Psychopathology, hypnotizability, and dissociation.

OBJECTIVE: The purpose of the study was to replicate and extend previous findings regarding the hypnotizability of different clinical groups. METHOD: The authors compared the differential hypnotizability of four psychiatric groups--patients with dissociative disorders (N = 17), schizophrenia (N = 13), mood disorders (N = 13), and anxiety disorders (N = 14)--and one normal group of college students (N = 63). Hypnotizability was assessed by four different measures: the eye roll sign and the induction score of the Hypnotic Induction Profile, the Stanford Hypnotic Susceptibility Scale, Form C, and two self-ratings of hypnotizability. RESULTS: As predicted, dissociative disorder patients had significantly higher hypnotizability scores on all measures than all other groups. Schizophrenic patients, on the other hand, had significantly lower scores than normal subjects on the eye roll sign and induction score but not on the other measures of hypnotizability. Some other unpredicted between-group differences were also found. Nevertheless, despite the between-group differences, the intercorrelations between the various hypnotizability measures within the normal group were very similar to those observed in the combined patient groups. CONCLUSIONS: The findings suggest that routine hypnotizability assessment may be useful in the differential diagnosis of patients with dissociative disorders.

Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study.

OBJECTIVE: The Dissociative Experiences Scale has proved a reliable and valid instrument to measure dissociation in many groups, but its capacity to distinguish patients with multiple personality disorder from patients with other psychiatric disorders has not yet been conclusively tested. METHOD: A discriminant analysis was performed to classify 1,051 subjects as having or not having multiple personality disorder. Another discriminant analysis was performed on a subgroup of 883 subjects more closely representing patients in a typical psychiatric facility in terms of base rates of dissociative disorders. A cutoff score of 30 was also used to classify subjects, and Bayes's theorem, which allows for the calculation of the positive predictive value and the negative predictive value of a screening test, was applied. RESULTS: According to discriminant analysis of the total study group, the scale's sensitivity was 76% and its specificity was also 76%; according to discriminant analysis of the more representative subgroup, the scale's sensitivity was 76% and its specificity was 85%. Use of the cutoff score of 30 produced similar results. Results of the application of Bayes's theorem showed that 17% of the subjects scoring 30 or higher would actually have multiple personality disorder and 99% of those scoring less than 30 would not have multiple personality disorder. CONCLUSIONS: These results indicate that the Dissociative Experiences Scale performs quite well as a screening instrument to identify subjects with multiple personality disorder. In addition, the consistency of responses to scale items across centers indicates that the symptoms reported by patients with multiple personality disorder are highly similar across diverse geographic centers. This consistency supports the reliability and validity of the diagnosis of multiple personality disorder across centers.

Psychotherapy of the survivor of incest with a dissociative disorder.

The treatment of the survivor of incest who suffers from a dissociative disorder is probably somewhat more difficult than that of other survivors of incest because for these others the material is more readily available. Also the patient with DD was probably more severely abused or the dissociative defense would not have been needed. This too makes therapy difficult, especially in that most necessary step: the development of trust and rapport. Despite these problems, there is a very good chance for a successful therapy that will bring the dissociated material back into the main stream of consciousness with a "here and now" appropriate perspective. This can be accomplished through proper diagnosis, good theoretics grounding, and therapy including psychotherapy with appropriate limit setting and the judicious use of medication. This article presents a summary of the BASK model of dissociation and two other models and gives ideas on how these models may be applied to the understanding of the etiology of dissociative disorders and their treatment. Case examples are used to illustrate successful treatment. Although treatment of incest survivors with dissociative disorders is difficult, success can be anticipated, and the rewards to the patient and the satisfaction for the therapist are great.

Towards a theory of multiple personality and other dissociative phenomena.

That dissociation and multiple personality occur has been well documented. In this article the guest editor asks the following question: Are they created? To arrive at an answer he brings together various concepts under the rubric of state-dependent learning and presents ideas about how the states come together psychologically, physiologically, neurophysiologically, and physically.

Are multiple personalities borderline? An analysis of 33 cases.

The authors detail their investigation into the positive relationship between borderline personality and multiple personality and present their finding that although borderline personality disorder is very prevalent in patients with multiple personality disorder, it is not universal and is a separate and distinct disorder.

