Effect of psychosocial trauma and stress on sexual dysfunction in women with endometriosis.

BACKGROUND: Endometrial tissue plays an important role in the regulation of female fertility and there is evidence that endometrial pathology (including endometriosis) is closely related to endocrine disorders. On the other hand, various neuroendocrine changes can be significantly affected by psychosocial stress. In connection with these findings, we tested the relationship between neuroendocrine changes, sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms in women with endometriosis. METHODS: A total of 65 patients with endometriosis were included in the study. Clinical examinations were focused on the biochemical analysis of neuroendocrine markers of endometriosis (cancer antigen 125 [CA 125] and cancer antigen 19-9 [CA 19-9]), estradiol, psychometric evaluation of sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms. RESULTS: The results showed significant Spearman correlations between the values of the revised range of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale), psychosocial/traumatic stress (Trauma Symptoms Checklist) (R = 0.31), and dissociative symptoms (Somatoform Dissociation Questionnaire) (R = 0.33). Positive correlations were also found between CA 125 and CA 19-9 (R = 0.63), and between CA 125 and the results of the values of the revised scale of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale) (R = 0.29). Also psychosocial/traumatic stress (Trauma Symptoms Checklist) significantly correlated with CA 125 (R = 0.38) and with CA 19-9 (R = 0.33). CONCLUSION: These results represent the first findings regarding the relationship of the neuroendocrine markers CA 125 and CA 19-9 and sexual dysfunction with trauma/stress-related symptoms and dissociative symptoms in women with endometriosis.

Levels of childhood traumatic experiences and dissociative symptoms in extremely obese patients with and without binge eating disorder.

Background: It has been suggested that obese patients with binge eating disorder (BED) show higher levels of dissociation and childhood trauma. Aim: This study assesses childhood trauma history and dissociative symptoms in obese patients with BED compared to obese patients without BED. Methods: The 241 patients participating in the study had to meet obesity criteria. These patients were applicants for bariatric surgery and were consulted by a psychiatry service. Patients were separated into two groups that were accompanied by BED diagnoses according to structured clinical interviews administered according to the DSM-IV (SCID-I). Patients were assessed using the Dissociation Questionnaire (DIS-Q) and the Childhood Trauma Questionnaire (CTQ). The two groups of patients were compared. Results: A total of 75 (31.1%) of the 241 obese patients were diagnosed with BED. The study showed that obese patients with BED had higher dissociative scores than those without BED (p < .05). The results showed higher total scores and two different types of childhood trauma (physical abuse and emotional abuse) in BED patients compared to non-BED patients (p < .05). Conclusions: Clinicians should be fully aware of BED, dissociative symptoms and childhood traumatic experiences. These results show that, for at least a sub-group of obese patients, BED is associated with obesity and may be connected with dissociative symptoms and childhood physical abuse and emotional abuse.

Fibromyalgia and dissociative symptoms.

BACKGROUND: Fibromyalgia (FM) is a chronic pain syndrome with a controversial etiopathogenesis. Patients with FM usually complain of cognitive symptoms, which are described as "fibrofog." These cognitive complaints might be caused partially by dissociative disorders (DD). The aim of this research is to determine the association between FM and DD. METHODS: The authors conducted a case-control study for this purpose, integrated by 3 groups: control (C), patients with rheumatic disorders (R), and patients with FM (FM), who were compared through the Dissociative Experiences Scale (DES).The findings are as follows: 42% were taking medications in the FM group, and their differences in scores with those who were not under medications were then considered. In terms of the results, the FM group showed higher scores than both C and R groups (p < 0.05). Patients with FM who were taking antidepressants had lower scores than those who were not (Z-score -8.03; p < 0.05); and finally, 5.71% had a score over 30 (χ2 = 3.73, p = 0.15). CONCLUSION: Patients with FM had higher scores, which might be related to the association of dissociative experiences, lifetime trauma, and victimization. Antidepressants might have some role on dissociative symptoms as well.

Secondary Traumatization and Proneness to Dissociation Among Palliative Care Workers: A Cross-Sectional Study.

