Dissociation : Vol. 5, No. 4 (Dec. 1992)
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Item Open Access Dissociation : Vol. 5, No. 4, p. 205-209 : Pain and suffering as a function of dissociation level and instructional set(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12) Giolas, Marina H.; Sanders, BarbaraThe Dissociative Experiences Scale (DES) developed by Bernstein and Putnam is a frequently used measure of dissociation. This study is the first to validate the scale against a behavioral criterion by demonstrating differences between high and low dissociating female college students in their response to physical pain. Forty-eight female students who scored above 20 on the DES were selected for the high dissociating group, and 48 scoring below 20 on the DES were selected for the low dissociating group. Each subject underwent an ischemic pain procedure under one of three instruction conditions: Imaginal (imagine your arm becoming numb and insensitive); distraction (concentrate on your breathing); or, control (no instructions concerning pain reduction). During the procedure, at one minute intervals, subjects rated both their pain (sensory experience) and suffering (emotional experience); the procedure was terminated at the subject 's request or after 20 minutes. Across all instruction conditions high dissociators tolerated the pain significantly longer than low dissociators. Analysis of pain and suffering ratings during the first seven minutes of the procedure revealed a difference between high and low dissociators in the imaginal condition: high dissociators reported significantly lower degrees of suffering than low dissociators, although they did not differ from low dissociators in their ratings of sensory pain. Across conditions, DES scores were negatively correlated with subjects' overall suffering ratings (r = -.20, p<.05), but not with their overall pain ratings. These results are consistent with the view that dissociation is a coping mechanism enabling subjects to better tolerate pain; moreover, they suggest that imagination plays a role in this process.Item Open Access Dissociation : Vol. 5, No. 4, p. 236-241 : An overview of family treatment in dissociative disorders(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12) Benjamin, Lynn R.; Benjamin, RobertFamily treatment interventions, in contradistinction to family therapy, are an important concomitant to individual therapy in the treatment of multiple personality disorder (MPD). Such interventions have the potential to restore trustworthy relationships in the family and, thus, to promote the healing of the individual patient and other family members. This article discusses some of the possible modalities of treatment, including parallel therapy with a partner, marriage therapy, child therapy, parenting counseling, group therapy with MPD mothers, and group therapy with partners or parents of individuals with MPD. It also explores some of the philosophical underpinnings of these approaches with particular emphasis on ethical concepts derived from Contextual Family Therapy.Item Open Access Dissociation : Vol. 5, No. 4, p. 227-235 : Dissociative symptoms and disorders in patients with eating disorders(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12) McCallum, Kim E.; Lock, James; Kulla, Mary; Rorty, Marcia; Wetzel, Richard D., Ph. D.This study sought to describe the relationship between dissociative symptoms and syndromes in patients with eating disorders. We studied 38 patients clinically identified with eating disorders. They were evaluated in two sites by experienced clinicians using standard interviews to elicit symptoms of eating disorders, dissociative disorders and to obtain histories of traumatic abuse. A self report measure, the Dissociative Experiences Scale, was used to identify those with frequent dissociative symptoms. The temporal relationship of these symptoms to eating and sexual behaviors was explored by a uniformly administered interview. Diagnoses of dissociative disorders and other comorbid syndromes were made using DSM-III-R criteria. We found that dissociative disorders were prevalent in our sample (29%). The prevalences of multiple personality disorder and depersonalization disorder were 10% and 18% respectively. The presence of dissociative disorder was significantly related to a history of self-harm. Dissociative symptoms which occurred frequently were temporally associated with the binge/purge cycle or severe restriction in 74%, with sexual behavior in 39% and with self-harm in 28%. A dissociative disorder diagnosis was correlated to history of trauma or abuse but was not limited solely to sexual abuse. We conclude that dissociative symptoms are relevant to the behaviors characteristic of patients with eating disorders. Trauma should be considered in those who present with discrete dissociative disorders. These comorbid syndromes may alter outcome in patients with eating disorders.Item Open Access Dissociation : Vol. 5, No. 4, p. 221-226 : Natural history of severe symptoms in borderline women treated in an incest group(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12) Goodwin, Jean, 1946-; Wilson, Nancy; Connell, VirginiaIn 1989 the authors described a cluster of severe symptoms in 10 women treated in a time-limited group for incest survivors who had been psychiatrically hospitalized. All had experienced multiple prior hospitalizations and multiple suicide attempts. Multiple diagnoses including borderline and affective disorders were present in the first l0 and in a replication sample. The present study explores two clinical questions raised in the treatment and follow-up of these patients: 1) Did the trauma focused groups exacerbate severe symptoms in some patients? and 2) On long-term follow-up did group treatment lead to a greater likelihood of recovery? We used chart review to follow emergency contacts and hospitalizations through three intervals: the two years that preceded treatment, and the two years that included treatment, and a two year follow-up interval. Acute contacts actually decreased during the treatment interval and on follow-up only one group-treated patient remained severely ill and suicidal. In comparison a control group of hospitalized borderline women showed increased rather than decreased acuity in the treatment