The link between dissociative tendencies and hyperassociativity.

BACKGROUND AND OBJECTIVES: Anecdotal and research evidence suggests that individuals with dissociative symptoms exhibit hyperassociativity, which might explain several key features of their condition. The aim of our study was to investigate the link between dissociative tendencies and hyperassociativity among college students. METHODS: The study (n = 118) entailed various measures of hyperassociativity, measures of dissociative tendencies, depressive experiences, unusual sleep experiences, cognitive failures, and alexithymia. RESULTS: We found a positive association between dissociative experiences (i.e., depersonalization) and hyperassociativity specific for associative fluency and associative flexibility tasks (including neutral and valenced material), but not for a remote association task. We also found tentative evidence for cognitive failures and alexithymia explaining the link between hyperassociativity and daytime dissociation and nighttime unusual sleep experiences. LIMITATIONS: Limitations include the use of hyperassociation tasks limited to verbal associations vs. imagistic associations, the lack of a measure of trauma history, and a sample limited to college students. CONCLUSION: Our study reports a link between depersonalization and hyperassociativity on tasks that allow for free associations across different semantic domains, potentially explained by alexithymia and cognitive failures. This finding may, with replication, open the pathway to applied intervention studies.

Symptom overreporting and dissociative experiences: A qualitative review.

We discuss a phenomenon that has received little attention to date in research on dissociative phenomena, namely that self-reports of these phenomena overlap with the tendency to overendorse eccentric items. We review the literature documenting the dissociation-overreporting link and then briefly discuss various interpretations of this link: (1) overreporting is an artifact of measuring dissociative symptoms; (2) dissociative psychopathology engenders overreporting of eccentric symptoms through fantasy proneness or impairments in internal monitoring; (3) an overreporting response style as is evident in malingerers, for example, promotes reports of dissociative symptoms. These three interpretations are not mutually exclusive. Also, the dissociation-overreporting link may have different origins among different samples. Because overreporting may introduce noise in datasets, we need more research specifically aimed at disentangling the dissociation-overreporting link. We suggest various avenues to accomplish this goal.

Adult-onset inflammatory myopathy: North Canterbury experience 1989-2001.

AIM: To perform a clinical audit of all patients diagnosed with inflammatory myopathy in the North Canterbury region. METHODS: A retrospective case note audit of patients with a discharge diagnosis of inflammatory myopathy from June 1989 to June 2001 was performed. The audit was based at Christchurch Hospital, New Zealand, which services a population of 430,000. RESULTS: Of 77 case notes reviewed, 44 patients were identified who were considered to fulfil clinical criteria for inflammatory myopathy. There was a female preponderance (80% female, 20% male). Diagnostic categories in descending order of frequency included: dermatomyositis (41%), polymyositis (39%), inclusion body myositis (IBM) (14%) and overlap syndromes (6%). Malignancy-associated myositis occurred in 20% overall (dermatomyositis 11%, polymyositis 9%). Delays in diagnosis and late age at presentation (average 72 years) were seen in the IBM group. Proximal limb weakness was common, but not universal at presentation (80%). A muscle biopsy was performed in all patients and electromyography in 82%. All were treated with high dose prednisone (0.5-1 mg/kg) of whom 29% were maintained on prednisone alone. Immunosuppressives/immunomodulators used included: azathioprine (58%), methotrexate (31%), intravenous immunoglobulin (13%), chlorambucil (13%), and cyclophosphamide (9%). Thirteen patients (42%) required more than one agent, with three trialling five agents. There were 59 relapses in 20 patients (45%), with mean time to first relapse of 7.8 months. At audit completion, 33% had deceased with malignancy and respiratory failure the main causes. CONCLUSION: Inflammatory myopathy is a challenging condition in both diagnosis and management. Our audit has shown delays in the diagnosis of IBM, a relatively high incidence of malignancy and a notable risk of relapse and mortality.

Idiopathic spontaneous bladder rupture in an intoxicated patient.

Spontaneous bladder rupture is a rare condition associated with significant morbidity and mortality. We describe a case that occured following a period of alcohol intoxication and presented as acute renal failure. The factors that contribute to this condition in an intoxicated person are outlined and useful clinical markers are suggested. This case demonstrates the difficulties with diagnosis and the need for a high index of suspicion.

Information processing of an acquaintance rape scenario among high- and low-dissociating college women.

To assess the impact of dissociation on information processing, 66 college women with high and low levels of trait dissociation were studied with regard to how they unitized videotape segments of an acquaintance rape scenario (actual assault not shown) and a nonthreatening control scenario. Unitization is a paradigm that measures how actively people process stimuli by recording how many times they press a button to indicate that they have seen a significant or meaningful event. Trait dissociation was negatively correlated with participants' unitization of the acquaintance rape videotape, unitization was positively correlated with danger cue identification, and state dissociation was negatively correlated with dangerousness ratings.

