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Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. Themyths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group. [ABSTRACT FROM AUTHOR]

The aim of this study was to inquire about the possible relations of childhood trauma, anger, and dissociation to depression among women with fibromyalgia or rheumatoid arthritis. Fifty female patients diagnosed as having fibromyalgia (n= 30) or rheumatoid arthritis (n= 20) participated in the study. The Childhood Trauma Questionnaire, Somatoform Dissociation Questionnaire (SDQ), Dissociation Questionnaire (DIS-Q), Beck Depression Inventory (BDI), Spielberger State-Trait Anger Expression Inventory, and Dissociative Disorders Interview Schedule were administered to all participants. Women with a lifetime diagnosis of depressive disorder had higher scores for somatoform and psychoform dissociation than the nondepressive patients. However, childhood trauma scores did not differ between the 2 groups. In regression analysis, current severity of depression (BDI) was predicted by psychoform dissociation (DIS-Q) and lower education, and lifetime diagnosis of major depression was predicted by somatoform dissociation (SDQ). Whereas childhood emotional neglect predicted somatoform dissociation, psychoform dissociation was predicted by childhood sexual abuse. Mental processing of anger seems to be 1 of the dimensions of psychodynamics in trauma-related depressive conditions. In the context of the perceived threat of loss of control due to expressed anger and mental disintegration, somatoform dissociation seems to contribute to overmodulation of emotions in dissociative depression. Among patients suffering from physical illness with possible psychosomatic dimensions, assessment of somatoform dissociation in addition to psychoform dissociation may be helpful to understand diverse psychopathological trajectories emerging in the aftermath of childhood adversities. The recently proposed category of “dissociative depression” (Sar, 2011) seems to be a promising concept for future research on psychosomatic aspects of traumatic stress. [ABSTRACT FROM PUBLISHER]

The authors comment on the Australian Royal Commission into Institutional Responses of Child Sexual Abuse. They discuss institutional aspects of child sexual abuse and the opportunity provided by the commission. The authors also describe how the commission can be conceptualized as representing a sort of proxy investigation at two other levels.

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

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

Fifty first-degree relatives of 24 Turkish dissociative patients and 50 Turkish non-clinical controls were screened for childhood traumas, dissociative experiences/disorders, and borderline personality disorder/criteria. The Dissociative Experiences Scale, the borderline personality disorder section of the Structured Clinical Interview for DSM-IV Personality Disorders, the Childhood Trauma Questionnaire, and a structured history form were admistered to all participants. Family members had dissociative experiences, borderline personality disorder criteria (subtreshold scores included), and childhood traumas more frequently than the normal control group. Family members with a Dissociative Experiences Scale score 25 and above (N = 3) were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders. None of the family members were diagnosed as having a dissociative disorder and/or borderline personality disorder on a clinical level. Our findings suggest that these apparently normal families of dissociative patients need to be evaluated for trauma-related family dynamics overall and for hidden subclinical psychopathology. [ABSTRACT FROM AUTHOR]

Although the official term of posttraumatic stress disorder implies the opposite, trauma is not identical with the noxious event itself. An adequate definition of trauma would require the inclusion of both the objective and subjective components of a traumatic experience. Moreover, trauma is not limited solely to the traumatic situation, but is better defined as a socio-psychological process which can be completed in the course of time, if at all. The superposition of multiple trauma processes throughout a person's life span can make this task even more complex. We propose that what turns an experience to be traumatic is not only the interruption of information processing, but the activation of a maladaptive process, i.e., trauma is a threatening experience which turns an adaptive process to a maladaptive one. The six concepts of traumatic double-bind, traumatic turning point, completion expectancy, traumatic time perception, traumatic obsessions, and traumatic whirlpool are presented to better clarify this maladaptive process. Traumatic experiences and the consequently altered self-perceptions contribute to the impairment of the mutuality between internal world and external reality of the affected person. This is accompanied by a renewed perception of the self in context of a different reality accompanied by an alteration in vigilance, awareness, control, and sense of concentration. Depersonalization is the core clinical element of this resulting condition which is called dissociation. [ABSTRACT FROM AUTHOR]

Abstract A questionnaire consisting of items about abuse, neglect, self-mutilation and suicide attempt and the Turkish Version of the Dissociative Experiences Scale were given to 862 high school students. The rates of suicide attempt and self-mutilative behaviors were 10.1% and 21.4%, respectively. Abused or neglected groups (34.3%) had 7.6-fold higher suicide attempts and 2.7-fold higher self-mutilation behaviours. The logistic regression model showed that each type of trauma and dissociation contributed to suicide attempts and self-mutilation, but dissociation was the most powerful. Suicidal and self-destructive adolescents should precisely be evaluated for abuse, neglect and dissociation in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract The Adolescent Dissociative Experiences Scale (A-DES) is designed to measure dissociation in adolescents. The present study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the A-DES. The Turkish version of the A-DES was administered to 20 patients with a dissociative disorder, 24 patients with post-traumatic stress disorder (PTSD), 31 patients with anxiety disorder, 31 patients with mood disorder, 24 patients with attention deficit–hyperactivity disorder (ADHD), and 201 non-clinical participants. The internal consistency and the test–retest correlation of the A-DES were excellent. The mean total score of A-DES was 6.2 in dissociative disorder, 3.9 in PTSD, 2.1 in anxiety disorder, 2.4 in mood disorder, 2.5 in ADHD groups and 2.4 in non-clinical participants. There was a statistically significant difference between dissociative patients and other diagnostic groups on the A-DES total score. The good psychometric characteristics of the A-DES among Turkish participants support its cross-cultural validity. [ABSTRACT FROM AUTHOR]