Utility of the Minnesota Multiphasic Personality Inventory-2 in differentiating genuine from feigned dissociative identity disorder.

OBJECTIVE: This study sought to determine the utility of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in accurately distinguishing genuine dissociative identity disorder (DID) patients from coached and uncoached DID simulators. METHOD: DID patients (n = 34) who were diagnosed using the Structured Clinical Interview for DSM-IV-Dissociative Disorders were recruited from inpatient and outpatient settings. Coached (n = 25) and uncoached (n = 64) simulator groups were recruited from a Mid-Atlantic university. All participants completed the MMPI-2. RESULTS: MMPI-2 validity scales reliably distinguished simulators from DID patients with high sensitivity (0.95) and specificity (0.97). The scales showing greatest promise making the distinction were F minus K index, back infrequency scale, and superlative self-presentation. Simulators and genuine DID patients also differed in their pattern of symptoms. All results were calculated with White female DID patients and simulators only. CONCLUSIONS: Genuine DID patients can be differentiated from simulators. Simulators appear to overweight symptoms of paranoia and alienation relative to mood and somatic symptoms. Further research is needed to generalize these findings to male and non-White populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychometrics of Three Dissociation Scales: Reliability and Validity Data on the DESR, DES-II, and DESC.

The current study assessed the reliability and validity of three measures of dissociation. Three hundred students completed the Dissociative Experiences Scale Revised (DESR), the Dissociative Experiences Scale-II (DES-II), and the Dissociative Experiences Scale Comparison (DESC); an additional 252 community adults evaluated clarity of instructions. Findings revealed that the three dissociation measures showed acceptable test-retest reliability and Cronbach's alphas. The DESR and DES-II strongly intercorrelated, but the DESC correlated only moderately with the two remaining dissociation measures, sharing less than 10% of the variance with the original scale. Additionally, the DESR and DES-II showed stronger convergent validity (correlation with measures of alexithymia and post-traumatic stress disorder) than did the DESC. The DESC was the only measure unrelated to trauma history. Participants reported substantially greater difficulty in understanding and utilizing the metric offered by the DESC. In conclusion, evidence supports the DES-II and DESR as alternate measures, but the DESC requires more investigation.

Relationship of abuse by religious authorities to depression, religiosity, and child physical abuse history in a college sample.

OBJECTIVE: Discussion of sexual abuse by religious authorities has been plagued by allegations of false memories and misreports, often attributed to media attention. An analysis of a historical archive with information on abuse by religious and other authority figures and coexisting psychopathology is extremely useful to the current debate on outcomes of sexual abuse. METHOD: The present study utilizes a database from the late 1970s that contains data on physical abuse and sexual abuse by various perpetrator types as well as on symptoms of depression, anxiety, and religiosity in a college population sample. RESULTS: Students alleging sexual abuse by religious authorities were as symptomatic (depressed and anxious) as students abused by parents and were more symptomatic than controls. Further, those abused by religious authorities showed greater variance in religiosity and a greater likelihood of breaking ties with their religious communities. Students self-labeling as physically abused by parents were more at risk for sexual abuse by religious authorities. CONCLUSIONS: Religious authorities often play complex roles in social and family life. These complexities then may produce parallel complexities in the patterns of symptoms. The intensity of the trauma from abuse by religious authorities may make it more difficult to study, treat, and recover from sexual abuse. Additional research is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Contributing factors predicting nightmares in children: Trauma, anxiety, dissociation, and emotion regulation.

OBJECTIVE: There is little research in the current literature regarding contributing factors to nightmares in children. This study aimed to test potentially overlapping predictors of nightmare distress and severity, including anxiety, dissociation, trauma history, vagal tone, and parental processing of emotions. METHOD: Sixty parent-child dyads (children ages 6-11) filled out a variety of child-report and parent-observation inventories on nightmare frequency and distress, dissociation, anxiety, and trauma history of the child. Children were monitored on heart rate variability and vagal tone. Both parent and child participated in a discussion of positive and negative life events that were later coded for degree of parent processing of emotional information. RESULTS: Anxiety, trauma history, dissociation, and baseline vagal tone accounted for 39% of the variance in nightmare distress. Anxiety and dissociation were positive predictors of nightmare distress in the multiple regression. Parent processing variables were weak predictors in the current analysis. CONCLUSIONS: The predictive power of anxiety, dissociation, vagal tone, and trauma history was not entirely due to their overlap, as shown by uniquely significant beta weights in the prediction of distress. Treatment procedures with multiple intervention points targeting physiological and psychological sources of nightmare distress may be warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Meta-analyses of clinical neuropsychological tests of executive dysfunction and impulsivity in alcohol use disorder.

