ABSTRACT OBJECTIVE: This paper describes the clinical characteristics of 20 hospitalized psychiatric patients in the Hebei province of China who believed they were possessed. METHODS: A structured interview focused on clinical characteristics associated with possession phenomena was developed and administered to 20 patients at eight hospitals in the province. All patients had been given the Chinese diagnosis of yi-ping (hysteria) by Chinese physicians before being recruited for the study. RESULTS: The subjects' mean age was 37 years. Most were women from rural areas with little education. Major events reported to precede possession included interpersonal conflicts, subjectively meaningful circumstances, illness, and death of an individual or dreaming of a deceased individual. Possessing agents were thought to be spirits of deceased individuals, deities, animals, and devils. Twenty percent of subjects reported multiple possessions. The initial experience of possession typically came on acutely and often became a chronic relapsing illness. Almost all subjects manifested the two symptoms of loss of control over their actions and acting differently. They frequently showed loss of awareness of surroundings, loss of personal identity, inability to distinguish reality from fantasy, change in tone of voice, and loss of perceived sensitivity to pain. CONCLUSIONS: Preliminary findings indicate that the disorder is a syndrome with distinct clinical characteristics that adheres most closely to the DSM-IV diagnosis of dissociative trance disorder under the category of dissociative disorder not otherwise specified.

ABSTRACT The aim of the study was to determine the frequency of dissociative disorders among psychiatric inpatients in Germany and to investigate the relationship between childhood trauma and dissociation. The German version of the Dissociative Experiences Scale (DES), the Fragebogen fur Dissoziative Symptome (FDS), was used to screen 115 consecutive inpatients admitted to the psychiatric clinic of a university hospital. Patients with FDS scores higher than 20 were interviewed by a trained clinician, using the German translation of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). The German version of the Childhood Trauma Questionnaire (CTQ) was administered to investigate prevalence of childhood trauma and relations between childhood trauma and dissociation in adult life. 25 of the 115 patients (21.7 percent) had a score higher than 20 on the FDS. Of these, 15 patients were interviewed with the SCID-D-R. 1 patient was diagnosed with a dissociative identity disorder, 3 with dissociative disorders not otherwise specified, and 1 patient with depersonalization disorder. All diagnoses were confirmed clinically. A significant positive relationship was found between the severity of childhood trauma and dissociation. Dissociative disorders are common among German psychiatric inpatients. Clinicians who work in psychiatric inpatient units should be mindful of these disorders.

ABSTRACT In North America, dissociative disorders have gained a central position in psychiatric research of the last 20 years. Their most severe form, the dissociative identity disorder, has been explored with utmost thoroughness. The dissociative identity disorder seems to be a complex posttraumatic disorder with a central etiological role of sexual traumatizations in early childhood. Critics, however, expressed their doubts about the validity of the posttraumatic model and the psychiatric diagnosis itself. They assume it to be a matter of the cultural and suggestive impact of the media and of improper psychotherapy. In the present article evidence is provided about the arguments of the socio-cognitive model being scientifically unsubstantiated. A bulk of empirical results supports the assumption that dissociative identity disorder and similar diseases regularly occur both in North America and Europe, but they are rather rarely diagnosed. Therefore, it seemes both to make sense and be necessary to develop diagnostic and treatment programs for dissociative identity disorders and to promote their implementation.

ABSTRACT The aim of the study was to determine the frequency of dissociative disorders among psychiatric inpatients in Germany and to investigate the relationship between childhood trauma and dissociation. The German version of the Dissociative Experiences Scale (DES), the Fragebogen fur Dissoziative Symptome (FDS), was used to screen 115 consecutive inpatients admitted to the psychiatric clinic of a university hospital. Patients with FDS scores higher than 20 were interviewed by a trained clinician, using the German translation of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). The German version of the Childhood Trauma Questionnaire (CTQ) was administered to investigate prevalence of childhood trauma and relations between childhood trauma and dissociation in adult life. Twenty-five of the 115 patients (21.7%) had a score higher than 20 on the FDS. Of these, 15 patients were interviewed with the SCID-D-R. One patient was diagnosed with a dissociative identity disorder, three with dissociative disorders not otherwise specified, and one patient with depersonalization disorder. All diagnoses were confirmed clinically. A significant positive relationship was found between the severity of childhood trauma and dissociation. Dissociative disorders are common among German psychiatric inpatients. Clinicians who work in psychiatric inpatient units should be mindful of these disorders.

Gershuny, B.S., & Thayer, J.F. (1999).  
Relations among psychological trauma, dissociative phenomena, and trauma-related distress: A review and integration.
Clinical Psychology Review, 19, 631-657.