Dissociative states in multiple personality disorder: a quantitative study.

Multiple personality disorder (MPD) patients may experience themselves as several discrete alter personalities who do not share consciousness or memories with one another. In this study, we asked whether MPD patients are different from controls in their ability to learn and remember, and their ability to compartmentalize information. MPD patients were not found to differ from controls in overall memory level. Learning of information by MPD patients in disparate personality states did not result in greater compartmentalization than that of which control subjects were capable. However, there were qualitative differences between the cognitive performance of patients and that of controls attempting to role-play alter personalities. Our results suggest that simple confabulation is not an adequate model for the MPD syndrome, and we consider a possible role for state-dependent learning in the phenomenology of MPD.

Patients reporting ritual abuse in childhood: a clinical syndrome. Report of 37 cases.

Thirty-seven adult dissociative disorder patients who reported ritual abuse in childhood by satanic cults are described. Patients came from a variety of separate clinical settings and geographical locations and reported a number of similar abuses. The most frequently reported types of ritual abuse are outlined, and a clinical syndrome is presented which includes dissociative states with satanic overtones, severe post-traumatic stress disorder, survivor guilt, bizarre self abuse, unusual fears, sexualization of sadistic impulses, indoctrinated beliefs, and substance abuse. Questions relating to issues of reliability, credibility and verifiability are addressed in depth, and the findings and implications are discussed.

Suggested posthypnotic amnesia in psychiatric patients and normals.

The present study examined both quantitative and qualitative hypnotizability differences among four psychiatric patient groups (dissociative disorder (n = 17), schizophrenic (n = 13), mood disorder (n = 14), and anxiety disorder (n = 14) patients), and normals (college students (n = 63). Dissociative disorder patients earned significantly higher corrected total scores on the Stanford Hypnotic Susceptibility Scale, Form C (mean = 7.94), than all other groups. Likewise, dissociative disorder patients initially recalled significantly fewer items when the posthypnotic amnesia suggestion was in effect (mean = .41) and reversed significantly more items when the suggestion was canceled (mean = 3.82) than all other groups. In contrast, schizophrenic patients recalled significantly fewer items when the amnesia suggestion was in effect (mean = 1.85) and reversed significantly fewer items when it was canceled (mean = .77) than the remaining groups. This qualitative difference between schizophrenic patients and the other groups on the suggested posthypnotic amnesia item was observed even though there were no significant quantitative differences between groups in overall hypnotic responsivity.

Construct validity of the Dissociative Experiences Scale: II. Its relationship to hypnotizability.

Undergraduates (n = 311) who volunteered to participate in an experiment on "Hypnotizability and Personality" filled out several personality questionnaires (including the Dissociative Experiences Scale; DES), were administered the Harvard Group Scale of Hypnotic Susceptibility (HGSHS), and completed a self-rating of hypnotizability. The DES overall score correlated significantly with the HGSHS summary score (r(309) = .12, p < .05, two-tailed) and with subject's self-rating of hypnotizability (r(309) = .13, p < .05, two-tailed). The magnitude of these correlations was similar to that observed in a previous study (.14 & .18) and is also similar in magnitude to the correlations typically observed between the HGSHS and the Tellegen Absorption Scale. The potential clinical implications of these findings are discussed.

Multiple personality disorder: an overview.

Multiple personality disorder is understood today as chronic dissociative psychopathology that most often develops in response to severe abuse in childhood. The dissociative component is a manifestation of a defense mechanism out of control. The person with a biopsychological capacity to dissociate flees inward from overwhelming abuse or feared abuse. When continuing abuse perpetuates dissociations and they are chained by common affective themes, the foundations of multiple personality disorder are laid. Although the disorder has its roots in childhood, most patients are not diagnosed with this condition until 20 to 50 years of age. Many have received several prior, erroneous diagnoses of mental or physical disorders or both over a period of 7 or more years. Failure of diagnosis is an indication of the multiple factors that contribute to making this a covert disorder. Diagnosis and management begin at the same place: the establishment of trust and therapeutic alliance between patient and therapist.

Rorschach indicators of Multiple Personality Disorder.

