Clusters of resilience and vulnerability: executive functioning, coping and mental distress in patients with diffuse low-grade glioma.

PURPOSE: Diffuse low-grade gliomas (dLGG) often have a frontal location, which may negatively affect patients' executive functions (EF). Being diagnosed with dLGG and having to undergo intensive treatment can be emotionally stressful. The ability to cope with this stress in an adaptive, active and flexible way may be hampered by impaired EF. Consequently, patients may suffer from increased mental distress. The aim of the present study was to explore profiles of EF, coping and mental distress and identify characteristics of each profile. METHODS: 151 patients with dLGG were included. Latent profile analysis (LPA) was used to explore profiles. Additional demographical, tumor and radiological characteristics were included. RESULTS: Four clusters were found: 1) overall good functioning (25% of patients); 2) poor executive functioning, good psychosocial functioning (32%); 3) good executive functioning, poor psychosocial functioning (18%) and; 4) overall poor functioning (25%). Characteristics of the different clusters were lower educational level and more (micro)vascular brain damage (cluster 2), a younger age (cluster 3), and a larger tumor volume (cluster 4). EF was not a distinctive factor for coping, nor was it for mental distress. Maladaptive coping, however, did distinguish clusters with higher mental distress (cluster 3 and 4) from clusters with lower levels of mental distress (cluster 1 and 2). CONCLUSION: Four distinctive clusters with different levels of functioning and characteristics were identified. EF impairments did not hinder the use of active coping strategies. Moreover, maladaptive coping, but not EF impairment, was related to increased mental distress in patients with dLGG.

Protocol for the MS-CEBA study: an observational, prospective cohort study identifying Cognitive, Energetic, Behavioural and Affective (CEBA) profiles in Multiple Sclerosis to guide neuropsychological treatment choice.

BACKGROUND: Neuropsychological symptoms in the Cognitive, Energetic, Behavioural, and Affective (CEBA) domains are common in people with multiple sclerosis (PwMS) and can negatively affect societal participation. The current study aims to investigate whether there are combinations of symptoms in the different CEBA domains that consistently occur together, that is, if there are CEBA profiles that can be identified. If so, this study aims to develop a screening instrument identifying CEBA profiles in PwMS to select the most suitable neuropsychological rehabilitation treatment for a given CEBA profile and consequently improve the societal participation of PwMS. METHODS: This study is an observational, prospective cohort study consisting of 3 phases. Phase 1 focuses on the identification of CEBA profiles in a large sample of PwMS (n = 300). Phase 2 focuses on validating these CEBA profiles through replication of results in a new sample (n = 100) and on the development of the screening instrument. Phase 3 focuses on qualitatively evaluating in a small group of PwMS whether the selected treatment is suitable for the given CEBA profile or whether existing neuropsychological treatments should be adapted to meet the needs of PwMS suffering from symptoms in multiple CEBA domains simultaneously. Primary outcome is the CEBA profile, which will be derived from performance on neuropsychological assessment consisting of tests and questionnaires regarding the CEBA domains using a latent profile analysis. Inclusion criteria include MS diagnosis, sufficient ability in the Dutch language, and an age between 18 and 70 years. DISCUSSION: The results of the current study will contribute to a more comprehensive understanding of the entire spectrum of neuropsychological symptoms in PwMS. Identification of possible CEBA profiles, and accordingly, the development of a screening instrument determining the CEBA profile of PwMS in clinical practice, contributes to the timely referral of PwMS to the most suitable neuropsychological rehabilitation treatment. If necessary, adjustments to existing treatments will be suggested in order to sufficiently meet the needs of PwMS. All of this with the ultimate aim to improve societal participation, and thereby quality of life, of PwMS. TRIAL REGISTRATION: Dutch Central Committee on Research Involving Human Subjects (CCMO) NL83954.042.23; ClinicalTrials.gov NCT06016309.

Does a three-dimensional Impact Message Inventory-Circumplex (IMI-C) enclose an indirect measure of reactance?