ABSTRACT Recently, there has been a resurgence of interest in relations among psychological trauma, dissociative phenomena (DP), and various forms of trauma-related distress (TRD) that has spawned a prolific amount of research. This paper provides a comprehensive review of this research to help summarize and synthesize recent findings, illuminate study limitations, and offer suggestions for future research. In general, findings have revealed fairly strong and consistent relations among the constructs of trauma, dissociation, and TRD (e.g., posttraumatic stress disorder [PTSD], borderline personality disorder, bulimia); individuals who have experienced a traumatic event are more likely to dissociate than individuals who have not, and individuals who experience more DP are more likely to also experience higher levels of TRD. It is theorized here that DP and subsequent TRD may relate to fears about death and fears about loss or lack of control above and beyond the occurrence of the traumatic event itself. Such fears about death and loss/lack of control may also help differentiate traumatized individuals who psychologically suffer to varying degrees. Possible functions of dissociation in response to trauma and in relation to forms of TRD are considered and discussed.

Giesbrecht T , Merckelbach H, Geraerts E, Smeets E.(2004).  
Dissociation in undergraduate students: disruptions in executive functioning.
J Nerv Ment Dis. 2004 Aug;192(8):567-9.

ABSTRACT The concept of dissociation refers to disruptions in attentional control. Attentional control is an executive function. Few studies have addressed the link between dissociation and executive functioning. Our study investigated this relationship in a sample of undergraduate students (N = 185) who completed the Dissociative Experiences Scale and the Random Number Generation Task. We found that minor disruptions in executive functioning were related to a subclass of dissociative experiences, notably dissociative amnesia and the Dissociative Experiences Scale Taxon. However, the two other subscales of the Dissociative Experiences Scale, measuring depersonalization and absorption, were unrelated to executive functioning. Our findings suggest that a failure to inhibit previous responses might contribute to the pathological memory manifestations of dissociation.

Glaser, Danya (2000).  
Child Abuse and Neglect and the Brain - A Review .
Journal of Child Psychology and Psychiatry (2000), 41:97-116. Cambridge University Press.

ABSTRACT Developmental psychology and the study of behaviour and emotion have tended to be considered in parallel to the study of neurobiological processes. This review explores the effects of child abuse and neglect on the brain, excluding nonaccidental injury that causes gross physical trauma to the brain. It commences with a background summary of the nature, context, and some deleterious effects of omission and commission within child maltreatment. There is no post-maltreatment syndrome, outcomes varying with many factors including nature, duration, and interpersonal context of the maltreatment as well as the nature of later intervention. There then follows a section on environmental influences on brain development, demonstrating the dependence of the orderly process of neurodevelopment on the child's environment. Ontogenesis, or the development of the self through self-determination, proceeds in the context of the nature-nurture interaction. As a prelude to reviewing the neurobiology of child abuse and neglect, the next section is concerned with bridging the mind and the brain. Here, neurobiological processes, including cellular, biochemical, and neurophysiological processes, are examined alongside their behavioural, cognitive, and emotional equivalents and vice versa. Child maltreatment is a potent source of stress and the stress response is therefore discussed in some detail. Evidence is outlined for the buffering effects of a secure attachment on the stress response. The section dealing with actual effects on the brain of child abuse and neglect discusses manifestations of the stress response including dysregulation of the hypothalamic-pituitary-adrenal axis, and parasympathetic and catecholamine responses. Recent evidence about reduction in brain volume following child abuse and neglect is also outlined. Some biochemical, functional, and structural changes in the brain that are not reflections of the stress response are observed following child maltreatment. The mechanisms bringing about these changes are less clearly understood and may well be related to early and more chronic abuse and neglect affecting the process of brain development. The behavioural and emotional concomitants of their neurobiological manifestations are discussed. The importance of early intervention and attention to the chronicity of environmental adversity may indicate the need for permanent alternative caregivers, in order to preserve the development of the most vulnerable children.

Glisky EL, Ryan L, Reminger S, Hardt O, Hayes SM, Hupbach A. (2004)  
A case of psychogenic fugue: I understand, aber ich verstehe nichts.
Neuropsychologia. 2004;42(8):1132-47.

