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The association and overlap between psychotic and dissociative phenomena have been increasingly recognized. Previous studies found that psychotic symptoms are closely associated with post-traumatic and dissociative symptoms and that these trauma-related phenomena may mediate the relationship between trauma and psychotic symptoms. It remained less explored which specific post-traumatic and dissociative symptom clusters are particularly associated with psychotic symptoms. This cross-sectional study used a data-driven approach (network analysis) to explore the associations among different psychotic and post-traumatic/dissociative symptom clusters in an online convenience predominantly female sample (N = 468)(59.2% had ever seen a psychiatrist). Participants completed well-established multidimensional measures that assessed different symptom clusters of psychosis, dissociation, and PTSD. In addition, multiple mediation analysis was conducted to examine which post-traumatic/dissociative symptoms could mediate the relationship between childhood and adulthood trauma and different psychotic symptoms. Our results confirmed previous findings that PTSD and dissociative symptoms are closely associated with psychotic symptoms. More importantly, both data-driven and multiple mediation analysis results indicated that identity dissociation was particularly associated with perceptual anomalies and bizarre experiences, while emotional constriction was particularly associated with negative symptoms. It is important to screen for trauma and dissociation and provide trauma-and dissociation-informed care when working with people at risk of or experiencing psychosis. Further longitudinal studies using more representative samples are needed. [ABSTRACT FROM AUTHOR]

People with dissociative symptoms are generally poly-symptomatic and require high levels of healthcare resources. Post-traumatic stress disorder (PTSD) and depressive symptoms are two major disabling comorbid symptoms in people with dissociative symptoms. While the sense of control over symptoms may be associated with PTSD and dissociative symptoms, the interplay among these factors over time remains unexplored. This study examined the predictors of PTSD and depressive symptoms in people with dissociative symptoms. Longitudinal data from 61 participants with dissociative symptoms were analyzed. Participants completed self-report measures of dissociative, depressive, and PTSD symptoms and the sense of control over symptoms two times (T1 & T2) with an interval of over one month. PTSD and depressive symptoms were not transient or time-specific, but they persisted over time in our sample. Hierarchical multiple regression analyses revealed that, after controlling for age, treatment usage and baseline symptom severity, T1 symptom management scores (β = −.264, p =.006) negatively predicted T2 PTSD symptoms, while T1 PTSD symptoms (β =.268, p =.017) positively predicted T2 depressive symptoms. T1 depressive symptoms (β = −.087, p =.339) did not predict T2 PTSD symptoms. The findings highlight the importance of improving symptom management skills and treating comorbid PTSD symptoms when working with people with dissociative symptoms. [ABSTRACT FROM AUTHOR]

