Evaluation of Childhood Traumas, Depressive Symptoms, and Dissociative Experiences in Tinnitus Cases.

OBJECTIVE: Tinnitus is described as the perceived sound without any external stimulus and is a common problem, but its mechanism is not fully understood. This study aimed to evaluate childhood traumas and dissociative experiences, which may be predisposing factors in patients with tinnitus. METHODS: The study included 90 voluntary patients (45 patients with tinnitus and 45 in the control group) aged older than 18 years who applied to the otorhinolaryngology clinic between November 2018 and February 2019 and were diagnosed with subjective tinnitus. A personal information form together with childhood trauma, hospital anxiety and depression, and dissociative experiences scales were used to assess the patients. RESULTS: Of all participants, 55.60% were males, 28.90% were 20-30 years old, 71.10% were married, 40% were primary school graduates, and 68.90% were employed. In addition, 77.78% of patients did not visit a psychiatrist and 75.56% did not have any chronic diseases. The mean total score of Childhood Trauma Scale for the tinnitus group was 54.37±10.17, the mean total score of The Hospital Anxiety and Depression Scale for the tinnitus group in the depression subscale was 12.22±5.41 and in the anxiety subscale was 10.54±3.5, and Dissociative Experiences was 13.48±4.68. A positive significant relationship was found between the childhood traumas of the tinnitus cases in their depressive symptoms, and dissociative experiences (p<0.05). CONCLUSIONS: The study results found a positive relationship between the childhood traumas and dissociative experiences of tinnitus cases, which can be considered as predisposing factors in patients with tinnitus who should also be investigated for childhood trauma, and the treatment approach should be multidisciplinary.

The investigation of the mediating role of coping trategies on the relationship between childhood traumas, depression and alcohol use disorder in university students.

The aim of this study is to investigate the mediating effect of coping strategies on the relationship among childhood traumas, depression, and alcohol use disorder in university students. The participants of this study consisted of 735 (209 males and 526 females) university students. Participants completed measures of depressive symptoms, childhood traumas, problematic alcohol consumption, and coping strategies as well as a sociodemographic information form. According to results, coping strategies fully mediated the relationship between childhood traumas and alcohol use disorder, and partially mediated the relationship between childhood traumas and depression.

Fear of happiness among college students: The role of gender, childhood psychological trauma, and dissociation.

AIMS: This study aimed to evaluate the fear of happiness among college students and its relationship to gender, childhood psychological trauma, and dissociation. SETTING AND DESIGN: College students were addressed as study population, and a relational screening method was implemented. MATERIALS AND METHODS: Among 184 participants, 93 (50.5%) were women. The Fear of Happiness Scale (FHS), the Childhood Trauma Questionnaire (CTQ), and the Dissociative Experiences Scale (DES) were administered to all participants. STATISTICAL ANALYSIS USED: Mann-Whitney-U and Student's t-tests were implemented for comparison of groups. Pearson correlation and stepwise multiple regression analyses were conducted to identify associations between variables. RESULTS: There were no differences on DES, FHS, and CTQ total scores between genders. DES was associated with CTQ total scores in both genders. Women had higher scores than men on childhood emotional abuse and fear of "cheerfulness ends up with bad faith." Compared to nonmembers, female dissociative taxon members had higher scores on all childhood trauma types except sexual abuse, and on all types of fear of happiness except "good fortune ends up with disaster" which was the only type of fear significantly elevated among male dissociative taxon members. A stepwise regression analysis revealed that depersonalization, childhood emotional neglect, and physical abuse predicted fear of happiness among women which was predicted by absorption among men. CONCLUSIONS: There is a relationship between childhood psychological trauma, dissociation, and fear of happiness. Women seem to be more vulnerable in this path of obsessional thinking which affects different realms in male and female genders.

Dissociative depression among women in the community.

