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Introduction: The core symptoms of narcolepsy such as excessive daytime sleepiness and cataplexy are well known. However, there is mounting evidence for a much broader symptom spectrum, including psychiatric symptoms. Disordered sleep has previously been linked with dissociative symptoms, which may imply that patients with narcolepsy are more prone to develop such symptoms. Objectives: To investigate the frequency of dissociative symptoms in adult patients with narcolepsy type 1 compared to population controls. Methods: In a retrospective case control study, sixty adult patients fulfilling the criteria for narcolepsy type 1 and 120 matched population control subjects received a structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to assess dissociative symptoms and disorders. Results: A majority of narcolepsy patients reported dissociative symptoms, and even fulfilled the DSM-IV-TR criteria of a dissociative disorder (62% vs 1% in controls, p < .001). Most frequently reported symptoms were "dissociative amnesia" (37% vs 1%, p < .001) and "dissociative disorder of voluntary movement" (32% vs 1%, p < .001). Conclusion: Dissociative symptoms are strikingly prevalent in adult patients with narcolepsy type 1. Although a formal diagnosis of dissociation disorder should not be made as the symptoms can be explained by narcolepsy as an underlying condition, the findings do illustrate the extent and severity of the dissociative symptoms. As for the pathophysiological mechanism, there may be symptom overlap between narcolepsy and dissociation disorder. However, there may also be a more direct link between disrupted sleep and dissociative symptoms. In either case, the high frequency of occurrence of dissociative symptoms should result in an active inquiry by doctors, to improve therapeutic management and guidance.

National audience; The history of ketamine begins in 1962, when Calvin Stevens of the pharmaceutical laboratory Parke-Davis synthesizes it from phencyclidine, a molecule with psychodysleptic, hallucinogenic and dissociative properties. Following the first administration of ketamine to humans in 1964 in Jackson prison (Michigan, USA), its dissociative effects associated with short anaesthesia were reported, and a patent for its human use was filed in 1966. In the 1990s, the discovery of opioid-induced hyperalgesia sparked interest in ketamine as an analgesic. In recent years, the human use of ketamine, and in particular its esketamine enantiomer, has shifted towards the treatment of depression. The first cases of ketamine abuse were reported in 1992 in France, leading to special surveillance by the health authorities, and its inclusion in the list of narcotic drugs in 1997. Today, ketamine has become an attractive substance for recreational use, gradually emerging from alternative techno circles to spread to more commercial party scenes. These elements represent a public health concern, associated with the risk of developing new chemically synthesized analogues, the harmful effects of which are still little known.

Aims : To study the socio-demographic variables of the patients who were admitted in the department of psychiatry with an initial diagnosis of dissociative disorder. Methods : Patients who were initially admitted with a diagnosis of dissociative symptoms were taken into the study sample and the various sociodemographic variables such as age, sex, religion, educational status, marital status were studied. ICD-10 diagnostic criteria for dissociative disorders was used to diagnose dissociative disorders. The patients who were not initially diagnosed with dissociative disorders were excluded from the study. Results : The results show that most of the patients (n=38) were young female (84.21%) patients belonging to 10-20 year age group (39.47%),currently married (44.26%),educated (84.21%) and Hindu by religion (84.21%).In the majority of the patients the initial diagnosis at the time of admission was not changed at the time of discharge (84.21%). Conclusion : The findings of the study concur with the findings of other studies that dissociative disorders is more common in females of the 10-30 year age group and that the initial diagnosis remained unchanged in the majority of the patients. Most of the patients were educated though the level of education was not very high . The prognosis was good in the majority of the patients.

Background: In the Indian setting, several studies have documented that dissociative disorders (DDs) are more common in females, and the most commonly elicited stressors are interpersonal. However, much of the research up to now has been quantitative. There is a notable paucity of qualitative studies exploring the subjective experiences of women with DD. Therefore, the present study sought to explore and gain an in-depth understanding of the lived experiences of women diagnosed with DD. Methods: Five women were recruited who were seeking psychological treatment for dissociative symptoms at a tertiary care neuropsychiatric institute in North India. In-depth interviews were conducted with each, and the transcripts were analyzed using the analytic method of interpretative phenomenological analysis. Results: Three superordinate themes that emerged were: patients’ illness perspectives, the salience of relationships, and dealing with relationship conflicts. Conclusions: Our findings highlight the role of culture in influencing the participants’ illness perspectives. Women with DD tend to define their self in relational terms and, thus, inhibit the expression of one’s needs and opinions, to avoid conflict and to maintain harmony in relationships.

Some adolescents admitted to the child and adolescent psychiatry outpatient clinic experience dissociative symptoms, such as hearing strange sounds, temporary blackouts, seeing images, changes in body parts, and looking at themselves from outside themselves. Some may also have sleep disturbances and a history of spending a long time on the internet. This study investigated the relationship between dissociative symptoms and sleep disorders, problematic internet usage (PIU),aggression and digital game addiction in adolescents. Participants completed the State-Trait Anger Expression Inventory (STAXI), Problematic Internet Usage Scale (PIUS), Digital Game Addiction Scale (DGAS-7), Children's Depression Inventory (CDI), Adolescent Dissociative Experiences Scale (A-DES), Pittsburgh Sleep Quality Index (PSQI), Screen for Child Anxiety Related Emotional Disorders Child Version (SCARED), and a sociodemographic form. Regression analyses were performed to identify associations. The sample consisted of 244 adolescents between 14 and 18 years of age (M = 15.93, SD = 0.90), of which 171 (70.1%) were girls and 73 (29.9%) were boys. Fifty-two (21.3%) were classified as having problematic online gaming (POG+), whereas 192 (78.7%) were classified as not having problematic online gaming (POG-). There was a difference between the two groups in all sub-dimensions of the PIUS, STAXI, CDI, and A-DES. Adolescents who had higher scores on the A-DES had a higher risk of sleep disorders and had higher scores on the PIU, CDI, and SCARED. The POG+ group dissociation scores were considerably higher than POG- group scores. Adolescents with high A-DES scores also had higher anger scores and weaker anger control skills. Consequently, sleep disorders, PIU, and POG may increase dissociative symptoms.