CONTEXT: Exposure to dying patients can contribute to secondary traumatic stress (STS) among palliative care workers. Peritraumatic dissociation (PETD), an individual's personal proneness to dissociation during exposure to a stressful event, is the strongest predictor of post-traumatic stress, but existing research on its relationship to STS is limited. OBJECTIVE: To compare the level of STS among palliative workers with clinical levels of PETD compared with those without clinical levels of PETD. METHODS: A cross-sectional self-report survey. SETTING/PARTICIPANTS: These include about 420 physicians and nurses working in hospital-based and/or home-based palliative care units. INCLUSION CRITERIA: two years' experience with at least 10 hours/week of direct care for terminally ill patients. RESULTS: About 144 participants returned completed questionnaires (response rate 35%). Sixty percent reported a nonclinical level of dissociation. Workers with a clinical level of dissociation had significantly higher levels of STS compared with workers who did not. Awareness of an interaction effect between PETD and fear of dying progression can advance our understanding of how the development of PETD during exposure to dying can have an impact that is beyond the main effect on STS. CONCLUSIONS: The clinical level of PETD correlates significantly with STS. Further research is needed to understand whether STS is related to the individual's own vulnerability, as reflected by their personal proneness to dissociation, during exposure to death and dying.

Development and Preliminary Psychometric Properties of an Instrument for the Measurement of Obsessional Dissociative Experiences: The Van Obsessional Dissociation Questionnaire (VOD-Q).

A growing body of research evidence documents the substantial associations between obsessive-compulsive disorder (OCD) and dissociation. This article describes the development and preliminary psychometric properties of the Van Obsessional Dissociation Questionnaire (VOD-Q). Obsessional dissociation is defined as a tendency to dissociate in reaction to distressing, unwanted and intrusive thoughts, images and impulses. The screening tool is conceptualized to tap obsessional dissociation across three dimensions: obsessional absorption, obsessional depersonalization/ derealization and obsessional amnesia. The VOD-Q, the Padua Inventory-Revised (PI-R), the Dissociative Experiences Scale (DES), and the Obsessive Belief Questionnaire (OBQ-44) were administered in this study. The results showed that the VOD-Q had excellent test-retest reliability (ranging from 0.73 to 0.90) and internal consistency (ranging from 0.90 to 0.97). The VOD-Q total and subscale scores were significantly associated with measures of obsessive-compulsive symptoms and dissociative experiences. OCD patients scored significantly higher on the VOD-Q than community participants. Based on the present findings, the VOD-Q appears to be a reliable and valid instrument for the measurement of obsessional dissociative experiences.

Alexithymia and anesthetic bladder capacity in interstitial cystitis/bladder pain syndrome.

OBJECTIVE: In contrast to the inconsistent results of organic causes, it has been found that psychological risk factors are reliably related to functional somatic syndromes (FSSs), including interstitial cystitis/bladder pain syndrome (IC/BPS). Compared to patients with acute cystitis, a subgroup of IC/BPS patients with a history of childhood relational trauma reported intensified unregulated affective states (i.e., anxiety and depression) and trauma-related psychopathology (i.e., dissociation). Nevertheless, it remains unknown whether psychosocial risk factors can be separated from bladder-centric factors. This study aimed to verify whether psychosocial factors such as alexithymia, which is a key psychological factor of FSSs, are less likely to be linked to a low bladder capacity in patients with IC/BPS. METHODS: Ninety-four female IC/BPS patients were recruited from the outpatient departments of urology, obstetrics, and gynecology. Anxiety, depression, dissociation, childhood relational trauma, and alexithymia were assessed using standardized scales, and anesthetic bladder capacity was examined by cystoscopic hydrodistention. RESULTS: Positive correlations were found between anesthetic bladder capacity and the psychosocial variables, including alexithymia. An increased bladder capacity was associated with anxiety, dissociation, and childhood relational trauma, and a combination of high cognitive and low affective alexithymia mediated the correlations between bladder capacity and the psychosocial variables. CONCLUSIONS: Psychosocial variables that are associated with an aversive childhood relational environment and affect dysregulation may constitute a pathogenic trajectory that differs from bladder-centric defects such as a lower bladder capacity. The findings of this study support the notion that IC/BPS in some patients may be due to an FSS.

Childhood trauma perpetrated by close others, psychiatric dysfunction, and urological symptoms in patients with interstitial cystitis/bladder pain syndrome.

