RESUMO
OBJECTIVES: Dissociative identity disorder (DID) and schizophrenia-spectrum disorders (SSD) share some overlapping phenomenological features making accurate diagnosis more difficult. Childhood abuse and depersonalization have been associated with psychotic symptoms across psychological disorders but their relationship to psychotic phenomenology remains understudied. METHOD: The present study used quantitative measures to examine (1) similarities and differences in phenomenological voice hearing experiences, interpretations of voices, and thought disorder symptoms in individuals with DID (n = 44) or SSD (n = 45), and (2) whether depersonalization and childhood maltreatment influenced the initial pattern of findings. RESULTS: DID participants perceived their voices as being more internally located and generated, louder, and uncontrollable than SSD participants. Furthermore, the DID participants endorsed a greater frequency of thought disorder symptoms. Adding the covariates (sex, depersonalization, and child maltreatment) did not change the findings associated with location and origin of voices, and derailment, but there were now no differences in loudness or controllability. However, the schizophrenia sample reported more distress and metaphysical beliefs associated with voices, as well as more thought disorder incoherence and word substitution with the covariates controlled. CONCLUSION: While tentative, metaphysical interpretations of voices, incoherent thoughts and word substitution may reflect more psychotic processes.
Assuntos
Transtorno Dissociativo de Identidade , Transtornos Psicóticos , Esquizofrenia , Voz , Humanos , Criança , Transtorno Dissociativo de Identidade/complicações , Alucinações/psicologia , Transtornos Psicóticos/psicologia , Transtornos DissociativosRESUMO
Some evidence in non-clinical groups suggests that the relationship context in which dissociation is experienced might moderate its association with shame. The current study used vignettes detailing either dissociative symptoms or the expression of sadness occurring in three different relationship contexts: with a friend, an acquaintance, or when alone. Ratings of emotional (e.g. shame, anxiety) and behavioral (e.g. leave, talk) reactions were made on single-item measures, and shame feelings were further assessed with the State Shame Scale. Participants were in treatment for either dissociative identity disorder (n = 31) or other specified dissociative disorder (n = 3; N = 34). Feelings of shame were elevated in the acquaintance condition compared to when with a close friend or alone regardless of whether dissociation or sadness was experienced. In the acquaintance context, participants exposed to dissociation or sadness reported feeling annoyed at themselves, having a greater desire to leave, and a lesser desire to talk compared to when these experiences happened with a close friend or alone. Results suggest those with a dissociative disorder appraise themselves as more vulnerable to shame if experiencing dissociation or sadness when with an acquaintance, potentially because the risk of not being understood and rejected is heightened.
Assuntos
Emoções , Vergonha , Humanos , Ansiedade , Transtornos Dissociativos/psicologia , Transtornos de AnsiedadeRESUMO
INTRODUCTION: Recent theoretical models and preliminary data suggest that shame is a central emotion in the context of auditory verbal hallucinations (AVH or voice-hearing). Nevertheless, all previous studies were correlational. Thus, the present study sought to explore whether simulated AVH experiences can trigger shame using an experimental design. METHODS: 346 participants from the general population were randomised to one of 6 conditions. They had to read a vignette describing a character who was either in a situation alone or with a close friend. While reading the vignettes, participants also heard either negative or neutral simulated voices or non-voice neutral sounds. Subsequently, participants completed different measures, including shame. RESULTS: Our results showed that both the negative and neutral simulated voice-hearing triggered higher levels of shame, but also other negative emotions when compared to ambient sound, regardless of the social context. Participants in the simulated voice-hearing conditions reported higher levels of maladaptive coping strategies and negative beliefs about voices than in the ambient sound condition. CONCLUSIONS: The simulation of neutral and negative voices trigger similar levels of subjective shame, indicating the effect is not specific to negative voices but rather associated with the experience per se. Nevertheless, it can also trigger other negative emotions.
