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Kebede, D.,  Alem, A. (1999)   
Major mental disorders in Addis Ababa, Ethiopia. II. Affective disorders.
Acta Psychiatr Scand Suppl 1999;397:18-23 -

ABSTRACT This report examines the prevalence and socio-demographic correlates of affective disorders based on a survey conducted in Addis Ababa between September and December of 1994. An Amharic version of the CIDI was used to collect data from a random community sample of 1420 individuals aged 15 and above. The lifetime prevalence for specific affective disorders was as follows: bipolar disorders 0.3%, depressive episodes 2.7%, recurrent depressive episodes 0.2%, and persistent mood disorders 1.6%. The weighted lifetime prevalence of affective disorders was 5.0% (women 7.7% and men 3.2%). One-month prevalence was 3.8% (women 5.9% and men 2.3%). After adjusting for several potential confounders, the risk of affective disorders was only 29% higher in women compared to men. This difference in risk was not statistically significant. Age was also not associated with risk of affective disorders. On the other hand, education was associated with the risk of disorder, the risk decreasing with increasing educational attainment. This inverse trend was statistically significant (P for trend = 0.02). The risk was also 37% lower in the employed than the unemployed: Odds Ratio (OR), 95% confidence interval (95% CI) = 0.63 (0.39, 1.01). There were no statistically significant associations between affective disorders and marital status or ethnicity

Kebede, D.,  Alem, A. (1999)  
Major mental disorders in Addis Ababa, Ethiopia. III. Neurotic and somatoform disorders
Acta Psychiatrica Scandinavica, Supplementum, 100, 24-29.

ABSTRACT Estimated the prevalence and sociodemographic correlates of phobic, dissociative, somatoform, and other anxiety disorders. Estimates of lifetime and point (1-mo) prevalence are based on a survey conducted in Addis Ababa in 1994, using an Amharic version of the Composite International Diagnostic Interview to collect data from 1,420 city residents aged 15 yrs and above. Sociodemographic correlates were sex, age, education, employment and marital status, and ethnicity. Phobic anxiety disorders were the most common of the anxiety disorders, with lifetime prevalence (LP) of 4.8%. LP for dissociative disorders was .8%; for other anxiety disorders 2.7%, and for somatoform disorders 3.1%. LP for all neurotic and somatoform disorders was 10.8%. Point prevalence estimates (percent) were: phobic anxiety disorders 4.4; other anxiety disorders 1.2; dissociative disorders .4; and somatoform disorders 2.5. Women had over a 2-fold risk of neurotic and somatoform disorders compared to men. Those aged 60 yrs and above had a 60% lower risk compared to those aged 15-24 yrs. The 25% decreased risk for the employed vs unemployed, was not statistically significant. Education, marital status, and ethnicity were not significantly associated with neurotic and somatoform disorders.

Kellner M, Wiedemann K, Yassouridis A, Levengood R, Guo LS, Holsboer F, Yehuda R (2000)
Max Planck Institute of Psychiatry, Clinical Institute, Munich, Germany.
Behavioral and endocrine response to cholecystokinin tetrapeptide in patients with posttraumatic stress disorder.
Biol Psychiatry 2000 Jan 15;47(2):107-11