ABSTRACT Psychogenic fugue is a disorder of memory that occurs following emotional or psychological trauma and results in a loss of one's personal past including personal identity. This paper reports a case of psychogenic fugue in which the individual lost access not only to his autobiographical memories but also to his native German language. A series of experiments compared his performance on a variety of memory and language tests to several groups of control participants including German-English bilinguals who performed the tasks normally or simulated amnesia for the German language. Neuropsychological, behavioral, electrophysiological and functional neuroimaging tests converged on the conclusion that this individual suffered an episode of psychogenic fugue, during which he lost explicit knowledge of his personal past and his native language. At the same time, he appeared to retain implicit knowledge of autobiographical facts and of the semantic or associative structure of the German language. The patient's poor performance on tests of executive control and reduced activation of frontal compared to parietal brain regions during lexical decision were suggestive of reduced frontal function, consistent with models of psychogenic fugue proposed by Kopelman [The Handbook of Memory Disorders, 2nd ed., Wiley, Chichester, 2002, p. 451] and Markowitsch [Memory, Consciousness, and the Brain, Psychology Press, Philadelphia, 2000, p. 319].

Gidron, Yori; Gal, Reuven; Freedman, Sara A; Twiser, Irit; Lauden, Ari; Snir, Yoram; Benjamin, Jonathan. (2001)  
Translating research findings to PTSD prevention: results of a randomized-controlled pilot study.
Journal of Traumatic Stress (ISSN: 0894-9867), v. 14, no. 4, pp. 773-780 (October 2001). 5.

ABSTRACT Based on therapeutic studies revealing positive prognostic factors and on research findings revealing how trauma is processed, we developed the memory structuring intervention (MSI) in attempt to prevent PTSD. The MSI attempts to shift processing of traumatic memory from uncontrollable somatosensory and affective processes to more controlled linguistic and cognitive processes by providing patients organization, labeling, and causality. In a single-blind randomized-controlled pilot study, 17 traffic accident victims at risk for PTSD (heart rate > 94 BPM) were assigned to two MSI or two supportive-listening control sessions. Three months later, MSI patients reported significantly less frequent intrusive, arousal, and total PTSD symptoms than controls. A replication study with a larger sample is underway.

Gilbertson, Mark W. Martha E. Shenton, Aleksandra Ciszewski, Kiyoto Kasai, Natasha B. Lasko1, Sott P. Orr1, & Roger K. Pitman (2002)
Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma
Nature Neuroscience: November 2002 Volume 5 Number 11 pp 1242 - 1247

ABSTRACT In animals, exposure to severe stress can damage the hippocampus. Recent human studies show smaller hippocampal volume in individuals with the stress-related psychiatric condition posttraumatic stress disorder (PTSD). Does this represent the neurotoxic effect of trauma, or is smaller hippocampal volume a pre-existing condition that renders the brain more vulnerable to the development of pathological stress responses? In monozygotic twins discordant for trauma exposure, we found evidence that smaller hippocampi indeed constitute a risk factor for the development of stress-related psychopathology. Disorder severity in PTSD patients who were exposed to trauma was negatively correlated with the hippocampal volume of both the patients and the patients' trauma-unexposed identical co-twin. Furthermore, severe PTSD twin pairs—both the trauma-exposed and unexposed members—had significantly smaller hippocampi than non-PTSD pairs.

Gleaves, D.H., Hernandez, E., & Warner, M.S. (1999)  
Corroborating premorbid dissociative symptomatology in dissociative identity disorder.
Professional Psychology - Research & Practice, 30, 341-345.

ABSTRACT Clinicians are often cautious about making the diagnosis of Dissociative Identity Disorder (DID). The existence of corroborating evidence that symptoms of DID existed prior to assessment may address concerns about the genuineness of individual cases. The authors report the results of a survey of clinicians to determine the frequency of corroboration that clients' DID symptoms existed prior to being diagnosed or prior to therapy. On the basis of 446 cases of DID, clinicians reported some form of corroboration (e.g., reports from family, medical records) in 73% of cases for symptoms prior to diagnosis and in 67% of cases for symptoms prior to therapy

Gold, Steven N; Elhai, Jon D; Rea, Bayard D; Weiss, Donna; Masino, Theodore; Morris, Staci Leon; McIninch, Jessica. (2001)  
Contextual treatment of dissociative identity disorder: three case studies
Journal of Trauma and Dissociation (ISSN: 1529-9732), v. 2, no. 4, pp. 5-36 (2001).

