Helpful and meaningful aspects of a psychoeducational programme to treat complex dissociative disorders: a qualitative approach.

Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs.Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses.Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure.Conclusion: Clients and therapists in the TOP DD Network programme described the programme's components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs.

The aim of the present study was to qualitatively explore significant aspects of the TOP DD Network programme through the experiences of complex dissociative disorder (CDD) clients and psychotherapists.Helpful and meaningful aspects of the programme included its components (i.e. content and structure), processes, and outcomes.This psychoeducational programme can be effective and result in improved therapeutic processes and outcomes for individuals with CDDs in psychotherapy.

Sleep-Related Dissociative Disorders.

In sleep-related dissociative disorders, phenomena of the psychiatrically defined dissociative disorders emerge during the sleep period. They occur during sustained wakefulness, either in the transition to sleep or following an awakening from sleep. Behaviors during episodes vary widely, and can result in injury to self or others. Daytime dissociative episodes and a background of trauma are almost always present; there is typically major co-existing psychopathology. Diagnosis is based on both clinical history and polysomnography; differential diagnosis primarily involves other parasomnias and nocturnal seizures. Information available about treatment is limited; in a few reported cases, psychological interventions have proven effective.

Treatment of dissociative identity disorder: leveraging neurobiology to optimize success.

INTRODUCTION: Dissociative identity disorder (DID) is a treatable mental health condition that is associated with a range of psychobiological manifestations. However, historical controversy, modern day misunderstanding, and lack of professional education have prevented accurate treatment information from reaching most clinicians and patients. These obstacles also have slowed empirical efforts to improve treatment outcomes for people with DID. Emerging neurobiological findings in DID provide essential information that can be used to improve treatment outcomes. AREAS COVERED: In this narrative review, the authors discuss symptom characteristics of DID, including dissociative self-states. Current treatment approaches are described, focusing on empirically supported psychotherapeutic interventions for DID and pharmacological agents targeting dissociative symptoms in other conditions. Neurobiological correlates of DID are reviewed, including recent research aimed at identifying a neural signature of DID. EXPERT OPINION: Now is the time to move beyond historical controversy and focus on improving DID treatment availability and efficacy. Neurobiological findings could optimize treatment by reducing shame, aiding assessment, providing novel interventional brain targets and guiding novel pharmacologic and psychotherapeutic interventions. The inclusion of those with lived experience in the design, planning and interpretation of research investigations is another powerful way to improve health outcomes for those with DID.

The role of dissociation-related beliefs about memory in trauma-focused treatment.

OBJECTIVE: Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. METHOD: Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. RESULTS: Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. CONCLUSION: The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.

This study investigated the role of dissociation-related beliefs about memory on trauma-focused treatment.Dissociation-related beliefs were related to post-traumatic and dissociative symptoms, and were especially prominent in patients with the dissociative subtype of post-traumatic stress disorder.Dissociation-related beliefs about memory do not impact the effectiveness of trauma-focused treatment. In fact, trauma-focused treatment effectively decreased these beliefs, suggesting that dissociation-related beliefs about memory should not be a determining factor in withholding patients from receiving trauma-focused therapy.

Dissociative experiences reduce online problem gambling treatment effectiveness.

AIMS: To determine whether dissociative experiences moderate online problem gambling treatment effectiveness, and to characterize the temporal persistence of the relationship between dissociation and problem gambling. DESIGN: Repeatedly measured self-report data on a guided online cognitive behavioral therapy for problem gambling collected on four occasions: before treatment, after treatment, and at 6- and 12-month follow-ups. SETTING AND PARTICIPANTS: The data (N = 1243, 59.2% males) were collected in Finland between 2019 and 2021. MEASUREMENTS: The primary outcome variable was the self-reported level of problem gambling. The predictors were the treatment phase and dissociative experiences, their interaction, and the demographic covariates of age, education, income, and gender. FINDINGS: Problem gambling scores and dissociative experiences declined significantly following treatment and remained low through the follow-ups (retention rates: 52.6% [post-treatment], 26.3% [at the 6-month follow-up], and 16.1% [at the 12-month follow-up]). However, the treatment was significantly less effective in reducing problem gambling for individuals who kept experiencing dissociation after the treatment. CONCLUSIONS: Dissociation is an integral sign of problem gambling severity and sustained dissociative experiences may significantly reduce the long-term effectiveness of online problem gambling treatments. Treatment efforts should be customized to account for individual differences in dissociative tendencies, and future research should broaden the study of dissociative experiences to other behavioral addictions.

