Darves-bornoz JM

ABSTRACT This study took place in a forensic center for rape victims. The authors aims were: first, to explore the longitudinal course of post-traumatic stress disorder (PTSD) and prevalence of disorders over the 6-month period following rape, then second, to group these disorders into syndromes related to chronic PTSD while remaining distinct from it, and third, to establish some predictive factors for chronic PTSD. 92 rape victims consecutively admitted to the center were regularly interviewed over a 6-month period by a psychiatrist. The paper confirms that rape leads to a high proportion of PTSD. Generally speaking, the psychopathology following rape is severe. PTSD at 6 months is associated with phobic and dissociative disorders. It is further associated with a cluster of symptoms arising after rape that the authors term borderline-like. Incestuous rape is a predictive factor for PTSD at 6 months. In the aftermath of rape several semiologically distinct psychotraumatic syndromes exist.

ABSTRACT Assessed the construct validity and internal consistency of a French version of the 28-item, self-rated Dissociative Experiences Scale (DES) in a sample of 140 rape victims (mean age 23.6 yrs, 9% male) consecutively attending a Consultation for Victims of Psychological Trauma at the University Hospital in Tours, France. The mean score (24.1) was high, and 33% of the scores exceeded a threshold set at 30. The Principal Components Analysis of the DES ratings yielded a 3-factor solution: depersonalization-derealization, amnestic fragmentation of identity, and absorption-imaginative involvement. DES reliability was studied through computation of Cronbach's alphacoefficient (0.94). The authors conclude that during the validation of a French version of the DES, this study showed that dissociation is considerably linked to rape-trauma victim populations.

Darves-Bornoz JM ,Berger C, Degiovanni A, Gaillard P, Lepine JP

ABSTRACT Clinicians are familiar with the life and psychological difficulties of incest victims, but their observations often are refuted as being retrospective and unsystematic. We aimed to ascertain similarities and differences between incestuous rape and nonincestuous rape. One hundred and two victims consulting a French forensic center were interviewed in a systematic follow-up study over 6 months using structured interview schedules. Stepwise logistic regression analysis adjusted for age, gender, and characteristics of the trauma showed that posttraumatic stress disorder, dissociative disorders, agoraphobia, and low self-esteem were overrepresented in the incest-rape group compared to the nonincest-rape group.

ABSTRACT (Dissociation referred to here is between implicit and explicit memory)In contrast to previous research on directed forgetting, the present studies adopted a recent modification of the process dissociation procedure to accommodate the cross-contamination of memory test performance by implicit and explicit memorial factors. In Experiment 1, 120 subjects were compared in global directed forgetting, item-by-item directed forgetting, and control conditions on estimates of voluntary conscious memory, involuntary conscious memory, and involuntary unconscious memory performance. In Experiment 2, 80 subjects were compared in specific directed forgetting and control conditions on estimates of voluntary conscious memory, involuntary conscious memory, and involuntary unconscious memory performance. Subjects showed significant decrements in voluntary and involuntary conscious memory performance following instructions for directed forgetting in all conditions. None of the directed forgetting conditions showed a decrement in involuntary- unconscious memory performance. Results suggest that, regardless of instruction type, directed forgetting prevents the conscious expression of memorial information (both voluntary and involuntary) while leaving unconscious memory intact.

ABSTRACT This study's objectives were to assess psychotic symptoms according to Mental Disorders-III-Revised (DSM-III-R) criteria in patients with a primary diagnosis of combat-related posttraumatic stress disorder (PTSD) and determine the associations of those symptoms with psychiatric comorbidity and ethnicity. 53 male combat veterans (aged 26-63 yrs) consecutively admitted to a PTSD rehabilitation unit were assessed for psychotic symptoms and Axis I disorders. 40% of patients reported a psychotic symptom or symptoms in the preceding 6 mo. These symptoms featured auditory hallucinations in all but 1 case. The psychotic symptoms typically reflected combat-themes and guilt, were nonbizarre, and were not usually associated with formal thought disorder or flat or inappropriate affect. Psychotic symptoms were significantly associated with current major depression, but not with alcohol or drug abuse or with self-rated PTSD and dissociation severity.