BACKGROUND: Promising models for cognitive rehabilitation in alcohol treatment rest on a more nuanced understanding of the associated impairments in the multifaceted domains of executive functioning (EF) and impulsivity. OBJECTIVES: This meta-analysis examined the effects of alcohol on the individual subcomponents of EF and impulsivity in recently detoxified participants, including 1) Inhibition & Self-Regulation, 2) Flexibility & Set Shifting, 3) Planning & Problem Solving, 4) Reasoning & Abstraction, and 5) Verbal Fluency. Impulsivity was further examined through an analysis of motor, cognitive, and decisional subcategories. METHOD: Investigators searched, coded, and calculated effect sizes of impairments demonstrated in a broad range of neuropsychological tests for EF. A total of 77 studies were selected covering 48 years of research with a sample size of 5140. RESULTS: Findings ranged from a Hedges' g effect size of 0.803 for Inhibition to a Hedges' g of 0.359 for Verbal Fluency. Results also varied for the individual subcategories of Inhibition, including a large effect size for decisional impulsivity (g = 0.817) and cognitive impulsivity (0.860), and a moderate effect size for motor impulsivity (g = 0.529). The Hayling Test, Wisconsin Card Sorting Test, and Iowa Gambling Task were the measures most sensitive for alcohol effects. CONCLUSION: Planning, problem solving, and inhibitory abilities are significantly affected by alcohol abuse, with decisional and cognitive forms of impulsivity most impacted. Cognitive remediation targeting these deficits might increase the related functions that mediate the ability to moderate or abstain from alcohol, and so lead to improved treatment results.

Contributions of risk and protective factors to prediction of psychological symptoms after traumatic experiences.

OBJECTIVE: Traumatic experiences cause considerable suffering and place a burden on society due to lost productivity, increases in suicidality, violence, criminal behavior, and psychological disorder. The impact of traumatic experiences is complicated because many factors affect individuals' responses. By employing several methodological improvements, we sought to identify risk factors that would account for a greater proportion of variance in later disorder than prior studies. METHOD: In a sample of 129 traumatically injured hospital patients and family members of injured patients, we studied pre-trauma, time of trauma, and post-trauma psychosocial risk and protective factors hypothesized to influence responses to traumatic experiences and posttraumatic (PT) symptoms (including symptoms of PTSD, depression, negative thinking, and dissociation) two months after trauma. RESULTS: The risk factors were all significantly correlated with later PT symptoms, with post-trauma life stress, post-trauma social support, and acute stress symptoms showing the strongest relationships. A hierarchical regression, in which the risk factors were entered in 6 steps based on their occurrence in time, showed the risks accounted for 72% of the variance in later symptoms. Most of the variance in PT symptoms was shared among many risk factors, and pre-trauma and post-trauma risk factors accounted for the most variance. CONCLUSIONS: Collectively, the risk factors accounted for more variance in later PT symptoms than in previous studies. These risk factors may identify individuals at risk for PT psychological disorders and targets for treatment.

Advantages and psychometric validation of proximal intensive assessments of patient-reported outcomes collected in daily life.

