DISSOCIATIVE
DISORDERS IN JAPAN: A
PILOT STUDY WITH
THE DISSOCIATIVE
EXPERIENCE SCALE AND
A SEMI-STRUCTURED INTERVIEW
Masahiro Umesue, M.D., Ph.D.
Tadashi Matsuo, M.D., Ph.D.
Noboru Iwata, Ph.D.
Nobutada Tashiro, M.D., Ph.D.
Masahiro Umesue, M.D., Ph.D., is a psychiatrist in the
Department of Psychiatry at National Kyushu Medical Center
Hospital in Japan. Tadashi Matsuo, M.D., Ph.D., is a lectur-
er in the Department of Neuropsychiatry at Kyushu
University, Japan. Noboru Iwata, Ph.D., is an Assistant
Professor at the Institute of Industrial Ecological Sciences
at University of Occupational and Environmental Health, in
Japan. Nobutada Tashiro, M.D., Ph.D., is Professor of
Neuropsychiatry at Kyushu University.
For reprints write Masahiro Umesue, M.D., Ph.D., Depart-
ment of Psychiatry at National Kyushu Medical Center
Hospital 1-8-1, Jigyo Chuouku Fukuotca, 810, Japan.
A part of the study was presented at 12th International Fall
Conference of the International Society for the Study of
Dissociation which was held in Lake Buena Vista, Florida in
September 1995.
ABSTRACT
A Japanese version of the Dissociative Experiences Scale (]DES) was
developed and administered to 199 late adolescents, 40 normal
adults, 16 schizophrenics, and 19 subjects with dissociative disor-
ders whose diagnoses were made with a comprehensive assessment
including a semi-structured interview. As a result, theJDES yield-
ed comparable reliability and validity with those established for the
Dissociative Experience Scale in North America. Of 19 with disso-
ciative disorders, one was identified as multiple personality disorder
(MPD fDSM-Wname change: dissociative identity disorder]) and
eight were identified as dissociative disorder not otherwise specified
(DDNOS). A large percentage of those with DDNOS had partial symp-
tomatic profiles of MPD except for identity disturbance. The distri-
bution of J-DES scores suggested that the concept of a dissociative
continuum is cross-culturally applicable, although the presentation
of dissociative disorders may be influenced by the Japanese cultural
background.
INTRODUCTION
During the past decade there has been a rapid increase
in the number of case reports and publications about dis-
sociative disorders, especially of multiple personality disor-
der (MPD [ DSM-IV name change: dissociative identity disor-
der]) mainly in North America (Bliss 1986; Kluft 1987; Coons,
Bowman, Kluft, Milstein, 1991; Putnam 1991; Goff Simms
1993). On the other hand, there is much skepticism about
the dissociative disorders as distinct diagnostic categories,
particularly about MPD (Dell, 1988; Fahy, 1988; Merskey,
1992). Some critics have suggested that the increase in case
reporting of MPD reflects iatrogenic and cultural influences
on suggestible patients in North America (Fahy, 1988; Fahy,
1992; Merskey, 1992).
There have been very few case reports on MPD in japan,
although the first Japanese case of MPD was reported in 1919
(Nakamura, 1919). Ichimaru identified only five cases ofMPD
in the Japanese literature between 1919 and 1992 (Ichimaru,
1993). Takahashi reviewed and diagnosed 489 inpatients uti-
lizing DSM-I1I or DSM-III-R criteria and found no case ofMPD
(Takahashi, 1990). His study has been criticized for its
methodology. It used no structured diagnostic instruments
and failed to control for skeptical bias among Japanese psy-
chiatrists (Ross, 1990).
There have been several studies using the Dissociative
Experience Scale in Japan (Tanabe Ogawa, 1992; Berger,
Ono, Nakajima, Suematsu, 1994; Berger et al. 1995) ,
although validation of the scale in Japanese populations had
not been established with a clinical population of dissocia-
tive disorders.
The present study was designed to clarify the character-
istics of dissociative disorders in japan. We developed a
Japanese version of the DES(j-DES) and validated it using a
clinical population of dissociative disorder patients diagnosed
on the basis of a comprehensive assessment including a semi-
structured interview.
