Trauma, Emotional Regulation, and Coping Styles in Individuals with and without Probable Dissociative Disorders in Hong Kong.

Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (ß = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required.

COULD FAMILY WELL-BEING MODERATE THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD EXPERIENCES AND SOMATOFORM DISSOCIATION? A PRELIMINARY INVESTIGATION.

The impacts of adverse childhood experiences (ACEs) have been well documented. One possible consequence of ACEs is dissociation, which is a major feature of post-traumatic psychopathology and is also associated with considerable impairment and health care costs. Although ACEs are known to be associated with both psychoform and somatoform dissociation, much less is known about the mechanisms behind this relationship. Little is known about whether social and interpersonal factors such as family environments would moderate the relationship between ACEs and somatoform dissociation. This paper discusses the importance of having a positive and healthy family environment in trauma recovery. We then report the findings of a preliminary study in which we examined whether the association between ACEs and somatoform dissociation would be moderated by family well-being in a convenience sample of Hong Kong adults (N = 359). The number of ACEs was positively associated with somatoform dissociative symptoms, but this association was moderated by the level of family well-being. The number of ACEs was associated with somatoform dissociation only when the family well-being scores were low. These moderating effects were medium. The findings point to the potential importance of using family education and intervention programs to prevent and treat trauma-related dissociative symptoms, but further investigation is needed.

The Acceptability and Potential Benefits of a Web-Based Psychoeducation Program for People with Pathological Dissociation: A Pilot Evaluation Study.

Pathological dissociation is a common trauma-related condition and is associated with considerable health and social care needs. People with pathological dissociation typically require psychosocial interventions, but there are many challenges in providing such interventions for this vulnerable population. An important question that remains unexplored is whether web-based interventions are acceptable and beneficial for people with pathological dissociation. This paper reports the findings of a pilot evaluation study of a web-based psychoeducation program for people with pathological dissociation. A total of 80 participants were included. The preliminary findings revealed that: most participants were satisfied with the web-based program (e.g., most participants agreed that the program helped them understand [94.1%] and manage [66.7%] their mental health conditions and remain hopeful for recovery [78.4%]); and participants had improvements in symptom management (large effect; partial eta squared = .143) and self-esteem (medium-to-large effect; partial eta squared = .111) after the program. However, no improvements in clinical symptoms were observed on measures of post-traumatic or dissociative symptoms. The dropout rate at posttest was 36.3%. This is one of the first studies that evaluated web-based interventions for people with pathological dissociation. Although the web-based program is well-accepted by the participants and might be associated with some potential benefits, the limitations of this pilot study should be acknowledged. Implications are discussed in terms of the directions for future developments of the program and the needs for further evaluation.

The False Memory Debate A Reply to Otgaar.

The author replies to a critique of his paper about false memories in an effort to clarify issues on which there is disagreement. A key point made is that the validity of dissociation as a phenomenon, that is, as reported symptoms, does not depend on theories about the mechanisms of dissociation. There are no proven mechanisms for any mental health symptoms or DSM-5 diagnoses including anxiety, depression, psychosis and substance use disorders.

Reversal of Amnesia for Trauma in a Sample of Psychiatric Inpatients with Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified.

The authors interviewed 118 highly dissociative inpatients in a Trauma Program with the Dissociative Disorders Interview Schedule, the Dissociative Experiences Scale and the Adverse Childhood Experiences questionnaire; of the 118 participants 42 met DSM-5 criteria for dissociative identity disorder and 52 for other specified dissociative disorder. The average score on the Dissociative Experiences Scale in the sample of 118 participants was 44.7. The authors also conducted semi-structured interviews inquiring about the circumstances and triggers for reversal of amnesia for childhood trauma in the participants. Only a small minority of the reversal of amnesia took place in therapy sessions, and 24 different triggers for remembering were described. Childhood sexual abuse was by far the most common type of trauma for which amnesia was reversed. The findings are inconsistent with the view that amnesia for childhood sexual abuse is reversed primarily during psychotherapy.

The Dissociative Taxon and Dissociative Identity Disorder.