Self-stigma predicts post-traumatic and depressive symptoms in traumatized individuals seeking interventions for dissociative symptoms: a preliminary investigation.

Background: Previous studies showed that self-stigma is associated with poor clinical outcomes in people with serious mental illness, and is associated with post-traumatic stress disorder (PTSD). However, less is known about self-stigma in people with dissociative symptoms, which are often related to psychological trauma. This study examined whether baseline self-stigma would be associated with dissociative, PTSD and depressive symptoms at post-intervention, after controlling for treatment usage and baseline symptom severity, in a sample of traumatized Chinese adults undertaking a psychoeducation intervention for dissociative symptoms.Methods: We conducted a secondary analysis of data from a 60-day web-based psychoeducation programme. A total of 58 participants who provided data before and after the intervention were included for analysis. Hierarchical regression analyses were conducted.Results: In this highly traumatized, dissociative, and symptomatic help-seeking sample, baseline self-stigma was associated with PTSD (ß = .203, p = .032) and depressive (ß = .264, p = .025) symptoms at post-intervention, even after controlling for baseline symptom severity, age, location, number of sessions attended in the web-based psychoeducation programme, and use of psychological treatments for PTSD/dissociative symptoms. However, self-stigma was not associated with dissociative symptoms (p = .108).Conclusions: This is the first study showing that self-stigma is a significant predictor of comorbid symptoms (i.e. PTSD and depressive symptoms) in people seeking interventions for dissociative symptoms. The findings that post-traumatic and dissociative symptoms have different relationships to self-stigma also highlight the possibility dissociation might be an independent psychological construct closely associated with trauma, but not merely a PTSD symptom, although further studies are necessary. The preliminary findings call for more efforts to understand, prevent, and address self-stigma in people with trauma-related mental health issues such as dissociative symptoms.

Little is known about the clinical impacts of self-stigma in people with trauma and dissociation.Self-stigma predicted post-traumatic and depressive symptoms in people seeking interventions for dissociative symptoms.More efforts to understand and prevent self-stigma in people with trauma-related symptoms are needed.

Clinical impact and misdiagnosis of functional ophthalmological symptoms: a case report.

BACKGROUND: There is a high prevalence of somatoform disorders and medically unexplained symptoms. When it comes to deciding whether a patient is able to work, it is essential to differentiate a somatoform disorder from a factitious disorder. The case presented demonstrates the impact on disability benefits and the subsequent psychosocial repercussions of misdiagnosing between a factitious disorder and a somatoform disorder. CASE PRESENTATION: A 42-year-old Caucasian woman worked as a 100% fiduciary accountant until the age of 32 when she was placed on medical leave due to persistent trigeminal neuralgia. Afterward, she developed total blindness, not explained by a physiological process, accompanied by distress in a crucial emotional context. We evaluated the patient for a revision of a disability income after a diagnosis of factitious disorder with severe consequences such as disability income suspension and family conflict. Our psychiatric examination concluded the diagnoses of pain disorders related to psychological factors and a dissociative neurological symptom disorder with visual disturbance. CONCLUSIONS: Blindness not explained by a physiological process may accompany trauma and psychological distress. Differentiating this pathology from factitious disorder or simulation is essential from an insurance medicine point of view, but also for its treatment.

[Dissociation - an Interdisciplinary Challenge]. / Dissoziation ­ eine interdisziplinäre Herausforderung.

Dissociative phenomena are not only encountered in everyday life, but increasingly require neurological as well as psychiatric attention in practice and clinic in order to recognize and diagnose corresponding phenomena at an early stage and to provide patients with appropriate treatment. In this article, dissociative disorders, taking into account the new classification of the ICD-11, are presented and corresponding diagnostics and therapeutic measures are described.

