Subject(s)
Depressive Disorder/therapy , Substance-Related Disorders/therapy , Adult , Female , HumansABSTRACT
OBJECTIVE: This study attempted to determine the prevalence of somatic symptoms, somatization disorder, and medical interventions in patients with dissociative disorders. METHOD: Fourteen psychiatric inpatients with a DSM-III dissociative disorder were matched for age and gender with a comparison group of inpatients who reported few dissociative symptoms. All subjects were interviewed in a blind manner with the Dissociative Disorders Interview Schedule (this semistructured interview schedule includes a section on somatization disorder), and their hospital charts were reviewed to determine somatic symptoms and medical histories. RESULTS: Sixty-four percent of the patients with dissociative disorders met DSM-III criteria for somatization disorder and reported an average of 12.4 somatic symptoms. None of the comparison patients met DSM-III criteria for somatization disorder, and these patients reported an average of 3.1 somatic symptoms. These differences between the two groups were significant. Significant differences were also found in the number of medical hospitalizations and consultations between the two groups. A significant correlation was found between the degree of dissociation and degree of somatization in patients with dissociative disorders. CONCLUSIONS: The authors conclude that somatization disorder is a frequent and serious comorbid disorder among patients with dissociative disorders.
Subject(s)
Dissociative Disorders/epidemiology , Somatoform Disorders/epidemiology , Adult , Child , Child Abuse/statistics & numerical data , Child Abuse, Sexual/epidemiology , Comorbidity , Dissociative Disorders/diagnosis , Dissociative Disorders/psychology , Female , Hospitalization , Humans , Life Change Events , Male , Middle Aged , Prevalence , Psychiatric Status Rating Scales , Severity of Illness Index , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Stress Disorders, Post-Traumatic/epidemiologyABSTRACT
OBJECTIVE: This study attempted to determine 1) the prevalence of dissociative disorders in psychiatric inpatients, 2) the degree of reported childhood trauma in patients with dissociative disorders, and 3) the degree to which dissociative experiences are recognized in psychiatric patients. METHOD: A total of 110 patients consecutively admitted to a state psychiatric hospital were given the Dissociative Experiences Scale. Patients who scored above 25 were matched for age and gender with a group of patients who scored below 5 on the scale. All patients in the two groups were then interviewed in a blind manner, and the Dissociative Disorders Interview Schedule, the Traumatic Antecedent Questionnaire, and the posttraumatic stress disorder (PTSD) module of the Structured Clinical Interview for DSM-III-R, Nonpatient Version, were administered. Chart reviews were also conducted on all patients. RESULTS: Fifteen percent of the psychiatric patients scored above 25 on the Dissociative Experiences Scale; 100% of these patients met DSM-III criteria for a dissociative disorder. These patients had significantly higher rates of major depression, PTSD, substance abuse, and borderline personality than did the comparison patients, and they also reported significantly higher rates of childhood trauma. Chart review data revealed that dissociative symptoms were largely unrecognized. CONCLUSIONS: A high proportion of psychiatric inpatients have significant dissociative pathology, and these symptoms are underrecognized by clinicians. The proper diagnosis of these patients has important implications for their clinical course.
Subject(s)
Dissociative Disorders/epidemiology , Hospitalization , Mental Disorders/diagnosis , Adolescent , Adult , Child , Child Abuse/diagnosis , Child Abuse/psychology , Comorbidity , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Diagnosis, Differential , Dissociative Disorders/diagnosis , Dissociative Disorders/psychology , Double-Blind Method , Female , Humans , Life Change Events , Male , Mental Disorders/classification , Mental Disorders/psychology , Personality Inventory , Prevalence , Psychiatric Status Rating Scales , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychologyABSTRACT
Childhood abuse has been implicated as a leading factor in the development of borderline personality disorder (BPD). Data in this report, drawn from an ongoing study of the therapeutic effect of fluoxetine in BPD patients, were gathered in an attempt to replicate previous findings indicating a history of physical abuse in 71% and sexual abuse in 67% of adult BPD subjects. Thirty-one subjects for a study of the pharmacological treatment of BPD or BPD traits met criteria for the study. Those who had been previously hospitalized for a psychiatric disorder, who had recently been suicidal, or who had recent histories of self-mutilation were excluded. Specific information about childhood abuse was gathered using questions from a previous study of abuse histories in BPD patients. All subjects were then interviewed in greater depth regarding past experiences of abuse as part of the ongoing study of the relationship of childhood attachment experience and adult psychopathology. Six of 31 subjects (19.4%) reported a definite history of childhood physical and/or sexual abuse. Four of these subjects met criteria for full BPD, and two met criteria for BPD traits. Three of 31 subjects reported a history of physical abuse (9.7%); five reported a history of sexual abuse (16.1%). Two of the six who reported abuse reported both physical and sexual abuse. A history of childhood abuse is not necessarily linked to the development of BPD or BPD traits in all individuals. The following hypothesis is suggested: BPD may represent a spectrum of symptomatic severity.(ABSTRACT TRUNCATED AT 250 WORDS)