METHODS
Subjects
The study subjects consisted of four groups: 199 late ado-
lescents, 40 normal adults, 16 subjects with schizophrenia,
and 19 subjects with dissociative disorders.
The late adolescent subjects were undergraduate students
at Kyushu University. They were from health science classes
and volunteered to participate in the study. The normal adult
subjects were staff members at a private psychiatric hospital
182
DISSOCIATION, Vol. IX, No. 3, Septcmberl996
UMESUE/MATSUO /IWATA/TASHIRO
and volunteered to participate in the study.
All clinical subjects were outpatients of Kyushu University
Hospital. Twenty-two subjects had been referred consecu-
tively to the authors by several colleagues for evaluation of
dissociative states; 19 subjects met criteria for dis-
sociative disorders. The remaining three subjects received a
DSM-III-Rdiagnosis of post-traumatic stress disorder, obses-
sive-compulsive disorder, and dysthymic disorder, respec-
tively, and were excluded from the study. Sixteen subjects
with schizophrenia were the first available patients with this
diagnosis within the time limit of the study.
The meanD age of the 199 late adolescents and the 40
normal adults were 18.6.9 (range = 18-21) and 37.8.0
years (range = 23-54), respectively. Of 199 late adolescents,
168 (84%) were men and 31 (16%) were women. Of 40 nor-
mal adults, 21 (53%) were women and 19 (48%) were men.
The meanD ages of the subjects with dissociative disorders
and with schizophrenia were 24.7.5 (range = 17-59), and
34.60.6 years (range = 14-54), respectively. Of the 19 sub-
jects with dissociative disorders, 10 (53%) were men and 9
(47%) were women. Of the 16 subjects with schizophrenia,
8 (50%) were men and 8 (50 %) were women.
Instruments
The structured clinical interview forDSM-III-RDissociative
Disorders (SCID-D) is a diagnostic instrument developed for
the assessment of five dissociative symptom areas (amnesia,
depersonalization, derealization, identity confusion, and
identity alteration) and for the diagnosis of the dissociative
disorders (Steinberg, 1993; Steinberg, 1993; Steinberg,
Cicchetti, Buchanan, Rakfeldt, Rounsaville,1994). It has
proven utility in confirming known cases of dissociative dis-
orders as well as in detecting unknown cases of dissociative
disorders cross-nationally (Steinberg et al., 1990; Boon 
Draijer, 1991); With reference to SCID-D, we conducted a
semi-structured interview and rated each five dissociative
symptom according to the severity rating definitions of SC1D-
D: absent, mild, moderate, or severe (Steinberg, 1993).
The Dissociative Experience Scale (DES) is a 28-item visu-
al analog self-report scale that was developed to quantify dis-
sociative experiences in normal and clinical populations
(Bernstein Putnam, 1986). The subject indicates how often
he or she has had the experience described in the question
by making a slash on a 100-mm line.
The DES has been the most widely used and studied instru-
ment in the dissociation research field for which reliability
and validity have been reported by several investigators
(Bernstein Putnam, 1986; Ross et al.,1988; Dubester 
Braun, 1995). Making of theJ-DES was accomplished as fol-
lows. First, the original DES items were translated into
Japanese by the authors and checked by several senior psy-
chiatrists. This version was then back-translated blindly into
English by a professional translator. Dr. E. B. Carlson, the
first author of the DES, was asked to compare these two
English versions to confirm the content of the Japanese ver-
sion. Only a few minor difficulties were identified through
this process and it was then modified to obtain a better trans-
lation. Then, a pilot field trial was conducted with the pre-
liminary version of the J-DES using normal adults and late
adolescents. A few ambiguous points were identified through
this process, and then wording was modified to ensure that
the questions were understood more clearly.
The final form ofj-DES contains the same 28 items as orig-
inalDES. However, we modified the directions cover
sheet. The original directions specify that the questions only
apply to those experiences that are not associated with the
use of alcohol or drugs. We deleted drugs conditions from
the directions, because drug problems appear less prevalent
among Japanese.
Diagnosis
To reach DSM-III-R
lowing procedures were conducted to meet the LEAD stan-
dard proposed by Spitzer (1983). Twenty-two subjects con-
secutively referred to the authors for evaluation of dissociative
states received the aforementioned semistructured interview;
chart reviews were also conducted. On the basis of a com-
prehensive assessment of all available data, the diagnoses were
made by one of the authors and then were confirmed by one
of the other authors. These procedures were carried out blind
to the results of the J-DES.