Background:Ketamine is a phencyclidine derivative with dissociative anaesthetic properties. Increasing numbers of individuals in England take ketamine recreationally. Information on deaths arising from such use in England is presented.Methods:Cases were extracted on 31 January 2020 from the National Programme on Substance Abuse Deaths database, based on text searches of the cause of death, coroner’s verdict and positive toxicology results for the terms ‘ketamine’ or ‘norketamine’.Findings:During 1997–2005, there were Conclusions:Although controlled, recreational ketamine use and related fatalities continue to increase. Consumers need to be more aware of the potentially fatal risks they face.

Objective:Ketamine is a dissociative anesthetic used in medical practice, used recreationally since the mid-1960s. This study describes trends in ketamine use in sentinel cross-sectional samples of...

We treated a man with a chief complaint of memory impairment after the Great East Japan Earthquake. Initially, he was diagnosed with dementia. However, after several tests, neither could a definitive diagnosis of dementia be reached, nor was there any apparent evidence for depression, epilepsy, delirium, or internal medicine diseases. During the earthquake, the patient experienced the severe trauma of watching his wife being swept away by a tsunami. Furthermore, he experienced separation from his family. Because of this traumatic experience, we suspected that dissociative disorder was involved in the development of the memory impairment and thus, we switched to treatments focusing on emotional support. Subsequently, the patient’s memory impairment gradually improved. The present case demonstrates the importance of considering dissociative disorders when examining a patient with memory impairment in areas affected by disasters.

Objective: To increase awareness of practising clinicians and researchers to the phenomenological distinctions between visual hallucinations and trauma-based, dissociative, visual re-experiencing phenomena seen in psychiatric disease. Conclusions: The experience of visual hallucinations is not exclusive to psychotic disorders in psychiatry. Different forms of experiences that resemble visual hallucinations may occur in patients with a trauma background and may potentially affect diagnosis. Given the paucity of literature around the subject, it is imperative that further research aims to characterise the distinction between visual hallucinations in psychosis and visual phenomena associated with trauma.

A number of new psychoactive substances (NPS) have been released in the last decade, and the list of NPS continues to grow. This paper reports a retrospective evaluation of the toxicological analyses in 1,445 suspected intoxication cases by psychostimulant, hallucinogen, and dissociative NPS occurring in hospitals across Italy from 2011 to 2019. The objectives of the study were to contribute to the monitoring of the NPS diffusion based on analytically confirmed intoxications, and to evaluate the importance of the clinical toxicological laboratory in the diagnosis of NPS intoxication. For at least one NPS of the considered classes, 246 patients (17.0%) tested positive. Forty-four different NPS were detected and a consistent turnover was observed during the nine-year period, especially regarding cathinones. Among the positive cases, 47.2% tested positive for dissociative NPS, with particular regard to ketamine. Hallucinogens (30.9%) was the second most frequent NPS involved. Stimulants were found in 20% of the positive cases with a considerable presence of cathinones. Findings confirm the dynamism of the NPS phenomenon, underline the importance of awareness of this new public health threat among health care professionals, and highlight the need for analytical confirmation for the identification of the drugs in forensic contexts.

Structural Family Therapy is one of the most widely used family therapy model which focuses on bringing change in structural and functional aspect of the family. This article focuses on the use of structural family therapy with a client diagnosed with Dissociative Disorder. An in-dept analysis of the case was done by using case study design. The Case Study is presented with client's background, individual assessment, family assessment, the treatment plan with techniques and outcome of interventions. Individual assessment showed that client had low self-esteem, poor problem-solving skills, insecure attachment and inter-personal conflict with the father. Family assessment revealed that client was never allowed to explore and develop according to his individual and unique characteristics. As he grew older the mother became more enmeshed and father became too rigid in terms of his expectation from the client. In order to reduce tensions between parents and cope up with stressful situation client started dissociating. Individual therapy focused on enhancing client's current level of functioning, improving his coping skills and learning to be more assertive in a relationship. Therapy with family emphasized on restructuring unhealthy boundaries by regulating power dynamics within relationship and correcting dysfunctional hierarchies. The outcome of interventions was improvement in family's functioning, interaction pattern and changes in power dynamics within relationship.

Emergency clinicians often treat severe agitation resulting from intoxicants, psychiatric illness, and other CNS or systemic diseases. Recreational drugs-especially stimulants-are frequently used by attendees of electronic dance music festivals (EDMFs), and festivalgoers may become dangerously agitated and pose an immediate threat to themselves and others. Although benzodiazepines and antipsychotics are classically used to treat severe agitation, these medications are burdened by safety concerns including respiratory depression and cardiac arrhythmias. The effects of ketamine when used to treat severe agitation in an exclusive cohort of patients with psychostimulant drug-induced toxicity (PDIT) has not previously been reported, and existing literature describes a widely variant safety profile when ketamine is used for sedation of the agitated patient.To describe ketamine's adverse event profile when used to treat patients with severe agitation resulting from PDIT.This is a retrospective, observational study enrolling consecutive patients who presented for medical attention at a large outdoor EDMF over a period of eight days on two consecutive weekends in the summer of 2017. The EDMF had an estimated attendance of 40,000 per weekend. A medical tent was set up on-site; patients were managed by a team of EMS providers, nurses and emergency physicians. Medications used, adverse events and the need for repeat dosing were abstracted from prehospital care reports.Over the course of eight days, 1081 of 1186 patients who were evaluated in the medical tent had a recorded chief complaint. 274 of these patients (25.3%) had a chief complaint of altered mental status. In patients presenting with AMS, 68 patients (24.8%) had severe agitation that was treated with dissociative-dose (≥4 mg/kg) intramuscular ketamine. The mean initial dose of ketamine was 308 mg. There were four serious adverse events (5.9%): Two patients (2.9%) had copious hypersalivation treated with atropine, one patient (1.5%) had transient apnea requiring assisted ventilation, and one patient (1.5%) was intubated and transported to the hospital. 42 patients (61.8%) required redosing of calming medications. All patients who received ketamine except the single patient who was intubated and transported were observed in the medical tent until resolution of symptoms and discharged back to the festival.In this cohort of festival attendees who developed stimulant-induced severe agitation and were treated with dissociative-dose ketamine, serious adverse events occurred in 5.9% of patients including one patient who was intubated.