Assuntos
Alucinações , Voz , Emoções , Alucinações/psicologia , Humanos , Vergonha , Meio SocialRESUMO
Previous research has shown that the relationship between childhood abuse and the presence of auditory hallucinations is mediated by dissociation, specifically depersonalization and absorption. The current study assessed dissociation as a mediator of the relationship between childhood abuse and auditory hallucination frequency, characteristics and associated distress in those with dissociative identity disorder (DID; n = 50) and schizophrenia spectrum disorders (SSD; n = 49). It also tested whether dissociation mediated the relationship between childhood abuse and the presence of non-auditory hallucinations. Participants completed measures of childhood abuse, dissociation, auditory hallucination frequency, characteristics, distress, and non-auditory hallucinations. With distress associated with auditory hallucinations as the outcome, depersonalization was a mediator in the DID group. For non-auditory hallucinations, in the DID group depersonalization and amnesia were mediators between childhood abuse and the presence of visual, tactile and olfactory hallucinations. In the SSD group absorption mediated between childhood abuse and visual, olfactory and gustatory hallucinations. Results suggest that the presence of non-auditory hallucinations in DID and SSD are associated with different dissociative experiences.
Assuntos
Maus-Tratos Infantis , Transtorno Dissociativo de Identidade , Esquizofrenia , Criança , Transtornos Dissociativos , Alucinações , HumanosRESUMO
Two studies employed a dissociative detachment induction technique to examine if experiences of dissociation increased acute shame feelings. Study 1 recruited college participants, while Study 2 enlisted adults attending treatment for childhood sexual abuse. Two hypotheses were explored: (1) more shame would be reported following a dissociative detachment induction than a relaxation induction; and (2) shame would increase when detachment was induced in the relationship context of a close other than when alone. Study 1 (N = 81) effectively induced detachment and participants reported higher shame in this condition compared to the relaxation condition. This effect was maintained when state anxiety was controlled. The relationship context produced no impact on dissociation or shame. Attributions around feeling flawed predominantly linked detachment experiences with subsequent shame feelings. In Study 2 with clinical participants (N = 28), regression analyses showed state shame was predicted by acute detachment after controlling for state anxiety, gender, and trait shame and dissociation. The most common appraisals offered for why detachment led to feelings of shame was being flawed and exposed. Collectively, our findings suggest that increased acute shame results from detachment experiences, making more specific the relationship between shame and dissociation.
Assuntos
Transtornos Dissociativos , Vergonha , Adulto , Ansiedade , Transtornos de Ansiedade , Criança , Emoções , HumanosRESUMO
This paper investigated a 60-item version of the Multidimensional Inventory of Dissociation (MID) with the potential to capture the full range of dissociative symptoms that characterize each of the dissociative disorders (DD). The 28-item Dissociative Experiences Scale (DES) was designed to capture a wide range of dissociative phenomena, but college population studies indicate it may not be adept at identifying the full range of dissociative symptoms and disorders. The 218-item MID has the advantage of capturing the full range of dissociative symptoms and has diagnostic capabilities for all DSM-5 DD, but the disadvantage of taking considerably longer than the DES to complete. Using university students and staff (N = 313), this paper investigated a 60-item version of the MID with the potential to capture the full range of dissociative symptoms that characterize each of the DD. Results indicate the MID-60 has a nearly identical factor structure to the full MID, excellent internal reliability, and content and convergent validity. Using the MID-60, at least 8% of participants at an Australian university were positive for a DD and, on average, participants self-reported having dissociative experiences 13% of the time. The present study's findings suggest the MID-60 is a promising alternative to the DES, with results about the prevalence of DDs and dissociative experiences consistent with those found using clinical interviews and the DES.