Background: Dissociation remains a controversial topic in terms of its prevalence, cross-cultural validity, and relationship with childhood trauma and adversities. Aims: This study investigated the prevalence of dissociative symptoms and probable dissociative disorders among Chinese high school students and tested the trauma model of dissociation. Methods: A total of N = 1,720 high school students completed standardized measures of positive and adverse childhood experiences (PCEs and ACEs), dissociation, depression, and anxiety. Results: The prevalence rates of dissociative symptoms and (probable) DSM-5 dissociative disorders (DDs) were 11.2% and 6.9%, respectively. Dissociation was a reliable construct (ICC =.682 to.752, p <.001) and was moderately correlated with general psychopathology (r =.424 with depressive symptoms, r =.423 with anxiety symptoms). Participants with a probable DD reported more ACEs, fewer PCEs, and more mental health symptoms than those without a probable DD. ACEs were significantly associated with dissociative symptoms (β =.107, p <.001) even after controlling for age, depressive, and anxiety symptoms. PCEs moderated the relationship between ACEs and dissociative symptoms. Conclusions: This is the first report of the prevalence of dissociative symptoms and probable DSM-5 DDs among nonclinical children. We provide cross-cultural evidence that dissociation is a reliable and valid clinical phenomenon associated with psychopathology in children across cultures. The findings partly support the trauma model of dissociation. This study contributes to the limited literature on dissociation in children. It also offers empirical data to facilitate the ongoing controversy about (childhood) trauma and dissociation. Our findings imply that dissociation is cross-culturally associated with childhood adversities, but trauma is not the only, sufficient cause. Theoretical and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Complex post-traumatic stress disorder (CPTSD) has recently been recognized as an official psychiatric diagnosis in ICD-11, after years of research and advocacy in the field. It has been suggested that dissociative symptoms are a major feature of CPTSD. This scoping review aimed to summarize the existing knowledge base on the relationship between dissociation and CPTSD, and to identify relevant research gaps. We searched the two largest and most widely used academic databases (i.e., the Web of Science and Scopus databases) and the ProQuest database and identified original studies published in English relevant to our research questions, namely: (1) Would CPTSD be associated with dissociative symptoms? 2) How common are dissociative symptoms among people with CPTSD? (3) What are the correlates of dissociative symptoms among people with CPTSD? In all, 26 studies were included. We found 10 studies which reported that people with CPTSD scored significantly higher on a dissociation measure than those without CPTSD, and 11 studies reported a positive correlation between CPTSD symptoms and psychoform/somatoform dissociation scores. While very few studies reported the prevalence and correlates of dissociative symptoms among people with CPTSD, there may be a considerable subgroup of people with CPTSD who have clinically significant levels of dissociative symptoms (e.g., 28.6–76.9%). Dissociation may also be associated with other comorbidities (e.g., DSM-IV Axis II features, shame, somatic symptoms) in people with CPTSD. We recommend that more studies are needed to investigate the prevalence of dissociative symptoms among people with CPTSD and examine how these symptoms are associated with other comorbid conditions and clinical needs in this vulnerable group. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated the high prevalence of dissociative symptoms and their association with considerable healthcare costs. However, there is a lack of studies that describe whether dissociative symptoms persist and lead to other clinical outcomes over time in the community. Objectives: This study investigated the persistence, predictors, and consequences of dissociative symptoms in the community. Methods: We analyzed longitudinal data in a sample of community health service users in Hong Kong (N = 173). Results: A relatively high proportion (63.6%) of participants with baseline dissociative symptoms continued to exhibit dissociative symptoms after approximately 9 months. Baseline non-betrayal trauma predicted subsequent dissociative symptoms (β =.141, p =.024). Participants with baseline dissociative symptoms were more likely to have received subsequent emergency mental health services (9.1% vs 0.7%, p =.005). Baseline dissociative symptoms significantly predicted subsequent post-traumatic symptoms (β =.165 to.191, p <.05) and difficulty in social and occupational participation (β = −.152 to −.182, p <.05) even after controlling for baseline scores, trauma exposure, and use of professional support. The predictive role of dissociative symptoms on subsequent disturbances in self-organization symptoms and social participation difficulty remained significant after applying the Bonferroni correction. Conclusions: This is one of the very few studies showing that dissociative symptoms are persistent to a certain degree and could predict other symptoms and subsequent impairments even in community settings. Factors that affect the trajectory of dissociative symptoms should be further investigated. Regular screening for dissociative symptoms is recommended. Considering its prevalence, persistence, and clinical and social consequences, dissociation should be given greater public health attention. Dissociative symptoms have been linked to considerable healthcare costs. The persistence and consequences of dissociation in the community had not been previously reported. This study showed that dissociative symptoms persisted to a certain degree and predicted subsequent impairments after approximately 9 months. Dissociation should be given greater public health attention. [ABSTRACT FROM AUTHOR]

Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms. This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms. We analyzed longitudinal data from an international sample of people self-reporting depressive emotions (N = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31). More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally (r =.286 to.528, p <.001) and longitudinally (r =.181 to.462, p <.001) correlated with depressive symptoms. A sense of current threat (β =.146, p <.05) and negative self-concept (β =.173, p <.05) at baseline significantly predicted depressive symptoms after one year. These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice. Post-traumatic and dissociative symptoms are common in people with depressive symptoms. These symptoms generally persist over one year and predict more depressive symptoms at follow-up. Trauma-related symptoms should be regularly screened for in clinical settings. [ABSTRACT FROM AUTHOR]

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

Objective: Childhood trauma is associated with adulthood depressive symptoms, but very few studies explored potential social and interpersonal mediators behind this association. This study made the first attempt to test the potential mediating effects of interpersonal stress in the associations between childhood betrayal and non-betrayal trauma and depressive symptoms. Method: We analyzed data in a sample of English-speaking adults from diverse backgrounds (from 19 different countries, mainly from Western countries) (N = 468). We then replicated and compared the results with those in another convenience sample of Chinese-speaking younger adults with different cultural backgrounds and mental health status (N = 205). Results: The results in both samples indicated that (1) childhood betrayal trauma had a stronger relationship with depressive symptoms than childhood non-betrayal trauma and that (2) interpersonal stress was a significant mediator in the relationship between childhood betrayal trauma and depressive symptoms, even when childhood non-betrayal trauma was included as a covariate. The indirect effect of childhood non-betrayal trauma on depressive symptoms through interpersonal stress was not consistent in two samples. Conclusions: Our findings point to the importance of taking social and interpersonal contexts into account when investigating, preventing and managing depression in trauma-exposed populations. Early social interventions such as family interventions, interpersonal skills training and building social resources may have the potential to change the trajectory of the development of mental health problems in trauma survivors. [ABSTRACT FROM AUTHOR]