Prevalencia del Estrés Postraumático en médicos residentes, expuestos al SARS-COV-2 / Prevalence of posttraumatic stress in resident doctors, exposed to SARS-COV-2

Objetivo: Determinar la prevalencia del trastorno de estrés postraumático (TEPT) en una muestra de médicos residentes del Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina, un año después del cierre total durante la cuarentena por COVID-19. Materiales y métodos: Se administraron los siguientes cuestionarios autoadministrados: una encuesta demográfica, el cuestionario de la Escala de Trauma de Davidson y la Escala de Experiencias Disociativas (EED). Se excluyeron a los residentes de primer año de especialidades básicas, a aquellos que por su especialidad no tienen contacto con pacientes y a los médicos con licencia fueron excluidos. Resultados: La prevalencia de TEPT fue de 24.3% (n=25). Las medianas de las puntuaciones de DES fueron mayores en los participantes con puntaje positivo para TEPT en comparación con los que no lo presentaban (Mann-Whitney U:13.30, p = 0.001). Se encontraron asociaciones entre el género (X2:6.074, p = 0.013), el TEPT y el tipo de especialidad (prueba exacta de Fisher, p = 0.017). No se encontraron otras asociaciones entre las demás variables analizadas y el TEPT. Conclusion: La prevalencia del TEPT fue similar a los informes previos. Se hallaron asociaciones entre este desorden, el género y el tipo de especialidad. Estos resultados deberían llamar la atención de los sistemas de salud para establecer medidas preventivas y terapéuticas para manejar esta situación.

Objective: Determine the prevalence of posttraumatic stress disorder (PTSD) in a sample of resident doctors of the Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina, one year after the total closure during the quarantine by COVID-19. Materials and Methods: The following self-administered questionnaires were dispensed: a demographic survey, the Davidson Trauma Scale questionnaire, and the Scale of Dissociative Experiences (EED). First year residents of basic specialties were excluded, those who for their specialty do not have contact with patients and licensed doctors were excluded. Results: PTSD prevalence was 24.3% (n = 25). The medium-sized ones were greater in the participants with positive score for PTSD compared to those who did not present it (Mann-Whitney U: 13.30, p = 0.001). Associations between the genre were found (X2: 6,074, p = 0.013), the PTSD and the type of specialty (Fisher's exact test, p = 0.017). No other associations were found between the other variables analyzed and the PTSD. Conclusion: The prevalence of the PTSD was similar to the previous reports. Associations between this disorder, gender and type of specialty were found. These results should draw the attention of health systems to establish preventive and therapeutic measures to handle this situation

Dissociation: Factor structure and the role of trauma among treatment-seeking adolescents.

OBJECTIVE: Research examining the factor structure of the Adolescent Dissociative Experiences Scale (A-DES) has yielded mixed findings. This study sought to further clarify the factor structure of the A-DES among youth with histories of exposure to multiple traumas and adversities. METHOD: We conducted a factor analysis of the A-DES using data from 1,157 treatment-seeking adolescents with histories of trauma exposure in order to expand understanding of dissociation's construct validity and provide the first attempt at post hoc analysis of trauma-impacted adolescents. RESULTS: A bifactor CFA model fit the data best and identified a strong general factor, supporting a unidimensional latent structure. Only the general dissociation factor was associated with cumulative trauma exposure, operationalized as the number of different types of exposure endorsed on the Trauma History Profile (THP), but this association was small. CONCLUSIONS: The study findings point toward a unidimensional conceptualization of dissociation. A developmental psychopathology framework is recommended for future research, allowing a nuanced and integrated approach to understanding dissociation and increasing generalizability across adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

[Complex posttraumatic stress disorder in adults]. / Die Komplexe Posttraumatische Belastungsstörung im Erwachsenenalter.

