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Query: UMLS:C0011551 (depersonalization)
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Dissociation involves a variety of clinical concepts, and some disorders are also similar to but not the same as dissociation. Dissociative disorder is considered to be a pathological phenomenon based on a psychological mechanism. Accurate diagnosis is very important to ensure that patients receive adequate treatment, although such consideration is not unique to dissociative disorder. Accordingly, there is a need to carefully distinguish dissociation from other disorders. In this article, we outline a number of dissociative and dissociative-like states from the symptoms of amnesia, depersonalization and switching. In particular, we highlight the differences between transient global amnesia and dissociative amnesia, and imaginary companions and dissociative alter personality. Additionally, as the symptoms of conditions such as dissociative amnesia and dissociative identity disorder are easily confused, we also made efforts to organize them.
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PMID:[Significance of and considerations relating to the diagnosis of dissociation]. 2211 95

The rationale, research literature, and proposed changes to the dissociative disorders and conversion disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are presented. Dissociative identity disorder will include reference to possession as well as identity fragmentation, to make the disorder more applicable to culturally diverse situations. Dissociative amnesia will include dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia but does not always include confused wandering or loss of personality identity. Depersonalization disorder will include derealization as well, since the two often co-occur. A dissociative subtype of posttraumatic stress disorder (PTSD), defined by the presence of depersonalization or derealization in addition to other PTSD symptoms, is being recommended, based upon new epidemiological and neuroimaging evidence linking it to an early life history of adversity and a combination of frontal activation and limbic inhibition. Conversion disorder (functional neurological symptom disorder) will likely remain with the somatic symptom disorders, despite considerable dissociative comorbidity.
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PMID:Dissociative disorders in DSM-5. 2339 28

To explain the phenomenological overlap between dissociation and schizophrenia, a dissociative subtype of schizophrenia has been proposed as a possibility. Dissociation is often believed to be organized on a continuum, although 2 qualitatively different phenomena can be distinguished in theory, research, and clinical practice: (a) states of separation from self or environment (detachment dissociation) and (b) inaccessibility of normally accessible mental contents (compartmentalization dissociation). This study used the Positive and Negative Syndrome Scale (PANSS) and the Association for Methodology and Documentation in Psychiatry module for the interview assessment of dissociation to investigate the relationships between PANSS subscales, detachment dissociation, and compartmentalization dissociation in a sample of 72 patients with schizophrenia. A confirmatory factor analysis sustained the bipartite model, yielding factors that grouped dissociative items around amnesia and depersonalization/derealization. The latter factor also contained identity disturbances and was therefore not entirely consistent with the theoretical formulations of detachment dissociation. It is important to note that the structure of those factors may be influenced by the symptoms of schizophrenia to which they were specifically linked: The factor containing depersonalization/derealization was connected to the positive symptoms subscale of the PANSS, whereas the factor containing amnesia was associated with the negative subscale. Hence, a dichotomy of dissociation is confirmed inasmuch as its subtypes are as distinguishable as PANSS subscales. This has implications on theoretical and clinical levels.
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PMID:Detachment, compartmentalization, and schizophrenia: linking dissociation and psychosis by subtype. 2362 77

Individuals with dissociative disorders (DDs) suffer from high levels of dissociation as well as posttraumatic stress disorder (PTSD) and general distress. No research has investigated how changes in dissociation relate to changes in other symptoms over the course of treatment in patients with DD. Using a prospective, naturalistic design, we collected reports of symptoms from a sample of therapists and their patients diagnosed with dissociative identity disorder or dissociative disorder not otherwise specified who participated in the Treatment Outcome of Patients with Dissociative Disorders study. The patients completed surveys at intake (Time 1) into the study and at 30-month follow-up (Time 4). We found that dissociative symptoms, including amnesia, depersonalization/derealization, and absorption, at the initial assessment of the study ("initial") were related to initial levels of PTSD and general distress and that changes in dissociative symptoms were related to changes in PTSD and general distress. Initial dissociation was a significant predictor of change in dissociation at 30 months when we controlled for length of time for follow-up, length of time practicing therapy, and length of time treating dissociative patients. Our results suggest that a reduction in dissociative symptoms in DD patients is associated with reductions in the overall severity of dissociative, posttraumatic stress, and distress symptoms.
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PMID:What contributes to predicting change in the treatment of dissociation: initial levels of dissociation, PTSD, or overall distress? 2362 81

Understanding which factors predict individual dissociative response during stressful situations is important to clarify the nature of dissociation and the mechanisms associated to its use as a coping strategy. The present study examined (1) whether experiential avoidance (EA), anxiety sensitivity (AS), depressive symptoms, and state anxiety concurrently predicted trait dissociation (TD)-absorption, amnesia, depersonalization, and total TD scores-and laboratory induced dissociation (LID); and (2) whether TD and catastrophizing predicted LID. We also examined whether catastrophizing mediated the relationships between both AS and depressive symptoms and LID. A total of 101 female undergraduate students participated in a cold pressor task, which significantly induced dissociation. Results of hierarchical regression analyses showed that AS at Time 1 (9 months before the experimental session), as well as depressive symptoms and catastrophizing at the time of the experiment (Time 2), predicted LID at Time 2. Depressive symptoms at Time 2 predicted total TD, absorption, and amnesia scores. AS at Time 1 and depressive symptoms at Time 2 predicted depersonalization. AS, depressive symptoms, and catastrophizing seem to facilitate the use of dissociative strategies by healthy individuals, even in response to non-traumatic but discomforting stress.
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PMID:Predictors of trait dissociation and peritraumatic dissociation induced via cold pressor. 2383 21