Davidson, Jonathan R T; Rothbaum, Barbara Olasov; Van der Kolk, Bessel A; Sikes, Carolyn R; Farfel, Gail M. (2001).  
Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder
Archives of General Psychiatry (ISSN: 0003-990X), v. 58, no. 5, pp. 485-492 (May 2001).

ABSTRACT BACKGROUND: PTSD is a common illness associated with significant disability. Few large, placebo-controlled trials have been reported. METHODS: Outpatients with a DSM-III-R diagnosis of moderate-to-severe PTSD were randomized to 12 weeks of double-blind treatment with either sertraline (N = 100) in flexible daily doses in the range of 50 to 200 mg or placebo (N = 108). Primary outcome measures consisted of the Clinician-Administered PTSD Scale (CAPS-2) total severity score, the patient-rated Impact of Event Scale (IES), and the Clinical Global Impression-Severity (CGI-S) and -Improvement (CGI-I) ratings. RESULTS: Mixed-effects analyses found significantly steeper improvement slopes for sertraline compared with placebo on the CAPS- 2 (t = 2.96, P = .003), the IES (t = 2.26, P = .02), the CGI-I score (t = 3.62, P < .001), and the CGI-S score (t = 4.40, P < .001). An intent-to-treat end- point analysis found a 60 percent responder rate for sertraline and a 38 percent responder rate for placebo (chi-square [subscript-1] = 8.48, P = .004). Sertraline treatment was well tolerated, with a 9 percent discontinuation rate because of adverse events, compared with 5 percent for placebo. Adverse events that were significantly more common in subjects given sertraline compared with placebo consisted of insomnia (35 percent vs 22 percent), diarrhea (28 percent vs 11 percent), nausea (23 percent vs 11 percent), fatigue (13 percent vs 5 percent), and decreased appetite (12 percent vs 1 percent). CONCLUSION: The results of the current study suggest that sertraline is a safe, well-tolerated, and significantly effective treatment for PTSD.

Davies, J.M. (1999).  
Getting cold feet, defining "safe enough" borders: Dissociation, multiplicity, and integration in the analyst's experience
Psychoanalytic Quarterly, 68, 184-208.

ABSTRACT This paper attempts to explore the fate of the analyst's multiple self/other organizations during times of heightened countertransferential enactment. It is suggested that such countertransference activity involved the "de-homogenization" of otherwise indecipherable integrated self/other constellations, evoked independently or in response to, but always in interaction with, the patient's own unique organization of multiple centers of psychic awareness and unconscious receptivity. An extended clinical example is used to illustrate the theoretical conceptualization.

DeBellis, M.D., Keshavan, M.S., Clark, D.B., Casey, B.J., Giedd, J.N., Boring, A.M., Frustaci, K., Ryan, N.D. (1999)  
Developmental traumatology: II. Brain development.
Biological Psychiatry, 45, 1271-1284.

ABSTRACT Previous investigations suggest that maltreated children with a diagnosis of posttraumatic stress disorder (PTSD) evidence alterations of biological stress systems. In this study, 44 maltreated children and adolescents (aged 6.7-17 yrs) with PTSD and 61 healthy matched controls underwent comprehensive psychiatric and neuropsychological assessments and an anatomical magnetic resonance imaging (MRI) brain scan. Results show that PTSD Ss had smaller intracranial and cerebral volumes than matched controls. The total midsagittal area of corpus callosum and middle and posterior regions remained smaller; while right, left, and total lateral ventricles were proportionally larger than controls, after adjustment for intracranial volume. Brain volume robustly and positively correlated with age of onset of PTSD trauma and negatively correlated with duration of abuse. Symptoms of intrusive thoughts, avoidance, hyperarousal or dissociation correlated positively with ventricular volume, and negatively with brain volume and total corpus callosum and regional measures. It is concluded that the overwhelming stress of maltreatment experiences in childhood is associated with adverse brain development.