The term "complex posttraumatic stress disorder" (cPTSD) appeared in the scientific literature 30 years ago and has now been included in a diagnostic catalogue for the first time, namely in the International Statistical Classification of Diseases and Related Health Problems 11 (ICD-11) which was officially published at the beginning of 2022. This usually severely debilitating disorder often poses great challenges to treating physicians and psychotherapists in everyday clinical practice. Due to the much-debated overlap of cPTSD with borderline personality disorder (BPD), which is very high in cases of comorbidity of BPD and PTSD, cPTSD became embroiled in scientific discussions about the raison d'être of BPD in the new dimensional concept of personality disorders (PD) in the ICD-11. In addition to a detailed explanation of the diagnostic criteria of cPTSD and their differentiation from other mental disorders, particularly from PTSD, BPD and dissociative disorders, this article summarizes the historical development of the concept of cPTSD to date and the currently available treatment options. The same criteria apply to cPTSD in childhood and adolescence as in adulthood, but there are some special features that are not addressed in this article.

Stuck in a Moment: Tonic Immobility Predicts Poor Quality of Life in Treated PTSD Patients.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a prevalent and disabling multisystem disorder, with significant physical and psychiatric morbidity and poor quality of life (QOL). Although peritraumatic reactions - tonic immobility and dissociation - are established predictors of PTSD severity and development, there is a dearth of investigation assessing the impact of peritraumatic reactions on QOL of PTSD patients. Quality of life has become increasingly important in health care and research as a reliable outcome measure. It comprises psychological, physical, social and environmental domains, providing important information about the impact of diseases on patient's life. This study aims to investigate the impact of peritraumatic tonic immobility and peritraumatic dissociation on QOL of PTSD civilian outpatients. SUBJECTS AND METHODS: It is a cross-sectional study of 50 victims of urban violence with current PTSD, recruited in a specialized outpatient clinic. Instruments used were: Structured Clinical Interview IV, Peritraumatic Dissociative Experiences Questionnaire, Tonic Immobility Scale and WHOQOL-BREF (psychological, physical, social and environmental domains). Linear regression models were fitted to evaluate the impact of peritraumatic reactions - tonic immobility and dissociation - on WHOQOL-BREF scores. We controlled for sex as potential confounding. RESULTS: The severity of peritraumatic tonic immobility negatively impacted on psychological and environment domains of quality of life. For each additional point on the Tonic Immobility Scale, there was a decreased of 0.8 points on the scores of these domains of WHOQOL-BREF. Neither the peritraumatic reactions showed effects on physical nor social domains. Possible limitations of this study include cross-sectional design, relatively small sample size of tertiary center outpatients and recall bias. CONCLUSIONS: Peritraumatic tonic immobility is related to poor quality of life, adding new insights about the relationship between this immobility reaction and PTSD.

A Schema Therapy approach to complex dissociative disorder in a cross-cultural setting: a single case study.

Complex dissociative disorders (CDD) include dissociative identity disorder (DID) and the most common other specified dissociative disorder (OSDD, type 1). While consensus-based treatments for CDD are lacking in several international guidelines, patients suffering from CDD show high levels of impairment, treatment utilization and costs. Migrants and refugees often present risk factors for trauma-related and dissociative disorders and need effective and culturally adapted treatments. Schema Therapy (ST) is an integrative psychotherapy that has been recently proposed as a treatment for CDD. This case study examined the process of individual ST, in a three phases-based approach, with a 38-year-old male Yemeni refugee with OSDD, type 1, posttraumatic stress disorder and borderline personality disorder. The treatment was provided in a Western country and the setting included two Western therapists (co-therapy) and an Arabic interpreter/cultural mediator. We assessed the patient's change by using self-report assessments of dissociative and PTSD symptoms, cognitive schemas over 2-year and 4-months treatment periods and a 6-months follow-up. Posttreatment and follow-up reliable change analyses showed significant improvements in dissociative and PTSD symptoms as well as in some cognitive schemas. Despite any firm conclusion cannot be drawn due to the limitations of this study (i.e., single case study), the findings suggest that ST integrated in a phase-oriented approach may be an effective treatment for CDD. Additionally, our study provides some preliminary elements about cross-cultural validity of the schema modes construct as well as cross-cultural effectiveness of ST. More research based on larger samples and specific cross-cultural focused design is needed to confirm these assumptions.