The subject of this report murdered four young girls between 1988 and 1989. The forensic psychiatric evaluation showed that soon after the sudden death of his dearest grandfather he had developed dissociative symptoms including depersonalization, autoscopy, fugue, dissociative amnesia, Ganser's syndrome and DID, on the basis of earlier traumatic experiences under the dysfunctional family circumstances of his early childhood. His DID was thought to be manifest in at least four personalities, i.e., a host personality, a child personality, a cool personality and a female personality. In Japan only five cases of DID were reported between 1919 and 1990, whereas more than 30 cases were reported in journals or at academic meetings from 1991 to 1997. Although the incidence is still quite low in Japan, DID can be considered to be a valid clinical entity in spite of Merskey's severe criticism of the disorder. (Int J Psych Clin Pract 2000; 4:155-160).
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PMID:Dissociative identity disorder (DID) in Japan: A forensic case report and the recent increase in reports of DID. 2492 54

Depersonalization/derealization disorder is characterized by depersonalization often co-occurring with derealization in the absence of significant psychosis, memory, or identity disturbance. Depersonalization/derealization is categorized as one of the dissociative disorders, which also includes dissociative amnesia, dissociative fugue, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Although these disorders may be under-diagnosed or misdiagnosed, many persons with psychiatric illness who have experienced trauma report symptoms consistent with dissociative disorders. There are limited scientific data on prevalence of depersonalization/derealization disorder specifically. This paper reviews clinical, phenomenological and epidemiological information regarding diagnosis and treatment of dissociative disorders in general, and illustrates common presenting histories of persons with derealization/depersonalization disorder utilizing composite cases. The clinical vignettes focus on recommended psychotherapy and pharmacotherapy interventions as part of a comprehensive multidisciplinary treatment plan for these individuals.
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PMID:STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder. 2533 44

It has been claimed that the progress of psychiatry has lagged behind that of other medical disciplines over the last few decades. This may suggest the need for innovative thinking and research in psychiatry, which should consider neglected areas as topics of interest in light of the potential progress which might be made in this regard. This review is concerned with one such field of psychiatry: dissociation and dissociative disorders. Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity. While dissociative identity disorder (DID) is the most pervasive condition of all dissociative disorders, partial representations of this spectrum may be diagnosed as dissociative amnesia (with or without fugue), depersonalization disorder, and other specified dissociative disorders such as subthreshold DID, dissociative trance disorder, acute dissociative disorders, and identity disturbances due to exposure to oppression. In addition to constituting disorders in their own right, dissociation may accompany almost every psychiatric disorder and operate as a confounding factor in general psychiatry, including neurobiological and psycho-pharmacological research. While an anti- dissociative drug does not yet exist, appropriate psychotherapy leads to considerable improvement for many patients with dissociative disorders.
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PMID:The many faces of dissociation: opportunities for innovative research in psychiatry. 2559 19

This study assessed childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with panic disorder (PD). A total of 92 psychotropic drug-naive patients with PD, recruited from outpatient clinics in the psychiatry department of a Turkish hospital, were involved in the study. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), Dissociation Questionnaire, Panic and Agoraphobia Scale, Panic Disorder Severity Scale, and Childhood Trauma Questionnaire. Of the patients with PD, 18 (19%) had a comorbid dissociative disorder diagnosis on screening with the SCID-D. The most prevalent disorders were dissociative disorder not otherwise specified, dissociative amnesia, and depersonalization disorders. Patients with a high degree of dissociation symptoms and dissociative disorder comorbidity had more severe PD than those without (p < .05). All of the childhood trauma subscales used were correlated with the severity of symptoms of dissociation and PD. Among all of the subscales, the strongest relationship was with childhood emotional abuse. Logistic regression analysis showed that emotional abuse and severity of PD were independently associated with dissociative disorder. In our study, a significant proportion of the patients with PD had concurrent diagnoses of dissociative disorder. We conclude that the predominance of PD symptoms at admission should not lead the clinician to overlook the underlying dissociative process and associated traumatic experiences among these patients.
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PMID:Childhood Traumatic Experiences, Dissociative Symptoms, and Dissociative Disorder Comorbidity Among Patients With Panic Disorder: A Preliminary Study. 2601 85

More than a third of the population report childhood adversity, and these experiences are associated with an increased risk of clinical and subclinical psychosis. The reason why some people go on to develop mental health problems and others do not is a key question for study. It has been hypothesized that dissociative processes mediate the relationship between early adversity and psychosis. The current study assessed whether dissociation, and specifically depersonalization (one component of dissociation), plays a mediating role in the relationship between childhood maltreatment and both hallucination proneness and delusional ideation. The study used a cross-sectional design and recruited a student sample to assess these relationships in a nonclinical group. Dissociation mediated the relationship between early maltreatment and both hallucination proneness and delusional ideation. In terms of specific dissociative processes, depersonalization did not mediate hallucination proneness or delusional ideation. Absorption mediated hallucination proneness; dissociative amnesia (negatively) and absorption mediated delusional ideation. It is likely that dissociation interferes with the encoding of traumatic information in nonclinical as well as clinical groups and in certain ways. Absorption may be particularly relevant. For some people, traumatic memories may intrude into conscious awareness in adulthood as psychotic-type experience.
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PMID:Dissociation mediates the relationship between childhood maltreatment and subclinical psychosis. 2704 64


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