Introduction: Dissociative symptoms are present in a various number of psychiatric disorders and are viewed as a major risk factor for suicidal and self-destructive behavior. Dissociation is defined in DSM-5 as a “disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior”. Assessing dissociation within different categories of mental disorders can be used to predict symptom severity and nonresponse to psychotherapeutic treatments. The most important tool in this process is the Dissociative Experiences Scale (DES). The purpose of the current study is to extend the understanding of dissociation in Psychiatric Disorders. Material and methods: The current study used PubMed and Cochrane databases to identify relevant articles that refer to the subject of dissociation in Psychiatric Disorders. Results and Discussions: Dissociation and dissociative disorders have been at the root of continuous controversy in psychiatric and psychology communities. The general confusion comes from the reduced conceptual distinction between dissociation as a symptom, process, deficit and psychological defense. At the high end of the DES score we find dissociative disorders, but closely followed by posttraumatic stress disorder, borderline personality disorder and conversion disorder with eating disorders, schizophrenia and anxiety disorders at midrange and the lowest scoring DES psychiatric disorder is found in bipolar disorders. Early intervention, based on these scores, show major improvement in maladaptive functionality, suicidal and self-destructive behavior, coupled with a reduction in total treatment cost. Conclusions: There is a significant benefit in careful assessment of dissociative symptoms for the entire spectrum of mental disorders. There is a major need to raise awareness in all mental health facilities, of the value that this has in the current clinical setting.

Backgroud: Network models suggest that co-occurring symptoms are conceptualized as a syndrome due to interactions, rather than a categorical entity with an underlying common cause.Aim: Our study aimed to examine the network structure and centrality of Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV posttraumatic stress disorder (PTSD) symptoms, including essential and associated features.Methods: We constructed a network structure of 21 intertwined symptoms, evaluated with the Clinician-Administered PTSD Scale (CAPS), in 249 PTSD patients who have been exposed to various types of traumatic events (73% being traffic or other accidents) and were beginning psychiatric treatment. In addition, we estimated the centrality of the 21 symptoms through network analysis. Each of the symptoms was defined as ordered-categorical variables.Results: The network, with 21 symptoms, demonstrated a strong correlation among difficulty concentrating, reduced awareness of surroundings, and derealization. In addition, reduced awareness of surroundings was estimated as the most central symptom, whereas inability to recall important aspects of trauma was estimated as the least central symptom in the subjects. A community-detection analysis estimated that the 21 PTSD symptoms were organized into three clinically meaning clusters.Conclusion: Although dissociative features have been defined as associative symptoms rather than essential symptoms for the DSM diagnostic criteria, reduced awareness of surroundings may be regarded as the most central symptom in patients in the early phase of PTSD. Thus, evaluation and intervention for dissociative features may be needed in clinical practice and studies on PTSD.

Background Inborn errors of metabolism are often characterized by various psychiatric syndromes. Previous studies tend to classify psychiatric manifestations into clinical entities. Among inborn errors of metabolism, propionic acidemia (PA) is a rare inherited organic aciduria that leads to neurologic disabilities. Several studies in children with PA demonstrated that psychiatric disorders are associated to neurological symptoms. To our knowledge, no psychopathological description in adult with propionic acidemia is available. Case presentation We aimed to compare the case of a 53-year-old woman with PA, to the previous psychiatric descriptions in children with PA and in adults with other inborn errors of metabolism. Our patient presented a large variety of signs: functional neurologic disorders, borderline personality traits (emotional dyregulation, dissociative and alexithymic trends, obsessive-compulsive disorders), occurring in a context of neurodevelopmental disorder. Conclusion Clinical and paraclinical examinations are in favor of a mild mental retardation since childhood and disorders of behavior and personality without any definite psychiatric syndrome, as already described in other metabolic diseases (group 3). Nonetheless, further studies are needed to clarify the psychiatric alterations within adult patients with PA.

Background:There is a gap in understanding the pathogenesis of dissociative conversion disorder (DCD), despite the disorder having a strong historical root. The role of personality and neurocognitive factors are now highlighted; however, inconsistencies are reported. This study explores the personality disposition, arousability, and decision-making ability of patients with DCD, in reference to a healthy control group (HCG).Methods:In this cross-sectional study, the sample comprised ten adult psychiatric patients with DCD. Ten participants of the HCG were matched according to age, gender, education, economic status, domicile, religious background, and handedness. The study assessed personality disposition with Temperament and Character Inventory, arousability with reaction time task, and decision-making ability with the Iowa Gambling Task (IGT PEBL version).Results:The DCD group differed significantly on personality disposition related to both temperament and character. There was also evidence of easy arousability and frustration along with deficit in executive function related to decision-making ability.Conclusion:This study highlights the presence of both temperamental and characterological factors associated with DCD. Moreover, this study identifies the role of cognitive arousability and decision-making or feedback utilization ability in the psychopathology of DCD.

Background: Dissociative symptoms are under recognized and scarcely studied by clinicians and researchers in patients with bipolar disorder (BD). We examined the relationship between dissociative symptoms and the psychotic features in patients with BD and assessed clinical and socio-demographic characteristics more frequently associated with dissociative symptoms and treatment response.Methods: Participants were 100 adult outpatients with BD. They were screened with semi-structured interview to collect socio-demographic and clinical characteristics; the Dissociative Experiences Scale-II (DES-II) and the ALDA scale were used to assess dissociative psychopathologies and response to treatment with mood stabilizers, respectively.Results: DES score (mean 31.7 ± 21.7) correlated with clinical variables, BD features, and course of illness. Psychotic symptoms, mixed features, and previous suicide attempts significantly predicted DES score [F(3, 47) = 39.880, p < 0.001, R2 corrected = 0.713]. Dissociative symptoms were inversely correlated with poor response to treatment (r = −0.593; p < 0.001).Limitations: Cross-sectional design with a small sample and backward clinical assessment of psychotic symptoms.Conclusions: Dissociative phenomena are closely related to the presence of psychotic symptoms, mixed features, and previous suicide attempts in BD, especially in BD-I. Given the close association between dissociative and psychotic symptoms, this association could represent a diagnostic indicator of BD-I that may guide the clinician to plan the most appropriate treatment.