Assuntos
Transtornos Dissociativos , Universidades , Austrália , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Dissociativos/diagnóstico , Humanos , Psicometria , Reprodutibilidade dos TestesRESUMO
People respond differently to potentially traumatic events. To explore predictors of a chronic and delayed trajectory of posttraumatic stress symptoms (PTSS) after a natural disaster, we analyzed psychometric data collected from 412 residents of Christchurch, New Zealand after a 6.3 magnitude earthquake struck in February 2011. Participants from suburbs with different levels of socioeconomic status (SES) and earthquake impact completed a door-to-door survey 4-7 months after the earthquake (Time 1; N = 600) and again 10-11 months after the earthquake (Time 2; N = 412). The survey included the Acute Stress Disorder Scale, the Patient Health Questionnaire's nine-item Depression subscale, and the Generalized Anxiety Disorder-7 scale, along with single-item measures of variables including aftershock anxiety and family tension. Hobfoll's conservation of resources theory was used to guide data interpretation. High levels of depression, odds ratio (OR) = 1.24, and anxiety, OR = 1.24, at Time 1 significantly predicted membership in the chronic trajectory. Predictors of a delayed onset of symptoms included increased aftershock anxiety, OR = 1.29, and family tension, OR = 1.35, over time, as well as living in an area defined as being of low, OR = 5.36, or medium, OR = 11.39, SES. Results highlight risk factors for elevated PTSS and resources that individuals can use to offset threatened loss. These findings have implications for service providers, agencies, and the public.
Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Predictores de las trayectorias de los síntomas de estrés postraumático después de un terremoto fatal TRAYECTORIAS SEPT DESPUÉS DE UN TERREMOTO MORTAL Las personas responden de manera diferente a eventos potencialmente traumáticos. Para explorar los predictores de la trayectoria de los síntomas de estrés postraumático (SEPT) crónicos y retardados después de un desastre natural, analizamos los datos psicométricos recopilados de 412 residentes de Christchurch, Nueva Zelanda, después de un terremoto de magnitud 6.3 ocurrido en febrero de 2011. Participantes de suburbios con diferentes niveles de estatus socioeconómico (NSE) y el impacto del terremoto completaron una encuesta puerta a puerta 4-7 meses después del terremoto (Tiempo 1, N = 600) y nuevamente 10-11 meses después del terremoto (Tiempo 2, N = 412). La encuesta incluyó la Escala de Trastorno de Estrés Agudo, la escala de depresión de nueve ítems del Cuestionario de Salud del Paciente y la escala de Desorden de Ansiedad Generalizada-7, junto con medidas de un solo ítem de variables que incluyen ansiedad por réplica y la tensión familiar. La teoría de la conservación de los recursos de Hobfoll se utilizó para guiar la interpretación de los datos. Altos niveles de depresión, odds ratio OR = 1.24 y ansiedad, OR = 1.24, en el Tiempo 1 predijeron significativamente la pertenencia a la trayectoria crónica. Los predictores de un inicio retardado de los síntomas incluyó aumento de la ansiedad por replica, OR = 1.29, y tensión familiar, OR = 1.35, a lo largo del tiempo, además de vivir en un área definida como baja, OR = 5.36 o NSE medio, OR = 11.39. Los resultados destacan los factores de riesgo para SEPT elevados y recursos que los individuos pueden utilizar para compensar la amenaza de pérdida. Estos hallazgos tienen implicaciones para los proveedores de servicio, agencias, y el público.
Assuntos
Transtornos de Ansiedade/epidemiologia , Depressão/epidemiologia , Terremotos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Idoso , Transtornos de Ansiedade/diagnóstico , Depressão/diagnóstico , Progressão da Doença , Relações Familiares/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Escalas de Graduação Psiquiátrica , Fatores de Risco , Índice de Gravidade de Doença , Isolamento Social/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologiaRESUMO
While evidence suggests a division between two qualitatively distinct forms of dissociation, no scale has been specifically designed to differentiate between them. This study describes the development and validation of the Detachment and Compartmentalization Inventory (DCI). The DCI was developed from dissociation theory, 29 existing dissociation scales and expert opinion. An initial pilot study was conducted which assessed readability, explored validity and reduced items before the DCI was administered online to 89 nonclinical and 105 clinical participants. The Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), and Mindfulness Attention Awareness Scale (MAAS) were included in the survey battery. The DCI exhibited good internal reliability, discriminant validity, convergent validity, construct validity and concurrent validity. The final version containing 22-items, is self-administered, grounded in the theoretical literature and supported by initial psychometric evaluation. It has 10 items assessing compartmentalization, 10 items assessing detachment and two items examining valid responding. The DCI could detect compartmentalization and detachment, and was designed for clinical research and for screening patients.