Objectives: Complex post-traumatic stress disorder (CPTSD) is a newly recognized trauma disorder in ICD-11. Little is known about the prevalence and correlates of CPTSD in primary care settings. Its cultural aspects also remained minimally explored. This study investigated the prevalence and sociocultural correlates of PTSD and complex PTSD among Chinese community health service users in Hong Kong. Methods: This study investigated ICD-11 PTSD and CPTSD in a sample of adults (N = 376) who had recently received services from Registered Chinese Medicine Practitioners in Hong Kong. Traditional Chinese medicine service is part of primary care services in Chinese societies. Participants completed self-report measures of CPTSD, trauma exposure, perceived family support, perceived caregiver's Chinese traditionality/modernity, participation (social activities and occupational productivity), depression and pain. Results: The past-month prevalence of ICD-11 PTSD and CPTSD was 5.6% and 18.4%, respectively, in our sample. Chi-square tests and one-way ANOVAs revealed that participants with CPTSD were younger and reported more trauma, lower family support, lower levels of social participation and productivity, more depressive symptoms and pain, and more social welfare and mental health service usages than those without PTSD. We found that perceived caregiver's Chinese modernity (e.g. egalitarianism) was negatively correlated with CPTSD symptoms. Apart from age, non-betrayal trauma had the strongest association with classical PTSD symptoms, while betrayal trauma and perceived family support had the strongest association with disturbances in self-organization symptoms. Conclusion: This study provides the first data regarding the prevalence and correlates of ICD-11 PTSD and CPTSD among community health service users in Hong Kong. PTSD and CPTSD are common but often unrecognized mental health problems which are associated with more impairments and more service needs. [ABSTRACT FROM AUTHOR]

Betrayal trauma theory proposes that betrayal and non-betrayal traumas are different in terms of their nature and impacts. The theory predicts that dissociation is more strongly related to betrayal than to non-betrayal trauma, however there is a lack of cross-cultural evaluation of the theory. One competing theory is the socio-cognitive model, which proposes that dissociative amnesia (DA) and identity dissociation (ID) are the results of social influence and are not trauma-related conditions. This study aimed to test the hypotheses based on betrayal trauma theory and investigated the relationship between trauma, dissociation and other mental health problems in two culturally different convenience samples of people seeking web-based educational interventions for dissociation (N = 83 English speakers and N = 82 Chinese speakers). Compared with childhood non-betrayal trauma, childhood betrayal trauma had a statistically stronger relationship with dissociation and borderline personality disorder (BPD) symptoms in both samples. DA and ID symptoms were cross-culturally associated with childhood betrayal trauma after controlling for other variables (including sample membership, age, depression levels, medication treatment and non-betrayal trauma). Participants with DA/ID symptoms reported significantly more trauma-related symptoms in both samples. The findings supported the cross-cultural application of the betrayal trauma theory for dissociative features and BPD symptoms. Implications for research and practice (e.g., child protection, assessment for survivors of childhood betrayal trauma) are highlighted. [ABSTRACT FROM AUTHOR]

Pathological dissociation is a common trauma-related condition and is associated with considerable health and social care needs. People with pathological dissociation typically require psychosocial interventions, but there are many challenges in providing such interventions for this vulnerable population. An important question that remains unexplored is whether web-based interventions are acceptable and beneficial for people with pathological dissociation. This paper reports the findings of a pilot evaluation study of a web-based psychoeducation program for people with pathological dissociation. A total of 80 participants were included. The preliminary findings revealed that: most participants were satisfied with the web-based program (e.g., most participants agreed that the program helped them understand [94.1%] and manage [66.7%] their mental health conditions and remain hopeful for recovery [78.4%]); and participants had improvements in symptom management (large effect; partial eta squared =.143) and self-esteem (medium-to-large effect; partial eta squared =.111) after the program. However, no improvements in clinical symptoms were observed on measures of post-traumatic or dissociative symptoms. The dropout rate at posttest was 36.3%. This is one of the first studies that evaluated web-based interventions for people with pathological dissociation. Although the web-based program is well-accepted by the participants and might be associated with some potential benefits, the limitations of this pilot study should be acknowledged. Implications are discussed in terms of the directions for future developments of the program and the needs for further evaluation. [ABSTRACT FROM AUTHOR]

Background: The overlapping symptoms of schizophrenia and dissociation have been increasingly recognized. This paper explains why it is reasonable to expect that there would be a substantial subgroup of patients diagnosed with schizophrenia spectrum disorders (SSDs) who suffer from pathological dissociation. Objective: As little is known about the prevalence of dissociative disorders and symptoms among patients with SSDs, we investigated the prevalence of dissociative disorders and symptoms among patients with SSDs. Method: We used both self-report measures and structured interviews to examine dissociative disorders and symptoms in a randomly recruited sample of inpatients with a clinical diagnosis of SSDs in Taiwan (N = 100). Results: Over 60% of participants exhibited pathological dissociation, and 54% had a dissociative disorder according to structured interview data; three participants met the DSM-5 diagnostic criteria for dissociative identity disorder. The concurrent validity of pathological dissociation in this sample was similar to that of depression among patients with schizophrenia reported in the literature. Participants with a dissociative disorder were more likely to report high-betrayal traumas and meet DSM-5 criteria for post-traumatic stress disorder; they also reported more psychotic symptoms than those without a dissociative disorder. Conclusions: This was one of very few studies that used structured interviews to examine pathological dissociation in patients with SSDs. The results indicate that pathological dissociation in SSDs is not uncommon. Clinical assessment should include measures of dissociation to facilitate early identification. Patients with dissociative disorders are often diagnosed with a psychotic disorder. Our study found that unrecognized dissociation is common in a sample of Taiwan inpatients with schizophrenia. Patients with schizophrenia spectrum disorders should be screened for dissociation. Trauma and dissociation are not rare among inpatients diagnosed with schizophrenia spectrum disorders in Taiwan. [ABSTRACT FROM AUTHOR]