Group treatment for complex dissociative disorders: a randomized clinical trial.

BACKGROUND: Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment. METHODS: Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group-treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties. RESULTS: Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period. CONCLUSION: In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning. TRIAL REGISTRATION: Clinical Trials ( NCT02450617 ).

Examining the 4-D Model in Persons Enrolled in the Top DD Internet Intervention.

The 4-dimensional (4-D) model of trauma-related dissociation differentiates between dissociative experiences involving trauma-related altered states of consciousness and symptoms of distress that do not appear to involve alterations in normal waking consciousness across four phenomenological dimensions (i.e., our experience of time, thought, body, and emotions). The current study evaluated hypotheses associated with the 4-D model using analyses of variance and correlation analyses in individuals with a primary diagnosis of a trauma-related dissociative disorder who were participating in the TOP DD internet study involving a combination of in-person psychotherapy and an online psychoeducational program (n = 111). Intrusive memories of traumatic events were more frequently endorsed than flashbacks, but emotional numbing was more frequently endorsed than other forms of affect dysregulation. Negative thoughts and emotion dysregulation were more strongly intercorrelated than were voice hearing and emotional numbing. Distress symptoms were more strongly associated with PTSD symptoms and difficulties in emotion regulation, whereas experiences of depersonalization were more strongly associated with dissociative self-states. Greater reduction in distress symptoms was also seen in comparison with trauma-related altered states of consciousness over the course of the combined psychotherapy and internet-based psychoeducational intervention. Overall, results continue to suggest that measures of distress and dissociative experiences can be distinguished by measures of symptom frequency, co-occurrence, and convergence with other measures of distress vs. dissociation albeit that results varied across the four phenomenological dimensions that were surveyed.

An examination of the relations between emotion dysregulation, dissociation, and self-injury among dissociative disorder patients.

Background: Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To the best of our knowledge, however, the link between emotion dysregulation and self-injury has not yet been examined within a DD population. Objective: The present study investigated relations between emotion dysregulation, dissociation, and self-injury in DD patients, and explored patterns of emotion dysregulation difficulties among DD patients with and without recent histories of self-injury. Method: We utilized linear and logistic regressions and t-test statistical methods to examine data from 235 patient-clinician dyads enrolled in the TOP DD Network Study. Results: Analyses revealed emotion dysregulation was associated with heightened dissociative symptoms and greater endorsement of self-injury in the past six months. Further, patients with a history of self-injury in the past six months reported more severe emotion dysregulation and dissociation than those without recent self-injury. As a group, DD patients reported the greatest difficulty engaging in goal-directed activities when distressed, followed by lack of emotional awareness and nonacceptance of emotional experiences. DD patients demonstrated similar patterns of emotion dysregulation difficulties irrespective of recent self-injury status. Conclusions: Results support recommendations to strengthen emotion regulation skills as a means to decrease symptoms of dissociation and self-injury in DD patients.

Antecedentes: Los pacientes con trastorno disociativo (DD en sus siglas en inglés) reportan altas tasas de autolesiones. Estudios anteriores han encontrado que la disociación y las autolesiones están relacionadas con el sufrimiento emocional. Sin embargo, hasta donde sabemos, la relación entre la desregulación emocional y las autolesiones aún no se ha examinado en una población con DD.Objetivo: El presente estudio investigó las relaciones entre la desregulación emocional, la disociación y la autolesión en pacientes con DD, y exploró los patrones de las dificultades de desregulación emocional entre los pacientes con DD con y sin historias recientes de autolesión.Método: Se utilizaron regresiones lineales y logísticas y métodos estadísticos de prueba t para examinar los datos de 235 díadas paciente-médico inscritas en el Estudio TOP DD Network.Resultados: Los análisis revelaron que la desregulación emocional se asoció con un aumento de los síntomas disociativos y una mayor tendencia a la autolesión en los últimos seis meses. Además, los pacientes con un historial de autolesiones en los últimos seis meses informaron de una desregulación emocional y una disociación más graves que los que no se habían autolesionado recientemente. Como grupo, los pacientes con DD informaron de la mayor dificultad para participar en actividades dirigidas a objetivos cuando estaban angustiados, seguidos por la falta de conciencia emocional y la no aceptación de las experiencias emocionales. Los pacientes con DD demostraron patrones similares de dificultades de desregulación emocional, independientemente del estado de autolesión reciente.Conclusiones: Los resultados apoyan las recomendaciones de fortalecer las habilidades de regulación de las emociones como medio para disminuir los síntomas de disociación y autolesión en pacientes con DD.