This study screened the prevalence and correlates of dissociative disorders among depressive women in the general population. The Dissociative Disorders Interview Schedule and the posttraumatic stress disorder (PTSD) and borderline personality disorder sections of the Structured Clinical Interview for DSM-IV were administered to 628 women in 500 homes. The prevalence of current major depressive episode was 10.0%. Of the women, 26 (40.6%) had the lifetime diagnosis of a DSM-IV, dissociative disorder, yielding a prevalence of 4.1% for dissociative depression. This group was younger (mean age = 30.7 years) than the nondissociative depression women (mean age = 39.6 years). There was no difference between the 2 groups on comorbid somatization disorder, PTSD, or borderline personality disorder. Besides suicide attempts, the dissociative group was characterized by secondary features of dissociative identity disorder; Schneiderian symptoms; borderline personality disorder criteria; and extrasensory perceptions, including possession experiences. They reported suicidality, thoughts of guilt and worthlessness, diminished concentration and indecisiveness, and appetite and weight changes more frequently than the nondissociative group. Early cessation of school education and childhood sexual abuse were frequently reported by the dissociative depression group. With its distinct features, the concept of dissociative depression may facilitate understanding of treatment resistance in, development of better psychotherapy strategies for, and new thinking on the neurobiology and pharmacotherapy of depressive disorders.

Stimulus deprivation and overstimulation as dissociogenic agents in postmodern oppressive societies.

Societal conditions associated with overstimulation or understimulation may precipitate and maintain oppression among individuals and communities by inducing dissociation. Distortion of reality and the flooding of everyday awareness with irrelevant information by mass media is a type of community-wide overstimulation. Alternatively, stimulus deprivation enables single-minded thinking to be narrowly preoccupied with rigid religious ideas, traditional rituals, and postmodern thought and behavior patterns. Provoked sex is utilized as a soothing tool for those who live in overstimulation and as an opportunity for transient enjoyment and rejuvenation for those who live in stimulus deprivation. Chronic exposure to disproportionate stimuli resurrects the trauma-based developmental detachment between the sociological and psychological selves of the individual at the cost of the latter. The enlarged sociological self of the individual is misused to induce a conforming identity transformation of individuals and entire communities that is a prerequisite to setting and maintaining an oppressive system. Constituting overstimulation itself, the enduring fear of chaos in a world akin to crisis enables deliberate acceptance of oppression to restore a sense of control. In fact, the expectancy of crisis triggers the trauma-related dissociative fears of individual internal chaos, which are misused, in turn, to aggravate fears of external chaos again. By facilitating the denial of internal fears rather than integrating them, psychological theories and practices of the past century have failed in addressing the problem of individual and societal oppression.

Childhood trauma and dissociation in schizophrenia.

BACKGROUND: This study is concerned with relationships between childhood trauma history, dissociative experiences, and the clinical phenomenology of chronic schizophrenia. SAMPLING AND METHODS: Seventy patients with a schizophrenic disorder were evaluated using the Structured Clinical Interview for DSM-IV, Dissociative Experiences Scale, Dissociative Disorders Interview Schedule, Positive and Negative Symptoms Scales, and Childhood Trauma Questionnaire. RESULTS: Childhood trauma scores were correlated with dissociation scale scores and dissociative symptom clusters, but not with core symptoms of the schizophrenic disorder. Cluster analysis identified a subgroup of patients with high dissociation and childhood trauma history. The dissociative subgroup was characterized by higher numbers of general psychiatric comorbidities, secondary features of dissociative identity disorder, Schneiderian symptoms, somatic complaints, and extrasensory perceptions. A significant majority of the dissociative subgroup fit the diagnostic criteria of DSM-IV borderline personality disorder concurrently. Among childhood trauma types, only physical abuse and physical neglect predicted dissociation. CONCLUSIONS: A trauma-related dissociative subtype of schizophrenia is supported. Childhood trauma is related to concurrent dissociation among patients with schizophrenic disorder. A duality model based on the interaction of 2 qualitatively distinct psychopathologies and a dimensional approach are proposed as possible explanations for the complex relationship between these 2 psychopathologies and childhood trauma.

Childhood emotional abuse and dissociation in patients with conversion symptoms.