Clinicians can rely on the Impact Message Inventory-Circumplex (IMI-C) to map their emotional reactions to their patients' communication style in octant and main dimension scores on the two-dimensional interpersonal circle, based on affiliation (AFF) and control (CON) as the underlying main dimensions. However, modern emotion theories distinguish three, rather than two, robust dimensions of emotional experience and the perception of interpersonal behaviours: (1) positive versus negative evaluation (related to AFF), (2) strong versus weak (related to CON) and (3) active versus passive (arousal). In a large Dutch patient sample (N = 1,001), we first tested whether the two-dimensional circumplex structure of the IMI-C could be replicated using Browne's circumplex model. Then we explored whether a third dimension could be retrieved from therapists' IMI-C responses using exploratory factor analysis, followed by orthogonal target rotation towards a partially specified target matrix, with the first two factors specified according to the circumplex structure, and the other factor(s) left free. The two-dimensional circumplex of the IMI-C could be validated to a fair extent. Using exploratory factor models, we found supporting evidence for a third factor, which could be interpreted as reflecting reactance ('active' vs. 'passive' opposition). We recommend to extend the current two-dimensional interpretation to a three-dimensional interpretation of IMI-C responses, by adding a reactance dimension.

White matter microstructure of the neural emotion regulation circuitry in mild traumatic brain injury.

Emotion regulation is related to recovery after mild traumatic brain injury (mTBI). This longitudinal tractography study examined white matter tracts subserving emotion regulation across the spectrum of mTBI, with a focus on persistent symptoms. Four groups were examined: (a) symptomatic (n = 33) and (b) asymptomatic (n = 20) patients with uncomplicated mTBI (i.e., no lesions on computed tomography [CT]), (c) patients with CT-lesions in the frontal areas (n = 14), and (d) healthy controls (HC) (n = 20). Diffusion and conventional MRI were performed approximately 1- and 3-months post-injury. Whole-brain deterministic tractography followed by region of interest analyses was used to identify forceps minor (FM), uncinate fasciculus (UF), and cingulum bundle as tracts of interest. An adjusted version of the ExploreDTI Atlas Based Tractography method was used to obtain reliable tracts for every subject. Mean fractional anisotropy (FA), mean, radial and axial diffusivity (MD, RD, AD), and number of streamlines were studied per tract. Linear mixed models showed lower FA, and higher MD, and RD of the right UF in asymptomatic patients with uncomplicated mTBI relative to symptomatic patients and HC. Diffusion alterations were most pronounced in the group with frontal lesions on CT, particularly in the FM and UF; these effects increased over time. Within the group of patients with uncomplicated mTBI, there were no associations of diffusion measures with the number of symptoms nor with lesions on conventional MRI. In conclusion, mTBI can cause microstructural changes in emotion regulation tracts, however, no explanation was found for the presence of symptoms.

Clinical, societal and personal recovery in schizophrenia spectrum disorders across time: states and annual transitions.

BACKGROUND: Recovery in schizophrenia is a complex process, involving clinical, societal and personal recovery. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. AIMS: This study aimed to examine different states of recovery and transition rates between states. METHOD: The Pharmacotherapy Monitoring and Outcome Survey (2006-2017) yearly assesses patients with schizophrenia in the Northern Netherlands. Data from 2327 patients with one up to 11 yearly measurements on clinical, societal and personal recovery were jointly analysed with a mixture latent Markov model (MLMM). RESULTS: The selected MLMM had four states that differed in degree and pattern of recovery outcomes. Patients in state 1 were least recovered on any domain (16% of measurements), and partly recovered in states 2 (25%; featured by negative symptoms) and 3 (21%; featured by positive symptoms). Patients in state 4 (38%) were most recovered, except for work, study and housekeeping. At the subsequent measurement, the probability of remaining in the same state was 77-89%, transitioning to a better state was 4-12% and transitioning to a worse state was 4-6%; no transitions occurred between states 1 and 4. Female gender, shorter illness duration and less schizophrenia were more prevalent in better states. CONCLUSIONS: Quite a high recovery rate was present among a substantial part of the measurements (38%, state 4), with a high probability (89%) of remaining in this state. Transition rates in the other states might increase to a more favourable state by focusing on adequate treatment of negative and positive symptoms and societal problems.

Trajectories of Fatigue, Psychological Distress, and Coping Styles After Mild Traumatic Brain Injury: A 6-Month Prospective Cohort Study.

