Patterns of dissociation in clinical and nonclinical samples.

Research has consistently found elevated mean dissociation scores in particular diagnostic groups. In this study, we explored whether mean dissociation scores for different diagnostic groups resulted from uniform distributions of scores within the group or were a function of the proportion of highly dissociative patients that the diagnostic group contained. A total of 1566 subjects who were psychiatric patients, neurological patients, normal adolescents, or normal adult subjects completed the Dissociative Experience Scale (DES). An analysis of the percentage of subjects with high DES scores in each diagnostic group indicated that the diagnostic group's mean DES scores were a function of the proportion of subjects within the group who were high dissociators. The results contradict a continuum model of dissociation but are consistent with the existence of distinct dissociative types.

Reliability and validity of a brief patient-report instrument for psychiatric outcome evaluation.

OBJECTIVE: The authors describe the Behavior and Symptom Identification Scale (BASIS-32), a brief patient-report measure for psychiatric outcome assessment, and present the measure's factor structure and reliability and validity data. METHODS: Using the BASIS-32, interviews were conducted with a total of 387 patients shortly after their admission to the adult inpatient services of a private not-for-profit psychiatric hospital. Six months after admission, they received a follow-up questionnaire version of the instrument. RESULTS: Factor analysis of the instrument yielded five factors, on which subscales were based: relation to self and others, daily living and role functioning, depression and anxiety, impulsive and addictive behavior, and psychosis. Internal consistency of the subscales ranged from .63 to .80. Internal consistency of the full 32-item scale was .89. Test-retest reliability ranged from .65 to .81 for the five subscales. Concurrent and discriminant validity analyses indicated that the BASIS-32 ratings successfully discriminated patients hospitalized six months after admission from those living in the community, patients working at follow-up from those not working, and patients with particular diagnoses. Follow-up ratings indicated that the BASIS-32 is sensitive to changes in symptomatology and functioning. CONCLUSIONS: The BASIS-32 provides a brief, standardized assessment of symptoms and problems from the patient's perspective. The instrument can be used for outcome assessment with most psychiatric inpatients.

Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study.

OBJECTIVE: The Dissociative Experiences Scale has proved a reliable and valid instrument to measure dissociation in many groups, but its capacity to distinguish patients with multiple personality disorder from patients with other psychiatric disorders has not yet been conclusively tested. METHOD: A discriminant analysis was performed to classify 1,051 subjects as having or not having multiple personality disorder. Another discriminant analysis was performed on a subgroup of 883 subjects more closely representing patients in a typical psychiatric facility in terms of base rates of dissociative disorders. A cutoff score of 30 was also used to classify subjects, and Bayes's theorem, which allows for the calculation of the positive predictive value and the negative predictive value of a screening test, was applied. RESULTS: According to discriminant analysis of the total study group, the scale's sensitivity was 76% and its specificity was also 76%; according to discriminant analysis of the more representative subgroup, the scale's sensitivity was 76% and its specificity was 85%. Use of the cutoff score of 30 produced similar results. Results of the application of Bayes's theorem showed that 17% of the subjects scoring 30 or higher would actually have multiple personality disorder and 99% of those scoring less than 30 would not have multiple personality disorder. CONCLUSIONS: These results indicate that the Dissociative Experiences Scale performs quite well as a screening instrument to identify subjects with multiple personality disorder. In addition, the consistency of responses to scale items across centers indicates that the symptoms reported by patients with multiple personality disorder are highly similar across diverse geographic centers. This consistency supports the reliability and validity of the diagnosis of multiple personality disorder across centers.

Correlates of dissociative symptomatology in patients with physical and sexual abuse histories.