Amongst the most important conditions in the differential diagnosis of epilepsy is the one that manifests as paroxysms of altered behaviour, awareness, sensation or sense of bodily control in ways that often resemble epileptic seizures, but without the abnormal excessive or synchronous electrical activity in the brain that defines these. Despite this importance, there remains little agreement – and frequent debate – on what to call this condition, known inter alia as psychogenic non-epileptic seizures (PNES), dissociative seizures (DS), functional seizures (FS), non-epileptic attack disorder (NEAD), pseudoseizures, conversion disorder with seizures, and by many other labels besides. This choice of terminology is not merely academic – it affects patients’ response to and understanding of their diagnosis, and their ability to navigate health care systems.This paper summarises two recent discussions hosted by the American Epilepsy Society and Functional Neurological Disorders Society on the naming of this condition. These discussions are conceptualised as the initial step of an exploration of whether it might be possible to build consensus for a new diagnostic label.

Psychogenic vision disorders in children and adolescents are a common disorder primarily encountered by ophthalmologists at the onset because, as with other disorders of dissociation, the presentation suggests a neurologic or other somatic condition. Loss of visual acuity, blurred vision and visual field restriction-often described as tunnel vision-appears to be typical. The onset may be sudden, frequently related to a wide range of stressful life events (school failure, family conflicts, accidents). While the majority of these children quickly recover from their symptoms, a substantial percentage experience persistent symptoms or a fluctuating course. Due to the lack of efficacy studies of specific treatment protocols, diagnostic work-up and treatment suffer from a high degree of uncertainty. Differentiating dissociative visual loss from physical illness requires special expertise. The uncertainty of ophthalmologists and the other specialists involved in dealing with this clinical condition often delays the specialised treatment and may also trigger inadequate therapy with the iatrogenic risk of harming the patient. This article primarily describes the disorder-specific psychiatric diagnostic as well as the somatic differential diagnostic work-up and outlines the therapeutic principles of dissociative visual loss.Psychogene Störungen der Sehfähigkeit bei Kindern und Jugendlichen sind eine nicht selten anzutreffende Störung, mit der am Beginn der Störung vorrangig Augenärzte konfrontiert sind, da das Erscheinungsbild, wie bei anderen Störungen aus dem dissoziativen Krankheitsspektrum, ein neurologisches oder anderweitiges somatisches Krankheitsbild nahelegt. Charakteristisch erscheint der Verlust der Sehschärfe, Verschwommensehen oder eine Gesichtsfeldeinschränkung – oft beschrieben als ein Tunnelsehen. Kennzeichnend sind ein häufig plötzlicher Beginn, nicht selten im zeitlichen Zusammenhang von belastenden Lebensereignissen eines weiten Spektrums (Schulversagen, familiäre Konflikte, Unfälle). Während bei einem Großteil der betroffenen Kinder die Symptomatik zügig rückläufig ist, zeigt ein substanzieller Anteil der Kinder eine anhaltende Symptomatik oder einen fluktuierenden Verlauf. Die diagnostischen Prozesse und das Behandlungsvorgehen sind durch das Fehlen von Wirksamkeitsüberprüfungen spezifischer Therapieverfahren von großer Unsicherheit geprägt. Differenzialdiagnostische Abgrenzungen einer dissoziativen Sehstörung von organmedizinischen Erkrankungen setzen eine besondere fachliche Expertise voraus. Die Unsicherheit von Ärzten der Augenheilkunde, aber auch der unterschiedlichen involvierten Fachdisziplinen im Umgang mit diesem Krankheitsbild trägt nicht selten zur Verzögerung einer fachspezifischen Behandlungsaufnahme bei oder auch zur Aufnahme nicht adäquater Therapieversuche, die auch die Gefahr einer iatrogenen Schädigung in sich bergen. Dieser Artikel beschreibt vorrangig die psychiatrische störungsspezifische Diagnostik sowie die somatische Differenzialdiagnostik und skizziert die therapeutischen Prinzipien der dissoziativen Sehstörung.

Highlights • People with functional seizures often suffer from psychiatric comorbidities. • People with FS report detrimental effects on social aspects of their lives. • FS are associated with a considerable direct and indirect economic burden. • FS have increased rates of mortality compared to healthy controls., Functional seizures (FS) are frequently encountered in neurology clinics, often affect young adults, and have significant negative impacts on many aspects of a person’s life. In the current narrative review, we searched the literature regarding some of the consequences of FS (i.e., psychiatric comorbidities, social consequences, costs that are associated with the condition, cognitive impairment in patients with FS, the quality of life of the people with FS, and the increased risk of mortality that is associated with FS). Evidence shows that FS have significant negative consequences, comparable in their magnitude to those affecting patients with epilepsy. The clinical and scientific communities should take steps to address these consequences through clinical care and research that prioritizes, facilitates, and expedites evidence-based diagnosis and treatment for FS.

Ketamine is a glutamate N-methyl D-aspartate receptor antagonist and an anaesthetic agent that has been effectively used to treat depression. However, ketamine has also been increasingly used for recreational purposes. The dissociative side-effects of ketamine use, such as hallucinations, are the reason for abuse. Additionally, long-term ketamine abuse has been highly associated with liver-gallbladder and urinary symptoms. The present study reports the case of a 28-year-old young male adult with an 8-year history of daily inhalation of ketamine. We investigated the association between ketamine abuse and the mechanism of its adverse effects, particularly encephalatrophy, and attempted to find a link between these disorders. These results would help us to better understand ketamine usage, ketamine abuse effects and the addictive mechanism. To the best of our knowledge, the present case is the first report of severe brain atrophy related to ketamine abuse. Details of the patient are presented and the mechanism of the encephalatropy-associated ketamine abuse is discussed. Furthermore, organ dysfunction following chronic ketamine abuse may indicate that the side effects are the result of comprehensive action on multiple regions in the brain.

Background Post-traumatic stress disorder affects 9% of individuals across their lifetime and increases nearly fourfold to 35% in Canadian public safety personnel (PSP). On-the-job experiences of PSP frequently meet criteria for traumatic events, making these individuals highly vulnerable to exposures of trauma and the negative consequences of PTSD. Few studies have reported on the clinical characteristics of Canadian samples of PSP and even fewer have examined the dissociative subtype of PTSD, which is associated with more severe, chronic traumatic experiences, and worse outcomes. Objective This study aimed to characterize dissociative symptoms, PTSD symptom severity, and other clinical variables among Canadian PSP with presumptive PTSD. Methods We sampled current and past PSP in Canada from both inpatient and outpatient populations (N = 50) that were enrolled in a psychological intervention. Only baseline testing data (prior to any intervention) were analysed in this study, such as PTSD symptom severity, dissociative symptoms, emotion dysregulation, and functional impairment. Results In our sample, 24.4% self-reported elevated levels of dissociation, specifically symptoms of depersonalization and derealization. Depersonalization and derealization symptoms were associated with more severe PTSD symptoms, greater emotion dysregulation, and functional impairment. Conclusions Nearly a quarter of this sample of Canadian PSP reported experiencing elevated levels of PTSD-related dissociation (depersonalization and derealization). These high levels of depersonalization and derealization were consistently positively associated with greater illness severity across clinical measures. It is imperative that dissociative symptoms be better recognized in patient populations that are exposed to chronic traumatic events such as PSP, so that treatment interventions can be designed to target a more severe illness presentation., HIGHLIGHTS 24.4% of traumatized Canadian public safety personnel reported elevated levels of depersonalization and derealization, which was associated with a severe illness profile characterized by greater trauma symptoms, emotional dysregulation, and difficulty with life tasks.