The DSM-III-Rdiagnoses for schizophrenia of the 16 sub-
jects were made respectively by the subjectstreating psy-
chiatrists and then were confirmed by one of the authors.
Data Collection
The J-DES was administered in three different settings. For
late adolescents, theJ-DES was administered to 199 under-
graduate students in a classroom setting. The was then
readministered to 133 of the 199 undergraduate students
after an interval of four weeks. For normal adults, the
was administered individually, after the first author inter-
viewed them personally and confirmed that they were well
adapted to their place of work and had no evidence of men-
tal disorders. For the subjects with dissociative disorders, the
J-DES was administered by one of the authors after the semi-
structured interview was conducted. For the subjects with
schizophrenia, their treating psychiatrist administered the
J-DES in their individual sessions.
An informed consent was obtained from all subjects after
the study procedure was fully explained.
Data Analyses
The score for each item and the overall score of theJ-DES
for each subject were measured using the method of
Bernstein and Putnam (1986). Scores for each item were
determined by measuring the subject slash mark to the near-
est left-hand 5 mm anchor point of the 100 mm line. The
183
DISSOCIATION, Vol. Iii, No. 3, Septemherl9%
DISSOCIATIVE DISORDERS IN JAPAN
score for the entire scale is an average of the 28-item scores.
It will be referred to as the J-DES score.
Non-parametric statistical methods were applied to ana-
lyze data whenever possible, because the distribution of J-
DES scores within the studied population is not known.
RESULTS
Diagnosis and Clinical Profiles of Dissociative Disorders
Nineteen subjects with dissociative disorders were classi-
fied into five diagnostic categories. The (Axis I) diag-
noses for these subjects are presented in Table 1. Although
dissociative disorder not otherwise specified (DDNOS) is a
residual category of dissociative disorder in a large
part of the DDNOS subjects reported high levels of dissocia-
tive symptoms except for identity disturbance on SLID-D sever-
ity rating definitions. Of the DDNOS subjects, six (75%)
reported moderate to severe psychogenic amnesia, and six
(75%) reported moderate to severe depersonalization
and/or derealization. On the contrary, of the DDNOS sub-
jects, only one (12.5%) reported moderate identity alteration,
and two (25%) reported moderate to severe identity confu-
sion. No alternate personalities or distinct personality states
were observed among the DDNOS subjects.
Of the 19 subjects with dissociative disorders, one met the
full DSM-III-R criteria for MPD. He had no history of contact
with psychiatric professionals prior to this study. His clinical
presentation was conforming to MPD symptomatic profiles
in North America except for severe amnesia for important
personal information.
TABLE 1
Diagnostic Subcategories for 19 Subjects with
Dissociative Disorders
Frequency
Subcategories N %
Psychogenic amnesia 2 10.5
Psychogenic fugue 3 15.8
Multiple personality disorder 1 5.3
Depersonalization disorder 5 26.3
Dissociative disorder not
otherwise specified 8 42.1
TABLE 2
Split-Half Reliability Coefficients for Japanese
Version of the Dissociative Experience Scale
Group Split Half p N
Normal adults 0.94 <0.0001 40
Late adolescents 0.94 <0.0001 199
Schizophrenia 0.91 0.0011 16
Dissociative disorders 0.82 0.0029 19
FIGURE 1
Distribution of Japanese Version of the Dissociative
Experience Scale (J-DES) Score by Groups; Normal .
Adults (N=40), Schizophrenia (N=16), Late
Adolescents (N-199), and Dissociative Disorders
(N=19). Boxplot shows 10%, 25%, 50% (median),
75%, and 90% of the J-DES Score Distribution of
Each Population Respectively
60
30
0
20
10
50 -
40 -
4 s  (Q~-
~~oa~
.y
ova
o
cc s
184
DISSOCIATION. Vol. IX.No.3, Septemberl996
UMESUE/MATSUO/IWATA/TASHIRO
Reliability of thef-DES
Test-retest reliability of IDES
using Spearman rank order cor-
relations for 133 late adolescents
over a four-week interval was 0.88
(p < 0.001). The internal consis-
tency was examined at four levels:
split-half reliability coefficient,
Cronbach s alpha coefficient, and
corrected item-total correlations.