BACKGROUND: A psychosocial phenotype of interstitial cystitis/bladder pain syndrome (IC/BPS), a urogenital condition without known organic causes, was proposed. While psychosocial variables, including interpersonal maltreatment and negative affect, were studied in association with IC/BPS, the specificities of the relationships between childhood trauma by close others, psychiatric dysfunctions (negative affect and post-traumatic psychopathology), and urogenital symptoms have not been established. METHODS: 94 IC/BPS patients were recruited together with 47 patients with acute cystitis who served as clinical controls. Standardized scales were used to assess various potentially traumatizing events in childhood and adulthood as well as psychiatric (dissociation and negative affect) and urogenital symptoms. RESULTS: Among the potentially traumatizing events, those perpetrated by close others during childhood were found to be the most salient features discriminating the IC/BPS group from the control group. When divided into 2 subgroups according to their history of childhood trauma by close others, only IC/BPS patients with childhood trauma by close others had more dissociative and anxiety symptoms compared with the control group. These two subgroups did not differ in urogenital symptom severity. CONCLUSIONS: Childhood trauma by close others, rather than other types of interpersonal trauma, was a differentiating characteristic in IC/BPS patients, and a childhood trauma related psychosocial phenotype with a distinct clinical profile of dissociation and anxiety proneness was identified. Future studies should investigate whether a distinct set of pathogenic factors exists in IC/BPS patients with a history of childhood trauma by close others, even if this subgroup is not readily differentiated by urogenital symptoms.

Association of peritraumatic dissociation with symptoms of depression and posttraumatic stress disorder.

AIM: In this study, we evaluated whether peritraumatic dissociation (PD) was associated with symptoms of depression and posttraumatic stress disorder (PTSD), and whether this association was modified by trauma prior to police work. METHOD: Symptoms of depression, PTSD, peritraumatic dissociative experience (PDE), and trauma prior to police work were measured using the Center for Epidemiologic Studies Depression scale, PTSD Checklist-Civilian, PDE questionnaire, and the Brief Trauma questionnaire, respectively, in 328 police officers. Separate regression models were used to assess if either symptoms of depression or PTSD were associated with PD stratified by prior trauma. Means were adjusted for race, number of drinks per week, and smoking. RESULTS: PD was associated with symptoms of PTSD and depression (ß = 0.65, p < .001 and ß = 0.27, p < .001, respectively). PD was positively associated with symptoms of PTSD regardless of prior trauma (ß = 0.61, p < .001(without prior trauma), 0.75, p < .001 (with prior trauma). In contrast to PTSD, depression symptoms were significantly associated with PD scores in individuals with prior trauma (ß = 0.47, p < .001), but not in individuals without prior trauma (ß = 0.13, p = .165). LIMITATIONS: This is a cross-sectional study. Outcomes were obtained via self-report and were not clinically diagnosed. Aspects of both the trauma event as well as the symptoms and severity of PD may have introduced recall bias. CONCLUSION: These results add to the literature indicating that PD plays a role in symptoms of PTSD and depression and how prior trauma may modify this relationship. (PsycINFO Database Record

Functional neurological symptoms modulate processing of emotionally salient stimuli.

OBJECTIVE: Dysfunctional emotion processing has been discussed as a contributing factor to functional neurological symptoms (FNS) in the context of conversion disorder, and refers to blunted recognition and the expression of one's own feelings. However, the emotion processing components characteristic for FNS and/or relevant for conversion remain to be specified. With this goal, the present study targeted the initial, automatic discrimination of emotionally salient stimuli. METHODS: The magnetoencephalogram (MEG) was monitored in 21 patients with functional weakness and/or sensory disturbance subtypes of FNS and 21 healthy comparison participants (HC) while they passively watched 600 emotionally arousing, pleasant, unpleasant or neutral stimuli in a rapid serial visual presentation (RSVP) design. Neuromagnetic activity was analyzed 110-330ms following picture onset in source space for prior defined posterior and central regions of interest. RESULTS: As early as 110ms and across presentation interval, posterior neural activity modulation by picture category was similar in both groups, despite smaller initial (110-150ms) overall and posterior power in patients with FNS. The initial activity modulation by picture category was also evident in the left sensorimotor area in patients with FNS, but not significant in HC. CONCLUSIONS: Similar activity modulation by emotional picture category in patients with FNS and HC suggests that the fast, automatic detection of emotional salience is unchanged in patients with FNS, but involves an emotion-processing network spanning posterior and sensorimotor areas.