ABSTRACT BACKGROUND: Given the relationship between posttraumatic stress disorder (PTSD) and panic, it was of interest to examine whether panic provoking agents affect PTSD symptoms. We therefore investigated the behavioral and endocrine response of PTSD patients to the panicogen cholecystokinin tetrapeptide (CCK-4). METHODS: Eight patients with PTSD (DSM-IV) received 50 micrograms CCK-4 intravenously in a placebo-controlled, double-blind balanced design. Provocation of panic, anxiety, and flashbacks was assessed. Plasma adrenocorticotropin (ACTH) and cortisol levels after CCK-4 were measured and compared to healthy subjects matched for age, gender, and provoked symptoms. RESULTS: Despite significant effects of CCK-4 on anxiety and panic symptoms, no significant provocation of flashbacks emerged. CCK-4-induced panic symptoms showed an inverse correlation to trait dissociation. The ACTH response after CCK-4 was significantly lower in PTSD patients than in controls. Cortisol was similarly increased in both groups after CCK-4, but PTSD patients showed a more rapid decrease of stimulated cortisol concentrations. CONCLUSIONS: Panic symptoms or heightened anxiety are not necessarily conditioned stimuli for the provocation of posttraumatic flashbacks. Further studies in PTSD with different panicogens should be controlled for the potential interference of trait dissociation. Our hormone data show further evidence for a corticotropin-releasing hormone (CRH) overdrive and enhanced negative glucocorticoid feedback in PTSD patients

Kessler, B.L ; Bieschke (1999)  
A retrospective analysis of shame, dissociation, and adult victimization in survivors of childhood sexual abuse.
Journal of Counseling Psychology, 46(3), 335-341.

King, Brenda Jayne (2002)  
Dissociation: An examination of memory processes.
Dissertation Abstracts International: Section B: the Sciences & Engineering. Vol 62(8-B), Mar 2002, 3823

ABSTRACT A directed forgetting task, using the fist-cuing method, was used to investigate whether dissociators differ in memory performance from non dissociators when material is subject to an intention to forget. Three conditions were used to determine whether context affects memory performance: no load, neutral load, and evocative load. Dissociators showed poorer recall than nondissociators in the no load and neutral conditions while performance on a recognition task was equivalent. This indicates that dissociators can more successfully inhibit retrieval of material subject to an intention to forget under some circumstances. When presented with the evocative condition, dissociators did not maintain greater forgetting. It is hypothesized that the evocative condition makes associative cues more salient so that to-be-forgotten material is more readily accessed and inhibition of retrieval is less likely to occur. Subjects were also presented with a proactive interference task as another means of sampling inhibition of retrieval. No differences existed between groups on this task.

Michael King, PhD; Adrian Coxell, DClinPsy ; Gillian Mezey, FRCPsych (2001)  
Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. E-mail:
Sexual molestation of males: associations with psychological disturbance
The British Journal of Psychiatry (2002) 181: 153-157

ABSTRACT OBJECTIVE: Background There are no epidemiological data in Europe on associations between sexual molestation in males and psychological disturbance. Aims To investigate whether sexual molestation in males is a significant predictor of psychological disturbance. Method We recruited men attending general practice and genitourinary medicine services. Participants took part in a computerised interview about sexual molestation as children or adults. We ranked reported sexual experiences into three categories of decreasing severity. Each category was treated as an independent predictor in a multivariate analysis predicting different types of psychological disturbance. Results Men who reported child sexual abuse were more likely to report any type of psychological disturbance. Men who reported sexual molestation in adulthood were 1.7 (1.0-2.8) times more likely to have experienced a psychological disorder, but self-harm was the single most likely problem to occur (odds ratio=2.6, range=1.3-5.2). Men reporting ‘consenting’ sexual experiences when aged under 16 years also were more likely to report acts of self-harm (odds ratio=1.7, range=0-2.8). Conclusions Sexual abuse as a child or adult is associated with later psychological problems. All forms of sexual molestation were predictive of deliberate self-harming behaviour in men.

Kisiel CL, Lyons JS. (2001)  
Dissociation as a mediator of psychopathology among sexually abused children and adolescents.
Am J Psychiatry 2001 Jul;158(7):1034-9