The increase in reported cases of Multiple Personality Disorder underscores a great need to differentiate clearly this from other psychiatric disorders and from simulation of Multiple Personality Disorder. Two sets of Rorschach signs have been advanced as clinical markers by their developers, namely Barach and also Wagner, Allison, and Wagner. As the Wagner signs are prevalent in much of the research on Rorschach responses in Multiple Personality Disorder, the purpose of the present study was to evaluate these signs using Wagner's administration and the resulting Rorschach protocols of 16 Multiple Personality Disorder patients and 16 psychiatric controls. Analysis indicated that this system was deficient in correctly classifying these 32 protocols. A new marker, the Splitting Response, emerged, however, which was more useful. This response, in combination with at least one Dissociative response, produced an accuracy rate of 94%. These new criteria may be useful aids in the detection of Multiple Personality Disorder from Rorschach protocols. Replication is urged.

Hyperphagia and weight loss during fluoxetine treatment.

OBJECTIVE: To report the unusual coincidence of weight loss with increased appetite and food intake in a patient treated for depression on two separate occasions with fluoxetine. CASE SUMMARY: A 27-year-old woman experienced a modest weight loss during treatment for depression with fluoxetine. The weight loss was associated with a reported increase in daily caloric intake and consumption of a greater proportion of dietary fat than usual for the patient. The same patient was treated again with fluoxetine more than a year later and again experienced weight loss associated with an increase in appetite, caloric intake, and dietary fat consumption. DISCUSSION: Fluoxetine is a selective serotonin reuptake inhibitor that often is associated with a modest weight loss when used for the treatment of depression, although it also has been reported to have the opposite effects of weight gain and hyperphagia in some patients. The effects on weight usually are assumed to be the result of primary effects on appetite, but the discrepancy between the appetite and weight changes in this case challenges the applicability of that assumption in all cases. CONCLUSIONS: The effects of fluoxetine on appetite and weight may be mediated by partially distinct mechanisms and might conceivably involve a direct metabolic effect in some patients.

Psychometric properties of the Dissociative Experiences Scale.

The test-retest reliability of the Dissociative Experiences Scale (DES; Bernstein EM, Putnam FW [1986] Development, reliability, and validity of a dissociation scale. The Journal of Nervous and Mental Disease 174:727-735) in a clinical sample was found to be .93 for the total DES score and .95, .89, and .82 for the three subscale scores of amnesia, depersonalization-derealization, and absorption (dissociative identity disorder [DID], DSM-IV), respectively. Test-retest reliabilities within diagnostic groups of multiple personality disorder, dissociative disorder not otherwise specified, and a general other category of psychiatric diagnoses were obtained for total and subscale scores on the DES. These ranged from .78 to .96. Tests of mean scores across the two test sessions showed the total and subscale scores to be temporally stable. The DES was also found to be highly internally consistent: Cronbach's alphas of .96 and .97 were observed for the total DES scores taken at times 1 and 2, respectively. Construct validity of the DES was demonstrated by differentiation among the subscale scores in a repeated-measures analysis of variance (F[2,154] = 32.03, p < or = .001). Normality and general distribution issues were also addressed and provided a rationale for using the DES with parametric statistics. Reasons why the DES (as it was originally designed) is not appropriate as a dependent measure in outcome research are discussed, along with needed future research. Implications of the findings for the clinical usefulness of the DES as a diagnostic instrument are noted.

Intellectual functioning of inpatients with dissociative identity disorder and dissociative disorder not otherwise specified. Cognitive and neuropsychological aspects.

The intellectual functioning of 105 inpatients with multiple personality disorder and dissociative disorder not otherwise specified was assessed using the Wechsler Adult Intelligence Scale-Revised as part of a comprehensive research protocol. There were no significant intellectual differences between the groups on any major intelligence quotient summary score or any of the age-adjusted empirical factor scores. The anecdotal but widely accepted hypotheses that dissociative patients either have above average premorbid intelligence or that their current intellectual functioning is deleteriously affected by their fluctuant psychiatric disorder were not supported in this sample. A significant subsample of the multiple personality disorder group manifested abnormal interest scatter on the Wechsler Adult Intelligence Scale-Revised verbal subtests, and this variability was attributed to subtle neuropsychological deficits on the Memory/Distractibility factor. We speculate that dissociative patients might need to be evaluated for attention deficit disorder in addition to the range of dissociative symptoms in a comprehensive evaluation.