Evidências de validade da escala de experiências dissociativas em amostra não clínica / Validity evidence of the dissociative experiences scale in a nonclinical sample / Evidencias de validez de la escala de experiencias disociativas em muestra no clinica

O objetivo deste artigo é apresentar as propriedades psicométricas, a estrutura fatorial e evidências de validade convergente da versão brasileira da Escala de Experiências Dissociativas (DES) em uma amostra não clínica. Participaram deste estudo 1450 respondentes (67,9% homens) com 18 anos de idade ou mais (M=29,32; DP=11,27), de vários estados brasileiros, que integraram um survey online sobre o papel das experiências dissociativas nas práticas religiosas e a relação com variáveis psicopatológicas e sociodemográficas. A análise fatorial exploratória indicou que a melhor solução seria trifatorial, tendo os fatores sido nomeados como: absorção, despersonalização-desrealização e amnésia. A versão brasileira da DES denotou consistência interna satisfatória. Também correlacionou positivamente com variáveis com as quais se esperava que correlacionasse, como sintomas conversivos e de somatização e relatos de experiências místico-religiosas. Pessoas com escore igual ou acima de 30 apresentaram média significativamente maior em abuso emocional, abuso físico e abuso sexual.

The aim of this paper is to present the psychometric properties, factor structure and evidence of convergent validity of the Brazilian version of the Dissociative Experiences Scale (DES) in a non-clinical sample. The study included 1,450 respondents (67.9% male), 18 and older (M=29.32; SD=11.27), from several Brazilian states, who joined an online survey about the role of dissociative experiences in religious practices and their relation to sociodemographic and psychopathological variables. The exploratory factor analysis indicated that the best solution would be tri-factorial. The factors were named as absorption, depersonalization/derealization and amnesia. The Brazilian DES denoted satisfactory internal consistency. The DES also correlated positively with expected variables, as measures of somatization and conversion symptoms, and reports of religious experiences. Participants with a score greater than or equal to 30 in the DES presented significantly higher scores in emotional abuse, physical abuse and sexual abuse.

El objetivo de este artículo es presentar en una muestra no clínica, las propiedades psicométricas, la estructura factorial y evidencias de validez convergente de la versión brasileña de la Escala de Experiencias Disociadas (DES). Participaron 1.450 encuestados (67,9% hombres), con 18 o más años de edad (M=29.32, SD=11.27), de varios estados brasileños, que integraron un levantamiento online sobre el papel de las experiencias disociativas en las prácticas religiosas, y su relación con variables sociodemográficas y psicopatológicas. El análisis factorial exploratorio indicó que la mejor solución sería trifactorial, siendo esos factores : absorción, despersonalización / desrealización y amnesia. La versión brasileña de la DES indica consistencia interna satisfactoria. La DES también se correlacionó positivamente con las variables con las cuales se esperaba que se correlacionase, como síntomas de conversión y de somatización, y relatos de experiencias místico-religiosas. Las personas con resultados igual o mayores de 30 en la DES presentaron media significativamente mayor en abuso emocional, abuso físico y abuso sexual.

Dissociative experiences in patients with epilepsy / Experiências dissociativas em pacientes com epilepsia

ABSTRACT A few studies have explored dissociative experiences in epilepsy patients. We investigated dissociative experiences in patients with epilepsy using the dissociative experiences scale (DES). Ninety-eight patients with epilepsy and sixty healthy controls were enrolled in this study. A sociodemographic questionnaire and the Dissociative Experiences Scale (DES), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to the participants. The DES scores were significantly higher for the patients with epilepsy than the healthy individuals. The number of individuals with pathological dissociation (DES ≥ 30) was higher in the epilepsy group (n = 28) than in the control group (n = 8). Also, higher levels of dissociation were significantly associated with frequency of seizures, but were not associated with duration of epilepsy and age at onset of the disorder. These findings demonstrate that patients with epilepsy are more prone to dissociation than controls. The high rate of dissociative experiences among patients with epilepsy suggest that some epilepsy-related factors are present.

