"#$%&% '()$*$*+ ,)*%-.' #-//0#'$-* -1 (010(0*#0 )('$#/0" 2 '345 ,6789:; <4;3 6=;4>? @47A5 =67 B? 89<7@968?8 6; 3;;CDEEF?G;;EHIJ87K5L 3;;CDEEF?G;;EHIJ87K5L M M N($O)(P "#$%&% (010(0*#0"D $7;?Q>4?4?4?< S9Q %"O&$T %4559=46;4>? %4559=46;4>? %459Q8?Q5& %459Q8?Q5& (?>45?8G (?>45?8G J65347F;97U %G#GU %G#GU )V?Q4=67 N5W=346;Q4= NQ?55U "?=978 NQ47;47FU LXXYU LXXZ 3;;CDEE<<4?4?< S9Q %"O&$T %4559=46;4>? %459Q8?Q5&(?>45?8 2"#$%&%MG J65347F;97U %G#GU %G#GU )V?Q4=67 N5W=346;Q4= NQ?55U "?=978 NQ47;47FU LXXYU LXXZ 3;;CDEE<<
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J3W )55?55 S9Q %4559=46;497 6G %4559=46;497 678 +@9B6@ 1:7=;49747F “Complex dissociative disorders, i.e., dissociative identity disorder and dissociative disorder-not- otherwise-specified, contribute to functional impairment above and beyond the impact of co-existing 797&84559=46;4>? 6[45 $ 8459Q8?Q5d 3;;CDEEF?G;;E^^AN-_5LE>E_
BG %4559=46;497R5 Q9@? 47 ;Q?6;V?7; Q?545;67=? 4G +?7?Q6@@WU 6V97F 5?>?Q?@W 4VC64Q?8 “The high comorbidity of DD yielded in our patients, who all received disability payments, compared to other outpatient studies raises the question of the relationship between impaired functioning and pathological dissociation. Axis 1 diagnoses included primarily depressive disorders (n = 6, 21%), psychotic disorders (n = 5, 18%), personality disorders (n = 4, 14%), eating disorders (n = 4, 14%) and somatoform disorders (n = 3, 11%). Seven (25%) of the 28 interviewed patients were diagnosed as having a DD, only one of which had a mention of dissociation in their medical chart” 3;;CDEEF?G;;EHFecf_5L
44G 'Q?6;V?7; Q?545;67=? <4;347 5;6786Q8 N'"% ;Q?6;V?7; Q?F4V?7;5 “The highly dissociative group was characterized by higher levels of posttraumatic and general distress, more frequent reports of suicidality, self-mutilation, eating problems and less favorable treatment response. High in dissociation patients needed more time to show improvement and were still clinically worse at the end of treatment and at follow-up. The results highlight the clinical relevance of using dissociation measures for identifying subgroups of [trauma] patients with severe psychopathology who may be more treatment resistant… The high distress level in complex dissociative disorder patients indicates that patients with complex dissociative disorders need treatment that is in part different from the more general treatment of polysymptomatic CSA survivors, addressing the pathological aspects of dissociation more vigorously.” 3;;CDEEF?G;;EYNF@'_5L
444G 'Q?6;V?7; Q?545;67=? <4;347 ":B5;67=? )B:5? 'Q?6;V?7;5 ^YGXg 9S 5:B5;67=? 47C6;4?7;5 ;36; 368 6 84559=46;4>? 8459Q8?Q B?F67 ;9 ?[C?Q4?7=? 84559=46;497 67 6>?Q6F? 9S ZG^ W?6Q5 CQ49Q ;9 5:B5;67=? :5?G N6;4?7;5 <4;3 =9V9QB48 84559=46;4>? 8459Q8?Q5 ?QQ?CQ?5?7;?8 6V97F 8Q9C9:;5 SQ9V ;3? ;Q?6;V?7; CQ9FQ6VG O9Q?9>?QU S4>? 9S ;3? C6;4?7;5 <4;3 34F3 5=9Q?5 97 ;3? %0" 8Q9CC?8 9:; 9S ;Q?6;V?7; B?S9Q? S:Q;3?Q ?>6@:6;497 <4;3 ;3? "#$%&%G ->?Q@99A47F ;3? 84559=46;4>? 8459Q8?Q 47 ;3?5? C6;4?7;5 =67 B? 6 36784=6C S9Q ;3?4Q ;Q?6;V?7;G