ABSTRACT The ability to accurately detect violations in social contracts likely helps people to avoid or to withdraw from relationships in which they are at risk of being cheated or harmed. Betrayal trauma theory argues that detecting violations of social contracts may be counter-productive to survival under certain conditions, such as when a victim is dependent on a perpetrator. When dependent on a perpetrator (as in the case of child abuse perpetrated by a caregiver), the victim may be better able to preserve the necessary attachment with the caregiver by remaining unaware of the abuse. Thus, the victim may develop a compromised capacity to detect violations of social contracts in the caregiving relationship. Over time, the victim may develop more generalized problems detecting violations in social exchange rules; in turn, generalized problems in detecting violations of social contracts may increase risk for later victimization. Participants in the current study were asked to detect violations in three types of conditional (if-then) rules: abstract, social contract (rules involving a social exchange), and precautionary (rules involving safety). Young adults who reported experiences of revictimization made more errors on social contract and precautionary problems than a no revictimization group; group performance did not differ for abstract problems, suggesting these findings are not explained by general deficits in conditional reasoning. Pathological dissociation significantly predicted errors on social contract and precautionary problems.

Dell, Paul F. (2002)  
Dissociative phenomenology of dissociative identity disorder
J Nerv Ment Dis 2002 Jan;190(1):10-5

ABSTRACT The goal of this study was to investigate the dissociative phenomenology of dissociative identity disorder (DID). The Multidimensional Inventory of Dissociation (MID) was administered to 34 patients with DID, 23 patients with dissociative disorder not otherwise specified (DDNOS), 52 patients with mixed psychiatric disorders, and 58 normal individuals. DID patients obtained significantly higher scores than the other three groups on 27 dissociation-related variables. DDNOS patients had significantly higher scores than normals and mixed psychiatric patients on 17 and 15 dissociation-related variables, respectively. The findings of the present study are virtually identical to a large body of replicated findings about the dissociative phenomenology of DID. This broad range of dissociation-related phenomena, which routinely occurs in individuals with DID, is largely absent from the DSM-IV-TR account of DID. Factor analysis of the 11 dimensions of dissociation that are measured by the MID extracted only one factor that accounted for 85% of the variance. It was concluded that dissociation is a unifactorial taxon or natural type that has different aspects or epiphenomena (i.e., amnesia, depersonalization, voices, trance, etc.).

Dell, Paul F. (2001)  
Why the diagnostic criteria for dissociative identity disorder should be changed.
Journal of Trauma and Dissociation (ISSN: 1529-9732), v. 2, no. 1, pp. 7-37 (2001).

ABSTRACT This paper examines the psychiatric diagnosis of dissociative identity disorder (DID) in light of the developments in psychiatric classification that have guided the last four revisions of the Diagnostic and Statistical Manual for Mental Disorders (DSM). The author argues that multiple personality's passage from DSM-III, through DSM-III-R, to its current form as DID in DSM-IV-TR has left the diagnosis out of step with the state of the art of psychiatric classification. Ten disadvantages of the DSM-IV-TR criteria for DID are identified. The DSM-IV-TR criteria for DID: (1) are out of step with the state of the art of psychiatric classification; (2) are not based on taxometric analysis of the symptoms of DID; (3) incorrectly imply that DID is a closed concept; (4) have poor content validity; (5) throw away important information; (6) discourage taxonomic research; (7) have poor reliability and cause frequent misdiagnoses; (8) are not "user-friendly"; (9) are unnecessarily controversial: and (10) along with previous versions of the DSM, have produced an artifactually low base-rate of DID for the past 20 years. In an effort to remedy these disadvantages, a reliable, user-friendly, polythetic set of diagnostic criteria for "Major Dissociative Disorder" is proposed for DSM-V. Using these polythetic criteria, the dissociative disorders (presently conceptualized as Dissociative Amnesia, Dissociative Fugue, DID, Depersonalization Disorder, and Dissociative Disorder Not Otherwise Specified) can be restructured into an easily understood and more reliable set of diagnostic entities. This alternate nosology of the dissociative disorders consists of Simple Dissociative Disorder (with at least three subtypes), Generalized Dissociative Disorder, Major Dissociative Disorder (with two subtypes), and Dissociative Disorder Not Otherwise Specified.