RESUMO Poucos estudos exploraram as experiências dissociativas em pacientes com epilepsia. Investigamos as experiências dissociativas em pacientes com epilepsia através da Escala de Experiências Dissociativas (EED). Noventa e oito pacientes com epilepsia e 60 controles saudáveis foram incluídos neste estudo. Um questionário sócio-demográfico, a EED, o Beck Depression Inventory (BDI) e o Beck Anxiety Inventory (BAI) foram administrados aos participantes. Os valores de EED foram significativamente maiores nos pacientes com epilepsia em relação aos controles saudáveis. O número de indivíduos com doença dissociativa (EED ≥ 30) foi maior no grupo de epilepsia (n = 28) todo que no grupo controle (n = 8). Além disto, altos níveis de dissociação estavam associados à frequência de crises epilépticas, mas não à duração da epilepsia ou idade de início da doença. Estes achados demonstram que pacientes com epilepsia são maus susceptíveis à dissociação do que os controles. O alto índice de experiências dissociativas entre os pacientes com epilepsia sugere que alguns fatores específicos da epilepsia possam estar relacionados aos achados.

The relationship between catatonia and dissociation: A preliminary investigation.

Unlike the relationship between dissociation and Schneiderian first-rank symptoms, the relationship between dissociation and catatonia has not been investigated empirically. In order to gather some initial data about catatonia, dissociation, and childhood adverse experiences, we administered the Bush-Francis Catatonia Scale (BFCS), the Dissociative Experiences Scale (DES), the Adverse Childhood Experiences Questionnaire, and the Dissociative Disorders Interview Schedule to 100 inpatients in a hospital trauma program. The average DES score was 44.1 (SD = 22.4), and 86 participants were in the DES-Taxon. The average score on the BFCS was 7.7 (SD = 10.3); 81 participants scored 2 or higher, and 67 scored 5 or higher. The results showed that, in this sample, catatonic symptoms are frequent and related to adverse childhood experiences but seem to be a separate symptom category from both dissociation and psychosis.

Transtornos mentais comuns e associação com variáveis sociodemográficas e estressores ocupacionais: uma análise de gênero / Common mental disorders and its association with sociodemographic variables and occupational stressors: a gender analysis / Trastornos mentales comunes y asociación con variables sociodemográficas y estresores ocupacionales: un análisis de género

Este estudo teve por objetivo identificar a prevalência de Transtornos Mentais Comuns (TMC) em servidores públicos da Justiça Estadual e verificar a existência de associações entre variáveis sociodemográficas e estressores ocupacionais entre homens e mulheres. A amostra aleatória constituiu-se de 541 servidores públicos, 354 mulheres e 187 homens, pertencentes a uma instituição do Poder Judiciário do Estado do Rio Grande do Sul, em 2011. Os instrumentos utilizados foram o Self Reporting Questionnaire (SRQ-20) para avaliar os Transtornos Mentais Comuns e um questionário composto por questões sobre dados sociodemográficos, laborais e estressores ocupacionais. Os resultados evidenciaram que as mulheres apresentam maior prevalência de TMC. Na relação entre TMC e variáveis sociodemográficas e estressores ocupacionais, de acordo com o sexo, verifica-se relação com o tempo de trabalho e com os estressores carga horária, diversidade, complexidade do trabalho e relação com chefia, colegas e ambiente social. Os dados foram discutidos a partir da compreensão sobre o mercado de trabalho contemporâneo e sua interface com as relações de gênero. Os resultados apontam a necessidade de intervenções diferenciadas nos grupos pesquisados

This study aimed at investigating the prevalence of common mental disorders (CMD) in public servants of the State Court, as well as to verify the associations between sociodemographic variables and occupational stressors among men and women. The random sample was composed by 541 public servants, 354 women and 187 men, working in an institution of the Judiciary in Rio Grande do Sul, in 2011. The adopted instruments were the Self Reporting Questionnaire (SRQ-20), to evaluate common mental disorders and a questionnaire composed by items containing sociodemographic, work and occupational stressors data. Results showed that women present a higher prevalence of CMD. Regarding the relationship between sociodemographic variables and occupational stressors, according to sex, there is a relation with both working time and the following stressors: workload, work diversity, work complexity, and the relationship with bosses, colleagues, and social environment. The data were discussed from the understanding of contemporary work market, and its interface with gender relations. The results point to the need of distinct interventions with the researched groups