Epidemiologic and etiological studies of dissociative disorders are a challenging area in psychiatry. These challenges become more complex when noting that the existing theories cannot explain the differences observed in certain cases; for example, studies in Iran have reported the prevalence of dissociative disorders (dissociative amnesia, dissociative fugue, and depersonalization disorder) as less than 0.6%, and there has been no reported case of dissociative identity disorder (DID) in this country; meanwhile, the prevalence of all dissociative disorders in the general population of the US has been reported as 18.3%, and the prevalence of DID as about 1.1%. Although several studies indicate the high prevalence of dissociative symptoms in many Iranian psychiatric illnesses, dissociative disorders as a stand-alone disorder have a very low prevalence in Iran. The present article attempts to propose a possible hypothesis for the answer to the above questions through a different cultural conceptualization and seeks to be of some help to future studies in this area. Certainly, this hypothesis requires a careful study to be validated.

Background: Epilepsy is highly comorbid with psychiatric disorders and a significant amount of the morbidity related to epilepsy is in fact a result of psychiatric comorbidities. Objective: To investigate the frequency of different psychiatric comorbidities in children with refractory epilepsy. Methods: We present preliminary observational data from a series of patients (n=82) examined in the psychiatric branch of a tertiary epilepsy center in Rio de Janeiro, Brazil. Patients were classified as presenting autism spectrum disorders, mood disorders, anxiety disorders, disruptive disorders, attention deficit hyperactivity disorder (ADHD), intellectual development disorder, psychotic episode, dissociative/conversive disorders or others. We determined the frequency of each disorder, along with demographic data, medications prescribed, electroencephalogram findings and additional medical examinations and consultations. Results: The most common comorbidities in our sample were autism spectrum disorders and ADHD. Antipsychotics and selective serotonin uptake inhibitors were the most commonly prescribed psychiatric medications. Conclusions: Knowledge about the prevalence of such comorbidities may provide more targeted interventions in Psychiatry and Psychology services linked to epilepsy centers. RESUMO Introdução: Epilepsia é altamente comórbida, com transtornos psiquiátricos, e uma parte significativa da morbidade da epilepsia se associa com os transtornos psiquiátricos comórbidos. Objetivo: Investigar a frequência de diferentes comorbidades psiquiátricas em crianças com epilepsia refratária. Métodos: Apresentamos dados observacionais preliminares de uma amostra de pacientes (n=82) avaliados no setor de Psiquiatria de um centro terciário de tratamento de epilepsia no Rio de Janeiro, Brasil. Pacientes foram classificados como apresentando transtorno do espectro autista, transtorno do humor, transtorno de ansiedade, transtornos disruptivos, transtorno do déficit de atenção de hiperatividade (TDAH), transtorno do desenvolvimento intelectual, episódio psicótico, transtornos dissociativos/conversivos e outros. Foram determinados frequência de cada transtorno, bem como dados demográficos, medicações prescritas e achados de eletroencefalograma. Resultados: As comorbidades mais comuns na nossa amostra foram transtornos do espectro autista e TDAH; antipsicóticos e inibidores seletivos da recaptura de serotonina (ISRS) foram as medicações psiquiátricas mais comumente prescritas. Conclusões: Conhecimento acerca da prevalência dessas comorbidades pode facilitar a instituição de intervenções mais precisas em serviços de Psiquiatria e Psicologia vinculados a centros de tratamento de epilepsia.

Aim: Skin-picking (excoriation) disorder is considered as a form of maladaptive coping methods used by individuals who have difficulties in applying more adaptive strategies. Skin-picking development has been suggested to be preceded by traumatic life events. Dissociative symptoms have been reported as experienced by skin-picking sufferers during picking episodes. The purpose of the study was to examine whether the link between trauma and automatic type of skin-picking is mediated by the frequency of dissociative experiences, and whether the COVID-19 pandemic conditions have changed this relationship in any way.Methods: The study sample consisted of 594 adults (76% women) aged from 18 to 60. Traumatic life events, dissociative experiences, and types of skin-picking (focused vs. automatic) were assessed with self-report questionnaires. Mediation analyses and multigroup path analyses were carried out.Results: Dissociative experiences partially mediated the link between traumatic events and both types of skin-picking. The model was robust considering the conditions in which survey was filled out (pre-pandemic vs. pandemic).Conclusions: Traumatic life events and dissociative experiences are associated with both automatic and focused skin-picking regardless of pandemic conditions. Further studies are needed to understand mechanisms underlying the relationship between dissociation and skin-picking styles.

Objective: To characterise the psychiatric symptoms of visual snow syndrome (VSS), and determine their relationship to quality of life and severity of visual symptoms.Methods: One hundred twenty-five patients with VSS completed a battery of questionnaires assessing depression/anxiety, dissociative experiences (depersonalisation), sleep quality, fatigue, and quality of life, as well as a structured clinical interview about their visual and sensory symptoms.Results: VSS patients showed high rates of anxiety and depression, depersonalisation, fatigue, and poor sleep, which significantly impacted quality of life. Further, psychiatric symptoms, particularly depersonalisation, were related to increased severity of visual symptoms. The severity/frequency of psychiatric symptoms did not differ significantly due to the presence of migraine, patient sex, or timing of VSS onset (lifelong vs. later onset).Conclusion: Psychiatric symptoms are highly prevalent in patients with VSS and are associated with increased visual symptom severity and reduced quality of life. Importantly, patients with lifelong VSS reported lower levels of distress and milder self-ratings of visual symptoms compared to patients with a later onset, while being equally likely to experience psychiatric symptoms. This suggests that the psychiatric symptoms of VSS are not solely due to distress caused by visual symptoms. While no consistently effective treatments are available for the visual symptomology of VSS, psychiatric symptoms offer an avenue of treatment that is likely to significantly improve patient quality of life and ability to cope with visual symptoms.