ABSTRACT OBJECTIVE: This study investigated the role of dissociation as a mediator of mental health outcomes in children with a history of sexual abuse. METHOD: The study group consisted of 114 children and adolescents (ages 10-18 years) who were wards of the Illinois Department of Children and Family Services and were living in residential treatment centers. Interviews, provider ratings, and chart reviews were used to assess the relationship of childhood abuse history, dissociative responses, and psychopathology. RESULTS: Sexual abuse history was significantly associated with dissociation, whereas a history of physical abuse was not. Both sexual abuse and dissociation were independently associated with several indicators of mental health disturbance, including risk-taking behavior (suicidality, self-mutilation, and sexual aggression). Severity of sexual abuse was not associated with dissociation or psychopathology. Analysis of covariance indicated that dissociation had an important mediating role between sexual abuse and psychiatric disturbance. These results were replicated across several assessment sources and varied perspectives. CONCLUSIONS: The findings suggest a unique relationship between sexual abuse and dissociation. Dissociation may be a critical mediator of psychiatric symptoms and risk-taking behavior among sexually abused children. The assessment of dissociation among children may be an important aspect of treatment.

Klain, E. and L. Pavi . (1999)  
Countertransference and empathic problems in therapists/helpers working with psychotraumatized persons
Croatian Medical Journal = ISSN 0353-9504: Vol. 40 (1999), no. 4

ABSTRACT Countertransference in therapists working with patients with posttraumatic stress disorder (PTSD) differs from countertransference in other psychotherapeutical settings. In this article we discuss the specificities of counter- transference in treating PTSD patients and its relation to empathy. The most difficult countertransference problems occur in treating multiply traumatized patients. Countertransference may occur towards an event (e.g., war), patients who have killed people, as well as to colleagues who avoid treating PTSD patients, or towards a supervisor who avoids, either directly or indirectly, supervision of therapists working with PTSD patients. Our recommendation for the prevention of problems in treating PTSD patients include : 1) careful selection of the therapist or helper, both in the personality structure and training; 2) prevention by debriefing and team work and peer supervision; and 3) education - theoretical, practical, and therapeutical

Kluft R.P. (1999)  
An overview of the psychotherapy of dissociative identity disorder.
Am J Psychother 1999 Summer;53(3):289-319

ABSTRACT Dissociative Identity Disorder (DID) is identified and studied with increasing frequency. However, the controversy that often surrounds DID can make it difficult to approach its treatment in a circumspect manner. This paper will provide an overview of DID treatment as it is practiced by those experienced and skilled in the treatment of this group of patients. The treatment of DID resembles the treatment of other traumatized populations in that it is stage-oriented, beginning with supportive and strengthening work. Various stances toward the treatment of DID are reviewed, and specific issues that arise in the psychotherapy of DID are addressed, such as pragmatic arrangements, informed consent, work with alters, and the use of specific techniques, such as hypnosis. The employment of therapeutic modalities and ancillary therapies is discussed. The heterogeneity of DID patients is reviewed, and the characteristics of three general groups of DID patients, high, intermediate, and low in both function and prognosis, are explored. Considerations in the matching of DID patients to either exploratory or supportive treatments are discussed, and observations are made about both trauma work and the supportive psychotherapy of DID.

Kluft R.P.; Foote B (1999)
Dissociative identity disorder: recent developments.
Am J Psychother 1999 Summer;53(3):283-8

Kluft R.P.(1999)
Current issues in dissociative identity disorder
Journal of Practical Psychiatry and Behaviral Health, 5, 3-19.

van der Kolk, Bessel A (2002)
Boston University School of Medicine, Boston MA, USA; Trauma Center, Boston MA, USA.
Psychoanalytic Dialogues (ISSN: 1048-1885), v. 12, no. 3, pp. 381-392 (2002).

Posttraumatic therapy in the age of neuroscience.

ABSTRACT When people develop PTSD in the wake of exposure to a traumatic event, the imprint of that trauma comes to dominate how they organize their way in the world. Verbalizing, making meaning, and putting the event in context may provide a means of feeling understood, rejoining the human race, and gaining perspective on the experience, but it may do little to reorganize the person to feel safe and focused on fulfilling the demands of the present. Given the subcortical nature of trauma imprints, effective therapy needs to help survivors tolerate the sensory reminders of the trauma, and physically experience efficacy and purpose in response to stimuli that once triggered feelings of helplessness and dependence.

van der Kolk, Bessel A; Hopper, James W; Osterman, Janet E. (2001)  
Exploring the nature of traumatic memory: combining clinical knowledge with laboratory methods.
Journal of Aggression, Maltreatment and Trauma (ISSN: 1092-6771), v.4, no 2, pp. 9-31(2001).