Split-half reliability coefficient was
calculated using the Spearman-
Brown formula. Table 2 presents
split half reliability coefficients
for each group. They ranged from
0.82 to 0.94. Cronbach alpha
coefficient for J-DES score was
94 N 27 ). l bil y o ffi-
Validity of theJ-DES
All the subclassifications of dissociative disorders were
grouped together as dissociative disorders to compare them
with other groups, given the small number of the subjects
with dissociative disorders. Figure 1 shows a distribution of
J-DES scores for each group. The highest median scores were
obtained by subjects with dissociative disorders and the low-
est median scores were obtained by normal adults. A Kruskal-
Wallis test demonstrated that)-DES score significantly differed
across the groups (chi-square = 62.94, N = 274, df = 3, p <
0.0001) . Pairwise comparisons by Scheffes test revealed that
all but one pair yielded significant difference in the score
(Table 3).
Spearman rank-order correlation between J-DES scores
and age was - 0.11 (p = 0.059, N = 274). A Man-Whitney U-
test revealed no significant differences on the J-DES scores
between sexes (p = 0.59, N = 274).
f-DES Scores Among the Subclassifications
of Dissociative Disorders
The median J-DES score for each subclassification of dis-
sociative disorders is presented in Table 4. A Kruskal-Wallis
test demonstrated thatJ-DES score significantly differed across
the subclassifications of dissociative disorders (chi square --
13.3, N = 19, df = 4, p = 0.0098). Pairwise comparisons of
each subclassification score were then performed by
Scheffe test, yielding the results in Table 4. Subjects with
DDNOS obtained the highest group median score and sub-
jects with depersonalization disorder obtained the lowest
group median score (Table 4). The subject with MPD in this
study obtained the relatively lower J-DES score of 32.3 than
group median score of DDNOS.
DISCUSSION
The present study provides sufficient evidence of the reli-
ability and validity off-DES. It has excellent test-retest relia-
bility, corrected item-total correlations, and split-half relia-
bility as well as an excellent Cronbach s alpha coefficient.
These findings replicate the high degree of reliability of DES
that was demonstrated by previous studies conducted in
North America (Bernstein Putnam, 1986; Ross et al., 1988;
Frischholz et al., 1990). This study established criterion-ref-
erenced validity by providing the evidence that J-DES scores
agree with the criteria ofDSM-IIIR dissociative disorder diag-
nosis.However, the composition of the subjects with disso-
ciative disorders included in this study was totally different
from that of the previous studies in North America. The cri-
terion-referenced validity of DES in North America has most-
ly been established by subjects with MPD (Bernstein 
Putnam, 1986; Ross et al., 1988; Frischholz et al., 1990), but
our study of 19 subjects contained only one with MPD.
However, our method for establishing criterion-referenced
validity is appropriate to original design of DES, because it
was developed to measure dissociation not only in MPD but
also in normal and clinical populations (Bernstein Putnam,
1986) . Notwithstanding the divergence of the subjects com-
position, this study showed good criterion-referenced valid-
ity ofJ-DES. These facts strongly indicate that }DES is a cross-
culturally reliable and valid instrument to measure
dissociation.
The distribution of J-DES scores demonstrates the over-
lapping continuum of dissociative experiences across groups
and shows a stepwise increasing median J-DES score for each
group (Figure 1). This finding also tends to replicate the pre-
vious studies with DES (Bernstein Putnam, 1986; Ross, et
al. 1988; Coons, et al. 1989). The consistency of responses
to the scale between Japan and North America indicates that
"dissociative phenomena exist on a continuum and become
185
cients of the corrected item-total
score were ranged 0.54 to 0.79, with a median of 0.73, and
all of these values reached a level of significance at p < 0.001
(N = 274).
TABLE 3
Post-hoc Pairwise Comparisons by Group
Normal
Adults Schizophrenia
Late
Adolescents
Dissociative
Disorders
Median score 1.88 6.61 11.78 38.03
Normal adults  ** 
Schizophrenia n.s. 