Barriers to accessing and continuing mental health treatment among individuals with dissociative symptoms.

Background: Dissociative disorders (DDs) are characterized by interruptions of identity, thought, memory, emotion, perception, and consciousness. Patients with DDs are at high risk for engaging in dangerous behaviours, such as self-harm and suicidal acts; yet, only between 28% and 48% of individuals with DDs receive mental health treatment. Patients that do pursue treatment are often misdiagnosed, repeatedly hospitalized, and experience disbelief from providers about their trauma history and dissociative symptoms. Lack of dissociation-specific treatment can result in poor quality of life, severe symptoms requiring utilization of hospitalization and intensive outpatient treatment, and high rates of disability. Objective: Given the extensive and debilitating symptoms experienced by individuals with DDs and the infrequent utilization of treatment, the current study explored barriers to accessing and continuing mental health treatment for individuals with dissociative symptoms and DDs. Method: A total of 276 participants with self-reported dissociative symptoms were recruited via online social media platforms. Participants completed a survey which featured 35 possible barriers to accessing treatment and 45 possible reasons for discontinuing treatment, along with open text boxes for adding barriers/reasons that were not listed. Results: Results showed 97% of participants experienced one or more barriers to accessing treatment (M = 9 barriers) and 92% stopped treatment with a provider due to at least one of the reasons captured in the survey (e.g. limited insurance coverage, poor therapeutic alliance, disbelief from providers, etc.; M = 7 barriers). Conclusions: The most frequently endorsed barriers were structural barriers, such as those related to finances, insurance, and lack of provider availability. It is imperative more service providers are trained to treat dissociation and that insurers and health care systems recognize the need for specialized, dissociation-focused treatment.

Antecedentes: Los trastornos disociativos (TD) se caracterizan por interrupciones en la identidad, pensamiento, memoria, emoción, percepción y conciencia. Los pacientes con TD tienen un alto riesgo de participar en conductas peligrosas, como autolesiones y actos suicidas; sin embargo, solo entre el 28­48% de las personas con TD reciben tratamiento de salud mental. Los pacientes que buscan tratamiento a menudo son mal diagnosticados, hospitalizados repetidamente y experimentan incredulidad por parte de los proveedores sobre su historial de trauma y síntomas disociativos. La falta de un tratamiento específico para la disociación puede resultar en una mala calidad de vida, síntomas graves que requieren hospitalización y tratamiento ambulatorio intensivo y altas tasas de discapacidad.Objetivo: Dados los síntomas extensos y debilitantes que experimentan las personas con TD y la utilización poco frecuente del tratamiento, el presente estudio exploró las barreras para acceder y continuar el tratamiento de salud mental para las personas con síntomas disociativos y TD.Método: Un total de 276 participantes con síntomas disociativos auto-reportados fueron reclutados a través de plataformas de redes sociales en línea. Los participantes completaron una encuesta que presentaba 35 posibles barreras para acceder al tratamiento y 45 posibles razones para interrumpir el tratamiento, junto con cuadros de texto abiertos para agregar barreras/razones no incluidas en la lista.Resultados: Los resultados mostraron que el 97% de los participantes experimentó una o más barreras para acceder al tratamiento (M = 9 barreras) y el 92% interrumpió el tratamiento con un proveedor debido al menos a una de las razones capturadas en la encuesta (por ejemplo, cobertura de seguro médico limitada, pobre alianza terapéutica, incredulidad por parte de los proveedores, etc.; M = 7 barreras).Conclusiones: Las barreras confirmadas con mayor frecuencia fueron las barreras estructurales, como las relacionadas con las finanzas, los seguros médicos y la falta de disponibilidad de proveedores. Es imperativo que más proveedores de servicios estén capacitados para tratar la disociación y que las aseguradoras y los sistemas de atención médica reconozcan la necesidad de un tratamiento especializado centrado en la disociación.