OBJECTIVE: To analyze fatigue after mild traumatic brain injury (TBI) with latent class growth analysis (LCGA) to determine distinct recovery trajectories and investigate influencing factors, including emotional distress and coping styles. DESIGN: An observational cohort study design with validated questionnaires assessing fatigue, anxiety, depression, posttraumatic stress, and coping at 2 weeks and 3 and 6 months postinjury. SETTING: Three level 1 trauma centers. PARTICIPANTS: Patients with mild TBI (N=456). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fatigue was measured with the fatigue severity subscale of the Checklist Individual Strength, including 8 items (sum score, 8-56). Subsequently, 3 clinical categories were created: high (score, 40-56), moderate (score, 26-38), and low (score, 8-25). RESULTS: From the entire mild TBI group, 4 patient clusters with distinct patterns for fatigue, emotional distress, and coping styles were found with LCGA. Clusters 1 and 2 showed favorable recovery from fatigue over time, with low emotional distress and the predominant use of active coping in cluster 1 (30%) and low emotional distress and decreasing passive coping in cluster 2 (25%). Clusters 3 and 4 showed unfavorable recovery, with persistent high fatigue and increasing passive coping together with low emotional distress in cluster 3 (27%) and high emotional distress in cluster 4 (18%). Patients with adverse trajectories were more often women and more often experiencing sleep disturbances and pain. CONCLUSIONS: The prognosis for recovery from posttraumatic fatigue is favorable for 55% of mild TBI patients. Patients at risk for chronic fatigue can be signaled in the acute phase postinjury based on the presence of high fatigue, high passive coping, and, for a subgroup of patients, high emotional distress. LCGA proved to be a highly valuable and multipurpose statistical method to map distinct courses of disease-related processes over time.

The combined self- and parent-rated SDQ score profile predicts care use and psychiatric diagnoses.

The Strengths and Difficulties Questionnaire (SDQ) is widely used, based on evidence of its value for screening. This evidence primarily regards the single informant total difficulties scale and separate difficulties subscales. We assessed to what degree adolescents' SDQ profiles that combined all self- and parent-rated subscales were associated with use of care and psychiatric diagnoses, and examined the added value thereof over using only a single informant and the total scale. Cluster analysis was used to identify common SDQ profiles based on self- and parent-reports among adolescents aged 12-17 in mental healthcare (n = 4282), social care (n = 124), and the general population (n = 1293). We investigated associations of the profiles with 'care use' and 'DSM-IV diagnoses', depending on gender. We identified six common SDQ profiles: five profiles with varying types and severities of reported difficulties, pertaining to 95% of adolescents in care, and one without difficulties, pertaining to 55% of adolescents not in care. The types of reported difficulties in the profiles matched DSM-IV diagnoses for 88% of the diagnosed adolescents. The SDQ profiles were found to be more useful for predicting care use and diagnoses than SDQ scores reported by the adolescent as single informant and the total difficulties scale. The latter indicated the presence of problems among 42-63% of the adolescents in care, missing a substantial number of adolescents with reported emotional difficulties and borderline problem severity. These findings advocate the use of combined self- and parent-rated SDQ score profiles for screening.

Social skills group training in children with autism spectrum disorder: a randomized controlled trial.