The evaluation of a sexual assault risk reduction program: a multisite investigation.

This article summarizes the results of the Ohio University Sexual Assault Risk Reduction Project, which is a program designed to reduce college women's risk for sexual assault. The program was evaluated at 2 separate universities with 762 women. Participants were randomly assigned either to the program or to the no-treatment comparison group, and they completed measures that assessed sexual victimization, dating behaviors, sexual communication, and rape empathy at the pretest and at the 2-month and 6-month follow-ups. At the 2-month follow-up, there were no differences between the groups on any of the outcome measures. However, those women who were moderately victimized during the 2-month follow-up were significantly less likely to be revictimized during the 6-month follow-up period if they participated in the program.

Behavioural differences between psychiatric patients with confirmed versus non-confirmed traumatic brain injuries.

The relationship between history of Traumatic Brain Injury (TBI) and BDI-2 depression scores at admission and discharge from the hospital was assessed in acutely hospitalized psychiatric patients. The participants were assigned to three groups: (1) no reported history of TBI (n = 18), (2) reported but not confirmed TBI history (n = 13), and (3) reported and confirmed TBI history (n = 15). It was found that confirmed history of TBI was associated with elevated BDI-2 depression scores. In contrast, the non-confirmed TBI group was characterized by over-reporting of psychological distress, as measured by MMPI-2 validity indices, 100% prevalence of alcohol use history, and depression scores that were intermediate between the control and confirmed TBI groups.

Hypnosis and suggestion-based approaches to smoking cessation: an examination of the evidence.

This article reviews 59 studies of hypnosis and smoking cessation as to whether the research empirically supports hypnosis as a treatment. Whereas hypnotic procedures generally yield higher rates of abstinence relative to wait-list and no-treatment conditions, hypnotic interventions are generally comparable to a variety of nonhypnotic treatments. The evidence for whether hypnosis yields outcomes superior to placebos is mixed. In short, hypnosis cannot be considered a specific and efficacious treatment for smoking cessation. Furthermore, in many cases, it is impossible to rule out cognitive/behavioral and educational interventions as the source of positive treatment gains associated with hypnotic treatments. Hypnosis cannot, as yet, be regarded as a well-established treatment for smoking cessation. Nevertheless, it seems justified to classify hypnosis as a "possibly efficacious" treatment for smoking cessation.

Hypnosis as an empirically supported clinical intervention: the state of the evidence and a look to the future.

Drawing on the literature reviews of this special issue of the International Journal of Clinical and Experimental Hypnosis (2000), this article summarizes the evidence for the effectiveness of hypnosis as an empirically supported clinical intervention. As a whole, the clinical research to date generally substantiates the claim that hypnotic procedures can ameliorate some psychological and medical conditions, as judged against the Chambless and Hollon methodological guidelines. In many cases, these clinical procedures can also be quite cost-effective. It is probable that with some key empirical refinement a number of other hypnosis treatment protocols will have sufficient empirical documentation to be considered "well-established." However, it is noted that the Chambless and Hollon guidelines are not particularly well-suited for assessing hypnosis' impact when used adjunctly with other interventions. The article concludes with recommendations regarding the efficacy questions that need to be more fully addressed empirically and offers methodological guidelines for researchers and practitioners.

The clinical importance of sociocognitive models of hypnosis: response set theory and Milton Erickson's strategic interventions.

This article documents the contributions and clinical relevance of influential sociocognitive models of hypnosis. We argue that an appreciation of the influence and interplay of sociocognitive constructs, combined with a knowledge of basic research findings, can contribute to sound clinical practice. This article extends previous statements of response set theory (e.g., Kirsch & Lynn, 1998, 1999; Lynn, 1998) by further elucidating the social and cognitive underpinnings of how response sets are established, maintained, and strengthened. It does so by providing a scientific rationale for Milton H. Erickson's most prominent strategic interventions.

Are cultic environments psychologically harmful?

This article is the first critical review of research that addresses the question of whether cult membership is psychologically harmful. The available evidence warrants three conclusions: (a) persons entering cults do not necessarily exhibit psychopathology; (b) current cult members appear psychologically well-adjusted generally, and demonstrate few conspicuous symptoms of psychopathology. However, pathology may be masked by conformity pressures and demand characteristics associated with the cultic environment; (c) a small but growing body of research indicates that at least a substantial minority of former cult members experience significant adjustment difficulties. There also are indications that these difficulties cannot be ascribed to demand characteristics. Although the review highlights definitional and methodological issues and problems that temper conclusions that can be drawn from the literature, no evidence indicates that cults improve adjustment after members leave the cultic environment.