ABSTRACT For over 100 years clinicians have observed and described the unusual nature of traumatic memories. It has been repeatedly and consistently observed that these memories are characterized by fragmentary and intense sensations and affects, often with little or no verbal narrative content. Yet, possibly because traumatic memories cannot be precipitated under laboratory conditions, the organization of traumatic memories has received little systematic scientific investigation. In our laboratory we have developed an instrument, the Traumatic Memory Inventory (TMI), which systematically assesses the ways that memories of traumatic experience are organized and retrieved over time. In this article we report findings from our third study using the TMI, of 16 subjects who had the traumatic experience of awakening from general anesthesia during surgery. We assessed changes in traumatic memory characteristics over time and differences between memories of subjects with and without current PTSD. Our findings suggest the need for more rigorous methods for the assessment of the evolution of traumatic memories. In order to develop a comprehensive and integrated understanding of the nature of traumatic memory, we need to combine careful clinical observations with replicable laboratory methods, including those of cognitive science and neuroscience. KEY WORDS: memory, awareness during anesthesia, PTSD, traumatic memories

van der Kolk, Bessel A. (2001)  
The psychobiology and psychopharmacology of PTSD.
Human Psychopharmacology (ISSN: 0885-6222), v. 16, no. Supplement 1, pp. S49-S64 (January 2001).

ABSTRACT This paper reviews the currently available knowledge about the psychobiology and psychopharmacology of PTSD. It also reviews the various studies that have elucidated changes in brain function and structure in PTSD populations, including position emission tomography (PET), single photon emission computed tomography (SPECT), and event-related potential (ERP) studies. It then reviews the literature on catecholamine and hypothalamic-pituitary-adrenal (HPA) axis abnormalities in PTSD, and finally reviews the literature available on the psychopharmacology of PTSD. It discusses how the pathophysiology of PTSD determines the nature of psychopharmacological interventions. Psychopharmacological interventions in PTSD are largely limited to good studies on the effects of the selective serotonin reuptake inhibitors (SSRIs). In order to effectively intervene in PTSD, studies of other psychopharmacological agents are necessary, specifically of agents which affect limbic activation, decreased frontal lobe functioning, altered HPA activity, and other biological features of PTSD. [Author Abstract] KEY WORDS: PTSD; psychopharmacology; SSRIs; psychobiology; brain lateralization; amygdala; hippocampus

van der Kolk, Bessel A.; Streeck-Fischer, Annette . (2000)  
Down will come baby, cradle and all: diagnostic and therapeutic implications of chronic trauma on child development
Australian and New Zealand Journal of Psychiatry (ISSN: 0004-8674), v. 34, no. 6, pp. 903-918 (December 2000).

ABSTRACT OBJECTIVE: This review examines the clinical outcomes associated with exposure to chronic intrafamilial trauma and explores the treatment of the psychological, biological, and cognitive sequelae. METHOD: The existing research literature on the subject was collected, using Index Medicus/MEDLINE, Psychological Abstracts, and the PILOTS database. The research findings were supplemented with clinical observations by the authors and other clinical writings on this topic. RESULTS: Children with histories of exposure to multiple traumatic experiences within their families or in medical settings usually meet criteria for numerous clinical diagnoses, none of which capture the complexity of their biological, emotional, and cognitive problems. These are expressed in a multitude of psychological, cognitive, somatic, and behavioural problems, ranging from learning disabilities to aggression against self and others. CONCLUSIONS: Exposure to intrafamilial violence and other chronic trauma results in pervasive psychological and biological deficits. Treatment needs to address issues of safety, stabilise impulsive aggression against self and others, promote mastery experiences, compensate for specific developmental deficits, and judiciously process both the traumatic memories and trauma-related expectations.

van der Kolk, Bessel A.(2000)  
Trauma, neuroscience, and the etiology of hysteria: an exploration of the relevance of Breuer and Freud's 1893 article in light of modern science
Journal of the American Academy of Psychoanalysis (ISSN: 0090-3604), v. 28, no. 2, pp. 237-262 (Summer 2000).