Assuntos
Transtornos Dissociativos/diagnóstico , Escalas de Graduação Psiquiátrica , Adulto , Diagnóstico Diferencial , Transtornos Dissociativos/classificação , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
Deliberate self-harm (DSH) involves a physical act with the intent of harming the self. There are many precipitants to this behavior, with dissociation receiving increasing attention. The current study examined the quartile risk model for predicting deliberate self-harm, which proposes that four quadrants of dissociation (low normative, high normative, low clinical, and high clinical) represent varying levels of risk for engagement in DSH. The model posits that quadrants one and three (low normative, low clinical), protect against engagement in deliberate self-harm. Quadrants two and four (high normative, high clinical), represent an increased risk of engaging in DSH. The current study also investigated the association between shame and deliberate self-harm. College students (n = 247) completed measures assessing trait dissociation, state and trait shame, and deliberate self-harm. Results did not support the quartile risk model, rather they suggested a general increasing level of deliberate self-harm with heightened dissociation. Furthermore, trait shame was significantly associated with deliberate self-harm. Significantly more state shame was found to occur before engaging in deliberate self-harm relative to after. Results suggest shame and dissociation are related to increased DSH.
Assuntos
Transtornos Dissociativos/psicologia , Medição de Risco/métodos , Comportamento Autodestrutivo/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Valor Preditivo dos Testes , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
This study examined shame and responses to it in adult dissociative disorder (DD; n = 24) and comparison psychiatric (n = 14) samples. To investigate how helpful different therapeutic responses are after shame disclosures in therapy, participants heard two vignettes from "mock" patients disclosing a) shame and b) surprise. Participants rated the helpfulness of five potential responses. Interventions covered withdrawing from the affect (withdrawal focused) to feeling it (feeling focused), with other interventions on cognitions (cognitive focused), management strategies (management focused), and previous experiences (history focused). The DD sample reported higher characterological and bodily shame, and more shame avoidance and withdrawal. There was no difference across groups for intervention ratings. For shame, interventions focused on feelings, cognitions, or previous shame experiences were deemed most helpful, but this was qualified by experiencing dissociation while hearing the script, where the history intervention was reported less helpful. Exposure to shame while monitoring dissociation should accompany therapy for DDs.
Assuntos
Transtornos Dissociativos/psicologia , Vergonha , Adolescente , Adulto , Transtornos Dissociativos/terapia , Feminino , Humanos , Masculino , Transtornos Mentais/parasitologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Testes Psicológicos , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVES: Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group. METHOD: Participants were drawn from the DID (n = 20), conflict-related chronic PTSD (n = 65), and nonclinical (n = 125) populations and completed questionnaires assessing the variables of interest. A model examining the direct impact of shame and dissociation on relationship functioning, and their indirect effect via complex PTSD symptoms, was tested through path analysis. RESULTS: The DID sample reported significantly higher dissociation, shame, complex PTSD symptom severity, relationship anxiety, relationship depression, and fear of relationships than the other two samples. Support was found for the proposed model, with shame directly affecting relationship anxiety and fear of relationships, and pathological dissociation directly affecting relationship anxiety and relationship depression. The indirect effect of shame and dissociation via complex PTSD symptom severity was evident on all relationship variables. CONCLUSION: Shame and pathological dissociation are important for not only the effect they have on the development of other complex PTSD symptoms, but also their direct and indirect effects on distress associated with relationships.