Recent studies have demonstrated a high prevalence of sexual and physical abuse histories and high levels of dissociative symptoms in psychiatric inpatients. We examined whether severity, frequency, and age of onset of abuse correlated with subjects' levels of dissociative symptoms. Sixty-four women reporting a lifetime history of physical and/or sexual abuse were recruited from consecutive admissions to three wards of a psychiatric hospital. Subjects completed the Life Experiences Questionnaire (LEQ) and the Dissociative Experiences Scale (DES). Subjects' self-reports of severity, frequency, and age of onset of abuse were analyzed for correlations with DES score. More invasive sexual abuse was associated with more dissociation. Higher-frequency physical abuse was associated with more dissociation, but no conclusion could be drawn about the impact of frequent sexual abuse due to missing data. An inverse correlation was found between age of onset of abuse and degree of dissociative symptomatology. These preliminary findings are consistent with hypotheses linking more severe, more chronic, and earlier abuse to the greater development of dissociative symptoms. The findings further emphasize the importance of recognizing dissociative symptoms in the clinical setting, and of continued study into the effects of childhood trauma.

Adult development and symptomatology.

The purpose of the current study was to explore relationships between symptomatology and ego development in adults. To that end we studied patients presenting for treatment in an outpatient clinic of a major psychiatric hospital. We examined the relationship of ego development to intensity of subjective distress and type of presenting symptoms and hypothesized that with increasing development of ego functioning, subjective distress from all kinds of psychiatric symptoms could be better tolerated and coped with and, therefore, would be experienced as less severe. For the sample as a whole, ego development was significantly related to psychiatric symptoms and symptom severity in patterns predicted from theory. On all but two scales, symptomatology decreased significantly as ego development increased. We argue that the ego development model is useful in further exploring psychopathology during the adult years.

The reliability of abuse history reports: a comparison of two inquiry formats.

We compared patients' reports about histories of physical or sexual abuse in two independent formats: the standard psychiatric intake interview at admission for inpatient treatment, and a subsequent confidential self-report survey about various forms of early childhood trauma. For 92 consecutively admitted female patients, nearly all reports of abuse histories obtained in the intake interview were consistent with later reports obtained in the survey. However, findings of no abuse history obtained in the intake format were frequently inconsistent with reports obtained in the survey, which were twice as frequent as intake reports. Gender of the intake interviewer was not related to reporting. These data suggest caution in accepting at face value initial denials of abuse histories.

Dissociative symptoms in relation to childhood physical and sexual abuse.

Studies have reported high rates of childhood abuse in people with psychiatric illness. This study examined whether dissociative symptoms are specific to patients with histories of abuse. Ninety-eight female psychiatric inpatients completed self-report instruments that focused on childhood history of trauma, dissociative symptoms, and psychiatric symptoms in general. Sixty-three percent of the subjects reported physical and/or sexual abuse. Eighty-three percent had dissociative symptom scores above the median score of normal adults, and 24% had scores at or above the median score of patients with posttraumatic stress disorder. Subjects with a history of childhood abuse reported higher levels of dissociative symptoms than those who did not.

Ego development and treatment requests.

Ego development theory suggests that patients might differ in the forms of psychiatric treatment they find helpful, depending on the maturity of their ego functioning. In our study, 100 adults beginning outpatient psychiatric treatment completed the Sentence Completion Test of ego development and the Patient Request Form, which measures treatment modality preference. Ego development was related to treatment requests in patterns predicted from theory: higher ego stage patients were more likely to request insight therapy, while lower stage patients were more likely to request reality checks, social intervention, and triage. We argue that the ego development construct can help treaters match patients to treatment modalities that are compatible with their frames of reference.

Validity of record ratings of the Global Assessment Scale.

The Global Assessment Scale (GAS) is a comprehensive rating of psychiatric status that is usually based on face-to-face interviews. Validity has not been established for the use of the GAS when it is based on secondary sources of information about the patient, source of patient information, although secondary sources have been used for this purpose. The current study examined agreement between GAS ratings based on medical records and ratings based on face-to-face interviews. Results showed moderate agreement between the two sets of ratings, with the intraclass correlation-coefficient (ICC) equaling .62. Record-based (R)-GAS ratings were upwardly biased and were restricted in range when compared with interview-based (I)-GAS ratings. A case-by-case analysis showed that the disagreement could be accounted for by inconsistent documentation of the degree of functional impairment in the most severely disturbed patients. We conclude the following: If R-GAS ratings are used, designs should be modified to adjust for probable overestimated functioning of the most severely disturbed patients.