In 122 high-functioning children with autism spectrum disorder (ASD; 9-13 years; 19 girls), we investigated the effectiveness of a 15-session social skills group training (SST) with and without parent and teacher involvement (PTI) in a randomized controlled trial with three conditions: SST (n = 47), SST-PTI (n = 51), and care-as-usual (CAU, n = 24). Hierarchical linear modeling was used for immediate and 6-month follow-up analyses. Measures were administered before randomization (blind), post-treatment and at follow-up (not blind). Trial registration: Dutch Trial Register; http://www.trialregister.nl ; NTR2405. At post-treatment, children in both SSTs had improved significantly more than CAU on the primary outcome, Vineland Socialization (SST: Cohen's d = 0.39; 95% CI - 2.23 to 3.11 and SST-PTI: d = 0.43; 95% CI - 2.19 to 3.15) and on the secondary outcome parent-SSRS "Cooperation" (SST: d = 0.43; 95% CI - 0.23 to 1.15 and SST-PTI: d = 0.45; 95% CI - 0.21 to 1.17), with no difference between post-treatment and follow-up. Additionally, children in SST-PTI improved significantly more on the teacher-SSRS than in CAU ["Cooperation" d =0.42 (95% CI - 0.33 to 1.13); "Assertion" d =0.34 (95% CI - 0.39 to 1.11); "Self-Control" d =0.61 (95% CI - 0.08 to 1.34)] and in SST ["Cooperation" d =0.34 (95% CI - 0.37 to 1.05); "Self-Control" d =0.59 (95% CI - 0.13 to 1.32)]. The current study corroborates earlier findings in smaller samples and wider age ranges, with small but statistically significant effects of SST for high-functioning pre-adolescent children with ASD. Parental and teacher involvement intensified treatment, yet did not yield an additional effect relative to SST for children only, as reported by parents. 6 months after training, no further improvement or decline was found.

Predicting therapy success from the outset: The moderating effect of insight into the illness on metacognitive psychotherapy outcome among persons with schizophrenia.

The degree to which a person recognizes their mental disorder, attributes symptoms to the disorder, and recognizes that treatment may be necessary is frequently referred to as clinical insight. The current study investigates whether clinical insight at baseline moderates the effects on metacognitive capacity of 40 sessions of metacognitive reflection and insight therapy among 35 participants with psychosis. Findings showed that clinical insight did not predict drop-out from therapy. Multilevel analyses provided support for our hypotheses that insight at baseline significantly moderates metacognitive gains at both postmeasurement and follow-up. Our findings demonstrate that lacking clinical insight substantially hampers the effect of this psychosocial intervention. We posit that research efforts should shift from developing interventions, which enhance clinical insight, to interventions, which are effective in absence of clinical insight.

Improving confidence intervals for normed test scores: Include uncertainty due to sampling variability.

Test publishers usually provide confidence intervals (CIs) for normed test scores that reflect the uncertainty due to the unreliability of the tests. The uncertainty due to sampling variability in the norming phase is ignored. To express uncertainty due to norming, we propose a flexible method that is applicable in continuous norming and allows for a variety of score distributions, using Generalized Additive Models for Location, Scale, and Shape (GAMLSS; Rigby & Stasinopoulos, 2005). We assessed the performance of this method in a simulation study, by examining the quality of the resulting CIs. We varied the population model, procedure of estimating the CI, confidence level, sample size, value of the predictor, extremity of the test score, and type of variance-covariance matrix. The results showed that good quality of the CIs could be achieved in most conditions. The method is illustrated using normative data of the SON-R 6-40 test. We recommend test developers to use this approach to arrive at CIs, and thus properly express the uncertainty due to norm sampling fluctuations, in the context of continuous norming. Adopting this approach will help (e.g., clinical) practitioners to obtain a fair picture of the person assessed.

Emotion differentiation and its relation with emotional well-being in adolescents.

Emotion differentiation (ED) refers to the precision with which people can identify and distinguish their emotions and has been associated with well-being in adults. This study investigated ED and its relation with emotional well-being (i.e. depressive symptoms, positivity and negativity intensity and propensity, implicit theories of emotions) in adolescents. We used an experience sampling method with 72 participants (Mage = 14.00, 71% girls) to assess adolescents' positive and negative emotions at different time points over the course of two weekends and a baseline questionnaire to assess emotional well-being. Differentiating negative emotions was related to less negativity intensity and propensity, and to the belief that emotions are malleable. Differentiating positive emotions was not related to any of the assessed well-being variables. Together, these results suggest that a detailed awareness of one's negative emotional states is an important dimension of well-being, also in adolescence.

Predictors of discrepancies between fathers and mothers in rating behaviors of preschool children with and without ADHD.