ABSTRACT Examined cognitive correlates of dissociative tendencies and considered the results in the context of theory-building in the dissociation and traumatic stress literature. The current study is a replication and extension of research by R. J. McNally et al (1998). Ss were undergraduate students selected based on their performance on the Dissociative Experiences Scale (DES): 28 Ss (mean age 19 yrs) were high-scorers (score>=20) and 28 Ss (mean age 21 yrs) were low-scorers (score<=10). Ss performed a computerized directed forgetting task using trauma, neutral, and positive words that they were directed to either remember or forget. Words were randomly assigned to 3 blocks, each of which was paired with 1 of 3 attention conditions: selective attention; divided attention with key press; and divided attention with voice response. Each block was viewed 3 times by each S and presented in a random order. After viewing all word blocks, Ss performed free recall and recognition tests. Results show differences between high- and low- DES scorers during the divided attention with key press condition. Consistent with prior research, when divided attention was required, high-scoring DES Ss recalled fewer trauma and more neutral words than did low-scoring DES Ss, who showed the opposite pattern.

Psychological Science, 10, 449-452.

ABSTRACT Two groups of college students were selected on the basis of their scores on the Dissociative Experiences Scale (DES). The high-DES group and low-DES group both completed the standard and a new dual-task version of the Stroop ink-naming task with xs (baseline condition) and color, neutral, and emotionally charged words. Free recall results indicated that high-DES participants remembered fewer emotionally charged words than low-DES participants. We found a crossover interaction for Stroop interference: High-DES participants showed more interference (conflicting color--baseline latency for ink naming) in a selective-attention Stroop task and less interference in the dual-task Stroop task. The interaction between attentional context and dissociation for Stroop interference and the free recall results are consistent with a cognitive-environments view of dissociative tendencies. In this view, dissociative tendencies, which have been otherwise speculated to be largely deleterious, can be advantageous in certain contexts.

Arch Pediatr Adolesc Med. 2000 Jan;154(1):16-22

ABSTRACT Objective: To identify differences between hospitalized children injured by child abuse and those with unintentional injuries. DESIGN: Comparative analysis of patients injured by child abuse (n = 1997) with patients injured unintentionally (n = 16 831), newborn to 4 years of age. Main Outcome Measures: Patient characteristics, nature and severity of injury, treatment, length of stay, survival, functional limitations, and disposition at discharge from the hospital. Data Source: Retrospective review of medical records submitted to the National Pediatric Trauma Registry between January 1, 1988, and December 31, 1997. Results: During the 10-year study period, child abuse accounted for 10.6% of all blunt trauma to patients younger than 5 years. Children injured by child abuse were significantly younger (mean, 12.8 vs 25.5 months) and were more likely to have preinjury medical history (53% vs 14.1%) and retinal hemorrhages (27.8% vs 0.06%) than children with unintentional injuries. Abused children were mainly injured by battering (53%) and by shaking (10.3%); unintentionally injured children were hurt mainly by falls (58.4%) and by motor vehicle-related events (37.1%). Abused children were more likely than unintentionally injured children to sustain intracranial injury (42.2% vs 14.1%) and thoracic (12.5% vs 4.5%) and abdominal (11.4% vs 6.8%) injuries; to sustain very severe injuries (22.6% vs 6.3%); to be admitted to the intensive care unit (42.5% vs 26.9%); and to receive Child Protective Services (82.3% vs 8%) and Social Services (72.9% vs 27.6%) intervention. The mean length of stay for children who were abused was significantly longer (9.3 vs 3.8 days) and the survival to discharge from the hospital was significantly worse (87.3% vs 97.4%) than for those unintentionally injured. Among the survivors, children who were abused developed extensive functional limitations more frequently than those unintentionally injured (8.7% vs 2.7%). More than half (56.6%) of the children who were abused were discharged to custodial/foster/Child Protective Services care; most (96.1%) of the children unintentionally injured returned to their homes. Conclusions: Child abuse continues to be a serious cause of mortality and morbidity to infants and toddlers. On average, among children hospitalized for blunt trauma, those injured by abuse sustain more severe injuries, use more medical services, and have worse survival and functional outcome than children with unintentional injuries.

Australian & New Zealand Journal of Psychiatry. Vol 38(1-2) Jan 2004, 47-55.