Assuntos
Ansiedade/psicologia , Depressão/psicologia , Transtornos Dissociativos/psicologia , Medo/psicologia , Relações Interpessoais , Parceiros Sexuais/psicologia , Vergonha , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
This paper examines one particular way a person abused may come to internally position themselves and the abuser to understand their abuse experience. It is based on a differentiation and exploration of the dynamic relationship between shame and humiliation associated with complex feelings the abused has to the abuser. Humiliation is described as denoting the naked self exposed by another, while shame is described as denoting the naked self exposed to another. From this lens, abusive events are conceived as humiliating experiences that come to be represented as shame experiences. Shame is argued to cover over humiliation in order to separate the abused from their internal representation of the abuser (i.e., conceal the self-other object-relationship). This process is facilitated by dissociation and serves several functions, including cloaking hostile feelings (e.g., humiliation fury) toward the abusive (though loved) object. Shame, with the assistance of dissociation, becomes a compromise formation. It punishes the self for the initial humiliation rage directed at the object, protects the object from further attack and blame for the abuse, and obscures awareness of the rage felt toward the object as well as the reparatory guilt possible from it. Dissociation maintains this position by isolating the interpersonal field, the self and object, from the narrative of abuse events. The potential for freedom comes from eroding dissociation, leaving the shame bubble, entertaining the abusive (though loved) object as etiologically significant, and facing the humiliation and humiliation rage that provides the path to reparatory guilt.
Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Vítimas de Crime/psicologia , Transtornos Dissociativos/psicologia , Relações Interpessoais , Motivação , Apego ao Objeto , Fúria , Vergonha , Feminino , Humanos , Masculino , Teoria PsicológicaRESUMO
Controversy exists regarding the merits of exposure-based treatments for posttraumatic stress disorder (PTSD) versus a phased approach when prominent dissociative symptoms are present. The first aim of this study was to examine the degree to which diagnosing dissociation in two traumatized patients' vignettes influenced clinicians' preference for phase-oriented treatment and whether clinicians' treatment experience contributed to their treatment preference. The second aim was to assess the extent to which participants had observed traumatized patients worsen when treated with exposure therapy or phase-oriented therapy and whether the theoretical orientation and treatment experience of the clinician were related to the observed deterioration. In the tradition of expert and practitioner surveys, 263 clinicians completed a survey of their diagnoses and treatment preferences for two vignettes and their treatment experience, theoretical orientation, and observations of patients' deterioration. When a marked degree of dissociation was noted in the PTSD vignette, respondents favored phased approaches regardless of the diagnosis given. Reports of having observed patient deterioration during both exposure and phased therapy were predicted by years of experience. Psychodynamic therapists reported more observations of worsening during exposure therapy than cognitive behavior therapy therapists. Clinical experience treating PTSD may heighten awareness of negative therapeutic effects, potentially because experienced clinicians have a lower threshold for detecting such effects and because they are referred more challenging cases.
Assuntos
Transtornos Dissociativos/diagnóstico , Transtornos Dissociativos/terapia , Padrões de Prática Médica/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
This study investigates the causal role of dissociation in intrusive memory development and possible underlying aberrant memory processes (e.g., increased perceptual priming). Using an audio-only adaption of the trauma film paradigm, we divided 60 participants into 3 conditions and presented them with different visual tasks-mirror staring, dot staring, or neutral images. The former 2 conditions were hypothesized to induce dissociation. Postaudio, a number of factors were assessed, including state dissociation, perceptual priming and conceptual priming, as well as intrusions over 3 days. Participants in the dissociation conditions displayed an increase in perceptual priming compared to those in the control condition and reported more distressing intrusions. No differences were found in conceptual priming and the overall number of intrusions between conditions. Findings contribute to the growing knowledge on the impact of dissociation and cognitive processing in the etiology of posttraumatic stress disorder intrusions.