To improve the outcomes of depression treatment, personalized treatments that take individual needs into account are recommended. Recent research suggests that a subgroup of depressed people who suffer from co-occurring dissociation may be more likely to have encountered traumatic or stressful experiences and they may also have more psychosocial intervention needs. This study examined the prevalence and correlates of dissociative symptoms in an online convenience sample of people (N = 410) from 18 different countries/regions who reported clinically significant levels of depressive symptoms (indicated by Patient Health Questionnaire-9 score ≥10). Over 60% of participants exhibited clinically significant levels of dissociative symptoms (indicated by a Multiscale Dissociation Inventory total score >66). Compared with those with low levels of dissociative symptoms, participants with high levels of dissociative symptoms reported more traumas, interpersonal stress, depression and trauma-related symptoms. Emotional constriction in particular had a weak but significant negative correlation with the level of perceived medication benefits. The use of an online convenience sample could limit the generalizability of our findings. Our cross-sectional data could not demonstrate causal relationships between the study variables. The findings highlight a need for complex health interventions for depressed people with co-occurring dissociative symptoms, focusing not only on depressive symptoms but also addressing trauma and dissociation-related symptoms. [ABSTRACT FROM AUTHOR]

People with pathological dissociation should receive proper clinical attention and timely support. Recent studies have shown that pathological dissociation is common in the Chinese context. However, little is known about the clinical features of Chinese people with pathological dissociation. This paper reports the first data regarding trauma histories, mental health symptoms, clinical diagnoses, service usages, stigma and psychosocial needs in a convenience sample of Chinese people who screened positive for pathological dissociation on a self-report measure (N = 72). This sample was characterized by a history of trauma and high levels of trauma-related symptoms and depression. Medication treatments were the most common interventions for them; many participants did not receive psychotherapy. We found no clinical differences between participants who had and had not received psychotherapy for post-traumatic/dissociative symptoms. This implies that many participants did not have the chance of receiving specific psychotherapy even though their trauma histories and clinical symptoms were as severe as those who were receiving specific psychotherapy. Stigma and unmet psychosocial needs were common in this sample and should receive more attention in the field. Implications for research and practice are highlighted. More dissociation-informed services are required for Chinese-speaking populations. [ABSTRACT FROM AUTHOR]

Childhood trauma is one of the most preventable risk factors for mental health problems. Considering the substantial amount of time that young people spend in school during their early years, it is important to understand the potential impacts of teachers' behaviors on students' mental health. This study examined the relationship between exposure to teacher violence and mental health problems. An international sample of young adults aged 18 to 24 (N = 283). Participants completed self-report measures of childhood trauma, exposure to teacher violence, depressive symptoms, post-traumatic stress, and alcohol misuse. Exposure to teacher violence could be reliably and validly measured using the Teacher Violence Scale (TVS). Current mental health problems – including depressive symptoms, post-traumatic stress, and alcohol misuse – were associated with exposure to teacher violence during high school years, but not with childhood non-betrayal trauma. Our findings expand the application of the betrayal trauma theory to school settings and point to the importance of preventing and managing teacher violence. It is important to provide more support and training to teachers and enhance monitoring measures in schools. More research on the prevalence and correlates of exposure to teacher violence is needed. We also provided first evidence supporting the reliability and validity of the English version of the TVS to facilitate future research. [ABSTRACT FROM AUTHOR]

Hearing voices is generally linked to biological factors, but its psychosocial aspects should not be overlooked. The empirical literature indicates the need for acknowledging the psychosocial aspects of voice-hearing experiences. We conducted a review of online health information about voice-hearing experiences and examined if the most widely accessible websites equally covered the biological and psychosocial aspects of voice-hearing. Forty-seven websites (including 23 English websites and 24 Chinese websites) were reviewed and rated. The English websites did not adequately mention trauma-related disorders as potential diagnoses for hearing voices, but there was a balanced discussion regarding the causes and treatment options for hearing voices. In contrast, most Chinese websites failed to acknowledge any psychosocial aspects of hearing voices. A comprehensive approach that recognizes both the biological and the psychosocial aspects of voice-hearing experiences is required to reduce stigma and ethically inform potential service users and the public about the possible causes, diagnoses and treatment options for voice-hearing experiences. Implications are discussed. Online information concerning voice-hearing experiences in the Chinese context should be updated. Mental health information providers in both language contexts should be familiar with the relationship between hearing voices and trauma-related disorders too. [ABSTRACT FROM AUTHOR]