OBJECTIVES: Ambulatory assessment data collection methods are increasingly used to study behavior, experiences, and patient-reported outcomes (PROs), such as emotions, cognitions, and symptoms in clinical samples. Data collected close in time at frequent and fixed intervals can assess PROs that are discrete or changing rapidly and provide information about temporal dynamics or mechanisms of change in clinical samples and individuals, but clinical researchers have not yet routinely and systematically investigated the reliability and validity of such measures or their potential added value over conventional measures. The present study provides a comprehensive, systematic evaluation of the psychometrics of several proximal intensive assessment (PIA) measures in a clinical sample and investigates whether PIA appears to assess meaningful differences in phenomena over time. METHODS: Data were collected on a variety of psychopathology constructs on handheld devices every 4 h for 7 days from 62 adults recently exposed to traumatic injury of themselves or a family member. Data were also collected on standard self-report measures of the same constructs at the time of enrollment, 1 week after enrollment, and 2 months after injury. RESULTS: For all measure scores, results showed good internal consistency across items and within persons over time, provided evidence of convergent, divergent, and construct validity, and showed significant between- and within-subject variability. CONCLUSIONS: Results indicate that PIA measures can provide valid measurement of psychopathology in a clinical sample. PIA may be useful to study mechanisms of change in clinical contexts, identify targets for change, and gauge treatment progress.

On building a science of common factors in trauma therapy.

Research on therapy outcome routinely finds that common factors (e.g., warmth, genuineness, trustworthiness) account for more variance than does therapy technique. This article makes the case for more attention to training in positive common factor variables within graduate schools and internships and for research on the effectiveness of such training. Recommendations are given for a change in focus in research and training, including more discussion of taboo topics in trauma therapy; attention to therapist behaviors that enhance the experience of warmth or trustworthiness; and research on client characteristics that impede the experience of being in the presence of a warm, genuine, and trustworthy other.

Protecting scientists, science, and case protagonists: a discussion of the Taus v. Loftus commentaries.

This article is a discussion of the articles by Nicole Taus Kluemper, Erna Olafson, Frank Putnam, Laura Brown, Ross Cheit, and Gerald Koocher. The papers center on the issues raised by a decision by two psychologists to break the confidentiality of a case study published by David Corwin and Erna Olafson to gather information to support an alternative theoretical view of the case. The article reviews best understandings of the justifications proposed by the psychologists, who saw themselves as investigative reporters, discusses the papers that have been submitted, and proposes enhanced ethical guidelines and increased professional discussion of these issues.

Reality versus fantasy: reply to Lynn et al. (2014).

We respond to Lynn et al.'s (2014) comments on our review (Dalenberg et al., 2012) demonstrating the superiority of the trauma model (TM) over the fantasy model (FM) in explaining the trauma-dissociation relationship. Lynn et al. conceded that our meta-analytic results support the TM hypothesis that trauma exposure is a causal risk factor for the development of dissociation. Although Lynn et al. suggested that our meta-analyses were selective, we respond that each omitted study failed to meet inclusion criteria; our meta-analyses thus reflect a balanced view of the predominant trauma-dissociation findings. In contrast, Lynn et al. were hypercritical of studies that supported the TM while ignoring methodological problems in studies presented as supportive of the FM. We clarify Lynn et al.'s misunderstandings of the TM and demonstrate consistent superiority in prediction of time course of dissociative symptoms, response to psychotherapy of dissociative patients, and pattern of relationships of trauma to dissociation. We defend our decision not to include studies using the Dissociative Experiences Scale-Comparison, a rarely used revision of the Dissociative Experiences Scale that shares less than 10% of the variance with the original scale. We highlight several areas of agreement: (a) Trauma plays a complex role in dissociation, involving indirect and direct paths; (b) dissociation-suggestibility relationships are small; and (c) controls and measurement issues should be addressed in future suggestibility and dissociation research. Considering the lack of evidence that dissociative individuals simply fantasize trauma, future researchers should examine more complex models of trauma and valid measures of dissociation.

Can sudden, severe emotional loss be a traumatic stressor?

Aspects of the stressor criterion for posttraumatic stress disorder (PTSD) have been controversial since its inception, and the theoretical or empirical reasons for decisions about it have not been clear. To investigate whether sudden events involving severe emotional loss have the potential to precipitate PTSD, we assessed exposure to Criterion A stressors, sudden abandonment, sudden move or loss of home, and symptoms of PTSD and dissociation in a community sample of 427 adults. In regression analyses, models that included a severe emotional loss stressor accounted for a significant amount of additional variance in PTSD and dissociation symptoms beyond that accounted for by a model including only Criterion A stressors. The findings suggest that limiting Criterion A1 to events involving actual or threatened death or injury may be overly restrictive. Future research is needed to replicate these findings in a clinical sample and to prospectively examine the conditional probability of PTSD following these events.