Late adolescents 
*p< .001 . 0001
DISSOCIATION, Vol. IX, Nn. 3. Septemberl996
DISSOCIATIVE DISORDERS IN JAPAN
TABLE 4
Post-hoc Painvise Comparisons of the Japanese Version of the Dissociative Experience Scale
Among Dissociative Disorders Subjects
Depersonalization
Disorder
Psychogenic
Amnesia
Multiple
Personality
Disorder
Dissociative
Psychogenic Not Otherwise
Fugue Specified
Median score 17.5 25.3 32.3 37.0 49.0
Depersonalization disorder n.s. n.s. n.s. p=0.024
Psychogenic amnesia n.s. n.s. n.s.
Multiple personality disorder n.s. n.s.
Psychogenic fugue n.s.
maladaptive only when they exceed certain limits in inten-
sity or frequency, or occur in inappropriate contexts"
(Putnam, 1989, p. 9); namely the concept of a dissociative
continuum (Hilgard, 1977; Bernstein Putnam, 1986; Put-
nam, 1989) is cross-culturally applicable in japan.
The distribution of J-DES scores for the subjects within
the dissociative disorders differs somewhat from earlier
findings in North American literatures. In previous studies
MPD subjects obtained considerably higher scores than
DDNOS or any other subject group, and scores above 40 on
DES were strongly suggestive of MPD (Coons et al., 1989;
Armstrong Loewenstein, 1990; Carlson Putnam, 1993) .
These earlier findings are consistent with the theoretical
assumption thatMPD is regarded as the most severe model
of dissociative process (Confer Ables, 1983; Ross, 1985;
Kluft et al.,1988; Putnam, 1989; Ross et al., 1992). In con-
trast, the present study demonstrates that the subjects with
DDNOS obtained the highest group median score of over 40
on J-DES among the subjects with dissociative disorders.
Berger et al. (1994) reported that six of 39 female sub-
jects with eating disorder in Japan obtained the DES score
over 30 and concluded that this finding reflected a high like-
lihood of MPD and post traumatic stress. In their study, nei-
ther a structured interview nor an unstructured interview was
conducted to determine if patients had a diagnosis of dis-
sociative disorders or post-traumatic stress disorder.
Moreover, they simply applied norms that had been estab-
lished in North America towards the Japanese population,
and this might have led to unjustified interpretations. The
mere translation of a psychometric instrument is insufficient
to make it applicable for use in populations from different
linguistic and cultural backgrounds (Flaherty et al.,1988;
Iwata et al., 1993; Rogler, 1993; Iwata et al., 1995). This study
suggests that a high score on J-DES does not necessarily asso-
ciate a high likelihood of MPD in Japan.
The present study revealed that a large part of our
DDNOS subjects had a resemblance to typical clinical pro-
files of MPD in North America except for identity disturbance,
and particularly for identity alteration. This suggests that dis-
parity of MPD incidence between Japan and North America
is fairly attributable to the difference in existence of identi-
ty alteration. However, the importance of identity alteration
cannot be dismissed, because the core feature of MPD is the
existence of alter personalities (Putnam, 1989; Steinberg,
1995).
In relation to cross-cultural differences about dissociative
disorders, Adityanjee et al. (1989) noted that the pathoplastic
influence of the cultural background may be important in
developing clinical presentation of dissociative disorders
regarding the current status of MPD in India. From a social
constructionist view, Martinez-Taboas (1995) noted that cul-
ture and consciousness make each other up and he argued
that MPD will be fairly visible in societies with an individual-
istic outlook of the self.
It should be possible to discuss the psychological char-
acteristics of a people or the culture with the language it
speaks (Whorf, 1956), because clinical psychiatry is based
on the assumption that it is possible to get to know a patient s
mental state via the words that he uses (Doi, 1973). Suzuki
(1978), aJapanese sociolinguist, investigated the use of terms
for self-reference in Japanese. He defined Japanese terms of
self-reference including all the words with which the speak-
er refers to himself. He found that the first-person pronouns
constitute only a small portion of self-references in Japanese.