Auditory hallucinations are common among people seeking treatment for trauma and dissociation and can result in diagnostic challenges. This study examined the correlates of hearing voices in two samples of people seeking interventions for dissociation – a sample of 83 English speakers and a sample of 82 Chinese speakers. We found that, compared with depersonalization, hearing voices was more closely associated with trauma and other dissociative phenomena (especially identity dissociation) across two samples from different cultures. We recommend that careful assessment of trauma and dissociation should take place before a clinician assumes that auditory hallucinations are a psychotic symptom. Our findings support the idea that at least some forms of hearing voices are a cross-culturally occurring trauma-related dissociative phenomenon. [ABSTRACT FROM AUTHOR]

The ability to predict which groups of mental health service users are more likely to require psychosocial care could facilitate intervention planning and optimize the utilization of resources. Dissociation may be a transdiagnostic indicator of psychosocial intervention needs because dissociation is theoretically and empirically associated with psychosocial adversities. This paper explains why that may be the case. We investigated the association of somatoform dissociation with indicators of psychosocial intervention needs (e.g., childhood trauma, poor family well-being, psychosocial-related symptoms) in a convenience sample of mental health service users (N = 111). The preliminary evidence supports the idea that dissociation is a transdiagnostic indicator of psychosocial intervention needs. Dissociation should be regularly assessed in mental health settings because it may help social workers and other psychosocial service providers identify service users who may especially need psychosocial care when there is a lack of resources. Further studies and discussions are needed. [ABSTRACT FROM AUTHOR]

Depression is a common and challenging comorbid condition in people with pathological dissociation. To our knowledge, this preliminary study is the first study that has looked at the clinical correlates of depression in a sample of people with pathological dissociation (N = 72). We found that severe depression is common in this sample and that depression is associated with dissociative symptoms, post-traumatic stress disorder (PTSD) symptoms, borderline personality disorder symptoms and clinical recovery; the level of depression is also associated with both childhood and adulthood betrayal trauma but not with childhood and adulthood trauma with less betrayal. PTSD symptoms are the most significant correlates of the level of depression in this sample. Some clinical implications are discussed. Our initial findings imply that it may be important to manage depression by preventing adulthood betrayal trauma and stabilizing PTSD and dissociative symptoms when working with service users with pathological dissociation. Further studies are needed. [ABSTRACT FROM AUTHOR]

Early identification of borderline personality disorder (BPD) is important as timely interventions are beneficial and cost-effective. Unrecognized BPD not only results in suffering for individuals and their families, but also leads to considerable social costs. Although web-based measures have the potential to facilitate screening assessment of BPD for research and clinical purposes, little is known about whether the results of web-based measures of BPD are valid. This preliminary study aims to examine the validity of a web-based measure of BPD. We analyzed data from five independent samples (N = 828 in total). The web-based BPD measure had a consistent relationship with relevant variables, including trauma exposure, mental well-being, depression, post-traumatic stress, dissociation and psychotic features across samples. It was also strongly correlated with another BPD measure. The web-based BPD measure could discriminate between participants with and without BPD and the discrimination performance was excellent (area under the curve =.853). The initial findings suggest that the web-based BPD measure used in the present study is valid and may be helpful for research and screening purposes, although it should be followed up with a more comprehensive assessment in clinical settings. Implications are discussed. Given the limitations in this study, further studies are needed. [ABSTRACT FROM AUTHOR]

Although people with pathological dissociation (PD) can benefit from specific interventions, there are challenges in providing suitable interventions for them in the field (e.g., high cost, lack of specialized services, stigma). Many people with PD cannot receive dissociation-focused services in their current service locations. It is important to develop easily-accessible interventions that can support people with PD, especially for those who cannot access dissociation-specific treatment. The authors developed a web-based psychoeducation program to support people with PD, and examined its feasibility and acceptability. A single-group pretest-posttest pilot study was conducted. Findings showed that most of the intended psychosocial outcomes were achieved as planned, which initially proved the feasibility and acceptability of the program. This is one of the first studies that report the use of web-based interventions to support people with PD, especially those who are in the early stages of recovery. The findings suggest that information and communication technology can contribute to different aspects of clinical practice, including recruitment, engagement, assessment and interventions. Further discussion and research are required. [ABSTRACT FROM AUTHOR]

Social workers are major mental health service providers in many countries and regions. This paper presents five reasons to explain why complex dissociative disorders (complex DD) should receive more attention from social workers. We conducted a preliminary review of complex DD in the social work literature. In June 2019, we searched all articles related to complex DD in academic journals classified under the "Social Work" research area in two Web of Science databases. Twenty-four articles were identified and reviewed. Most articles did not even have insights/implications for working with trauma and dissociation survivors regarding the social aspects of their care. None of the articles discussed the potential role of social workers in the assessment or management of complex DD. The body of knowledge regarding complex DD remains seriously limited in the social work field. Several knowledge gaps are discussed. We highlight some issues that social workers should consider when working with individuals with complex DD. [ABSTRACT FROM AUTHOR]

