RESUMO
Research has consistently found elevated mean dissociation scores in particular diagnostic groups. In this study, we explored whether mean dissociation scores for different diagnostic groups resulted from uniform distributions of scores within the group or were a function of the proportion of highly dissociative patients that the diagnostic group contained. A total of 1566 subjects who were psychiatric patients, neurological patients, normal adolescents, or normal adult subjects completed the Dissociative Experience Scale (DES). An analysis of the percentage of subjects with high DES scores in each diagnostic group indicated that the diagnostic group's mean DES scores were a function of the proportion of subjects within the group who were high dissociators. The results contradict a continuum model of dissociation but are consistent with the existence of distinct dissociative types.
Assuntos
Transtornos Dissociativos/diagnóstico , Transtornos Mentais/diagnóstico , Adolescente , Adulto , Fatores Etários , Análise de Variância , Transtornos Dissociativos/classificação , Transtornos Dissociativos/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicologia do Adolescente , Psicometria , Fatores SexuaisRESUMO
In the past decade we have seen many new articles devoted to the study of dissociation and its implications in health and illness. The area of dissociative disorders received special attention with many authors pointing out the probability that dissociative disorders may, in fact, be much more pervasive than used to be thought. The need for a reliable measurement of dissociation has become more acute. This paper reports the results of a study comparing the Perceptual Alteration Scale (PAS), a behavioral scale measuring dissociation capacity, with Spiegel's Eye-Roll Sign (ERS) a postulated biological marker for the capacity to dissociate. 107 subjects' PAS scales and eye-roll sign measurements were analyzed. The results showed a mean PAS score of 155, and a mean eye-roll of 3.7. The Pearson Correlation Coefficients were computed for the eye-roll scores vs. the PAS scores, and showed a correlation of 0.55, with a significance of p < 0.0001. These results indicate a high positive correlation between the eye-roll sign and the PAS, spanning through the entire dissociative continuum. Further studies are needed to correlate the eye-roll sign with the Dissociative Experiences Scale (DES), and other measurements of dissociation.
Assuntos
Transtornos Dissociativos/diagnóstico , Movimentos Oculares , Escalas de Graduação Psiquiátrica , HumanosRESUMO
After a brief review of the literature on self-inflicted violence, a practical approach to the treatment of patients who show self-injurious behavior and self-mutilation is developed. The treatment model uses therapeutic interventions based on a biopsychosocial understanding of the person and applies knowledge from the biological, psychological-behavioral, and social fields. Interventions discussed include ego strengthening, planning for substitute behaviors, therapeutic imagery, ego-state therapy, reframing, cognitive syllogism, behavioral reinforcement and extinction, and use of behavioral contracts. The case examples presented illustrate the importance of the therapist/patient relationship, which is based on trust, respect, and caring but also on patient responsibility for change.
Assuntos
Terapia Comportamental/métodos , Comportamento Autodestrutivo/terapia , Adulto , Feminino , Humanos , Relações Profissional-Paciente , Comportamento Autodestrutivo/psicologiaRESUMO
Hyperemesis gravidarum is not an uncommon condition in the first trimester of pregnancy. In some of these patients, the condition is so severe that it causes the development of dehydration and electrolyte imbalances. When that happens, the patient usually requires hospital treatment, which includes intravenous fluids and antiemetic medications. Obstetricians are very careful before prescribing any medications in the first trimester of pregnancy, making it necessary to consider methods of treatment that minimize the risk of medication side effects to both mother and baby. One such method is the use of hypnotherapy. In this paper, I describe five cases where hypnotherapy was successfully used with a variety of techniques to resolve the problem of hyperemesis. This is followed by a discussion regarding the most efficacious techniques and the type of patient that best responds to hypnotherapeutic interventions.
Assuntos
Hiperêmese Gravídica/terapia , Hipnose , Adulto , Feminino , Humanos , Gravidez , Terapia de RelaxamentoRESUMO
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.