ABSTRACT Memory dysfunction is a central feature of dissociative identity disorder (DID). Following the memorial anomalies outlined by Putnam [Putnam, F. W. (1994). Dissociation and disturbances of self. In: D. Cicchetti & S. L. Toth (Eds.), Disorders and dysfunctions of the self, vol. 5 (pp. 251-265). Rochester, NY: University of Rochester Press; Putnam, F. W. (1995). Development of dissociative disorders. In: D. Chicchetti & D. J. Cohen (Eds.), Developmental psychopathology, vol. 2 (pp. 581-608). New York: Wiley], the experimental research using DID case studies and samples is reviewed. As a whole, research suggests that amnesic barriers between alter personalities are typically impervious to explicit stimuli, as well as conceptually driven implicit stimuli. Autobiographical memory deficits are also experimentally evident in DID. Although no experimental studies have addressed the issue of source amnesia or pseudomemories, there is some evidence that pseudomemories are an infrequent but real phenomenon in DID patients. Finally, potential deficits in working memory are outlined, including those relating to cognitive inhibition. Research directions are discussed throughout to further elucidate the nature of memory dysfunction in DID.

Clin Psychol Rev 2001 Jul;21(5):771-95

ABSTRACT Memory dysfunction is a central feature of dissociative identity disorder (DID). Following the memorial anomalies outlined by Putnam [Putnam, F. W. (1994). Dissociation and disturbances of self. In: D. Cicchetti & S. L. Toth (Eds.), Disorders and dysfunctions of the self, vol. 5 (pp. 251-265). Rochester, NY: University of Rochester Press; Putnam, F. W. (1995). Development of dissociative disorders. In: D. Chicchetti & D. J. Cohen (Eds.), Developmental psychopathology, vol. 2 (pp. 581-608). New York: Wiley], the experimental research using DID case studies and samples is reviewed. As a whole, research suggests that amnesic barriers between alter personalities are typically impervious to explicit stimuli, as well as conceptually driven implicit stimuli. Autobiographical memory deficits are also experimentally evident in DID. Although no experimental studies have addressed the issue of source amnesia or pseudomemories, there is some evidence that pseudomemories are an infrequent but real phenomenon in DID patients. Finally, potential deficits in working memory are outlined, including those relating to cognitive inhibition. Research directions are discussed throughout to further elucidate the nature of memory dysfunction in DID.

Am J Psychiatry, 156(3):379-85 1999 Mar

ABSTRACT This study examined the level of dissociation in relation to childhood trauma (sexual/physical abuse, witnessing interparental violence), early separation from a parent, and perceived parental dysfunction. 160 Ss (mean age 35.6 yrs) admitted to a psychiatric hospital were given the Dissociative Experiences Scale (DES) and the Structured Trauma Interview. The mean DES score was 17.4; 18.0% of Ss scored beyond 30. Early separation was reported by 26.4% of the patients; 30.1% had witnessed interparental violence; 23.6% reported physical abuse; 34.6% reported sexual abuse; 11.7% reported rape before age 16; and 42.1% reported sexual and/or physical abuse. The level of dissociation was related to reported sexual and physical abuse. When sexual abuse was severe, dissociative symptoms were more prominent. Highest dissociation levels were found in Ss reporting cumulative sexual trauma or sexual and physical abuse. In particular, maternal dysfunction was related to the level of dissociation. Stepwise multiple regression analysis indicated that severity of dissociation was predicted by sexual and physical abuse and maternal dysfunction. These findings indicate that dissociation is trauma- and neglect-related.

Biol Psychiatry. 2004 Mar 15;55(6):603-11. doi:10.1016/j.biopsych.2003.08.018

ABSTRACT BACKGROUND: Early traumatization and additional posttraumatic stress disorder are frequent in patients with borderline personality disorder (BPD). The purpose of this study was to investigate neural correlates of traumatic memory in BPD with and without posttraumatic stress disorder (PTSD) using functional magnetic resonance imaging (fMRI). METHODS: We studied 12 traumatized female patients BPD, 6 of them with and 6 without PTSD. According to an autobiographical interview key words (cues) were defined for traumatic and for negative but nontraumatic episodes. In a block-designed fMRI task patients recalled these episodes. Contrasts between trauma condition and nontrauma condition were analyzed. RESULTS: Analyses for all subjects revealed activation of orbitofrontal cortex areas in both hemispheres, anterior temporal lobes, and occipital areas. In the subgroup without PTSD, activation of orbitofrontal cortex on both sides and Broca's area predominated. In the subgroup with additional PTSD, we observed right more than left activation of anterior temporal lobes, mesiotemporal areas, amygdala, posterior cingulate gyrus, occipital areas, and cerebellum. CONCLUSIONS: Dependent on absence or presence of additional PTSD different neural networks seem to be involved in the traumatic memory of patients with BPD.