Depression is a serious public health issue, but not all patients with depression respond well to pharmaceutical treatments. Some scholars suggested that dissociation could be a marker indicating the types of patients with depression that may benefit more from psychosocial interventions than from pharmaceutical treatments. This study explored the possibility to differentiate dissociative depression and nondissociative depression in a clinical sample (N = 68) in the Chinese context, and discusses the potential implications for treatment considerations. Compared with the nondissociative group, the dissociative group reported higher occurrences of psychosocial etiological risk factors (e.g., childhood physical abuse, lack of help from family) and psychosocial-related symptoms (e.g., unstable relations, fear of abandonment, trauma-related flashbacks, somatization symptoms). Our initial findings revealed that patients with dissociative depression appeared to have distinct clinical features and might require more psychosocial interventions. Implications for health care research and practice are discussed. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) have become a major concern in the mental health field. The literature suggests that ACEs could be associated with various mental health problems. Yet, ACEs require further investigation in Chinese cultures, especially in Hong Kong. Both the frequency of ACEs and their relationships with dissociation remain unknown in clinical settings in Hong Kong. In this study, we administered the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ) and the 10-item Adverse Childhood Experiences (ACEs) Questionnaire to 202 community mental health service users in Hong Kong. The frequency of ACEs and dissociation is reported and the trauma model of dissociation can be observed in this sample. Consistent with the Western literature, we found that ACEs are associated with mental health problems and that participants with childhood abuse and/or neglect report a significantly higher level of dissociation. While this study is preliminary, we suggest that ACEs and dissociation should receive more attention in the Chinese mental health field. Implications for practice are highlighted. Further studies are warranted. [ABSTRACT FROM AUTHOR]

The experience of hearing voices is common in both clinical and nonclinical populations and has been found to be associated with various psychosocial factors (e.g., trauma, dissociation). However, little is known about voice-hearers (VHs) in the Chinese context. This study investigated the experience of hearing voices and its relationships with psychosocial variables in four independent Chinese samples, including two college student samples (n = 328), a sample of patients with depression (n = 71) and a sample of females with disabilities (n = 94). Self-report survey data were analyzed. Around 26% to 28% of participants in the three non-psychiatric samples reported hearing voices. Evidence for the differences in age, trauma exposure, overall psychopathology, depression and post-traumatic stress symptoms between VHs and non-VHs is insufficient or inconsistent across samples. There is some evidence for voice-hearing being associated with poor mental well-being, dissociation and 'borderline personality' symptoms. This study provides the first data regarding voice-hearing experiences and their psychosocial correlates in the Chinese context. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Prior research has documented that mindfulness is negatively associated with aggressive behaviors. Recently, studies have examined mediating psychological constructs that account for the relationships between mindfulness and cyberbullying perpetration. The purpose of the current study was to examine the longitudinal relationship between mindfulness and cyberbullying behaviors through the mediating variables of self-esteem and empathy. This study used a two-wave longitudinal design. The final sample consisted of 661 Chinese junior high school students. Participants completed four self-report questionnaires including mindfulness, self-esteem, empathy, and cyberbullying perpetration. Structural equation modeling revealed that mindfulness was significantly related to cyberbullying perpetration over time. Self-esteem and empathy significantly mediated the relationship between mindfulness and cyberbullying. Future research may focus on the potential mechanisms linking mindfulness and other protective factors with cyberbullying perpetration to facilitate the development and use of cyberbullying interventions. [ABSTRACT FROM AUTHOR]

Purpose: Pathological dissociation (PD) is an easily overlooked phenomenon in the mental health field. Standardized assessment is important for identifying dissociative symptoms and disorders. However, the use of PD measures in Chinese cultures needs investigation. This pilot study investigated the psychometric properties of three PD measures among Hong Kong Chinese. Methods: The psychometric properties of the Dissociative Experiences Scale-Taxon, the 5-item Somatoform Dissociation Questionnaire, and the Self-Report Version of the Dissociative Disorders Interview Schedule (SR-DDIS) were evaluated using online methods in Hong Kong. Results: The PD measures exhibited adequate to excellent internal consistency. The PD measures were negatively related to family support and can discriminate between participants with and without self-reported childhood abuse. There was excellent agreement between the online SR-DDIS results and the clinical diagnoses for presence of any dissociative disorder (DD) versus no DD. The DDs group scored significantly higher on PD measures than the depression group and the college student group. Discussion: The initial findings suggest that PD can be assessed online in Hong Kong. Further investigation is necessary. [ABSTRACT FROM AUTHOR]