A total of 491 participants from four previous studies, 443 of whom were diagnosed with dissociative identity disorder (DID) on the Dissociative Disorders Interview Schedule, completed the Dissociative Experiences Scale (DES). Their results were analyzed to determine how many were in the dissociative taxon (DES-T) on the DES. Of the 443 individuals with DID, 419 (94.6%) were in the taxon, 13 (2.9%) were out of the taxon and 11 (2.5%) were indeterminate. The DES-T is therefore very effective at identifying people with DID as being in the dissociative taxon, although it does have a false negative rate of 5.4%. Out of 48 people with no dissociative disorder on the Dissociative Disorders Interview Schedule, the DES-T identified 26 (54.2%) as being in the taxon and 22 (45.8%) as being out of the taxon with no indeterminate cases. The clinical diagnoses of these 48 individuals are unknown: all were inpatients in the same Trauma Program. Thus, the sensitivity of the DES-T for confirming that individuals with DID are in the dissociative taxon was 94.6% and the specificity of the DES-T for confirming that individuals with no dissociative disorder are not in the dissociative taxon was 45.8%. It is possible that the DES-T yields false positives for taxon membership; this possibility should be investigated in future research.

Clinical Features of a Chinese Sample with Self-Reported Symptoms of Pathological Dissociation.

People with pathological dissociation should receive proper clinical attention and timely support. Recent studies have shown that pathological dissociation is common in the Chinese context. However, little is known about the clinical features of Chinese people with pathological dissociation. This paper reports the first data regarding trauma histories, mental health symptoms, clinical diagnoses, service usages, stigma and psychosocial needs in a convenience sample of Chinese people who screened positive for pathological dissociation on a self-report measure (N = 72). This sample was characterized by a history of trauma and high levels of trauma-related symptoms and depression. Medication treatments were the most common interventions for them; many participants did not receive psychotherapy. We found no clinical differences between participants who had and had not received psychotherapy for post-traumatic/dissociative symptoms. This implies that many participants did not have the chance of receiving specific psychotherapy even though their trauma histories and clinical symptoms were as severe as those who were receiving specific psychotherapy. Stigma and unmet psychosocial needs were common in this sample and should receive more attention in the field. Implications for research and practice are highlighted. More dissociation-informed services are required for Chinese-speaking populations.

Voices: Are They Dissociative or Psychotic?

Auditory hallucinations are widely regarded as symptoms of brain disease treated with medications. In an alternative paradigm, voices are understood as trauma-driven dissociated, disowned, or disavowed aspects of self; the goal is not to suppress them but to integrate them during psychotherapy. Auditory hallucinations are common in dissociative identity disorder, borderline personality disorder, and complex posttraumatic stress disorder and are not specific to psychosis. The features that differentiate psychotic from dissociative voices include the qualities of the voices themselves, as well as other symptoms: for example, compared with dissociative voices, psychotic voices are accompanied by less sociability, more formal thought disorder, more negative symptoms including blunted affect, and more delusions. The author proposes that the psychotherapy of dissociative voices can be indicated trans-diagnostically, including in a subgroup of individuals with diagnoses of schizophrenia. Psychotherapeutic strategies are illustrated with a case example.

Self-Reported Medication and Recreational Drug Effectiveness in Maladaptive Daydreaming.

Maladaptive daydreaming is a proposed disorder characterized by excessive daydreaming that causes subjective distress and/or interferes with function. The daydreaming involves complex inner worlds, characters, and plots that are understood by the person as fantasy, and the daydreaming may occupy many hours per day. The disorder has good reliability and validity in studies using a structured interview and a self-report measure developed for it. To date, no information on the responses of maladaptive daydreamers to either recreational or prescription drugs has been available. The authors obtained survey data from 202 participants who completed the Maladaptive Daydreaming Scale-16. The results indicated that this population has tried many different recreational drugs and has been prescribed many different psychotropic medications. Most of the participants reported little to no effect of drugs or medications on daydreaming, although tentative recommendations can be made in favor of prescribing antidepressants and against the use of marijuana for individuals with maladaptive daydreaming.

A Preliminary Investigation of Depression in People with Pathological Dissociation.