Patients with gender dysphoria (GD) report significant dissociative symptoms and are found to have a high prevalence of a dissociative disorder of any kind. When GD patients elect to undergo cross-sex hormone therapy, there is a significant reduction in dissociative symptoms. However, to the best of our knowledge, there are no known case reports that describe an alteration of personalities in dissociative identity disorder after initiating cross-sex hormone therapy. Thus, we present a case of a 20-year-old transgender male with GD, whom after initiating cross-sex hormone therapy with testosterone experienced an increased presence of his existing male personalities.

BACKGROUND: Shared psychotic disorder was first introduced in the 19th century in France with the name Folie à deux. Since then, the concept of Folie à deux has been developed and produces several subtypes in France. In DSM, this disorder is called Shared Psychotic Disorder, and in ICD-10, it is called Induced Delusional Disorder. However, some of the classic subtypes of Folie à deux are not included in the above categories. CASE REPORT: We found a case of shared psychotic disorder between a 38-year-old male inducer, a Batak tribe with two female recipients, 34 and 36 years from the Batak tribe. They were found to share the same delusions and hallucinations, and inducers could make recipients into trance conditions. These three individuals did not get along with the surrounding community and often carried out activities and perform rituals together. CONCLUSION: Overall, our case has some unique features of folie à deux. In this case, there is a trance condition that can be induced that have not been reported in the literature or case reports related to Folie à deux.

Background Trauma and adverse childhood experiences (ACE) occur more often in mental illness, including psychosis, than in the general population. Individuals with psychosis (cases) report a higher number and severity (dose) of adversities than healthy controls. While a dose-dependent increase of adversities has been related to more severe psychopathology, the role of type and timing is still insufficiently understood on the exacerbation of positive and negative psychotic symptoms. Moreover, dissociative symptoms were examined as potential mediator between adversities and severity of psychotic symptoms. Methods Exposure to adversities were assessed by interviews in n = 180 cases and n = 70 controls. In cases, symptom severities were obtained for psychotic symptoms and dissociation. Conditioned random forest regression determined the importance of type and timing of ACE for positive and negative symptom severity, and mediator analyses evaluated the role of dissociative symptoms in the relationship between adversities and psychotic symptoms. Results Cases experienced substantially more abuse and neglect than controls. Adversities were related in a dose-dependent manner to psychotic disorder. An array of adversities was associated with more severe positive symptoms, while the conditioned random forest regression depicted neglect at age 10 as the most important predictor. Dissociative symptoms mediated the small relation of trauma load in childhood and positive symptoms. Conclusion The role of trauma and ACE on psychotic symptoms can be specified by neglect during frontocortical development in the exacerbation of positive symptoms. The mediating role of dissociation is restricted to the relation of childhood trauma and positive symptoms.

This study used health insurance claims data to examine the relationship between the length of sick leave and treatment administered to employees who received middle- to long-term accident and sickness benefits for ≥91 d due to mood disorders, anxiety, and dissociative, stress-related, somatoform and other nonpsychotic mental disorders. Employees who received psychotherapy had significantly shorter leaves of absence over one year compared to those that did not. Treatment with psychotropic drugs was significantly higher among those on leave for ≤365 d than those on leave for ≥366 d. Age, sex and hospital treatment were not significantly associated with length of sick leave. These results suggest that professional psychological treatment is associated with length of sick leave.

Aim Increasing evidence suggests that childhood trauma and dissociation are associated with psychotic symptoms and disorders. Significant rates of dissociative disorders and clinical levels of dissociative symptoms are found in chronic schizophrenia. To date, no studies have examined the prevalence of these in a first episode psychosis (FEP) group. This study aimed to investigate the prevalence of dissociative disorders and symptoms in a FEP sample as well as the prevalence of severe dissociative symptoms in those with or without experiences of childhood trauma. Methods Sixty-six young people with FEP completed a research interview which included the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders, Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised. Results Dissociative symptoms at clinical levels were found in 36.4% of the sample. Furthermore, 13.6% of the sample met diagnostic criteria for a lifetime dissociative disorder. Significant differences in the frequency of clinical dissociative symptoms between those with or without childhood trauma were also found. Conclusions Dissociative symptoms should be routinely assessed for in early intervention settings, especially in cases where childhood trauma is disclosed or suspected. Where present, dissociative symptoms should also be incorporated into subsequent case formulation and treatment planning.

SUMMARYThe severe dissociative disorders of dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) are complex, not uncommon presentations associated with severe symptoms, high rates of comorbidity, high service use compared with other psychiatric disorders, and high suicidality. They exact high personal and socioeconomic burdens and show poor response to standard treatments, with high levels of treatment attrition and ‘revolving-door’ out-patient and in-patient service use; patients are often misdiagnosed or labelled ‘untreatable’. DID and DDNOS diagnoses remain controversial, but they have been repeatedly validated internationally over the past 20 years and the disorders can be accurately identified using screening tools and structured clinical interviews. Neurobiological understanding of the disorders is increasing; findings are consistent with a trauma origin and have commonality with features seen in other trauma-related disorders. Specialist treatment that addresses the dissociative symptoms alongside their trauma origins shows promise in early evidence. Working knowledge of these disorders among non-specialist psychiatrists and psychologists in the UK remains poor, resulting in long delays before diagnosis and treatment.LEARNING OBJECTIVES•Understand trauma-related DID and DDNOS, in particular that they are ‘real’ and not rare disorders•Know when to suspect their presence in general psychiatric settings and how to assess for them•Understand (and help the patient to access) specialist treatments and be able to apply general approaches in the non-specialist settingDECLARATION OF INTERESTNone.