Remission of schizophrenia after an EMDR session.

We present a case study of the remission of a chemically resistant schizophrenia disorder after a single session of EMDR. Our patient had been followed-up for schizophrenia according to DSM5 criteria, since 4 years. During our subject's fourth hospitalization for major delirious decompensation, a single EMDR session, according to the standard protocol, resulted in a complete and total remission of the delirious disorder and the disorganization/dissociative syndrome in 8 weeks. This allowed us to interrupt the patient's antipsychotic treatment without relapse at 18 months. This case study allows us to highlight, as many authors have previously done, the necessity of researching the traumatic history of patients diagnosed with schizophrenia in order to provide therapies focused on traumatic dissociation. It also questions the relevance of our diagnostic criteria for schizophrenia and other dissociative disorders.

Presentamos un estudio de caso sobre la remisión de una esquizofrenia químicamente resistente tras una sola sesión de EMDR. Nuestro paciente había sido seguido por esquizofrenia según los criterios del DSM 5, desde hace 4 años. Durante la cuarta hospitalización de nuestro sujeto, por descompensación delirante mayor, una única sesión de EMDR según el protocolo estándar, dio lugar a una remisión completa y total del trastorno delirante y del síndrome de desorganización/disociativo en 8 semanas. Esto nos permitió interrumpir el tratamiento antipsicótico de la paciente sin recaídas a los 18 meses. Este estudio de caso nos permite destacar, como muchos autores han hecho anteriormente, la necesidad de investigar la historia traumática de los pacientes diagnosticados de esquizofrenia para ofrecer terapias centradas en la disociación traumática. También cuestiona la pertinencia de nuestros criterios diagnósticos para la esquizofrenia y otros trastornos disociativos.

Negative affective responses to positive events and stimuli in patients with complex dissociative disorders: a mixed-methods pilot study.

Background: Research suggests that individuals exposed to (childhood) trauma are not only unable to experience pleasure, known as hedonic deficit (HD), but also experience 'negative affective responses to positive events', known as negative affective interference (NAI). The clinical relevance and prognostic features of NAI have increasingly been recognized. To date, no studies have focused on NAI in patients with complex dissociative disorders (CDDs) who were abused early in life. Objective: In this pilot study, we quantitatively and qualitatively investigated how NAI is related to trauma-related symptoms and how this phenomenon can be understood in a selected group of adult CDD patients. Method: CDD patients (N = 25) referred to an inpatient dissociation-focused treatment programme completed the Hedonic Deficit & Interference Scale (HDIS), and measures of trauma-related symptoms and interpersonal functioning, as well as a qualitative questionnaire addressing possible inner conflicts and phobias with respect to the experience of positive events. A convergent mixed-methods design was used to obtain different but complementary data on NAI to gain a more complete understanding of the phenomenon. Results: The quantitative analyses showed a significant relationship between NAI and trauma-related symptoms and interpersonal functioning. NAI seems to be more strongly associated with these symptoms than HD. The qualitative analysis revealed three themes - fear, shame, and aggressive 'parts' - preventing positive emotions, which provided a possible interpretation of the quantitative results. The integrated findings were discussed in light of theories of structural dissociation of the personality and attachment. Conclusions: These findings indicate that NAI is related to a spectrum of trauma-related symptoms and interpersonal functioning in patients with a CDD to a larger degree than HD and that different dissociative identities are involved. Studies of the relationship between changes in HDIS (particularly the NAI subscale) and changes in trauma-related symptoms and interpersonal functioning following treatment are warranted.