Depression is a common and challenging comorbid condition in people with pathological dissociation. To our knowledge, this preliminary study is the first study that has looked at the clinical correlates of depression in a sample of people with pathological dissociation (N = 72). We found that severe depression is common in this sample and that depression is associated with dissociative symptoms, post-traumatic stress disorder (PTSD) symptoms, borderline personality disorder symptoms and clinical recovery; the level of depression is also associated with both childhood and adulthood betrayal trauma but not with childhood and adulthood trauma with less betrayal. PTSD symptoms are the most significant correlates of the level of depression in this sample. Some clinical implications are discussed. Our initial findings imply that it may be important to manage depression by preventing adulthood betrayal trauma and stabilizing PTSD and dissociative symptoms when working with service users with pathological dissociation. Further studies are needed.

Faking Good: An Investigation of Social Desirability and Defensiveness in an Inpatient Sample With Personality Disorder Traits.

Accurate interpretations of psychological assessments rely heavily on forthright reporting. However, researchers and practitioners recognize that examinees can easily invalidate their test results by underreporting symptoms or overstating positive attributes. Rogers (2008) delineated two distinct but related forms of positive impression management (PIM): defensiveness (denying symptoms and psychological impairment) and social desirability (putting forth an exaggeratedly positive image). Although these two have often been combined in past research, this study sought to investigate each separately via a mixed within- and between-subjects simulation design. Simulation scenarios included a special rehabilitation program for the defensiveness (DF) condition and a competitive job for social desirability (SD). The study used the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012) and recruited 106 inpatients from a psychiatric hospital. As expected, inpatients with prominent personality traits substantially suppressed them under both PIM conditions. Having shown the susceptibility of the PID-5 to intentional distortion, two empirically derived and conceptually based validity scales were next developed to address this important concern. Pending further validation, they might contribute to screening PIM presentations, thus promoting the PID-5's clinical utility. Continued research is needed across multiscale inventories for differentiating PIM presentations.

Adverse childhood experiences and dissociation among Hong Kong mental health service users.

Adverse childhood experiences (ACEs) have become a major concern in the mental health field. The literature suggests that ACEs could be associated with various mental health problems. Yet, ACEs require further investigation in Chinese cultures, especially in Hong Kong. Both the frequency of ACEs and their relationships with dissociation remain unknown in clinical settings in Hong Kong. In this study, we administered the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ) and the 10-item Adverse Childhood Experiences (ACEs) Questionnaire to 202 community mental health service users in Hong Kong. The frequency of ACEs and dissociation is reported and the trauma model of dissociation can be observed in this sample. Consistent with the Western literature, we found that ACEs are associated with mental health problems and that participants with childhood abuse and/or neglect report a significantly higher level of dissociation. While this study is preliminary, we suggest that ACEs and dissociation should receive more attention in the Chinese mental health field. Implications for practice are highlighted. Further studies are warranted.

Future Research Directions for the Trophoblast Model of Cancer.

The trophoblast model of cancer is incorporated into The Gonzalez Protocol for treatment of cancer and a range of noncancer chronic diseases. The other main component of the Protocol involves the prescription of detailed diets and supplementation. The foundation of the diet and supplementation component of the Protocol is the theory of autonomic types, which range from parasympathetic-dominant, through balanced, to sympathetic-dominant; a person's autonomic type determines the details of the prescribed diet and supplements. The core anticancer component of the Protocol is pancreatic enzymes. Dr. Nicholas Gonzalez died in 2015; a research program studying the main components of The Gonzalez Protocol™ would contribute to his work being remembered and used by other practitioners. The author reviews the evidence base for the clinical effectiveness of The Gonzalez Protocol, which consists of Level II evidence, and outlines future research directions for the trophoblast model of cancer and the theory of autonomic types.

Altered states of consciousness among inpatients in a Trauma Program.