AIM: The aim of the present study was to evaluate the relationship between reported childhood trauma and dissociation in patients who have a conversion symptom. METHOD: Thirty-two outpatients with a conversion symptom were evaluated using Dissociative Experiences Scale, Somatoform Dissociation Questionnaire, Childhood Trauma Questionnaire, Spielberger Trait Anxiety Inventory, Clinician-Administered Dissociative State Scale, and Dissociative Disorders Interview Schedule. RESULTS: A DSM-IV dissociative disorder was diagnosed in 46.9% of the patients. Conversion patients with a dissociative disorder had borderline personality disorder more frequently than those without a dissociative disorder. Among childhood trauma types, emotional abuse was the only significant predictor of dissociation in regression analysis. None of the childhood trauma types predicted borderline personality disorder criteria. CONCLUSIONS: Borderline personality disorder, dissociation and reports of childhood emotional abuse refer to a subgroup among patients with conversion symptom. Dissociation seems to be a mediator between childhood trauma and borderline phenomena among these patients.

The prevalence of conversion symptoms in women from a general Turkish population.

BACKGROUND: Conversion symptoms have historically be seen to be related to dissociative disorders and early trauma. OBJECTIVE: This study sought to determine the prevalence of conversion symptoms among women in the general Turkish population. METHOD: Participants (N=628) were administered The Dissociative Disorders Interview Schedule, the Borderline Personality Disorder section of the Structured Clinical Interview for DSM-III-R Personality Disorders, and the PTSD Module of the Structured Clinical Interview for DSM-III-R; 48.7% of participants had a lifetime history of a conversion symptom. They reported various types of childhood abuse and neglect more frequently than nonconversion subjects. RESULTS: Lifetime diagnosis of major depression, dissociative disorder, and childhood physical abuse predicted a conversion symptom. Effects of childhood neglect and emotional and sexual abuse among subjects with conversion symptoms were mediated by comorbid lifetime diagnosis of major depression and dissociative disorders. CONCLUSION: The authors suggest revisions to the DSM-V regarding conversion and somatization disorders.

Somatization as a predictor of suicidal ideation in dissociative disorders.

AIM: This study was concerned with correlates of suicidal ideation among patients with chronic complex dissociative disorders. METHOD: Participants were 40 patients diagnosed as having either dissociative identity disorder or dissociative disorder not otherwise specified according to the DSM-IV. The Dissociative Disorders Interview Schedule, the Dissociative Experiences Scale, the Somatoform Dissociation and the Childhood Trauma Questionnaires, the Spielberger Trait Anger Inventory, the Beck Suicidal Ideation Scale, and the Borderline Personality Disorder section of the Structured Clinical Interview for DSM-IV Personality Disorders were administered to all patients. RESULTS: Patients with suicidal ideas (n = 15) had concurrent somatization disorder more frequently than the remaining patients. Having significantly high scores on both trait and state dissociation measures, their dissociative disorder was more severe than that of the patients with no suicidal ideation. They had elevated scores for childhood emotional abuse, physical abuse and emotional neglect. Concurrent somatization disorder diagnosis was the only predictor of suicidal ideation when childhood trauma scores and borderline personality disorder diagnosis were controlled. CONCLUSIONS: Among dissociative patients, there is an association between somatization and suicidal ideation. A trauma-related insecure attachment pattern is considered as a common basis of this symptom cluster.

Functional dissociation of the self: a socio-cognitive approach to trauma and dissociation.

A novel socio-cognitive theory of dissociation and dissociative disorders is proposed. The model, which is both theoretical and clinical, is based on "functional dissociation of the self." A new concept is introduced in this paper: the sociological self. While the sociological self may have cultural and societal dimensions, it is regarded here as a universal phenomenon rather than a culture-bound one; as an individual psychological instance rather than a sociological concept per se. It is proposed that the main sources of dissociation are trauma-related detachment of the sociological and psychological selves and the subsequent amplification of the sociological self. Thus, effective psychotherapy must curtail the enlargement of the sociological self and reactivate the psychological self. It is hoped that this conceptualization will contribute to efforts both toward understanding the everyday dissociation of the average contemporary individual and toward developing novel psychotherapeutic approaches which might shorten the length of treatment of dissociative disorders.