"?? ;3? ":B5;67=? )B:5? @47A ;9 Q?5?6Q=3 Q?5:@;5 CQ9>48?8 S:Q;3?Q B?@9? %459Q8?Q 45 6 ":C?Q9Q8476;? 8459Q8?Q ;36; =67 B? 5:==?55S:@@W 688Q?55?8 ;3Q9:F3 Phasic treatment “[With Phasic Treatment for Dissociative Disorders], patients showed decreased dissociation, PTSD, general distress, depression, suicide attempts, self-harm, dangerous behaviors, drug use, physical pain, and hospitalizations” 3;;CDEEF?G;;Ec-N9h_5L
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0C48?V49@9FW 9S %4559=46;4>? %459Q8?Q5 65 5??7 ;3Q9:F3 C6;4?7; 655?55V?7; S9Q 6 84559=46;4>? 8459Q8?Q 6G +?7?Q6@@W “Overall, independent studies from various countries clearly demonstrate that dissociative disorders constitute a common mental health problem not only in clinical practice but also in the community as well. … Using diagnostic tools designed to assess dissociative disorders yielded lifetime prevalence rates around 10% in clinical populations and in the community. Special populations such as psychiatric emergency ward applicants, drug addicts, and women in prostitution demonstrated the highest rates. 3;;CDEEF?G;;EX7e5A_5LE>E_
BG J4;347 5C?=4S4= C6;4?7; C9C:@6;4975 4G I4&C9@6Q “In a group of 51 people attending to Sisli Etfal Training and Research Hospital outpatients department who had been diagnosed as bipolar disorder according to DSM-IV-TR and not in an episode of mania, depression or mixed state on the assessment, the frequency of any dissociative disorder, when assessed with the SCID-D, was 35.4%” 3;;CDEEF?G;;EHXII?_5L
44G "=34a9C3Q?746 62% assessed as having a past or present Dissociative Disorder. “Results of this study support the hypothesis that there are unrecognized dissociative symptoms and disorders in a population of patients with prior clinical diagnoses of psychotic disorders. “ 3;;CDEEF?G;;E`4+ci_5LE>E_
444G "?[ )884=;497 “66% of the survey sample qualified for a dissociative disorder diagnosis.” 3;;CDEEF?G;;EZ*@$F_5LE>E_
4>G ":B5;67=? )B:5? j'3? 64V 9S ;3? CQ?5?7; 5;:8W <65 ;9 8?;?QV47? ;3? CQ?>6@?7=? 678 =9QQ?@6;?5 9S 84559=46;4>? 8459Q8?Q5 6V97F 47C6 ;4?7;5 <4;3 8Q:F 8?C?78?7=WG Twenty-seven patients (26.0%) had a dissociative disorder according to the SCID-D.” 3;;CDEEF?G;;E^5eZJZ5L >G 06;47F %459Q8?Q5 j-S ;3? KL B:@4V4=5 5=9Q47F 6B9>? K_ 97 ;3? %0"U ` 9S ;3?V 2KZGHgM V?; ;3? =Q4;?Q46 S9Q 6 84559=46;4>? 8459Q8?Q <3?7 655?55?8 <4;3 ;3? "#$%&%d 3;;CDEEF?G;;EHhXY^Z5LE>E_ >4G -#% “14% of the patients with OCD had comorbid dissociative disorder. There was a statistically significant positive correlation between Yale-Brown points and Dissociation Questionnaire points. We conclude that dissociative symptoms among patients with OCD should alert clinicians for the presence of a chronic and complex dissociative disorder.” 3;;CDEEF?G;;ELB+fC_5L