ABSTRACT Evidence for the effectiveness of contextual therapy, a new approach for treating adult survivors of prolonged child abuse (PCA), is provided via case studies of three women with Dissociative Identity Disorder (DID). Contextual therapy is based on the premise that it is not only traumatic experiences that account for PCA survivors' psychological difficulties. Even more fundamentally, many survivors grow up in an interpersonal context in which adequate resources for secure attachment and acquisition of adaptive living skills are not available. As a result, they are left with lasting deficits that undermine not only their current functioning, but also their ability to cope with reliving their traumatic memories in therapy. The primary focus of this treatment approach, therefore, is on developing capacities for feeling and functioning better in the present, rather than on extensive exploration and processing of the client's trauma history or, in the case of DID, of identity fragments. Treatment of the three cases presented ranged from eight months to two and one-half years' duration, and culminated in very positive outcomes. The women's reports of achievements, such as obtaining and maintaining gainful employment, greater self-sufficiency, and the establishment of more intimate and gratifying relationships, indicated marked improvements in daily functioning. Objective test data obtained at admission and discharge, and in one case, at follow-up, documented substantial reductions in dissociative, posttraumatic stress, depressive, and other symptoms.

Goldberg RT, Pachas WN, Keith D (1999)  
Relationship between traumatic events in childhood and chronic pain.
Disabil Rehabil 21(1):23-30 (1999)

ABSTRACT PURPOSE: The purpose was to examine the relationships between traumatic events in childhood, such as sexual and physical abuse, alcoholism, and drug addiction, and three types of chronic pain: facial pain, myofascial pain, and fibromyalgia. A fourth group, a heterogeneous group of other pain, was used as a comparison group. METHOD: Ninety one patients with chronic pain, age range 20-60, were consecutively recruited from the outpatient clinics of a rehabilitation hospital and a general hospital. Patients were given four measures for completion at evaluation: Childhood History Questionnaire; Childhood Traumatic Events Scale; McGill Melzack Pain Questionnaire; Pain Disability Index. Chi-square was used to test significant differences among four pain groups on sexual, physical, and verbal abuse; alcoholism; drug dependence; medications; major upheaval, childhood illness, death of a family member or friend, and separation or divorce of parents. Logistic regression was used to predict membership in the four pain groups.
RESULTS: All pain groups had a history of abuse exceeding 48%: fibromyalgia, 64.7%; myofascial, 61.9%; facial, 50%; other pain, 48.3%. All groups had a history of family alcohol dependence exceeding 38%, and a history of drug dependence ranging from 5.8 to 19.1%. A combined history of pain, child physical abuse, and alcoholism was prevalent in 12.9 to 35.3%. Logistic regression showed patients who were female, with an alcoholic parent, using non-narcotic drugs were more likely to be members of the facial, myofascial, and fibromyalgia groups. CONCLUSIONS: Child traumatic events are significantly related to chronic pain. Since the problem of child abuse is broader than physical and sexual abuse, health and rehabilitation agencies must shift from individualized treatment to interdisciplinary treatment of the family and patient.

Goldberg, L.R. (1999)  
The curious experiences survey, a revised version of the Dissociative Experiences Scale: Factor structure, reliability and relations to demographic and personality variables.
Psychological Assessment, 11, 134-145.

ABSTRACT A revision of the Dissociative Experiences Scale, including 3 new items and a more user-friendly item format, was administered to an adult community sample. Both orthogonal and oblique factor rotations of from 1 to 5 factors provide evidence of the hierarchical structure of self-reported dissociative experiences. Reliabilities are presented for a longer and a shorter Dissociation scale, and for subscales labeled Depersonalization, Absorption, and Amnesia. Also provided are the relations of the total scale and its 3 subscales to gender, age, and education, as well as to a broad and diverse set of personality attributes. The frequency of self-reported dissociative experiences was positively related to measures of Neuroticism (particularly Depression) and Imagination, and negatively related to Conscientiousness (particularly Dutifulness), Agreeableness, and to a lesser extent age. The Dissociation scales and subscales were not related to gender, educational level, or intelligence, nor to vocational interests or self-reported skills. Three subtle measures of dissociation are provided.

ABSTRACT A developmental and structural model of borderline personality disorder is described. Partial dissociation provoked by trauma and deprivation in childhood is seen to result in the persistence of separate self states. The characteristics of these and alternations between them are seen to account for the main features of the condition. The identification and characterization of states through clinical procedures and the use of the states grid are described and case illustrations are given. The states identified by the grid method in a series of 20 borderline patients are described and classified into six groups, named abuser rage, victim rage, passive victim, ideal, coping and zombie. The clinical value and nosological implications of the model and these findings are briefly discussed.

Psychol Sci. 2003 Mar;14(2):113-8.

