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Vedat Sar - One of the best experts on this subject based on the ideXlab platform.
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Childhood Trauma and Dissociative Disorders
Childhood Trauma in Mental Disorders, 2020Co-Authors: Vedat SarAbstract:Dissociative Disorders constitute an exemplary disease model of the biopsychosocial paradigm in psychiatry. Being a post-traumatic condition related to developmental adversities, both biological underpinnings, as well as the neurobiological consequences of chronic stress, and the social context where the traumatic experiences occur influence the pathogenesis, expression, and treatment of Dissociative Disorders. The central dimension of Dissociative psychopathology is a disturbance of sense of self and/or agency which may be accompanied by amnesias, due to altered metamemory processes. Such dissociation is a consequence of the disturbed mutuality between external realities and the internal world (psychological realities) which require synchronization. This disorganization may lead to alterations of consciousness, which may interfere with cognitive abilities, vigilance, and awareness of the individual. As one of these disturbances may predominate in a particular patient or for a period of time, the therapeutic intervention requires flexibility both within an ongoing treatment and between different patients. The trimodal model of complex trauma and dissociation provides a basis to understand this spectrum of psychopathology which is in analogy with the response of the body to an injury or the components of a bodily disease.
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Dissociative amnesia in Dissociative Disorders and borderline personality disorder self rating assessment in a college population
Journal of Trauma & Dissociation, 2014Co-Authors: Vedat Sar, Gamze Akyüz, Firdevs Alioglu, Sercan KarabulutAbstract:Dissociative amnesia (DA) among subjects with a Dissociative disorder and/or borderline personality disorder (BPD) recruited from a nonclinical population was examined. The Steinberg Dissociative Amnesia Questionnaire (SDAQ), the Childhood Trauma Questionnaire, and the self-report screening tool of the BPD section of the Structured Clinical Interview for DSM-IV(SCID-BPD) were administered to 1,301 college students. A total of 80 participants who were diagnosed with BPD according to the clinician-administered SCID-BPD and 111 nonborderline controls were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) by a psychiatrist blind to diagnosis and scale scores. Internal consistency analyses and test-retest evaluations suggested that the SDAQ is a reliable instrument for the population studied. Of the participants, 20.6% reported an SDAQ score of 20 or above and impairment by DA. Those who had both Dissociative disorder and BPD (n = 78) had the highest SDAQ scores. Both Disorders had significant effects on the SCID-D total and amnesia scores in the variance analysis. On SDAQ scores, however, only BPD had this effect. There was a significant interaction between the 2 Disorders for the SCID-D total but not for the SDAQ or SCID-D amnesia scores. BPD represented the severity of dissociation and childhood trauma in this study group. However, in contrast to the Dissociative Disorders, BPD was characterized by better awareness of DA in self-report. The discrepancies between self-report and clinical interview associated with BPD and Dissociative Disorders are discussed in the context of betrayal theory (J. J. Freyd, 1994) of BPD and perceptual theory (D. B. Beere, 2009) of Dissociative Disorders.
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Dissociative Disorders in DSM-5.
Depression and anxiety, 2011Co-Authors: David Spiegel, Etzel Cardeña, Vedat Sar, Richard J Loewenstein, Roberto Lewis-fernández, Daphne Simeon, Eric Vermetten, Richard J Brown, Paul F. DellAbstract:We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria. This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and Dissociative Disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding Dissociative symptoms and Disorders. We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should include derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category. There is a growing body of evidence linking the Dissociative Disorders to a trauma history, and to specific neural mechanisms. © 2011 Wiley Periodicals, Inc.
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Epidemiology of Dissociative Disorders: An Overview
Epidemiology Research International, 2011Co-Authors: Vedat SarAbstract:General psychiatric assessment instruments do not cover DSM-IV Dissociative Disorders. Many large-scale epidemiological studies led to biased results due to this deficit in their methodology. Nevertheless, screening studies 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. Data derived from epidemiological studies also support clinical findings about the relationship between childhood adverse experiences and Dissociative Disorders. Thus, Dissociative Disorders constitute a hidden and neglected public health problem. Better and early recognition of Dissociative Disorders would increase awareness about childhood traumata in the community and support prevention of them alongside their clinical consequences.
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Somatization as a predictor of suicidal ideation in Dissociative Disorders.
Psychiatry and clinical neurosciences, 2008Co-Authors: Erdinç Öztürk, Vedat SarAbstract:Aim: This study was concerned with correlates of suicidal ideation among patients with chronic complex Dissociative Disorders. Method: Participants were 40 patients diagnosed as having either Dissociative identity disorder or Dissociative disorder not otherwise specified according to the DSM-IV. The Dissociative Disorders Interview Schedule, the Dissociative Experiences Scale, the Somatoform Dissociation and the Childhood Trauma Questionnaires, the Spielberger Trait Anger Inventory, the Beck Suicidal Ideation Scale, and the Borderline Personality Disorder section of the Structured Clinical Interview for DSM-IV Personality Disorders were administered to all patients. Results: Patients with suicidal ideas (n = 15) had concurrent somatization disorder more frequently than the remaining patients. Having significantly high scores on both trait and state dissociation measures, their Dissociative disorder was more severe than that of the patients with no suicidal ideation. They had elevated scores for childhood emotional abuse, physical abuse and emotional neglect. Concurrent somatization disorder diagnosis was the only predictor of suicidal ideation when childhood trauma scores and borderline personality disorder diagnosis were controlled. Conclusions: Among Dissociative patients, there is an association between somatization and suicidal ideation. A trauma-related insecure attachment pattern is considered as a common basis of this symptom cluster.