ABSTRACT OBJECTIVE: The discovery of trauma as an etiological factor in mental disorders is more than a century old, but trauma has only been part of our contemporary lexicon for the past 20 years. Like a century ago, when there was an explosion in the careful description of psychological processes, the past two decades have seen a sudden increase of knowledge about how experience shapes the central nervous system and the formation of the self. Developments in the neurosciences are starting to make significant contributions to our understanding of how the brain is organized by experience, what areas are most malleable, and which are most resistant to change. These studies are beginning to clarify how life itself continues to transform the ways biology is expressed. Like a century ago, the study of trauma has been an extremely fertile area for developing a deeper understanding of the interrelationship among emotional, cognitive, social, and biological forces that shape human development. Starting with PTSD in adults, but expanding into early attachment and coping with overwhelming experiences in childhood, our field has discovered how certain experiences can "set" psychological expectations and biological selectivity. Research in these areas has opened up entirely new insights in how extreme experiences throughout the life cycle can have profound effects on memory, affect regulation, biological stress modulation, and interpersonal relatedness. These findings, in the context of the development of a range of new therapy approaches, are beginning to open up new perspectives on how traumatized individuals can be helped to overcome their past. Some of these methods are likely to jell with the brilliant observations of Breuer and Freud in 1893, while others, like the discoveries of a century ago, may again radically depart from preexisting explanatory frameworks.
van der Kolk, Bessel A.; Gersons, Berthold P R; Carlier, Ingrid V E; Lamberts, Regina D; (2000).
Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands; Harvard Medical School, Boston MA, USA.
Randomized clinical trial of brief eclectic psychotherapy for police officers with posttraumatic stress disorder
Journal of Traumatic Stress (ISSN: 0894-9867), v. 13, no. 2, pp. 333-347 (April 2000).
ABSTRACT The authors report on a randomized, controlled clinical trial on the treatment of PTSD, comparing manualized psychotherapy to wait-list control. This is the first study to evaluate Brief Eclectic Psychotherapy (BEP), which combines cognitive-behavioral and psychodynamic approaches within one treatment method. 42 police officers with the diagnosis of PTSD participated in the study; 22 were randomly assigned to the treatment group and 20 to the wait-list control group. Assessments of PTSD and comorbid conditions were made 1 week before treatment, after treatment session 4, upon termination of treatment (16 sessions), and at follow-up 3 months later. As expected, no significant differences between groups were observed at pretest or at session 4. At posttest and at follow-up, BEP had produced significant improvement in PTSD, in work resumption, and in some comorbid conditions.
Van der Kolk, Bessel A; Pelcovitz, David(1999).
Department of Psychiatry, Harvard Medical School, Boston MA, USA; Department of Psychology, New York University School of Medicine, New York NY, USA.
Clinical applications of the Structured Interview for Disorders of Extreme Stress (SIDES).
National Center for PTSD Clinical Quarterly (ISSN: 1052-7168), v. 8, no. 2, pp. 21, 23-26 (Spring 1999).
ABSTRACT The SIDES provides clinicians and researchers with a rational way of measuring the associated features of PTSD. The measure allows for further studies to provide empirical support for expanding the current PTSD DSM-IV diagnosis to include an additional category of "Disorders of Extreme Stress." It can also guide clinicians to set priorities in the care of traumatized patients. From a research point of view, it provides a vehicle for the systematic study of post-traumatic changes across different trauma populations. [Text, p. 24]
van der Kolk BA (1998)
Boston University Medical School, Brookline, MA 02146, USA.
Psychology and psychobiology of childhood trauma
Prax Kinderpsychol Kinderpsychiatr 1998 Jan;47(1):19-35 [ Article in German]
Cornelis G. Kooiman ; Sonja van Rees Vellinga, Philip Spinhoven, Nel Draijer, Rutger W. Trijsburg, Harry G.M. Rooijmans (2004) 
aDepartment of Psychiatry, Leiden University Medical Center, and bDepartment of Psychology, Faculty of Behavioral and Social Sciences, Leiden University, Leiden, cDepartment of Psychiatry, Free University, Amsterdam, and dDepartment of Medical Psychology and Psychotherapy, Erasmus University, Rotterdam, The Netherlands