Major depressive disorder (MDD) is a common psychiatric disorder with multifactorial aetiology and complex pathophysiology. Despite availability of various pharmacological and non-pharmacological therapeutic strategies, treatment resistant depression (TRD) remains a significant challenge with specific concern for those patients with severe depressive symptoms in particular suicidal ideations who require immediate and effective intervention. Inflammation has been widely studied for its association with MDD and treatment response. Ketamine known as a dissociative anaesthetic has a novel rapid-acting antidepressant effect at lower doses. Anti-inflammatory actions of ketamine appear to play a role in mechanisms underlying its antidepressant effects. Considering the rapid antidepressant action of ketamine, this review provides a brief overview of antidepressant properties of ketamine as well as its effects on peripheral and central inflammation to better understand the mechanisms underlying the therapeutic action of ketamine as an anti-inflammatory antidepressant target in psychiatric emergency. Development of effective medications, which act rapidly with dual effect on both inflammation and MDD would be of a significant clinical importance for a successful and personalised treatment of inflammatory-induced TRD and suicidal thoughts and behaviour., Highlights • Anti-inflammatory actions of ketamine play a role in mechanisms underlying its antidepressant effects. • Ketamine’s dual effect on inflammation and depression is particularly important in treatment of inflammatory-induced TRD and suicidal patients. • Ketamine affects CNS receptors and pathways, neurotransmitter systems, synaptogenesis, and inflammatory responses. • Ketamine remains a promising target for treatment of TRD and suicidal thoughts.

Background Previous studies revealed an association between traumatic childhood experiences and emotional dysregulation in patients with borderline personality disorder (BPD). However, possible mediating pathways are still not fully understood. The aim of the present study was to investigate the potential mediating role of body connection, describing the awareness of the relationship of bodily and mental states, for the association between a history of traumatic childhood experiences and BPD core symptomatology. Methods One-hundred-twelve adult female individuals with BPD and 96 healthy female controls (HC) were included. Impaired emotion regulation, traumatic childhood experiences, and BPD symptomatology were assessed with self-report questionnaires. The Scale of Body Connection was used to assess two dimensions of body connection, that is body awareness, describing attendance to bodily information in daily life and noticing bodily responses to emotions and/or environment and body dissociation, describing a sense of separation from one’s own body, due to avoidance or emotional disconnection. Mann-Whitney U tests were employed to test for group differences (BPD vs. HC) on the two SBC subscales and associations with clinical symptoms were analyzed with Spearman correlations. We performed mediation analyses in the BPD group to test the assumption that body connection could act as a mediator between a history of traumatic childhood experiences and emotion dysregulation. Results Individuals with BPD reported significantly lower levels of body awareness and significantly higher levels of body dissociation compared to HC. Body dissociation, traumatic childhood experiences, and emotion dysregulation were significantly positively associated. Further analyses revealed that body dissociation, but not body awareness, significantly and fully mediated the positive relationship between traumatic childhood experiences and impaired emotion regulation in the BPD sample. This mediation survived when trait dissociation, i.e., general dissociative experiences not necessarily related to the body, was statistically controlled for. Conclusion Certain dimensions of body connection seem to be disturbed in BPD patients, with body dissociation being an important feature linking a history of traumatic childhood experiences to current deficits in emotion regulation.

Dissociation is a disconnection between a person's thoughts, memories, feelings, actions, or sense of who he or she is Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration They are frequently associated with previous experience of trauma The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0 35 mmol/L), lumbar puncture, or brain imaging Consequently, he was admitted to a psychiatric unit for assessment The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation The patient continued to be witnessed wandering and having incoherent speech First signs of improvement came 21 days postadmission with brief conversation and lucidity This continued to improve over the next 7 days where he was reported to be at his baseline mental state Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode The patient reported almost complete unawareness of the psychiatric admission A diagnosis of dissociative disorder, unspecified, was given This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission [ABSTRACT FROM AUTHOR] Copyright of Case Reports in Psychiatry is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Background: The therapeutic benefits of ketamine have been demonstrated for a variety of psychiatric disorders. However, the role of ketamine induced psychoactive experiences in mediating the therapeutic effects is unclear. Despite the growing quantitative research on the efficacy of ketamine treatment, very few studies examined participant experiences of ketamine infusions in a treatment setting.Aims: The current study aimed to examine participant experiences of ketamine infusions and how these relate to therapeutic mechanisms in a clinical trial setting.Methods: We conducted semi-structured interviews with 12 participants who received up to three ketamine infusions (0.8 mg/kg) as part of a Phase II double blind, randomised controlled trial. The interviews explored participants' acute experiences of ketamine infusions, experiences of psychotherapy/education, and the lasting effects of the trial. The interviews were transcribed verbatim and analysed using thematic analysis.Results: Six key themes were identified. (1) Participants reported multifaceted motivations for trial participation. (2) The set and setting was found to be influential in determining acute ketamine experiences. The acute ketamine experiences included: (3) the inherent contradictions of the experience (e.g., dissociation vs feelings of connection), (4) rapidly fluctuating and changing experiences, (5) meaningful, mystical and spiritual experiences. Finally, the final theme (6) relates to the transformational effects of the infusions and the trial.Conclusion: Provided in a supportive and professional environment, ketamine treatment led to a significant change in relationship with alcohol. Ketamine induced ego dissolution and dissociation were reported to be related to the transformational effects on relationship with alcohol. The extent to which the acute psychoactive effects of ketamine mediate therapeutic effects on drinking outcomes remain to be investigated in the trial data. The acute effects of ketamine reported by our participants transcend its traditional conceptualisation as a “dissociative anaesthetic”; therefore, we suggest the development or use of new measures alongside ketamine infusions to fully capture the spectrum of these effects which may be crucial in its therapeutic and transformative effects.

Background Dissociative symptoms are widely expressed in patients with bipolar disorder (BD) and may precede the onset of the disorder and be a marker of poor treatment response. In the present study we aimed: 1) to assess the relationship between dissociative symptoms and the onset of psychotic symptoms in patients with BD; 2) to assess clinical and socio-demographic characteristics more frequently associated with dissociative symptoms and the response to treatment with mood stabilizers. Methods One-hundred patients diagnosed with BD were enrolled in this study. They underwent a semi-structured interview to collect socio-demographic and clinical characteristics. Dissociative Experiences Scale-II (DES-II) and ALDA scale were used to assess dissociative psychopathologies and response to treatment with mood stabilizers respectively. Results Forty-four percent of patients reported psychotic symptoms on the DES-II scale; BD I patients had a higher total DES-II score than BD II patients. Dissociative symptoms presented a direct correlation with the total number of episodes (p