ABSTRACT Previous research indicates that many adults (nearly 40%) fail to report their own documented child sexual abuse (CSA) when asked about their childhood experiences. These controversial results could reflect lack of consciously accessible recollection, thus bolstering claims that traumatic memories may be repressed. In the present study, 175 individuals with documented CSA histories were interviewed regarding their childhood trauma. Unlike in previous studies, the majority of participants (81%) in our study reported the documented abuse. Older age when the abuse ended, maternal support following disclosure of the abuse, and more severe abuse were associated with an increased likelihood of disclosure. Ethnicity and dissociation also played a role. Failure to report CSA should not necessarily be interpreted as evidence that the abuse is inaccessible to memory, although inaccessibility or forgetting cannot be ruled out in a subset of cases.

ABSTRACT This study approaches the question of nature and nurture of dissociative phenomena. Within C. R. Cloninger's concept of personality, character traits are thought to develop in response to environmental stimuli and conditions during childhood and adolescence, whereas temperament traits are considered to be genetically predisposed. The hypothesis is tested that dissociative symptoms are associated with distinct character traits but not with temperament dimensions. 191 psychiatric patients and 41 healthy Ss were evaluated for dissociative symptoms (Dissociative Experience Scale), temperament and character (Temperament and Character Inventory), and current psychopathology (SCL-90-R). Regression analyses for women and men were calculated separately. For both genders, the character traits of self-transcendence and self-directedness were significant and independent predictors for dissociation. These results support the hypothesis that dissociative symptoms are caused by environmental factors and point against a genetic predisposition in the development of dissociative symptoms. 

Psychopathology 32:6:1999, 319-324.

ABSTRACT Previous studies have described co-occurrence between obsessive-compulsive disorder (OCD) and dissociation. We intended to evaluate the phenomenological association between different obsessive-compulsive and dissociative symptoms more precisely. Seventy patients with OCD (DSM-IV) were evaluated with the Hamburg Obsessive-Compulsive Inventory (HZI) and the Dissociation Experience Scale. Correlation and discriminant analysis were performed. The dimensions 'Checking' and 'Symmetry and Ordering' were significantly related to dissociative symptomatology. A clear-cut lack of association was found in 'Washing and Cleaning', 'Counting and Touching' and 'Aggressive Impulses and Fantasies'. HZI dimensions significantly discriminated patients with high from patients with low dissociative symptomatology. Psychodynamic and therapeutical aspects of these findings are discussed.

Lancet 2000 Feb 5;355(9202):460-3

ABSTRACT BACKGROUND: Some people who come close to death report having experiences in which they transcend the boundaries of the ego and the confines of time and space. Such near-death experiences (NDEs) share some features with the phenomenon of dissociation, in which a person's self identity becomes detached from bodily sensation. This study explored the frequency of dissociative symptoms in people who had come close to death. METHODS: 96 individuals who had had self-reported NDEs, and 38 individuals who had come close to death but who had not had NDEs completed a mailed questionnaire that included a measure of "depth" of near-death experience (the NDE scale) and a measure of dissociative symptoms (the Dissociative Experiences Scale). Median scores in the two groups were compared with Mann-Whitney U tests. The association between depth of NDE and dissociative symptoms was tested by Spearman's rank-order correlation between scores on the NDE scale and the dissociative experiences scale. FINDINGS: People who reported NDEs also reported significantly more dissociative symptoms than did the comparison group. Among those who reported NDEs, the depth of the experience was positively correlated with dissociative symptoms, although the level of symptoms was substantially lower than that of patients with pathological dissociative disorders. INTERPRETATION: The pattern of dissociative symptoms reported by people who have had NDEs is consistent with a non-pathological dissociative response to stress, and not with a psychiatric disorder. A greater understanding of the mechanism of dissociation may shed further light on near-death and other mystical or transcendental experiences.

ABSTRACT OBJECTIVE: Depersonalization disorder is characterized by a detachment from one's sense of self and one’s surroundings that leads to considerable distress and impairment yet an intact testing of reality. Depersonalized individuals often report difficulties in perception, concentration, and memory; however, data on their cognitive profiles are lacking. METHOD: Fifteen patients with depersonalization disorder were compared to 15 matched normal comparison subjects on a comprehensive neuropsychological test battery that assessed cognitive function. RESULTS: The subjects with depersonalization disorder showed a distinct cognitive profile. They performed significantly worse than the comparison subjects on certain measures of attention, short-term visual and verbal memory, and spatial reasoning within the context of comparable intellectual abilities. CONCLUSIONS: The authors propose that depersonalization involves alterations in the attentional and perceptual systems, specifically in the ability to effortfully control the focus of attention. These early encoding deficits are hypothesized to have a deleterious effect on the short-term memory system; they manifest as deficits in the ability to take in new information but not in the ability to conceptualize and manipulate previously encoded information.