Pathological dissociation is widely regarded as a cross-culturally occurring condition related to trauma and adversity and is an important construct in the mental health field. Yet, the frequency of pathological dissociation in both clinical and nonclinical populations in Hong Kong remains unknown. In addition, the relationship of pathological dissociation with aggression and delinquency requires further investigation. To investigate these relationships, we administered the Dissociative Experiences Scale-Taxon (DES-T), the 5-item Somatoform Dissociation Questionnaire (SDQ-5), selected sections from the Self-Report Version of the Dissociative Disorders Interview Schedule (SR-DDIS), the Reactive-Proactive Aggression Questionnaire (RPQ), and a delinquent behaviors checklist to 177 college students in Hong Kong. The findings suggest that pathological dissociation is not as rare as it is traditionally believed to be in Hong Kong. In our sample, 4.52% of the participants may have a DSM-5 dissociative disorder (including other specified dissociative disorder) while 9.60% met the DSM-5 diagnostic criteria for borderline personality disorder (BPD). Our findings indicate that the RPQ total score and delinquency may be more characteristic of BPD than of pathological dissociation. In addition, while reactive aggression was related to pathological dissociation and BPD symptoms in both genders, proactive aggression was related to pathological dissociation and BPD symptoms only in females. Although the findings of this study are preliminary and the results should be interpreted with caution, the study provides the first data regarding pathological dissociation and its relationship with aggression and delinquency in Hong Kong. Some implications for research and practice are highlighted. Further investigation of pathological dissociation in Hong Kong is necessary. In addition, more studies are essential to further examine the relationships between pathological dissociation, aggression, and delinquency in both clinical and nonclinical populations. [ABSTRACT FROM AUTHOR]

Dissociative symptoms and disorders have been reported in many different cultures. If pathological dissociation is naturally occurring and related to adverse experiences, such phenomena should have been witnessed and portrayed before the modern age. To investigate whether this is the case, the author made use of the rich ancient Chinese medicine literature and looked for descriptions of pathological dissociation in medical documents written by ancient Chinese medical practitioners. In this paper, the author presents six cases selected from the ancient Chinese medicine literature. The phenomenon of pathological dissociation is observed in these cases. This is the first report of case descriptions of pathological dissociation documented in Chinese cultures before 1900. [ABSTRACT FROM AUTHOR]

Identifying dissociation is important for mental health services because it could fundamentally affect one’s diagnosis and treatment plan. The Dissociative Experiences Scale (DES) is a widely-used self-report scale for measuring dissociative experiences. It has been translated into many languages and used in many countries. However, there is no validated Hong Kong Chinese version of the DES available in the field, and there is no other validated Hong Kong Chinese instrument for assessing dissociative disorders. This pilot study used online methods to translate the DES to Hong Kong Chinese (HKC-DES). The results indicated that the HKC-DES has excellent internal consistency (α = .953) and very good test-retest reliability (r= .797). Bilingual participants’ responses to the DES and HKC-DES indicated high similarity, and were significantly correlated (r= .960). These results initially verified the reliability and cross-language equivalence of the scale. Implications for healthcare practice and research are discussed. [ABSTRACT FROM PUBLISHER]

Childhood adversities have been increasingly recognized as a significant risk factor for depression. However, the underlying mediating mechanism between childhood adversities and depression requires further investigation. The literature shows that childhood adversities are also closely associated with post-traumatic stress disorder (PTSD) symptoms and that PTSD symptoms can predict depressive symptoms. It remains unexplored whether PTSD symptoms can act as a mediator between childhood adversities and depression. The primary goal of this study was to examine whether PTSD symptoms would mediate the relationship between childhood adversities and depressive symptoms. We examined in a convenience sample of Hong Kong adults aged 18 or above (N = 418) whether PTSD symptoms would mediate the relationship between childhood adversities and depressive symptoms. We then examined and compared the results with those in another convenience sample of Chinese-speaking young adults (mainly from Taiwan and Hong Kong) aged between 18 and 24 (N = 205). Participants in both samples completed online surveys that included measures of childhood adversities, PTSD symptoms and depressive symptoms. Childhood adversities were significantly associated with depressive symptoms; and this relationship was mediated by PTSD symptoms in both samples. This study is one of very few studies demonstrating that PTSD symptoms mediate the relationship between childhood adversities and depressive symptoms. Our findings suggest that addressing unresolved PTSD symptoms for adults with childhood adversities may help in preventing or treating depressive symptoms. Therefore, PTSD symptoms should be taken into account in the prevention and management of depression. [ABSTRACT FROM AUTHOR]

This article provides a case report of a Chinese-Cantonese female with both cerebral palsy and dissociative identity disorder. To my knowledge, this is the first report of a case with dissociative identity disorder from Hong Kong, as well as the first report of a case with both dissociative identity disorder and cerebral palsy in the literature. Large-sample studies should be undertaken in the future to investigate the prevalence of dissociative disorders in a variety of populations in Hong Kong, including individuals with diagnosed brain diseases. [ABSTRACT FROM AUTHOR]