Antecedentes: Las investigaciones sugieren que los individuos expuestos a traumas (en la infancia) no sólo son incapaces de experimentar placer, lo que se conoce como déficit hedónico (HD), sino que también experimentan 'respuestas afectivas negativas a eventos positivos', lo que se conoce como interferencia afectiva negativa (NAI). Cada vez se reconoce más la importancia clínica y las características pronósticas de la NAI. Hasta la fecha, ningún estudio se ha centrado en la NAI en pacientes con trastornos disociativos complejos (TDC) que sufrieron abusos en las primeras etapas de su vida.Objetivo: En este estudio piloto, investigamos cuantitativa y cualitativamente cómo se relaciona la NAI con los síntomas relacionados con el trauma y cómo se puede entender este fenómeno en un grupo seleccionado de pacientes adultos con TDC.Método: Los pacientes con TDC (N = 25) derivados a un programa de tratamiento hospitalario centrado en la disociación completaron la Escala de Déficit e Interferencia Hedónica (HDIS en sus siglas en ingles), y medidas de síntomas relacionados con el trauma y el funcionamiento interpersonal, así como un cuestionario cualitativo que abordaba posibles conflictos internos y fobias con respecto a la experiencia de eventos positivos. Se utilizó un diseño convergente de métodos mixtos para obtener datos diferentes pero complementarios sobre la NAI y así obtener una comprensión más completa del fenómeno.Resultados: Los análisis cuantitativos mostraron una relación significativa entre la NAI y los síntomas relacionados con el trauma y el funcionamiento interpersonal. La NAI parece estar más fuertemente asociada a estos síntomas que la HD. El análisis cualitativo reveló tres temas - miedo, vergüenza y 'partes' agresivas - que impiden las emociones positivas, lo que proporcionó una posible interpretación de los resultados cuantitativos. Los resultados integrados se discutieron a la luz de las teorías de la disociación estructural de la personalidad y del apego.Conclusiones: Estos hallazgos indican que la NAI está relacionada con un espectro de síntomas relacionados con el trauma y el funcionamiento interpersonal en pacientes con un TDC en mayor grado que la HD y que están implicadas diferentes identidades disociativas. Se justifica la realización de estudios sobre la relación entre los cambios en el HDIS (particularmente la subescala NAI) y los cambios en los síntomas relacionados con el trauma y el funcionamiento interpersonal después del tratamiento.

Resting-state functional connectivity in patients with a complex PTSD or complex dissociative disorder before and after inpatient trauma treatment.

INTRODUCTION: Recent research suggests that traumatized patients are characterized by disrupted resting-state functional connectivity. We examined whether neural networks involved in resting-state change over the course of a phase-oriented inpatient treatment for complex traumatized and dissociative disorder patients. We also investigated associations between these network alterations and clinical symptoms and emotion regulation skills. METHODS: Pre- and post-treatment, electroencephalography (EEG) was recorded during resting-state in patients (n = 23) with a complex dissociative disorder (CDD) or complex posttraumatic stress disorder (cPTSD). Patients also completed clinical and emotion regulation questionnaires. To reduce variance in the collected data, patients were exclusively tested as one prototypical dissociative part referred to as Apparently Normal Part (ANP). Functional network connectivity was examined and compared with a matched healthy control group (n = 37), also measured twice. RESULTS: Prior to treatment and compared with controls, patients had a significantly lower functional connectivity strength within eyes-open and eyes-closed resting-state networks in the theta and alpha frequency band. Following treatment, functional connectivity strength within these networks was comparable to the control group and comprised areas belonging to the default mode network (DMN) and prefrontal as well as anterior cingulate control regions. Treatment-related network normalizations in the theta frequency band were associated with a self-reported increase in the use of cognitive reappraisal strategies and reduction in emotion regulation difficulties. CONCLUSION: Phase-oriented trauma treatment can strengthen resting-state network connectivity and can increase the capacity of complex traumatized and dissociative patients as ANP to handle emotional challenges effectively.