Not only that, there is a definite tendency to avoid their use
as often as possible. Instead of using first-person pronouns,
186
DISSOCIATION, WAX, No. 3, September1996
UMESUE/MATSU TASHIRO
Japanese tend to use kinship terms, position terms, occu-
pational titles, and so forth depending on a given social and
inter-personal context. On the contrary, in English, terms
for self-reference are almost exclusively limited to first-per-
son pronouns. The use of terms for self-reference can be
interpreted as the speaker act of identifying his status or
role linguistically. Self-designation in Japanese is relative and
other-oriented in comparison with the absolute type of self
designation in English (Suzuki, 1978). Relevant to this point,
Kirmayer (1991) noted thatJapanese socialization inculcates
a strong sense of interdependence and responsibility for the
feelings of others" (Kirmayer, 1991, p. 22).
Doi describes a "two-fold or even multifold structure of
consciousness" (Doi, 1973; Doi, 1986) in Japanese adaptive
psychological functioning. He states: "it doesn blemish a
person integrity to take recourse to one or the other depend-
ing upon the particular situation he finds himself in" (Doi,
1973, p. 259) . Furthermore he points out that the ease with
which one switches one attitude from one situation to anoth-
er situation and back again without much strain is regarded
as the measure of one social maturity in Japan (Doi, 1973;
Doi, 1986). As these quotations suggest, the meaning of an
integrated self is different in Japan compared with that in
North America. In Japan, a sense of self-designation is rela-
tive and pliable, and an awareness of self is covert in its cul-
tural context (Tashiro, 1994). Accordingly, it might be rea-
sonable to assume that a person who develops severe
dissociative symptoms is prone to manifest himself as DDNOS
rather than MPD in japan.
However, another hypothesis might be possible. The
avoidance of first person self-references and the two-fold or
even multifold structure of consciousness as cultural norms
in japan might combine to appear .so similar to mild forms
of MPD as to obscure the recognition of MPD in a culture
accustomed to accept the former as normative. This might
contribute to a possible systematic bias in our subjects
responses to questions (e.g., SCID-D and J-DES) about iden-
tity developed by North American researchers for North
American subjects. Kirmayer concisely puts it (1991, p. 26):
"the recognition of symptoms and syndromes is always selec-
tive and based on preconvinced culturally shaped notions
(of both patient and physician) as to what is deviant, prag-
matically relevant, and worthy of medical attention."
In spite of those cultural differences, this study detected
one MPD subject in a relatively small group of subjects. This
finding provides the evidence that MPD is not a culture-bound
syndrome that is defined as "a collection of signs and symp-
toms (excluding notions of cause) which is restricted to a
limited number of cultures, primarily on the basis of their
psychosocial features" (Prince Tcheng-Larouche, 1987, p.
6).
Potential limitations of this study should be acknowledged.
The subjects with dissociative disorders in the study were
referred outpatients for evaluation of dissociative states. Thus,
dissociative disorders subjects with subtle dissociative symp-
toms might be underrepresented in this study. Further stud-
ies are recommended to examine our findings in an unse-
lectedgroup of subjects. In addition, this study does not focus
other parameters of dissociative disorders than symptoma-
tology, such as, etiology, clinical course, and response to treat-
ment. These points may well be left to further investigation.
To summarize, this study demonstrated that the concept
of a dissociative continuum is cross-culturally applicable in
Japan, although the clinical presentation of dissociative dis-
orders may be influenced by the cultural background.
The authors thank Drs. Richard P. Kluft, George F. Rhoades
Jr., and John Curtis for reading the early draft of the
manuscript and immensely valuable comments; Dr. Marlene
Steinberg for allowing the first author to use SCID-D in
research; Dr. Eve B. Carlson for comments on translation of
DES; Drs. H. Yamada and K. Nishiura for their help in
research design; Drs. Y. Saeki, T. Matsuno, and K. An for dis-
cussions of the manuscript. 
REFERENCES
Adityanjee, G.S., Raju, G.S., Khanclelwal, S.K. (1989). Current
status of multiple personality disorder in India. of
Psychiatry, 146,
Armstrong, J.G., Loewenstein, R.J. (1990). Characteristics of
patients with multiple personality and dissociative disorders on psy-
chological testing. 448-
454.
Berger, D., Ono, Y., Nakajima, K., Suematsu, H. (1994).
Dissociative symptomatology in japan.American Journal of Psychiatry
151, 148-149.