To examine child factors and parental characteristics as predictors of discrepancies between parents' ratings of externalizing and internalizing behavior problems in a sample of preschool children with ADHD and behavior problems and in a nonclinical sample. We investigated correspondence and discrepancies between parents' ratings on the externalizing and internalizing behavior problems broadband scales of the Child Behavior Checklist version for preschool children (CBCL/1.5-5). Parents of 152 preschool children, with ADHD and behavior problems (n = 72) and nonclinical children (n = 80), aged between 28 and 72 months (M = 47.26, SD = 12.7), completed the CBCL/1.5-5. Candidate predictors of discrepancy included the child's age and sex, and parents' levels of parenting stress, depressive mood, attention-deficit and disruptive behavior. Hierarchical multiple regression analyses were conducted. Correspondence between parents, both for ratings on internalizing and externalizing behavior problems, was high (r = .63-.77). In the clinical sample, mothers rated the severity of externalizing behavior problems significantly higher than did fathers (p = < .001). Discrepancy between fathers and mothers on externalizing behavior problems was not predicted by child factors or interparental differences in psychopathology, but it was predicted by interparental differences in parenting stress (R 2 = .25, p < .001). This effect was significantly larger in the nonclinical sample (ΔR 2 = .06, p < .001). When parents disagree on the severity level of preschool children's externalizing behavior problems, the clinician should take into consideration that differences in parenting stress might be involved.

The Psycho-Lexical Approach in Exploring the Field of Values: A Reply to Schwartz.

We reply to each of the issues raised by Schwartz in a commentary on our article on a comparison of value taxonomies. We discuss two approaches, mentioned in that commentary, the lexical approach and the theory-driven approach, especially with respect to their capacities in covering the domain of values and with respect to the representation of important values in a useful structure. We refute the critique by Schwartz that the lexical approach is superfluous, because his theory "toward universals in values" would already cover all values, and that their mutual relationships are relevant to individuals around the globe. We explain the necessity and strength of the lexical approach in taxonomizing the value domain, both within and across languages. Furthermore, we argue that principal components analysis (PCA) and simultaneous component analysis (SCA) are most adequate in arriving at a satisfactory structuring of the great many values in terms of both underlying constructs and their facets. We point to a misrepresentation in Schwartz's circular model, and we review some misunderstandings on the side of Schwartz with respect to our results in comparison with those proceeding from his circular model.

How to detect which variables are causing differences in component structure among different groups.

When comparing the component structures of a multitude of variables across different groups, the conclusion often is that the component structures are very similar in general and differ in a few variables only. Detecting such "outlying variables" is substantively interesting. Conversely, it can help to determine what is common across the groups. This article proposes and evaluates two formal detection heuristics to determine which variables are outlying, in a systematic and objective way. The heuristics are based on clusterwise simultaneous component analysis, which was recently presented as a useful tool for capturing the similarities and differences in component structures across groups. The heuristics are evaluated in a simulation study and illustrated using cross-cultural data on values.

Approaches to Sample Size Determination for Multivariate Data: Applications to PCA and PLS-DA of Omics Data.

Sample size determination is a fundamental step in the design of experiments. Methods for sample size determination are abundant for univariate analysis methods, but scarce in the multivariate case. Omics data are multivariate in nature and are commonly investigated using multivariate statistical methods, such as principal component analysis (PCA) and partial least-squares discriminant analysis (PLS-DA). No simple approaches to sample size determination exist for PCA and PLS-DA. In this paper we will introduce important concepts and offer strategies for (minimally) required sample size estimation when planning experiments to be analyzed using PCA and/or PLS-DA.

MultiLevel simultaneous component analysis: A computational shortcut and software package.

MultiLevel Simultaneous Component Analysis (MLSCA) is a data-analytical technique for multivariate two-level data. MLSCA sheds light on the associations between the variables at both levels by specifying separate submodels for each level. Each submodel consists of a component model. Although MLSCA has already been successfully applied in diverse areas within and outside the behavioral sciences, its use is hampered by two issues. First, as MLSCA solutions are fitted by means of iterative algorithms, analyzing large data sets (i.e., data sets with many level one units) may take a lot of computation time. Second, easily accessible software for estimating MLSCA models is lacking so far. In this paper, we address both issues. Specifically, we discuss a computational shortcut for MLSCA fitting. Moreover, we present the MLSCA package, which was built in MATLAB, but is also available in a version that can be used on any Windows computer, without having MATLAB installed.

Generic framework for high-dimensional fixed-effects ANOVA.

