had borderline personality disorder, somatization disorder, major depression, PTSD, and history of suicide attempt more frequently than did participants without a dissociative disorder. Childhood sexual abuse, physical neglect, and emotional abuse were significant predictors of a dissociative disorder diagnosis. Only 28.7% of the dissociative participants had received psychiatric treatment previously. Because dissociative disorders are trauma-related, significant part of the adult clinical consequences of childhood trauma remains obscure in the minds of mental health professionals and of the overall community. Revisions in diagnostic criteria of dissociative disorders in the DSM-IV are recommended. [Copyright &y& Elsevier]

Saxe, G. N., Chawla, N., & Van Der Kolk, B. (2002). Self-destructive behavior in patients with dissociative disorders. Suicide & Life-Threatening Behavior, 32, 313. Retrieved from EBSCOhost.

Assesses self-destructive behavior in patients with dissociative disorders. Comparison with patients reporting dissociative symptoms; Exhibition of self-destructive behavior; Methods of self-injury.

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