Assuntos
Transtornos Dissociativos/diagnóstico , Transtorno Dissociativo de Identidade/diagnóstico , Inventário de Personalidade/normas , Adulto , Teorema de Bayes , Diagnóstico Diferencial , Análise Discriminante , Transtornos Dissociativos/psicologia , Transtorno Dissociativo de Identidade/classificação , Transtorno Dissociativo de Identidade/psicologia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Masculino , Transtornos do Humor/classificação , Transtornos do Humor/diagnóstico , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Curva ROC , Reprodutibilidade dos Testes , Esquizofrenia/classificação , Esquizofrenia/diagnóstico , Transtornos de Estresse Pós-Traumáticos/classificação , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
The authors describe the use of ego-state therapy for the treatment of self-injurious behavior (SIB). We propose that for some patients, SIB results from conflict among dissociated ego states. We review the historical and theoretical basis for this position and delineate a specific treatment technique. Our strategy consists of identifying an ego state in which SIB occurs, activating the patient's ego strengths using inner-adviser techniques and facilitating the integration of these resources within the ego state responsible for the behavior. We have used this strategy with favorable results for patients with dissociative symptoms, primarily those suffering from borderline personality disorder, posttraumatic stress disorder, or dissociative disorders.
Assuntos
Transtorno da Personalidade Borderline/terapia , Transtorno Dissociativo de Identidade/terapia , Ego , Hipnose/métodos , Comportamento Autodestrutivo/terapia , Adulto , Transtorno da Personalidade Borderline/psicologia , Transtornos Dissociativos/psicologia , Transtornos Dissociativos/terapia , Transtorno Dissociativo de Identidade/psicologia , Feminino , Humanos , Desenvolvimento da Personalidade , Comportamento Autodestrutivo/psicologiaRESUMO
In this paper I describe a special form of ego-state therapy that integrates writing letters to one's self as an internal therapeutic communication among various ego states previously not fully aware of each other or engaged in destructive power struggles. Expressing one's thoughts, feelings, and urges in writing transforms primary process activities of the self into secondary processes that are more mature and adaptive to healthy functioning in day-to-day living. This method also reinforces the idea of patient empowerment in the form of self-healing and utilizing internal resources in the process of recovery.
Assuntos
Conscientização , Transtornos Dissociativos/terapia , Ego , Hipnose/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Redação , Adulto , Transtornos Dissociativos/psicologia , Feminino , Humanos , Controle Interno-Externo , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
This paper briefly reviews the benefits of using age-progression techniques in hypnotherapy, followed by a detailed explanation and illustration of the "back-from-the-future" technique with two case examples, including their outcome. The patients presented with feelings of helplessness, hopelessness, and a sense of futurelessness. Following the hypnotherapeutic intervention, patients were instructed to take time to reflect on the session and to write down the specific experiences they had on their voyage into the future focusing on their visual images, auditory sensations, experiences with other senses (touch, smell, and taste), as well as thoughts, emotions, and self-perceptions. Follow-up validated that the patients maintained their therapeutic accomplishments several months after the initial interventions.
Assuntos
Conscientização , Hipnose/métodos , Rememoração Mental , Transtornos de Estresse Pós-Traumáticos/terapia , Percepção do Tempo , Adulto , Criança , Abuso Sexual na Infância/psicologia , Abuso Sexual na Infância/terapia , Feminino , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
This paper reviews the literature on the use of hypnosis in the assessment and treatment of eating disorders. It proposes that patients with eating disorders ought to be investigated as to the underlying dynamics behind the eating disorders symptoms. Following a thorough assessment, a number of hypnotherapeutic techniques are explained and discussed, such as: general relaxation and calmness, guided imagery, teaching self-hypnosis, ego-strengthening, direct and indirect suggestions for healing and recovery, cognitive restructuring and reframing, symbolic guided imagery, age progression ("back from the future" technique), metaphorical prescriptions, age regression and abreactions, and ego state therapy. Verbatim examples of these techniques are given as illustrations of how to use them.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Hipnose/métodos , Anorexia Nervosa/psicologia , Anorexia Nervosa/terapia , Bulimia/psicologia , Bulimia/terapia , Ego , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Humanos , Imaginação , Controle Interno-Externo , SugestãoRESUMO
This paper has reviewed the history of using imagery as a powerful change and healing agent in humans. It has been a rather underused technique in the practice of Western medicine and psychiatry. I hope that the specific examples and techniques described herein will stimulate and motivate the reader to adopt them in their clinical practice and creatively develop new strategies and techniques applicable in other fields such as sports, the arts, education, and the human life cycle.