Background: The 2019 coronavirus disease (COVID-19) outbreak is currently putting a strain on the mental health resilience of the world's population. Specifically, it is likely to elicit an intense response to fear and to act as a risk factor for the onset of posttraumatic stress disorder (PTSD). Some individuals may be more at risk than others, with pathological personality variables being a potential candidate as a central vulnerability factor. In addition, the pathways that lead the pathological personality to PTSD and intense fear responses to COVID-19 are likely to be explained by poor emotion regulation capacities, as well as by dissociative mechanisms.Aims: This study aimed to shed light on vulnerability factors that may account for the onset of PTSD and intense responses of fear in response to COVID-19 outbreak and to test the mediating role of emotion dysregulation and dissociation proneness in these pathways.Methods: We used a longitudinal design of research administered to a sample of community individuals (N = 308; meanage = 35.31, SD = 13.91; 22.7% were male). Moreover, we used self-report questionnaires to measure pathological personality, emotion regulation capacities, dissociative proneness at the beginning of the lockdown, and PTSD symptoms and fear of COVID-19 at the end of the Italian lockdown (from March 9 to May 18, 2020). Structural equation modeling was used to test the hypotheses.Results: We found that pathological personality levels longitudinally predicted PTSD and fear of COVID-19 levels. Moreover, the associations between emotion dysregulation and dissociation were shown to significantly and totally mediate the relationship between pathological personality and PTSD, whereas no significant mediation effects were observed in relation to fear of COVID-19.Conclusions: Individuals with pathological personality traits may be more vulnerable to the onset of negative psychological consequences related to COVID-19 outbreak, such as PTSD symptomatology and fear levels. Emotion regulation capacities appear to be relevant targets of interventions for PTSD symptomatology. Future research should explore the mediating variables linking pathological personality to intense fear responses to COVID-19.

Background A large amount of literature surrounds the differences between dissociative neurological symptom disorder with non-epileptic seizures (DNSD-S) and epilepsy. Aims To explore the research gap on phenotypic differences between DNSD-S and other psychiatric disorders. Method We conducted a case–control study of 1860 patients (620 patients with DNSD-S and 1240 controls with other psychiatric disorders) seen at the South London and Maudsley Hospital NHS Trust between 2007 and 2019. Results Compared with the controls, the patients with DNSD-S were more likely to be female (76 v. 47%, P < 0.001), of White ethnicity (77 v. 60%, P < 0.001), married (34 v. 14%, P < 0.001) and living in areas of lower socioeconomic status (−3.79, 95% CI −2.62 to −4.96, P < 0.001). Two peaks for age at diagnosis were observed for DNSD-S: the early 20s and late 40s. After 31 years of age, men's chance of being diagnosed with DNSD-S increased from 19 to 28% (P = 0.009). People with DNSD-S presented more commonly with a history of a neurological episodic or paroxysmal disorder (OR = 12, 95% CI 7.82–20.26), another dissociative disorder (OR = 10, 95% CI 1.64– 65.95) or unclassified signs or symptoms (OR = 4, 95% CI 2.61–6.43). Neither anxiety, depression nor other somatoform disorders predicted subsequent diagnosis of DNSD-S, and controls had a larger proportion of preceding psychiatric diagnoses than patients with DNSD-S (65 v. 49%, P < 0.001). Conclusions This is the first study comparing demographic and phenotypic correlates of patients with DNSD-S against a large cohort of psychiatric patients. These data will inform development and drive service needs in psychiatry for people with DNSD-S.

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., HIGHLIGHTS Dissociative disorder patients (DDs) experience negative affective responses to positive events (NAI) in addition to hedonic deficits.NAI is related to trauma-related symptoms and interpersonal functioning in DDs and may involve dissociative personality parts or ‘identities’.

Post-traumatic stress after abuse early in life, may be forgotten until late in life. Dissociative actions may be observed. An example of this is demonstrated in a case report from a resident psychiatric facility in Northern Norway. Under Norwegian Law, acts under dissociation is not regarded as being not fit for standing trial, but may be deemed a partial excuse. In the present case a sentence of 5 months was the result of court proceedings where dissociation was duly taken into account.

Background: Numerous years of theory and research have informed our understanding of the caregiving experiences that confer vulnerability for dissociation. This work has resulted in widespread agreement on the role of childhood maltreatment as an aetiological factor. Objective: With clear integration of this perspective, the current paper draws attention to the spectrum of vulnerability that can exist over and above the trauma of maltreatment within early caregiving experiences. Method: An integrative review of the developmental literature on dissociation is presented. Results: We first review and integrate existing developmental theories of dissociation into a more unified perspective, highlighting a combination of defensive and intersubjective pathways towards dissociative outcomes. Next, we present empirical research demonstrating which specific caregiving experiences are associated with dissociation. Lastly, we review recent neurodevelopmental research demonstrating that (non-extreme) caregiving stressors during infancy impact the developing limbic structures in the brain. We conclude by offering directions for future research. Conclusion: Findings make the case for approaching assessments of the caregiver-child relationship with discernment of factors beyond the presence/absence of maltreatment when conceptualizing risk pathways toward dissociation., HIGHLIGHTS: • Dissociation develops from infancy in the context of stressors in the caregiver-child relationship. • These stressors canoccur with, but also without maltreatment. • Changes in limbic brain regions may partly explain why such early stressors increase risk for dissociation.

Background Many patients with post-traumatic stress disorder (PTSD) experience dissociative symptoms. The question of whether these dissociative symptoms negatively influence the effectiveness of psychotherapy for PTSD is unresolved. Aims To determine the influence of dissociative symptoms on psychotherapy outcome in PTSD. Method We conducted a systematic search in Cochrane, Embase, PILOTS, PsycINFO, PubMed and Web of Science for relevant clinical trials. A random-effects meta-analysis examined the impact of dissociation on psychotherapy outcome in PTSD (pre-registered at Prospero CRD42018086575). Results Twenty-one trials (of which nine were randomised controlled trials) with 1714 patients were included. Pre-treatment dissociation was not related to treatment effectiveness in patients with PTSD (Pearson's correlation coefficient 0.04, 95% CI −0.04 to 0.13). Between-study heterogeneity was high but was not explained by moderators such as trauma focus of the psychotherapy or risk of bias score. There was no indication for publication bias. Conclusions We found no evidence that dissociation moderates the effectiveness of psychotherapy for PTSD. The quality of some of the included studies was relatively low, emphasising the need for high-quality clinical trials in patients with PTSD. The results suggest that pre-treatment dissociation does not determine psychotherapy outcome in PTSD.