Childhood Adversities as Risk Factors for Alexithymia and Other Aspects of Affect Dysregulation in Adulthood
Psychother Psychosom 2004;73:107-116 (DOI:10.1159/000075542)
ABSTRACT Background: Affect regulation is assumed to be a biologically based function that can become disrupted by inadequate parenting and by traumatic experiences. We studied the relation between the perceived parental parenting style, and sexual and physical abuse, with alexithymia, dissociation, anxiety and depression. Methods: In a cross-sectional study psychiatric outpatients were administered a structured interview on childhood physical and sexual abuse and they completed a number of questionnaires about the parenting styles of their parents, and about alexithymia, dissociation and mood pathology. Results: Maternal and paternal parenting styles were moderately correlated with alexithymia and depression. The paternal parenting style was also correlated with dissociation. Optimal parenting of one of the parents had a buffering effect on the degree of alexithymia, but not on the severity of other forms of affect dysregulation. The effect of sexual or physical abuse did not add to that of parental parenting style in terms of predicting affect dysregulation. However, a positively perceived maternal parenting style was found to have a buffering effect in terms of the degree of alexithymia, if sexual abuse had also taken place. Conclusions: Perceived parenting does appear to be of some significance in the development of alexithymia. Optimal parenting of one of the parents may protect against the development of alexithymia when the parenting of the other parent is perceived as non-optimal. However, it is likely that other factors besides parental care and sexual or physical abuse play an important role in the development of an adequate affect regulation.
Cheryl Koopman ;Victor Carrion, Lisa D. Butler, Shiv Sudhakar, Laura Palmer, Hans Steiner (2004) 
Relationships of Dissociation and Childhood Abuse and Neglect with Heart Rate in Delinquent Adolescents
Journal of Traumatic Stress 17 (1): 47-54, February 2004, doi:10.1023/B:JOTS.0000014676.83722.35
ABSTRACT This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.
Koos O, ; Gergely G. (2001) 
Department of Developmental Research at the Institute for Psychology, Hungarian Academy of Sciences, Budapest.
A contingency-based approach to the etiology of 'disorganized' attachment: the 'flickering switch' hypothesis.
Bull Menninger Clin 2001 Summer;65(3):397-410
ABSTRACT The authors present a new approach to the etiology of disorganized attachment based on contingency detection theory. According to this view, the relevant common factor in parental maltreatment and unresolved loss that leads to disorganized attachment has to do with the type of "deviant contingency environment" that both of these conditions generate. In such environments, infants experience periods of being in control followed by periods of sudden loss of control over the caregiver's behavior. The authors hypothesize that this adversely affects the developmental unfolding of the infant's innate "contingency detection module" (Gergely & Watson, 1999), which normally involves a maturational shift around 3 months from an initial attention bias for perfectly contingent stimulation to an emerging preference for less-than-perfect social contingencies. The periodically changing controllability of abusive and dissociating "unresolved" attachment figures is hypothesized to block this process and to lead to the defensive fixation of a dysfunctional "flickering contingency switch" mechanism with two dominant and competing target positions (self-oriented vs. other-oriented). This results in the dissociative style of attention and behavioral organization characteristic of disorganized infant attachment. The authors summarize the preliminary results of an empirical study that provides support for this model in 6.5-month-old infants using a modified Still-Face situation (the Mirror Interaction Situation). The study demonstrates differential emotional and behavioral reactions to sudden loss of maternal contingency and a specific interest in exploring the perfectly contingent self-image in the mirror in infants who at 12 months become categorized as "disorganized" in the Strange Situation.
Salla Koponen, M.D., Tero Taiminen, M.D., M.Sc.D., Raija Portin, Ph.D., Leena Himanen, M.A., Heli Isoniemi, M.D., Hanna Heinonen, M.D., Susanna Hinkka, Ph.Lic., M.Sc., and Olli Tenovuo, M.D., M.Sc.D (2002) 
Axis I and II Psychiatric Disorders After Traumatic Brain Injury: A 30-Year Follow-Up Study