Normative, group, and hypnotic influences on early autobiographical memory reports.

This study examines the effects of expectancies, group versus individual interview procedures, and recall trial on reports of early autobiographical memories. No effect for interview procedure or expectancy information was obtained. However, participants reported earlier memories during hypnosis than they did both prior to hypnosis and prior to memory recovery instructions. A third of the 85 participants reported memories below the cutoff of infantile amnesia (i.e., age 2) after they received suggestions that they could recall earlier memories. Two thirds of participants reported such memories during hypnosis. Even after being debriefed and contacted by telephone outside the experimental context, more than a third (37%) of the participants continued to report memories prior to age 2.

The plasticity of early memory reports: social pressure, hypnotizability, compliance, and interrogative suggestibility.

Early autobiographical memory reports by adults were very sensitive to social influence in a leading interview. The mean age of initial earliest memory report was 3.7 years. When participants were instructed to close their eyes, visualize, and focus on their 2nd birthday, 59% reported a birthday memory. After repeated probes for earlier memories, 78% of subjects reported memories at or prior to 24 months of age, and 33% reported memories within the first 12 months of age. The mean age of the final earliest memory reported was 1.6 years. Participants rated their memory reports as accurate and did not recant them when given an opportunity. The age of earliest memory reports in the suggestive interview correlated negatively with measures of compliance, hypnotizability, and interrogative suggestibility.

Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past.

In a recent article in this journal, D. H. Gleaves (1996) criticized the sociocognitive model (SCM; N. P. Spanos, 1994) of dissociative identity disorder (DID) and argued in favor of a posttraumatic model (PTM) in which DID is conceptualized as a consequence of childhood abuse and other traumatic events. The present authors demonstrate that (a) many of Gleaves's arguments were predicated on misunderstandings of the SCM, (b) scrutiny of the evidence regarding the psychopathology and assessment of DID raises questions concerning the PTM's conceptual and empirical underpinnings, (c) the treatment literature suggests that iatrogenic factors play an important role in the etiology of DID, and (d) the evidence linking child abuse to DID is more problematic than implied by Gleaves. The present authors conclude that Gleaves's analysis underemphasized the cultural manifestations of multiple role enactments and that the history of DID imparts a valuable lesson to contemporary psychotherapists.

Automaticity in clinical psychology.

The authors provide an overview of the literature on the ability of response expectancies to elicit automatic responses in the form of self-fulfilling prophecies and link it to the broader psychological investigation of automatic processes. The authors review 3 areas of research in which response expectancies have been shown to affect experience, behavior, and physiology: placebo effects, the effects of false biofeedback on sexual arousal, and the alteration of perceptual and cognitive functions by hypnotic and nonhypnotic suggestion. Also reviewed are data suggesting that all behavior, including novel and intentional behavior, is initiated automatically. Following this review, the authors summarize some of the ways in which knowledge of response expectancy effects and other automatic processes that influence experience and behavior can enhance clinical practice.

Dissociation, posttraumatic symptomatology, and sexual revictimization: a prospective examination of mediator and moderator effects.

Using prospective data gathered from a sample of 323 college women over a 10-week academic quarter, the present study examined whether dissociation and posttraumatic symptomatology mediate or moderate sexual revictimization. Results indicated that posttraumatic symptomatology, but not dissociation, moderated the link between previous and subsequent sexual victimization. Neither posttraumatic symptomatology nor dissociation mediated revictimization.

Primary process, hypnotic dreams, and the hidden observer: hypnosis versus alert imagining.

Previous research indicated that high-hypnotizable participants reported more primary-process mentation in hypnotic dreams than low-hypnotizable participants instructed to simulate hypnosis. Differences in primary process were not evidenced in response to instructions for a "hidden part" of the participant to report on the hypnotic dream. This research replicated and extended these findings by showing that high-hypnotizable participants (n = 20) passing the dream suggestion reported more primary process in their dreams than high-hypnotizable participants instructed to remain alert and think and imagine along with suggestions (n = 20). Differences in primary process were not evidenced in response to hidden-observer suggestions, and the frequency of dream (87% hypnosis vs. 96% imagining) and hidden-observer responses (100% in both groups) was equivalent across hypnotic and nonhypnotic groups. The results provided qualified support for a psychoanalytic model of hypnosis: Differences in primary process were apparent in response to the dream but not the hidden-observer suggestion.