Berger, D., Saito, S., Ono, Y., Tezuka, I., Shirahashi, J., Kuboki, T.,
Suematsu, H. (1994). Dissociation and child abuse histories in
an eating disorder cohort in japan.Arta Psychiatria Scandinavia, 90,
274-280.
Berger, D., Ono, Y, Saito, S., Tezuka, 1., Takahashi, Y., Uno, M.,
Ishikawa, Y., Kuboki, T., Asai, M., Suematsu, H. (1995).
Relationship of parental bonding to child abuse and dissociation
in eating disorders in japan.Ada Psychiatria Scandinavia, 91, 278-
282.
Bernstein, E.M., Putnam, (1986). Development, reliability,
and validity of a dissociation scale.Journal of Nervous and Mental
Disease, 174, 727-735.
Bliss, Multiple personality, allied disorders, and hypnosis.
Oxford: Oxford University Press.
187
DISSOCIATION, Vol. IX,1, 3, Septem5er1996
DISSOCIATIVE DISORDERS IN JAPAN
Boon, S., Draijer, N. (1991). Diagnosing dissociative disorders
in the Netherlands: A pilot study with the Structured Clinical
Interview for DSM-III-RDissociative Disorders.American Journal of
Psychiatry, 148, 458-462.
Carlson, E.B., Putnam, F.W. (1993). An update on the Dissociative
Experience Scale. DISSOCIATION, 6(1) 16-27.
Confer, W.N., Ables, B.S. (1983) . Multiple personality: Etiology, diag-
nosis, and treatment. New York, NY: Human Sciences.
Coons, P.M., Bowman, E.S., Pellow, T.A., Schneider, P. (1989).
Post-traumatic aspects of the treatment of victims of sexual abuse
and incest. Psychiatric Clinics of North America, 12,325-335.
Coons, P.M., Bowman, E.S., Kluft, R.P., Milstein, V. (1991). The
cross-cultural occurrence of MPD: Additional cases from a recent
survey. DISSOCIATION, 4(3), 124-127.
Dell, P.F. (1988). Professional skepticism about multiple person-
ality. Journal of Nervous and Mental Disease, 176,528-531.
Doi, L.T. (1973). Omote and ura: Concepts derived from the
Japanese two-fold structure of conciousness.Journal of Nervous and
Mental Disease, 57,258-261.
Doi, T. (1973). The anatomy of dependence. Tokyo: Kodansha
International.
Doi, T. (1986). The anatomy of self.
Dubester, K.A., Braun, B.G. (1995). Psychometric properties of
the Dissociative Experiences Scale. Journal of Nervous and Mental
Disease, 183, 231-235.
Fahy, M. (1992). Manufacture of multiple personality disorder.
British Journal of Psychiatry, 161,
Fahy, T.A. (1988). The diagnosis of multiple personality disorder.
A critical review. British Journal of Psychiatry, 153,
Flaherty, J.A., Gaviria, F.M., Pathak, D., Mitchell, T., Wintrob, R.,
Richman, J.A., Birz, S. (1988) . Developing instruments for cross-
cultural psychiatric research.
176, 257-263.
Frischholz, E.J., Braun, B.G., Sachs, KG., Hopkins, L., Schaeffer,
D.M., Lewis, J., Leavitt, F., Pasquatto, M.A., Schwartz, D.R. (1990) .
The Dissociative Experience Scale: Further replication and valida-
tion. DISSOCIATION, 3(3), 151-153.
Goff, D.C., Simms, C.A. (1993). Has multiple personality disor-
der remained consistent over time? A comparison of past and recent
cases.Journal of Nervous and Mental Disease, 181,595-600.
Hilgard, E.R. (1977). Divided conciousness: Multiple controls in human
thought and action.
Ichimaru, T. (1993). Multiple Personality Disorder: A review of its
recent progress [Japanese]. The Japanese Journal of Psycho-analysis,
37, 52-60.
Iwata, N., Saito, K, Roberts, R (1993). Responses to a self-admin-
istered depression scale among younger adolescents in Japan.
Psychiatry Research, 53,
Iwata, N., Roberts, C., Kawakami, N. (1995). Japan-U.S. com-
parison of responses to depression scale items among adult work-
ers. Psychiatry Research, 58,
Kirmayer,LT (1991) . The Place of Culture in Psychiatric Nosology:
Taijin Kyoufusho andDSM-III-R Journal of Nervous and Mental Disease,
179, 19-28.