Am J Psychiatry 159:1315-1321, August 2002
ABSTRACT OBJECTIVE: Patients who had suffered traumatic brain injury were evaluated to determine the occurrence of psychiatric disorders during a 30-year follow-up. METHOD: Sixty patients were assessed on average 30 years after traumatic brain injury. DSM-IV axis I disorders were diagnosed on a clinical basis with the aid of the Schedules for Clinical Assessment in Neuropsychiatry (version 2.1), and axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders. Cognitive impairment was measured with a neuropsychological test battery and the Mini-Mental State Examination. RESULTS: Of the 60 patients, 29 (48.3%) had had an axis I disorder that began after traumatic brain injury, and 37 (61.7%) had had an axis I disorder during their lifetimes. The most common novel disorders after traumatic brain injury were major depression (26.7%), alcohol abuse or dependence (11.7%), panic disorder (8.3%), specific phobia (8.3%), and psychotic disorders (6.7%). Fourteen patients (23.3%) had at least one personality disorder. The most prevalent individual disorders were avoidant (15.0%), paranoid (8.3%), and schizoid (6.7%) personality disorders. Nine patients (15.0%) had DSM-III-R organic personality syndrome. CONCLUSIONS: The results suggest that traumatic brain injury may cause decades-lasting vulnerability to psychiatric illness in some individuals. Traumatic brain injury seems to make patients particularly susceptible to depressive episodes, delusional disorder, and personality disturbances. The high rate of psychiatric disorders found in this study emphasizes the importance of psychiatric follow-up after traumatic brain injury
Kruger C, Mace CJ. (2002) 
Department of Psychiatry, University of Pretoria, Pretoria, South Africa.
Psychometric validation of the State Scale of Dissociation (SSD)
Psychol Psychother 2002 Mar;75(Pt 1):33-51
ABSTRACT Although dissociative phenomena are often transient features of mental states, existing measures of dissociation are designed to measure enduring traits. A new present-state self-report measure, sensitive to changes in dissociative states, was therefore developed and psychometrically validated. Fifty-six items were formulated to measure state features, and sorted according to seven subscales: derealization, depersonalization, identity confusion, identity alteration, conversion, amnesia and hypermnesia. The State Scale of Dissociation (SSD) was administered with other psychiatric scales (DES, BDI, BAI, SCI-PANSS) to 130 participants with DSM-IV major depressive disorder schizophrenia, alcohol withdrawal, dissociative disorders and controls. In these sample populations, the SSD was demonstrated as a valid and reliable measure of changes in and the severity of dissociative states. Discriminant validity, content, concurrent, predictive, internal criterion-related, internal construct and convergent validities, and internal consistency and split-half reliability were confirmed statistically. Clinical observations of dissociative states, and their comorbidity with symptoms of depression and psychotic illness, were confirmed empirically. The SSD, an acceptable, valid and reliable scale measuring state features of dissociation at the time of completion, was obtained. This is a prerequisite for further investigation of correlations between changes in dissociative states and concurrent physiological parameters.
Kuyk, Jarl M.A., Spinhoven, Philip Ph.D., Van Emde Boas, Walter M.D., Ph.D., Van Dyck, Richard M.D., Ph.D. (1999) 
Dissociation in Temporal Lobe Epilepsy and Pseudo-Epileptic Seizure Patients
Journal of Nervous & Mental Disease. 187(12):713-720, December 1999.
ABSTRACT Patients with epileptic seizures (ES) and especially those with temporal lobe epilepsy (TLE) share many symptoms with patients with pseudo-epileptic seizures (PES), and the differentiation between them is often difficult. There is growing evidence that a subgroup of PES patients suffer from a dissociative disorder. It is recognized that dissociative symptoms pertain to both psychological and somatoform components of experience. Questionnaires assessing dissociation might provide positive criteria for the diagnosis of PES. In this study, the Dissociation Questionnaire (DIS-Q) and the Somatoform Dissociation Questionnaire (SDQ-20) were administered to patients with ES (TLE, non-TLE) and PES. To control for the influence of general psychoneurotic complaints, the SCL-90 was administered. Apart from this, answers on a trauma questionnaire were related to the diagnosis. Results showed that PES patients scored significantly higher on the SDQ-20, also after correction with the SCL-90, and no difference was found on the DIS-Q. Also, PES patients significantly more often reported sexual traumatic experiences. A logistic regression revealed that results on the SDQ-20 have no independent value in addition to the contribution of gender, age, age at seizure onset, and the presence of sexual abuse in the prediction of the diagnosis. In conclusion, somatoform and not psychological dissociative symptoms are characteristic for PES patients in comparison to ES patients. Other measures are needed within the framework of the differential diagnosis between PES and ES.
Kroes, G., Veerman, J.W., & De Bruyn, E.E.J. . (2000)   
Realiteit en vertekening bij het beoordelen van probleemgedrag van kinderen  
[Reality and bias in the judgment of children's problem behavior].