Psychoform and somatoform dissociation and PTSD in deaf adults.

Both deafness and dissociation disconnect people from certain aspects of the external environment. Dissociation among the deaf population has been largely neglected as an area of scientific investigation. The purpose of this study was twofold: first, to examine the psychometrics of 2 dissociation measures--the Dissociation scale of the Trauma Symptom Inventory (TSI) and the Somatoform Dissociation Questionnaire-20 (SDQ-20); and second, to evaluate the relationship between dissociation and posttraumatic stress disorder (PTSD) in deaf adults. A diverse sample of 79 deaf adults was assessed using the Clinician-Administered PTSD Scale, the TSI, and the SDQ-20. Results provided support for the concept of psychoform dissociation, as measured by the TSI Dissociation scale, in deaf adults. However, somatoform dissociation, as measured by the SDQ-20, showed lower internal consistency. The SDQ-5, a shortened version of the SDQ-20, was unreliable in the current sample. Deaf adults were significantly higher on psychoform dissociation than the norm samples of hearing adults. As in hearing samples, dissociation--both psychoform and somatoform--was significantly related to PTSD symptoms. In addition, those with dissociative PTSD displayed significantly more symptoms of depression, anger, impaired self-reference, tension reduction behavior, and somatoform dissociation than did the nondissociative PTSD group.

Statistical support for subtypes in posttraumatic stress disorder: the how and why of subtype analysis.

A number of researchers have argued for the existence of different subtypes of posttraumatic stress disorder (PTSD). In the current paper we present criteria by which to assess these putative subtypes, clarify potential pitfalls of the statistical methods employed to determine them, and propose alternative methods for such determinations. Specifically, three PTSD subtypes are examined: (1) complex PTSD, (2) externalizing/internalizing PTSD, and (3) dissociative/nondissociative PTSD. In addition, three criteria are proposed for subtype evaluation, these are the need for (1) reliability and clarity of definition, (2) distinctions between subtypes either structurally or by mechanism, and (3) clinical meaningfulness. Common statistical evidence for subtyping, such as statistical mean difference and cluster analysis, are presented and evaluated. Finally, more robust statistical methods are suggested for future research on PTSD subtyping.

Evaluation of the evidence for the trauma and fantasy models of dissociation.

The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.

Relationship between child abuse history, trauma, and dissociation in Russian college students.

OBJECTIVE: The research was conducted to determine the relationship between violent trauma, child abuse history, and dissociative symptoms in a Russian population. METHOD: Three hundred and one undergraduate students from Moscow State Linguistics University participated in the study and completed the Dissociation Continuum Scale, the Violence History Questionnaire, the Traumatic Events Survey (TES), and a demographic measure. RESULTS: Scores on dissociation and its subfactors were significantly higher in the Russian sample compared to the normative US group. The best predictors for dissociation were experiencing a violent trauma, child abuse history, and/or the experience of a fearful event. Those participants with a prior child abuse history were more symptomatic after adult trauma than those with no such history. CONCLUSIONS: The relationship between trauma/abuse and dissociation is unlikely to be a result of suggestion by therapists or media exposure, since the correlation appears in a Russian population who are relatively unexposed to these suggestive sources. The validity, reliability, and structure of the dissociation measure were relatively similar in American and Russian samples.

A Reexamination of Developmental Changes in Causal Attributions.

The current study examined young children's use of the presence or absence of extrinsic reward to make inferences about the intrinsic motivation of another person. Previous research indicates that most kindergartners do not use a discounting heuristic, but it was hypothesized that they may have misinterpreted the questions asked. Kindergarten, second, and fourth graders were presented stories about children who were rewarded or not rewarded for performing various activities Two forms of questioning about motivation were compared. When a traditional form was used, kindergartners did not show evidence of a discounting heuristic. When the questions were adjusted to ask more specifically about intrinsic motivation, children at all grade levels appeared to use a discounting heuristic. Results are discussed in terms of the parameters of the attributional effects, the possible mechanisms responsible for the phenomena, and the significance of the findings for other developmental research using self-report techniques.