Kluft, R.P. (1987). An update on multiple personality disorder.
Hospital Community Psychiatry, 38,
Kluft, A.P., Steinberg, M., Spitzer, R.L. (1988). DSM-III-Rrevi-
sions in the dissociative disorders: An explanation of their obser-
vation and rationale. DISSOCIATION, 1(1), 39-46.
Martinez-Taboas, A. (1995). A sociocultural analysis of Merskey's
approach.Northvale, NJ: Jason Aronson Inc.
Merskey, H. (1992). The manufacture of personalities. The pro-
duction of multiple personality disorder.British Journal ofPsychiatry,
160, 327-340.
Nakamura, K. (1919). Hentai shinrigaku [Abnormal psychology].
Tokyo: Taishukan shoten.
Prince, R., Tcheng-Larouche, F. (1987). Culture-bound syn-
dromes and international disease classification. Culture, Medicine,
and Psychiatry, 11, 3-20.
Putnam, F.W. (1991). Recent research on multiple personality dis-
order. Psychiatric Clinicsof North America, 14,489-502.
Putnam, F.W. (1989). Diagnosis and treatment of multiple personality
disorder.New York, NY: The Guilford Press.
Rogler, L.H. (1993) . Culturally sensitizing psychiatric diagnosis: A
framework for research.Journal of Nervous and Mental Disease, 181,
401-408.
Ross, C.A. (1985) . Manual-III Problems in diagnosing
partial forms of multiple personality disorder: Discussion paper.
Journal of Royal Society of Medicine, 78,
Ross, C.A., Norton, G.R., Anderson, G. (1988). The Dissociative
Experience Scale: A replication study. DISSOCIATION, 1(3),21-22.
Ross, C.A. (1990). Comments on: Takahashi "Is MPD really rare
in japan?" DISSOCIATION, 3(2), 64-65.
188
DlSS0CLAT10N, Vol. IX, No. 3, September1996
UMESUE/ MATSUO
Ross, CA., Anderson, G., Fraser, G.A., Reagor, P., Bjornson, L., 
Miller, S.D. (1992). Differentiating multiple personality disorder
and dissociative disorder not otherwise specified. DISSOCIATION,
5(2), 87-90.
Spitzer, R. (1983). Psychiatric Diagnosis: Are clinicians still neces-
sary?Comprehensive Psychiatry, 399-411.
Steinberg, M., Rounsaville, B.,ScCicchetti, D.V. (1990). The Struc-
tured Clinical Interview for DSM-III-R Dissociative Disorders:
Preliminary report on a new diagnostic instrument. American
Journal of Psychiatry, 147, 76-82.
Steinberg, M. (1993). Interviewer's guide to the Structured Clinical
InterviewforDSM-IV DissociativeDisrrrders Washington, DC:
American Psychiatric Press.
Steinberg, M. (1993). Structured Clinical Interview for DSM-IV
Dissociative Disorders.Washington, DC: American Psychiatric Press.
Steinberg, M., Gicchetti, D., Buchanan, J., Rakfeldt, j., Rounsaville,
B. (1994). Distinguishing between multiple personality disorder (dis-
sociative identity disorder) and schizophrenia using the Structured
Clinical Interview for DSM-IVDissociative Disorders. Journal of
Nervous and Mental Disease, 182,495-502.
Steinberg, M. (1995). Handbook for the assessment of dissociation: A
clinical guide.Washington, DC: American Psychiatric Press.
Suzuki, T. (1978). Japanese and the Japanese. Tokyo: Kodansha
International.
Takahashi, Y. (1990). Is multiple personality disorder really rare in
Japan?DISSOCIATION, 3(2) 57-59.
Tanabe, H., Ogawa, T. (1992). On the measurement of disso-
ciative experiences: Development of the dissociative experiences
scale with a population of Japanese university students. Tsukuba
Psychological Research, 14,
Tashiro, N. (1994). Psychotherapy and religious culture.Journal of
Morita Therapy,5, 9-12.
Whorf, B.L. (1956). Language, thought, and reality.
Massachusetts Institute of Technology.
189
DISSOCIATION, Vol. IX, No.3, Scpteniherl9%