Assuntos
Hipnose/métodos , Imaginação , Transtornos Mentais/terapia , Psicoterapia/métodos , Adulto , Criança , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/terapia , Humanos , Controle Interno-Externo , Transtornos Mentais/psicologia , Terapia de Relaxamento , SimbolismoRESUMO
This paper reviews some historical aspects of hypnosis, discusses and clarifies the lingering misconceptions and the established facts. Moreover, the paper clarifies the predominant school of thought regarding the issue of hypnotizability and the relevance of hypnotizability scales for research and clinical practice. The paper concludes with a review of using hypnosis as a diagnostic and therapeutic tool.
Assuntos
Hipnose , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapiaRESUMO
Several facets of the Tree-Scar-Trauma hypothesis were addressed. The first inquiry was whether scars, knotholes, and/or broken branches on a drawn tree are indicative of previous victimization. A statistically significant relationship between these variables was found. The study also examined differences between mental health patients (N = 56) and control subjects (N = 215) with regard to their abuse history and tree drawings. No significant differences between these two populations were found. A modification of Buck's (1948) hypothesis with regard to the relationship between the location of traumatic indicators on projective tree drawings and age of traumatization was tested and not validated. However, the association between the duration of physical abuse and the number of indicators on the tree was statistically significant.
Assuntos
Abuso Sexual na Infância/diagnóstico , Maus-Tratos Infantis/diagnóstico , Desenvolvimento da Personalidade , Técnicas Projetivas/estatística & dados numéricos , Adolescente , Adulto , Criança , Maus-Tratos Infantis/psicologia , Abuso Sexual na Infância/psicologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , PsicometriaRESUMO
Frequently, MPD patients present themselves to the clinician with a variety of psychophysiological symptoms. Eating-disorder symptoms may be one of these, and may include the following: binge eating, self-induced vomiting, laxative abuse, excessive exercising, body image distortion, self-starvation, fluctuations in body weight, and nausea. Following are five cases in whom the pathological eating behavior was a manifestation of an underlying multiple personality disorder. The pathological eating behavior was so severe that some patients matched DSM-III-R diagnostic criteria for an eating disorder. Clinicians dealing with eating disorders should be aware that some patients may represent a subgroup in whom the underlying cause for the eating disorder may be MPD. These patients seldom respond to conventional treatment modalities used in eating-disorders programs, and only when the underlying multiplicity is identified and treated by a trained clinician, will the patient's eating-disorder symptoms improve.
Assuntos
Anorexia Nervosa/diagnóstico , Bulimia/diagnóstico , Transtornos Dissociativos/diagnóstico , Transtorno Dissociativo de Identidade/diagnóstico , Adulto , Anorexia Nervosa/psicologia , Bulimia/psicologia , Diagnóstico Diferencial , Transtornos Dissociativos/psicologia , Transtorno Dissociativo de Identidade/psicologia , Feminino , Humanos , Escalas de Graduação Psiquiátrica , PsicoterapiaRESUMO
There were 70% more burns in the October 1973 war than in the Six Day War of 1967. This increase caused great concern and emphasized the need for better personal and crew protection against burns. Some of these measures were already implemented by the outbreak of the 1982 war in Lebanon. Analysis of the burn injuries of this war is the subject of this short report.