Previous studies showed that nightmares are prevalent and are associated with negative health outcomes. However, no empirical data is available demonstrating the extent to which nightmare disorder persists over time. Current literature provides a limited understanding of the trajectory and wider mental health outcomes of nightmare disorder. This longitudinal study examined the persistence and mental health outcomes of nightmare disorder. A total of 230 Hong Kong Chinese adults completed standardized assessments twice with an interval of about 6 months. Over half (66.7%) of the participants with probable nightmare disorder at baseline remained to meet the DSM-5 criteria for the disorder at follow-up. Participants with probable nightmare disorder at baseline were significantly more likely to screen positive for PTSD (82.1% vs 18.3%) (p <.001) (p <.001), and they reported higher rates of mental health service usage at both timepoints (p =.001 to.003). Baseline nightmare disorder severity was negatively associated with subsequent self-rated mental health (β = -.151, p =.010) and self-esteem (β = -.141, p =.009) and it also predicted subsequent PTSD symptoms (β =.122, p =.012). This study provides first empirical data showing that nightmare disorder could be persistent over time. Nightmare disorder symptoms are associated not only with PTSD symptoms but also with a broader range of mental health issues. This study points to the public health importance of identifying and managing nightmare disorder symptoms in the community. Additionally, the presence of nightmare disorder symptoms may be a helpful indicator for identifying post-traumatic stress. [ABSTRACT FROM AUTHOR]

Recent studies showed that the ICD-11 C-PTSD is associated with considerable individual and social consequences. This study focused on the persistence and psychological predictors of C-PTSD. We analyzed longitudinal survey data from a sample of Hong Kong adults (N = 230) with an interval of approximately six months. Participants completed standardized self-report measures of C-PTSD and various psychological factors (including self-criticism, self-compassion, ruminative response, event centrality, and experiential avoidance) at both timepoints. Over 80% of participants with probable C-PTSD at baseline remained to meet the criteria for PTSD/C-PTSD at follow-up, while over 50% of participants with probable PTSD at baseline remitted at follow-up. Participants with probable C-PTSD were characterized by greater use of mental health services at both timepoints. Additionally, hierarchical multiple regression showed that, among a variety of psychological factors, experiential avoidance was the only significant predictor of PTSD (β = 0.271, p =.001) and disturbances in self-organization (DSO) (β = 0.200, p =.011) symptoms, after controlling for baseline symptom severity and treatment usage. This study shows that C-PTSD persists over time and its symptoms are predicted by experiential avoidance. More efforts are needed to prevent and address C-PTSD in the community. We also offer insights into the management of trauma-related disorders. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences are an important public health issue. It is well documented that they are associated with many health problems. Nevertheless, little is known about childhood emotional abuse and neglect (CEA and CEN) among Hong Kong people. This study aimed to explore the demographic and mental health correlates of CEA and CEN in a Hong Kong sample. A total of N = 418 Hong Kong adults completed an online survey that included questions regarding demographic information and measures of adverse childhood experiences, depression, anxiety, borderline personality disorder, post-traumatic stress disorder and somatoform dissociation. The rates of CEA and CEN were 43.3 % and 44.5 % respectively in this convenience sample. Both CEA and CEN were associated with poor socioeconomic status. They were also associated with psychiatric service usage and all five types of mental health problems. Both CEA and CEN increased the chance of having mental health problems even after taking into account the effects of other forms of childhood abuse and neglect. This study is the first to show that CEA and CEN are significantly associated with poor socioeconomic status and mental health problems in the Hong Kong context. Implications are discussed. Further studies are needed. [ABSTRACT FROM AUTHOR]

Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (β = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required. [ABSTRACT FROM AUTHOR]

The impacts of adverse childhood experiences (ACEs) have been well documented. One possible consequence of ACEs is dissociation, which is a major feature of post-traumatic psychopathology and is also associated with considerable impairment and health care costs. Although ACEs are known to be associated with both psychoform and somatoform dissociation, much less is known about the mechanisms behind this relationship. Little is known about whether social and interpersonal factors such as family environments would moderate the relationship between ACEs and somatoform dissociation. This paper discusses the importance of having a positive and healthy family environment in trauma recovery. We then report the findings of a preliminary study in which we examined whether the association between ACEs and somatoform dissociation would be moderated by family well-being in a convenience sample of Hong Kong adults (N = 359). The number of ACEs was positively associated with somatoform dissociative symptoms, but this association was moderated by the level of family well-being. The number of ACEs was associated with somatoform dissociation only when the family well-being scores were low. These moderating effects were medium. The findings point to the potential importance of using family education and intervention programs to prevent and treat trauma-related dissociative symptoms, but further investigation is needed. [ABSTRACT FROM AUTHOR]

Purpose: Nonviolent communication (NVC) has been increasingly recognized as a potentially beneficial approach that could promote empathy, resolve conflicts, and improve psychosocial well-being. No validated measure is available to assess or quantify NVC-specific characteristics or behaviors. This paper describes the development and pilot psychometric evaluation of a self-report measure for assessing behaviors characteristic of NVC (e.g., awareness of feelings, honest self-expression). Method: We analyzed data in an online convenience sample of young adults (N = 205). Results: The 7-item Nonviolent Communication Behaviors Scale (NVCBS) was found to have satisfactory internal consistency (α = 0.789 to 0.810), good test-retest reliability (ICC = 0.781) and a single-factor structure. The NVCBS was also positively correlated with empathy while negatively correlated with negative beliefs about emotions, demonstrating its construct validity. Discussion: The study provides a reliable and valid measure of NVC behaviors which can facilitate future studies on NVC. Directions for future research are discussed. [ABSTRACT FROM AUTHOR]