Este estudio tuvo por objetivo identificar la prevalencia de Trastornos Mentales Comunes (TMC) en funcionarios públicos de la Justicia Estadual y verificar la existencia de asociaciones entre variables sociodemográficas y estresores ocupacionales entre varones y mujeres. La muestra aleatoria se constituyó de 541 funcionarios públicos, 354 mujeres y 187 varones pertenecientes a una institución del poder judiciario del Estado del Rio Grande do Sul, en 2011. Los instrumentos utilizados fueron el Self Reporting Questionnaire (SRQ-20) para evaluar trastornos mentales comunes y un cuestionario compuesto por datos sociodemográficos, laborales y de estresores ocupacionales. Los resultados evidenciaron que las mujeres presentan mayor prevalencia de TMC. En la relación entre TMC y variables sociodemográficas y estresores ocupacionales, conforme el sexo, verificase relación con el tiempo de trabajo y con los estresores carga horaria, diversidad, complexidad del trabajo y relación con el jefe, compañeros y entorno social. Los datos fueron discutidos a partir de la comprensión del mercado de trabajo contemporáneo y su interface con las relaciones de género. Los resultados apuntan la necesidad de intervenciones diferenciadas en los grupos investigados

Patients use normalisation techniques to cope with the quality-of-life effects of anal cancer.

INTRODUCTION: Anal cancer is a rare malignancy, but during the past three decades, its incidence has increased in both sexes. Approximately 90% of anal cancers are related to human papillomavirus infection. The primary treatment for anal cancer is radiotherapy or radio-chemotherapy. This quality of life (QoL) study aimed at obtaining in-depth knowledge about patients' experiences with anal cancer and its impact on their QoL. METHODS: A literature study identified topics for qualitative interviews with six anal cancer patients who had received oncological treatment and were without recurrent disease. The interviews were analysed using a medical anthroo-logical approach focusing on patients' health-related phys-ical, psycho-sexual and social QoL. RESULTS: The participants suffered from common sequelae of anal cancer treatment, mainly ano-genital pain, reduced sphincter function and sexual dysfunction. The participants employed a number of "normalisation techniques", including dissociation from other cancer patients, delimitation of the cancer to a perceived external and peripheral body part and fast resumption of their usual activities. CONCLUSION: Anal sphincter dysfunction and sexual problems after radiotherapy for anal cancer may have a major impact on patients' QoL. By maintaining normalcy, patients tried to distance themselves from this tabooed cancer disease. FUNDING: not relevant. TRIAL REGISTRATION: not relevant, but approval was obtained from the Danish Data Protection Agency.

Disociaciones en teoría de la mente en la variante conductual de la demencia frontotemporal / Dissociations in theory of mind in the behavioral variant of frontotemporal dementia

Corroborar la presencia de disociaciones entre Teoría de la Mente (TdM) cognitiva y emocional en la variante conductual de la Demencia Frontotemporal (DFTvc). Muestra: 20 pacientes, media de edad 67 años, y 6 de escolaridad. Para diagnóstico de DFTvc se administró: Lectura de la Mente en los Ojos (LMO) como prueba de TdM emocional, Falsa creencia de primer orden (FC1O) como prueba de TdM cognitiva, y Faux Pas como prueba mixta. Resultados: El 80% de los pacientes mostró alteraciones en LMO y el 45% en FC1O. Se encontraron diferencias significativas entre LMO y FC1O, y entre Faux Pas y FC1O, y dobles disociaciones. Conclusión: La TdM emocional sería la más afectada en DFTvc. El hallazgo de disociaciones entre tareas podría deberse a que la TdM afectiva es procesada a través de la “teoría de la simulación”, mientras que la TdM cognitiva lo es a través de la “teoría teoría”...

Empirical testing of criteria for dissociative schizophrenia.