Jaarboek Ontwikkelingspsychologie, Orthopedagogiek en Kinderpsychiatrie, 4 (1999/2000), 87-118.
ABSTRACT Diagnostic information seems to be informant specific. This chapter reviews the relevant research literature. The focus is on the distortion hypothesis, which predicts biases in diagnostic accuracy to be related to the personality and emotional state of the informant. It is argued that research in this particular field can profit from Funder's (1995) comprehensive Realistic Accuracy Model (RAM).
Kuyk J., Spinhoven P., van Emde Boas W., van Dyck R. (1999) 
Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands.  
Dissociation in temporal lobe epilepsy and pseudo-epileptic seizure patients.
J Nerv Ment Dis 1999 Dec;187(12):713-20
ABSTRACT Patients with epileptic seizures (ES) and especially those with temporal lobe epilepsy (TLE) share many symptoms with patients with pseudo-epileptic seizures (PES), and the differentiation between them is often difficult There is growing evidence that a subgroup of PES patients suffer from a dissociative disorder. It is recognized that dissociative symptoms pertain to both psychological and somatoform components of experience. Questionnaires assessing dissociation might provide positive criteria for the diagnosis of PES. In this study, the Dissociation Questionnaire (DIS-Q) and the Somatoform Dissociation Questionnaire (SDQ-20) were administered to patients with ES (TLE, non-TLE) and PES. To control for the influence of general psychoneurotic complaints, the SCL-90 was administered. Apart from this, answers on a trauma questionnaire were related to the diagnosis. Results showed that PES patients scored significantly higher on the SDQ-20, also after correction with the SCL-90, and no difference was found on the DIS-Q. Also, PES patients significantly more often reported sexual traumatic experiences. A logistic regression revealed that results on the SDQ-20 have no independent value in addition to the contribution of gender, age, age at seizure onset, and the presence of sexual abuse in the prediction of the diagnosis. In conclusion, somatoform and not psychological dissociative symptoms are characteristic for PES patients in comparison to ES patients. Other measures are needed within the framework of the differential diagnosis between PES and ES.