A set of measures of trauma, dissociation, altered states of consciousness, and spiritual experiences was administered to a convenience sample of 100 inpatients in a hospital Trauma Program. The inpatients had an average Dissociative Experiences Scale score of 42.3 and an average Adverse Childhood Experiences Scale score of 6.6, both of which are very high. Both trauma and dissociation correlated significantly with measures of pathological altered states of consciousness (ASC) but not with adaptive, normal spiritual experiences as measured by the Spiritual Orientation Inventory and the ASC Scale. The authors conclude that future study of the relationships between psychological trauma, dissociation, and ASC should subdivide altered states into at least two major categories: more inherently pathological states versus those that are more adaptive and spiritual in nature.

Reliability of the Dissociative Trance Disorder Interview Schedule: A preliminary report.

One hundred inpatients in a hospital-based Trauma Program in the USA were interviewed with the Dissociative Trance Disorder Interview Schedule (DTDIS). There were no significant differences for the DTDIS total score or any of the subscale scores on test-retest: all t-values comparing the two administrations of the DTDIS were below 0.7, and all p-values were above 0.5. Cronbach's alpha for the US sample was 0.966 and for the Israeli sample it was 0.971. The findings indicate that the DTDIS has good reliability and may be suitable for use in cross-cultural research; however, the results require replication by independent researchers in a variety of cultures and languages, and in both clinical and nonclinical samples.

The Comorbidity of Daydreaming Disorder (Maladaptive Daydreaming).

To determine the comorbidity profile of individuals meeting criteria for a proposed new disorder, daydreaming disorder (more commonly known as maladaptive daydreaming [MD]), the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Structured Clinical Interview for DSM-IV Dissociative Disorders were administered to 39 participants who met criteria for MD on a structured interview. We determined high rates of comorbidity: 74.4% met criteria for more than three additional disorders, and 41.1% met criteria for more than four. The most frequent comorbid disorder was attention deficit hyperactivity disorder (76.9%); 71.8% met criteria for an anxiety disorder, 66.7% for a depressive disorder, and 53.9% for an obsessive-compulsive or related disorder. Notably, 28.2% have attempted suicide. Individuals meeting criteria for MD have complex psychiatric problems spanning a range of DSM-5 disorders. This finding provides evidence that MD is different than normal daydreaming and that these individuals experience considerable distress and impairment.

The self-report Dissociative Disorders Interview Schedule: A preliminary report.

A self-report version of the Dissociative Disorders Interview Schedule (SR-DDIS) was administered to 100 inpatients in a hospital-based trauma program. All participants had previously completed the interviewer-administered version of the DDIS. When we compared the overall results on the DDIS and SR-DDIS for the 100 inpatients, the findings were very consistent for both symptom clusters and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), diagnoses. The agreement rate between the 2 versions for DSM-5 diagnoses was fair to substantial using Cohen's kappa, with agreement being substantial for 4 out of the 7 diagnoses made by the DDIS. It appears likely that the SR-DDIS can be used instead of the DDIS, at least in clinical populations, with no clinically or conceptually significant differences between the results obtained with the 2 versions.

Response to Miccio-Fonseca (2015) and Defeo (2015) Concerning Commentary About DSM-5 Sexual Disorders Section.

Responses by Miccio-Fonseca (2015) and DeFeo (2015) to a commentary by Ross on problems with the sexual disorders sections of DSM-5 are based on a misunderstanding of Ross's article (2015a). Miccio-Fonseca and DeFeo describe what they consider to be confusion and misunderstanding in Ross's opinions about gender, sexuality, and related topics. However, Ross offered no personal opinions in his commentary and was focused solely on inconsistencies and contradictions within DSM-III, DSM-IV, and DSM-5.

LSD experiments by the United States Army.

Extensive LSD testing was conducted by the US Army at Edgewood Arsenal and other locations from 1955 to 1967. A number of different reports have been produced describing the health effects of this testing, including the Veterans Health Initiative Report in 2003. By and large, these reports gloss over and minimize the short and long-term side effects and complications of this testing. However, the reports themselves document frequent, severe complications of the LSD. These side effects were regarded by the Army as having been directly caused by the LSD exposure. In view of the current resurgence of interest in hallucinogens within psychiatry, the sanitized version of the effects of LSD exposure on US soldiers needs to be replaced with a more accurate account.

Dr Gonzalez as a Colleague: A Memoir.

No Abstract Available.