>44G NQ4597Ek:>?74@? 8?@47l:?7; Forensic Inpatients: “Almost 25% suffered from any kind of DD as diagnosed with the SCID-D. The rates are more than twofold higher than prevalence rates from the general population. These results suggest that forensic patients resemble a very high-risk population for both dissociative symptoms and disorders” Juveniles in Detention Center: “A total of 28.3% met the criteria for a dissociative disorder. Early detection may help identify a group of children who could benefit from early intervention. ” 3;;CDEEF?G;;EK#b%<_5L
=G %4559=46;497 678 %4559=46;4>? %459Q8?Q5 65 6 #9VV976@4;W 9S #97>?Q5497 E"9V6;4a6;497 EN'"%
4G %4559=46;4>? 8459Q8?Q5 <4;347 N'"% C9C:@6;497 jJ? 5;:84?8 Z_ >4=;4V5 9S 47;Q6S6V4@W Q6C? <39 ?Q ;3? 6F? 9S LKG '3?5? >4=;4V5 ? 68V4554975 ;9 6 S9Q?754= =?7;?Q S9Q 5?[:6@ >49@?7=?G '3? Q6C?5 4=;4V5 4?4=;4V5 368 6 84559=46;4>? 8459Q8?QGd 3;;CDEEF?G;;EH?P0l:CL 44G 0>48?7=?D N'"% 65 6 %4559=46;4>? %459Q8?Q Imaging studies in posttraumatic stress disorder (PTSD) have shown differing neural network patterns between hypoaroused/dissociative and hyper-aroused subtypes. Since dissociative identity disorder (DID) involves different emotional states, this study tests whether DID fits aspects of the differing brain-activation patterns in PTSD. Results confirm the notion that DID is related to PTSD as hypo-aroused and hyper-arousal states in DID and PTSD are similar.” 3;;CDEEF?G;;EXeBIH@CL “
444G #97>?Q5497 2F?7?Q6@@WM j'34Q;W&?4F3; =975?=:;4>? C6;4?7;5 CQ?>49:5@W 846F795?8 <4;3 =97>?Q5497 8459Q8?Q 6@:6;?8 mS9Q 6 C9554B@? 84559=46;4>? 8459Q8?Qn :547F ;3? "#$%&%G ) 84559=46;4>? 8459Q8?Q <65 5??7 47 YcGYg 9S ;3? C6;4?7;5Gd 3;;CDEEF?G;;E`B_aNZ5L 4>G N5?:89&5?4a:Q?5 65 6 %4559=46;4>? %459Q8?Q “Dissociation is nearly ubiquitous in pseudo-seizure patients but often is overlooked and not formally diagnosed. When the SCIDD was used systematically, 90% of pseudo-seizure patients were found to have a dissociative disorder.” 3;;CDEEF?G;;EXN#@=PlL
>G "9V6;4a6;497 65 6 %4559=46;4>? %459Q8?Q $7 ;345 5;:8WU `_g 9S ;3? 59V6;4a6;497 8459Q8?Q C6;4?7;5U <3?7 655?55?8 <4;3 ;3? "#$%&%U ? 6V7?546G 3;;CDEEF?G;;EZhA.Pe3L
8G N5W=39C3W549@9F4=6@ #367F?5 65 67 9B5?Q>?8 C6Q; 9S 84559=46;4>? C3?79V?79@9FW We present a patient with dissociative identity disorder (DID) who after 15 years of diagnosed cortical blindness gradually regained sight during psychotherapeutic treatment. At first only a few personality states regained vision, whereas others remained blind. 3;;CDEEF?G;;EXl:W").L
?G 'Q6:V6;4= (?5C975? 678 #:@;:Q? J4;347&#:@;:Q?&%4SS?Q?7=?5&->?Q&'4V?D j=67 CQ9>48? =@:?5 65 ;9 47;?Q&=:@;:Q6@ 84SS?Q?7=?5G 19Q 475;67=?U SQ9V <6Q ;9 <6QU 59V6;4= ?[CQ?554975 9S ?[C95:Q? ;9 ;Q6:V6 6@;?Q?8 47 Q?=9F74a?8 CQ?89V4767=?U SQ9V =6Q846= 5WVC;9V5 2V48& LH__o5M ;9 ;Q?V9Q 678 V9>?V?7; 8459Q8?Q5 2JJ$M ;9 F65;Q947;?5;476@ 5WVC;9V5 2JJ$$D p$7 O6W LXYKU 84F?5;4>? 8459Q8?Q5 6==9:7;?8 S9Q Lcg 9S 6@@ 845=36QF?5 S9Q 845?65?5 SQ9V ;3? 6QVW 678 ()1pM ;9 ;3? 59V6;4= ?[CQ?554975 9S p+:@S <6Q 5W78Q9V?pG '3?5? 84SS?Q?7=?5 =67 B? ?[C@647?8U 47 C6Q;U BW =367F?5 47 =:@;:Q6@@W 6==?C;6B@? <6W5 ;9 ?[CQ?55 ;Q6:V6;4= ?[C95:Q?U =9:C@?8 <4;3 ;3? 9B5?Q>?Qo5 2?FU 89=;9Q5oM =:@;:Q6@ B465 S9Q ?[C@676;4975 8:Q47F ;36; C6Q;4=:@6Q ?C9=3Gd #9VC6Q6;4>? #:@;:Q6@ %4SS?Q?7=?5D j$7 ;345 =65? Q?C9Q; 9S ON% 47 6 ,45C674= <9V67U ;3? 6:;39Q =9VC6Q?5 678 =97;Q65;5 3?Q CQ?5?7;6;497 9S 5WVC;9V5 <4;3 ;395? 9S ;3? =:@;:Q6@@W 6==?C;?8 );6l:? 8? *?Q>495U 9Q ooN:?Q;9 (4=67 5W78Q9V?G p $; 45 ;3?9Q4a?8 ;36; ;3? 54V4@6Q4;4?5 V6W 47=Q?65? ;3? 47=48?7=? 9S V45846F79545 9S ON% 47 ,45C674=5 678 4; 45 Q?=9VV?78?8 ;36; ;3? 846F79545 9S ON% B? =97548?Q?8 47 ,45C674=5 <4;3 345;9Q4?5 9S 6;6l:?G 3;;CDEEF?G;;ELSf5W8lL $$$G