This study examined the validity of dissociative schizophrenia diagnostic criteria. In the first phase, 50 participants with a psychotic disorder were administered the Dissociative Experiences Scale and the Childhood Trauma Questionnaire to identify those with dissociative characteristics. In the second phase, we selected those who had a score of 15 or above on the Dissociative Experiences Scale. Fifteen of these participants were evaluated thoroughly with the Structured Clinical Interview for DSM-IV Axis I, Structured Clinical Interview for DSM-IV Axis II, and Structured Clinical Interview for DSM-IV Dissociative Disorders to determine whether they met the criteria for dissociative schizophrenia and to generate a clinical description. Our results indicated that 24% of the individuals we tested met these criteria. We propose making mandatory 1 of the 3 dissociative symptoms of the criteria to eliminate people with only nonspecific symptoms (e.g., extensive comorbidity). According to this modified criterion, 14% of our sample would receive a diagnosis of dissociative schizophrenia. However, a more comprehensive look at the clinical picture begs the question of whether dissociative schizophrenia is truly present in every person meeting the criteria. We discuss the relevance of creating a new schizophrenia subtype and offer recommendations for clinicians.

Dissociative depression among women with fibromyalgia or rheumatoid arthritis.

The aim of this study was to inquire about the possible relations of childhood trauma, anger, and dissociation to depression among women with fibromyalgia or rheumatoid arthritis. Fifty female patients diagnosed as having fibromyalgia (n = 30) or rheumatoid arthritis (n = 20) participated in the study. The Childhood Trauma Questionnaire, Somatoform Dissociation Questionnaire (SDQ), Dissociation Questionnaire (DIS-Q), Beck Depression Inventory (BDI), Spielberger State-Trait Anger Expression Inventory, and Dissociative Disorders Interview Schedule were administered to all participants. Women with a lifetime diagnosis of depressive disorder had higher scores for somatoform and psychoform dissociation than the nondepressive patients. However, childhood trauma scores did not differ between the 2 groups. In regression analysis, current severity of depression (BDI) was predicted by psychoform dissociation (DIS-Q) and lower education, and lifetime diagnosis of major depression was predicted by somatoform dissociation (SDQ). Whereas childhood emotional neglect predicted somatoform dissociation, psychoform dissociation was predicted by childhood sexual abuse. Mental processing of anger seems to be 1 of the dimensions of psychodynamics in trauma-related depressive conditions. In the context of the perceived threat of loss of control due to expressed anger and mental disintegration, somatoform dissociation seems to contribute to overmodulation of emotions in dissociative depression. Among patients suffering from physical illness with possible psychosomatic dimensions, assessment of somatoform dissociation in addition to psychoform dissociation may be helpful to understand diverse psychopathological trajectories emerging in the aftermath of childhood adversities. The recently proposed category of "dissociative depression" (Sar, 2011) seems to be a promising concept for future research on psychosomatic aspects of traumatic stress.

The association among childhood maltreatment, somatic symptom intensity, depression, and somatoform dissociative symptoms in patients with fibromyalgia syndrome: a single-center cohort study.

Research demonstrates strong associations between childhood maltreatment and health problems that include dissociative symptoms and fibromyalgia syndrome (FMS). We assessed the associations among childhood maltreatment, somatic symptom severity, depression, and somatoform dissociative symptoms in all consecutive adult FMS patients of a tertiary referral pain medicine center between January 2010 and December 2011. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire, somatoform dissociative symptoms with the Somatoform Dissociation Questionnaire, somatic symptom severity with the Patient Health Questionnaire-15 and depression by the Patient Health Questionnaire-2. A total of 117 patients (84% women) were included in the analysis, of whom 20.5% reported severe emotional abuse, 8.6% severe physical abuse, 12.8% severe sexual abuse, 25.6% severe emotional neglect, and 12.0% severe physical neglect in childhood and adolescence. On average, patients reported high levels of somatoform dissociative symptoms and moderate levels of somatic symptom severity and depression. Somatoform dissociative symptoms and emotional abuse were moderately correlated (r = .32). In hierarchical regression analysis, gender (p = .01) and somatic symptom severity (p < .0001) but not childhood maltreatment and depression were significant predictors of somatoform dissociative symptoms. Reports of somatoform dissociative symptoms by FMS patients might be attributed to their tendency to report multiple somatic symptoms.