interval, but a similarly high level of pre-treatment acuity and a similar 50% likelihood of "recovery" by the follow-up interval. Better outcome for group participants was most evident when we compared the most severe cases in the two groups. The only suicide in the study sample occurred in the control group. Lack of appreciation both of the high level of baseline severity and the tendency of borderlines to respond negatively to any form of treatment contributed to our erroneous impression that group treatment exacerbated symptoms. Dissociative diagnoses were associated with poor outcome.Item Open Access Dissociation : Vol. 5, No. 4, p. 187-195 : Dissociative disorder not otherwise specified: a clinical investigation of 50 cases with suggestions for typology and treatment(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12) Coons, Philip M.Although the DSM-III-R lists six examples of subcategories of dissociative disorder not otherwise specified (DDNOS), the literature contains little about DDNOS proper, and only one subcategory, Ganser syndrome, has been studied in any depth, all studies having been completed before its inclusion under DDNOS in 1987. This is a comprehensive study of 50 individuals with DDNOS. Data from clinical history, mental status examination, collateral interviews, neurological examination, electroencephalogram (EEG), intelligence testing, Minnesota Multiphasic Personality Inventory (MMPI), and the Dissociative Experience Scale (DES), were analyzed on 50 consecutive individuals diagnosed with DDNOS by DSM-III-R criteria. The data suggest a number of different diagnostic subcategories including childhood dissociative disorder, ego-state disorder, dissociative psychosis, nocturnal dissociative disorder, gender identity disorder (dissociative type), and a truly not otherwise specified type. Each of these subcategories will be described including case vignettes and supporting data from previous studies and papers. Nosological issues are discussed as well as treatment implications.Item Open Access Dissociation : Vol. 5, No. 4, p. 196-204 : Disorganized/disoriented attachment in the etiology of the dissociative disorders(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12) Liotti, GiovanniIt has been suggested that multiple personality disorder (MPD) may be seen as an attachment disorder, related to the process of detachment (Barach, 1991). To think in terms of disorganized/disoriented (D) attachment seems a better way of conceptualizing not only MPD, but all the dissociative disorders in relation to difficulties experienced in early attachment relationships. This paper reviews recent findings concerning D (disorganized/disoriented) attachment in infants and its correlates in unresolved parental traumas (quite often, losses through death of significant others). It is proposed that D attachment in infancy may lead to increased vulnerability to dissociative disorders via a linking mechanism proposed by Main and Hesse (1990, 1992): parental frightened and/or frightening behavior. Mothers of dissociative patients were reported much more often than mothers of other psychiatric patients to have suffered the loss through death of a significant other in the two years before-two years after the patient's birth. This finding supports the hypothesis that many dissociative patients may have been infants attached in a disorganized/disoriented way to at least one attachment figure.Item Open Access Dissociation : Vol. 5, No. 4, p. 216-220 : Susceptibility of common self-report measures of dissociation to malingering(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12) Gilbertson, Alan D.; Torem, Moshe S.; Cohen, Rita; Newman, Isadore; Radojicic, Christina; Patel, ShirpaThis paper reports the results of a study undertaken to determine the extent to which common self-report measures of dissociation may be consciously distorted. It also examines the relationships between the Perceptual Alterations Scale, the Dissociative Experiences Scale, and the Questionnaire of Experiences of Dissociation. Three hundred and twenty nursing students were randomly assigned to one of four groups and instructed to respond to the aforementioned questionnaires honestly, "faking good," "faking bad," or "trying to appear as if you had multiple personality disorder." Results indicate that scores on these instruments correlated very highly within all groups. Also indicated is a high level of susceptibility on each instrument for subjects to consciously exaggerate the degree of dissociative symptomotology being measured. The implications of findings for clinical use of these measures is discussed.Item Open Access Dissociation : Vol. 5, No. 4, p. 210-215 : Dissociation, distress and family function(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12) Anderson, Gregory L.Studies of factors related to high utilization of medical services have not included Dissociation. This study examined relationships between dissociation, psychological distress, family function and medical utilization of 100 adult family medicine outpatients drawn from two urban residency centers. Results showed a strong positive correlation between dissociation and psychological distress; and a strong negative correlation between dissociation and family function. Dissociation and psychological distress were positively related and family function was negatively related to the frequency of reported physician office visits in the last year. Subjects who scored above the sample median on a quantitative measure of dissociation reported significantly more symptoms of psychological distress and family dysfunction than subjects who scored below the median. The association of dissociative symptoms, psychological distress and family function persisted after controlling for the effects of age, gender, race, marital status, employment status, education and income. Adult family medicine outpatients who report a high level of psychological distress and family dysfunction should be screened for dissociative pathology.Item Open Access Dissociation : Vol. 5, No. 4, p. 185-186 : Editorial(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12) Kluft, Richard P., 1943-Item Open Access Dissociation : Vol. 5, No. 4, p. 000 : Cover, table of contents(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1992-12)