Arch Gen Psychiatry. 2000;57:1115-1122

ABSTRACT Background: Based on findings of stress-induced neural disturbances in animals and smaller hippocampal volumes in humans with posttraumatic stress disorder), we hypothesized that patients with borderline personality disorders (BPD), who often are victims of early traumatization, have smaller volumes of the hippocampus and the amygdala. We assumed that volumes of these brain regions are negatively correlated with traumatic experiences and with neuropsychological deficits.
METHODS:e studied 21 female patients with BPD and a similar group of healthy controls. We performed clinical assessments, a modified version of the Childhood Trauma Questionnaire, and magnetic resonance imaging volumetric measurements of the hippocampus, amygdala, temporal lobes, and prosencephalon. Neuropsychological testing included scales on which disturbances in BPD were previously reported.
RESULTS: The patients with BPD had nearly 16% smaller volumes of the hippocampus (P<.001) and 8% smaller volumes of the amygdala (P<.05) than the healthy controls. The results for both hemispheres were nearly identical and were controlled for the volume of the prosencephalon and for head tilts. The volumes of the hippocampus were negatively correlated with the extent and the duration of self-reported early traumatization only when BPD and control subjects were considered together. Levels of neuropsychological functioning were associated with the severity of depression but not with the volumes of the hippocampus.onclusion In female patients with BPD, we found reduction of the volumes of the hippocampus (and perhaps of the amygdala), but the association of volume reduction and traumatic experiences remains unclear.

ABSTRACT The primary aim of the present study was to investigate the association between spontaneous experiences of depersonalization or derealization (D-D) during panic states and hypnosis in low and highly hypnotizable phobic individuals. Secondarily, the association among level of hypnotizability, capacity for imaginative involvement, and severity of phobic complaints was also assessed. Sixty-four patients with panic disorder with agoraphobia according to the DSM-III-R (American Psychiatric Association, 1987) criteria participated in the study. Proneness to experience D-D during hypnosis was positively related to hypnotizability, but only for agoraphobic patients who had already experienced these perceptual distortions during panic episodes. Correlations of level of hypnotizability and capacity for imaginative involvement with severity of agoraphobic complaints were not significant. These findings suggest that hypnotizability may be a mediating variable between two different, although phenotypically similar, perceptual distortions experienced during panic states and hypnosis. Implications for both theory and clinical practice are discussed.

Proc Natl Acad Sci U S A 1998 Feb 3;95(3):891-8

ABSTRACT Human functional neuroimaging techniques provide a powerful means of linking neural level descriptions of brain function and cognition. The exploration of the functional anatomy underlying human memory comprises a prime example. Three highly reliable findings linking memory-related cognitive processes to brain activity are discussed. First, priming is accompanied by reductions in the amount of neural activation relative to naive or unprimed task performance. These reductions can be shown to be both anatomically and functionally specific and are found for both perceptual and conceptual task components. Second, verbal encoding, allowing subsequent conscious retrieval, is associated with activation of higher order brain regions including areas within the left inferior and dorsal prefrontal cortex. These areas also are activated by working memory and effortful word generation tasks, suggesting that these tasks, often discussed as separable, might rely on interdependent processes. Finally, explicit (intentional) retrieval shares much of the same functional anatomy as the encoding and word generation tasks but is associated with the recruitment of additional brain areas, including the anterior prefrontal cortex (right > left). These findings illustrate how neuroimaging techniques can be used to study memory processes and can both complement and extend data derived through other means. More recently developed methods, such as event-related functional MRI, will continue this progress and may provide additional new directions for research.