Assuntos
Percepção Auditiva , Transtornos Dissociativos/psicologia , Priming de Repetição/fisiologia , Percepção Visual , Estimulação Acústica , Adulto , Causalidade , Sinais (Psicologia) , Feminino , Humanos , Masculino , Estimulação Luminosa , Escalas de Graduação Psiquiátrica , Estudantes , UniversidadesRESUMO
Only a select number of studies have examined different forms of child maltreatment in complex dissociative disorders (DDs) in comparison to other groups. Few of these have used child abuse-related chronic posttraumatic stress disorder (C-PTSD) and mixed psychiatric (MP) patients with maltreatment as comparison groups. This study examined child sexual, physical, and emotional abuse as well as physical and emotional neglect in DD (n = 39), C-PTSD (n = 13), and MP (n = 21) samples, all with abuse and neglect histories. The predictive capacity of these different forms of maltreatment across the 3 groups was assessed for pathological dissociation, shame, guilt, relationship esteem, relationship anxiety, relationship depression, and fear of relationships. All forms of maltreatment differentiated the DD from the MP group, and sexual abuse differentiated the DD sample from the C-PTSD group. Childhood sexual abuse was the only predictor of pathological dissociation. Emotional abuse predicted shame, guilt, relationship anxiety, and fear of relationships. Emotional neglect predicted relationship anxiety and relationship depression. Physical neglect was associated with less relationship anxiety. Different forms of abuse and neglect are associated with different symptom clusters in psychiatric patients with maltreatment histories.
Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Transtornos Dissociativos/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Idoso , Doença Crônica , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
Cognitive themes in two communities differentially affected by the September 2010 Christchurch earthquake and aftershocks were investigated. Participants (N = 124) completed questions about their thoughts during the earthquake and aftershocks as well as measures of acute stress, anxiety, and depression. Cognitions were qualitatively analyzed into themes for the earthquake and aftershocks. Themes were examined for differences across the two suburbs and associations with psychological distress. Nine cognitive themes were identified within three superordinate domains. The cognitive theme of worry and concern was the most frequently occurring for the earthquake and aftershocks across the whole sample and for the more affected suburb. Current threat was the most frequent theme for the earthquake in the less affected suburb, whereas worry and concern was the most evident in this group for aftershocks. The superordinate theme of threat was significantly related to higher acute stress disorder scores in the more affected suburb for earthquake-reported cognitions.
Assuntos
Terremotos , Estresse Psicológico/psicologia , Sobreviventes/psicologia , Adulto , Ansiedade/psicologia , Depressão/psicologia , Desastres , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Pesquisa Qualitativa , Método Simples-CegoRESUMO
Understanding posttraumatic stress disorder (PTSD) symptoms in police first-responders is an underdeveloped field. Using a cross-sectional survey, this study investigated demographic and occupational characteristics, coping resources and processes, along with first-responder roles and consequences 18 months following a disaster. Hierarchical linear regression (N = 576) showed that greater symptom levels were significantly positively associated with negative emotional coping (ß = .31), a communications role (ß = .08) and distress following exposure to resource losses (ß = .14), grotesque scenes (ß = .21), personal harm (ß = .14), and concern for significant others (ß = .17). Optimism alone was negatively associated (ß = -.15), with the overall model being a modest fit (adjusted R(2) = .39). The findings highlight variables for further study in police.
Assuntos
Terremotos , Exposição Ocupacional/efeitos adversos , Polícia/psicologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Adaptação Psicológica , Adulto , Estudos Transversais , Desastres , Emoções , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Otimismo/psicologia , Fatores de Risco , Estresse Psicológico/psicologia , Inquéritos e Questionários , Fatores de Tempo , Ferimentos e Lesões/psicologiaRESUMO
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, formally recognizes a dissociative subtype of posttraumatic stress disorder (PTSD; PTSD with dissociative symptoms). This nomenclative move will boost empirical and theoretical efforts to further understand the links between dissociation, trauma, and PTSD. This article examines the empirical literature showing that patients with PTSD can be divided into 2 different groups based on their neurobiology, psychological symptom profile, history of exposure to early relational trauma, and depersonalization/derealization symptoms. It then explores the conceptual and empirical challenges of conceiving 1 of these types as reflecting a "dissociative" type of PTSD. First, this classification is based on the presence of a limited subset of dissociative symptoms (i.e., depersonalization, derealization). This sets aside an array of positive and negative psychoform and somatoform dissociative symptoms that may be related to PTSD. Second, empirical evidence suggests heightened dissociation in PTSD compared to many other disorders, indicating that dissociation is relevant to PTSD more broadly rather than simply to the so-called dissociative subtype. This article sets out important issues to be examined in the future study of dissociation in PTSD, which needs to be informed by solid conceptual understandings of dissociation.
Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Dissociativos/classificação , Transtornos de Estresse Pós-Traumáticos/classificação , Humanos , Terminologia como AssuntoRESUMO
OBJECTIVE: Despite its long and auspicious place in the history of psychiatry, dissociative identity disorder (DID) has been associated with controversy. This paper aims to examine the empirical data related to DID and outline the contextual challenges to its scientific investigation. METHODS: The overview is limited to DID-specific research in which one or more of the following conditions are met: (i) a sample of participants with DID was systematically investigated, (ii) psychometrically-sound measures were utilised, (iii) comparisons were made with other samples, (iv) DID was differentiated from other disorders, including other dissociative disorders, (v) extraneous variables were controlled or (vi) DID diagnosis was confirmed. Following an examination of challenges to research, data are organised around the validity and phenomenology of DID, its aetiology and epidemiology, the neurobiological and cognitive correlates of the disorder, and finally its treatment. RESULTS: DID was found to be a complex yet valid disorder across a range of markers. It can be accurately discriminated from other disorders, especially when structured diagnostic interviews assess identity alterations and amnesia. DID is aetiologically associated with a complex combination of developmental and cultural factors, including severe childhood relational trauma. The prevalence of DID appears highest in emergency psychiatric settings and affects approximately 1% of the general population. Psychobiological studies are beginning to identify clear correlates of DID associated with diverse brain areas and cognitive functions. They are also providing an understanding of the potential metacognitive origins of amnesia. Phase-oriented empirically-guided treatments are emerging for DID. CONCLUSIONS: The empirical literature on DID is accumulating, although some areas remain under-investigated. Existing data show DID as a complex, valid and not uncommon disorder, associated with developmental and cultural variables, that is amenable to psychotherapeutic intervention.
Assuntos
Encéfalo/fisiopatologia , Transtorno Dissociativo de Identidade , Transtornos Cognitivos/complicações , Transtorno Dissociativo de Identidade/complicações , Transtorno Dissociativo de Identidade/diagnóstico , Transtorno Dissociativo de Identidade/epidemiologia , Transtorno Dissociativo de Identidade/fisiopatologia , Transtorno Dissociativo de Identidade/terapia , Humanos , Neuroimagem , Escalas de Graduação Psiquiátrica , Psicoterapia , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: Despite sexual victimization posing a serious social problem worldwide, inconsistencies in the conceptualization, definition, and measurement of sexual violence mean that many victims are not included in surveys designed to quantify the nature of this problem. The present studies developed, piloted, and finalized a novel survey of victimization, the sexual encounters questionnaire (SEQ), a robust and extensive tool that screens for a range of sexual violation scenarios that can be perpetrated against a victim of any gender and age. METHOD: Study 1 piloted the original version of the SEQ among 458 students while Study 2 examined the psychometric properties of the SEQ in a sample of 150 students. RESULTS: Study 1 found an overall victimization rate of 76.9%, with 59.8% of men and 80.5% of women being identified as victims. The prevalence and severity of victimization were higher among women than men. Twelve-month prevalence rates ranged from 2.2% to 23.4% depending on the type of violation surveyed with an overall 12-month prevalence of 34.9%. Study 2 found convergent validity with other measures of sexual victimization, and discriminant validity with participants' political orientation and a fear of intimacy measure. CONCLUSION: The SEQ, with more sensitivity to detect sexual victimization, showed high levels of victimization in students. These results suggest the usefulness of the SEQ as a gender-inclusive screening tool for sexual victimization across the lifespan. (PsycInfo Database Record (c) 2024 APA, all rights reserved).