.5? 9S ;3? "#$%&% 47 )55?5547F %4559=46;497 6G ->?Q>4?< $7;Q98:=;9QW 6Q;4=@?D j) =9VCQ?3?754>? 655?55V?7; 9S 84559=46;4>? 5WVC;9V5 45 Q?=9VV?78?8 S9Q ?SS?=;4>? ;Q?6;V?7; 9S ;Q6:V6 5:Q>4>9Q5G '3? 6:;39Q Q?>4?<5 ;3? 5W5;?V6;4= 8?;?=;497 9S 84559=46;4>? 5WVC;9V5 678 8459Q8?Q5 :547F ;3? "#$%&%d
(?>4?< 47 #6768467 k9:Q76@ 9S N5W=346;QWD j/4A? 6 Q4=3 5WVC397WU $ 7?>?Q ;4Q? 9S ;3? "#$%&% 678 5??V ;9 B? =975;67;@W 5:QCQ45?8 678 ?8:=6;?8 BW 4;G '345 45 47 @6QF? C6Q; B?=6:5? 9S ;3? 9C?7&?78?8 S9QV6;U <3?Q?BW V95; l:?5;4975 6Q? S9@@947F e:5; 675? <36; 45 B?47F 65A?8 S9QG O9Q? 9S;?7U ;39:F3U 4; 45 6V6a47F <36; ;3? C6;4?7; >9@:7;??Q5 6B9:; 84559=46;497U @97F B?S9Q? ;3? V9Q? 84Q?=; l:?5;4975 6Q? 65A?8Gd 3;;CDEEF?G;;EY_QNLZ5L BG "=Q??7?Q5 678 ;3?4Q @4V4;6;4975 S9Q 846F79545 Screener Study 1: “We found no significant differences between the diagnostic accuracy of the DES [cutoff=12], SDQ-20 [cutoff=30], and MID [cutoff=28] … Looking at positive predictive values and correct classification rates, the cut-off scores we selected for a sensitivity greater than .80 only predicted an accurate diagnosis (positive predictive value) of between 38 % and 51 % for DDs and between 39 % and 40 % for DDNOS-I/DID in our sample. In other words, the use of these instruments with optimal screening scores lacks sufficient diagnostic accuracy because of high false positive rates, which often is the case for screening instruments. This is not necessary an undesirable feature of instruments used for screening purposes, where the consequences of missing a true positive are more serious than diagnosing a false positive. However, as is often the case with screening instruments, follow-up testing with a more definitive diagnostic evaluation that has better specificity is required, e.g., by the SCID-D-R in patients with a positive result according to one of these three psychometric instruments.” Screener Study 2: “In a sample of 1,051 clinical subjects, however, only 17% of those scoring above 30 on the DES actually had DID (Carlson et al., 1993). The DES is not a diagnostic instrument. It is a screening instrument. High scores on the DES do not prove that a person has a dissociative disorder, they only suggest that clinical assessment for dissociation is warranted. … DID subjects sometimes have low scores, so a low score does not rule out DID. In fact, given that in most studies the average DES score for a DID patient is in the 40s, and the standard deviation about 20, roughly about 15% of clinically diagnosed DID patients score below 20 on the DES.” 3;;CDEEF?G;;EHA(H'K5L
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