In functional genomics it is more rule than exception that experimental designs are used to generate the data. The samples of the resulting data sets are thus organized according to this design and for each sample many biochemical compounds are measured, e.g. typically thousands of gene-expressions or hundreds of metabolites. This results in high-dimensional data sets with an underlying experimental design. Several methods have recently become available for analyzing such data while utilizing the underlying design. We review these methods by putting them in a unifying and general framework to facilitate understanding the (dis-)similarities between the methods. The biological question dictates which method to use and the framework allows for building new methods to accommodate a range of such biological questions. The framework is built on well known fixed-effect ANOVA models and subsequent dimension reduction. We present the framework both in matrix algebra as well as in more insightful geometrical terms. We show the workings of the different special cases of our framework with a real-life metabolomics example from nutritional research and a gene-expression example from the field of virology.

A randomized controlled study of a social skills training for preadolescent children with autism spectrum disorders: generalization of skills by training parents and teachers?

BACKGROUND: Social skills training (SST) is a common intervention for children with autism spectrum disorders (ASDs) to improve their social and communication skills. Despite the fact that SSTs are often applied in clinical practice, the evidence for the effectiveness of these trainings for children with ASD is inconclusive. Moreover, long term outcome and generalization of learned skills are little evaluated. Additionally, there is no research on the influence of involvement of parents and teachers on effectiveness of SST and on the generalization of learned social skills to daily life. We expect parent and teacher involvement in SST to enhance treatment efficacy and to facilitate generalization of learned skills to daily life. METHOD/DESIGN: In a randomized controlled trial (RCT) with three conditions, 120 participants with ASD at the end of primary school (10-12 years of calendar age) have been randomized to SST, SST-PTI (SST with Parent & Teacher Involvement), or care-as-usual. The SST consists of 18 group sessions of 1.5 hours for the children. In the SST-PTI condition, parents additionally participate in 8 parent sessions and parents and teachers are actively involved in homework assignments. Assessment takes place at three moments: before and immediately after the intervention period and at 6 months follow-up. Primary outcome is socialization, as an aspect of adaptive functioning. Secondary outcomes focus on specific social skills children learn during SST and on more general social skills pertaining to home and community settings from a multi-informant perspective. Additionally, possible predictors of treatment outcome will be assessed. DISCUSSION: The current study is an RCT study evaluating SST in a large sample of Dutch children with ASD in a specific age range (10-12 years). Strengths of the study are the use of one manualized protocol, application of standardized and internationally used rating instruments, use of multiple raters, investigation of generalization of learned skills to daily life, and the evaluation of efficacy in the longer term by follow-up measures at 6 months after the end of training. TRIAL REGISTRATION: NTR2405.

Accommodating the Bayley-III for motor and/or visual impairment: a comparative pilot study.

PURPOSE: This study assessed the validity and usefulness of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) Low Motor/Vision accommodated version. Accommodations are adaptations to minimize impairment bias, without altering what the test measures. Of the items, 66% have Low Motor accommodations like enlarged materials; 62% have Low Vision accommodations. METHODS: Using a within-subject design, we tested 19 children with the accommodated and standard Bayley-III, in a randomly counterbalanced order. The children had motor and/or visual impairment and a chronological age between 22 and 90 months. The test administrators completed an evaluation form. RESULTS: A subgroup of children benefited from the accommodations; 2 children obtained a large raw score difference. Test administrators considered the accommodations as practical, and advantageous for most children. CONCLUSION: The Low Motor/Vision accommodated version seems to validly assess the development of this population. Future, larger-scale research should study whether the accommodations improve the construct validity of the Bayley-III.

Differential constellations of dissociative symptoms and their association with childhood trauma - a latent profile analysis.

Background: While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe.Objective: We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics.Methods: We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (Fragebogen zu Dissoziativen Symptomen-20) in a large aggregate sample (n = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics.Results: Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout.Conclusions: The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment.

Dissociative symptoms, including identity alterations, are closely related to the severity of experienced childhood abuse.Somatoform dissociation occurs on all levels of overall dissociation severity.Some subjects with a history extreme childhood maltreatment do not develop dissociative symptoms, while some subjects with extreme dissociative symptoms do not report any childhood maltreatment.