Frontal and occipital perfusion changes in dissociative identity disorder.

The aim of the study was to investigate if there were any characteristics of regional cerebral blood flow (rCBF) in dissociative identity disorder. Twenty-one drug-free patients with dissociative identity disorder and nine healthy volunteers participated in the study. In addition to a clinical evaluation, dissociative psychopathology was assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders, the Dissociative Experiences Scale and the Clinician-Administered Dissociative States Scale. A semi-structured interview for borderline personality disorder, the Hamilton Depression Rating Scale, and the Childhood Trauma Questionnaire were also administered to all patients. Normal controls had to be without a history of childhood trauma and without any depressive or dissociative disorder. Regional cerebral blood flow (rCBF) was studied with single photon emission computed tomography (SPECT) with Tc99m-hexamethylpropylenamine (HMPAO) as a tracer. Compared with findings in the control group, the rCBF ratio was decreased among patients with dissociative identity disorder in the orbitofrontal region bilaterally. It was increased in median and superior frontal regions and occipital regions bilaterally. There was no significant correlation between rCBF ratios of the regions of interest and any of the psychopathology scale scores. An explanation for the neurophysiology of dissociative psychopathology has to invoke a comprehensive model of interaction between anterior and posterior brain regions.

Dissociative disorders in the psychiatric emergency ward.

OBJECTIVE: The aim of this study was to determine the prevalence of dissociative disorders among emergency psychiatric admissions. METHOD: Forty-three of the 97 consecutive outpatients admitted to the psychiatric emergency unit of a university hospital were screened using the Dissociative Experiences Scale (DES). Seventeen (39.5% of the 43 evaluated) patients with a DES score above 25.0 were then interviewed with the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for Dissociative Disorders. RESULTS: Fifteen emergency unit patients (34.9% of the 43 evaluated participants) were diagnosed as having a dissociative disorder. Six (14.0%) patients had dissociative identity disorder, 6 (14.0%) had dissociative disorder not otherwise specified, and 3 (7.0%) had dissociative amnesia. The average DES score of dissociative patients was 43.7. A majority of them had comorbid major depression, somatization disorder, and borderline personality disorder. Most of the patients with dissociative disorder reported auditory hallucinations, symptoms associated with psychogenic amnesia, flashback experiences, and childhood abuse and/or neglect. CONCLUSIONS: Dissociative disorders constitute one of the diagnostic groups with high relevance in emergency psychiatry.

Axis I dissociative disorder comorbidity in borderline personality disorder and reports of childhood trauma.

OBJECTIVE: The purpose of this study was to examine the dissociative disorder comorbidity of borderline personality disorder and its relation to childhood trauma reports in a nonclinical population. METHOD: In April 2003, 1301 college students were screened for borderline personality disorder using the Structured Clinical Interview for DSM-IV Personality Disorders. The Childhood Trauma Questionnaire and Steinberg's dissociation questionnaires were also administered. During May and June 2003, 80 students with a diagnosis of borderline personality disorder and 111 nonborderline students were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders by an interviewer blind to the diagnosis and scores obtained during the first phase. RESULTS: The prevalence of borderline personality disorder was 8.5%. A significant majority (72.5%; 58/80) of the borderline personality disorder group had a dissociative disorder, whereas this rate was only 18.0% (20/111) for the comparison group (p < .001). Childhood emotional and sexual abuse, physical neglect, and total childhood trauma scores had significant effect for borderline personality disorder (p < .001, p = .038, p = .044, and p = .003, respectively), whereas emotional neglect and diminished minimization of childhood trauma had significant effect for dissociative disorder (p = .020 and p = .007, respectively). CONCLUSION: A significant proportion of subjects with borderline personality disorder have a comorbid dissociative disorder. Lack of interaction between dissociative disorder and borderline personality disorder diagnoses for any type of childhood trauma contradicts the opinion that both disorders together might be a single disorder. Recognizing highly prevalent but usually neglected Axis I dissociative disorder comorbidity in patients with borderline personality disorder may contribute to conceptual clarification of this spectrum of psychopathology.