Hamdi Tutkun - One of the best experts on this subject based on the ideXlab platform.
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Dissociative Disorders in Turkish inpatients with conversion disorder.
Comprehensive psychiatry, 2003Co-Authors: Ertan Tezcan, Murad Atmaca, Murat Kuloglu, Omer Gecici, Ayten Buyukbayram, Hamdi TutkunAbstract:The aim of our study was to determine the frequency of Dissociative Disorders (DDs) among inpatients with conversion disorder (CD) in a university clinic settled in Eastern Turkey. During a period of 24 months, 59 consecutively admitted adult CD patients were screened with the Dissociative Experience Scale (DES). Patients who scored above 30 (DDs group) did not differ by age or gender from a group of inpatients who scored below 10 on the scale (comparison group). All patients in the two groups were then interviewed in a blind manner using the Dissociative Disorders Interview Schedule (DDIS) and Structured Interview for DSM-IV Dissociative Disorders (SCID-D). According to the SCID-D, 18 of 59 patients (30.5%) received a diagnosis of Dissociative disorder; nine of these 18 patients (50%) were diagnosed as having Dissociative identity disorder, eight (44.4%) were diagnosed as having Dissociative disorder not otherwise specified (NOS), and one (5.6%) was diagnosed as having Dissociative amnesia. Accordingly to the DDIS, borderline personality disorder was frequent in the DDs group, and all of the patients in the DDs group reported sexual abuse and neglect during childhood, latency, or adolescence. A high proportion of CD patients have significant Dissociative pathology. The proper diagnosis of these patients has important implications for their clinical course.
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Frequency of Dissociative Disorders among psychiatric outpatients in Turkey
Comprehensive psychiatry, 2000Co-Authors: Vedat Sar, Hamdi Tutkun, Behiye Alyanak, Bahadir Bakim, Isin BaralAbstract:Abstract The aim of this study was to determine the frequency of Dissociative Disorders among psychiatric outpatients in Turkey. One hundred fifty consecutive outpatients admitted to the psychiatry clinic of a university hospital were screened with the Dissociative Experiences Scale (DES). Twenty-three patients (15.3%) with a DES score greater than 30 and a comparison group selected from the same outpatient population who scored less than 10 on the scale were then interviewed with the Dissociative Disorders Interview Schedule (DDIS) in a blind fashion. According to the DDIS, 18 patients (12.0%) received a diagnosis of Dissociative disorder; 83.3% (n = 15) of the Dissociative patients reported neglect, 72.2% (n = 13) emotional abuse, 50.0% (n = 9) physical abuse, and 27.8% (n = 5) sexual abuse during childhood. Dissociative Disorders are not rare among psychiatric outpatients. Self-rating instruments and structured interviews can be used successfully for screening Dissociative Disorders, which are usually underrecognized. Neglect was the most frequently reported type of childhood trauma, suggesting the importance of other childhood experiences in addition to sexual and/or physical abuse in the development of Dissociative psychopathology.
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Frequency of Dissociative Disorders Among Psychiatric Inpatients in a Turkish University Clinic
The American journal of psychiatry, 1998Co-Authors: Hamdi Tutkun, Vedat Sar, L. Ilhan Yargic, Tuba Özpulat, Medaim Yanik, Emre KiziltanAbstract:OBJECTIVE: The aim of this study was to determine the rate of Dissociative Disorders among psychiatric inpatients in a university clinic in Turkey. METHOD: The Dissociative Experiences Scale was used to screen 166 consecutive inpatients admitted to the psychiatry clinic of a university hospital. The patients who had scores higher than 30 were matched for age and gender with 19 of the patients who scored below 10 on the scale. The patients in both groups were then interviewed with the Dissociative Disorders Interview Schedule by interviewers who were blind to their diagnoses and scores on the Dissociative Experiences Scale. Patients who were diagnosed as having a Dissociative disorder according to the Dissociative Disorders Interview Schedule were then interviewed by a clinician. RESULTS: Twenty-four (14.5%) of the 166 patients had a score higher than 30 on the Dissociative Experiences Scale; 17 patients (10.2%) were diagnosed as having a Dissociative disorder according to the Dissociative Disorders Interv...
Frank W Putnam - One of the best experts on this subject based on the ideXlab platform.
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six year follow up of the treatment of patients with Dissociative Disorders study
European Journal of Psychotraumatology, 2017Co-Authors: Amie C Myrick, Richard J Loewenstein, Frank W Putnam, Ruth A Lanius, Aliya R Webermann, Bethany L BrandAbstract:ABSTRACTObjective: Literature on the treatment of Dissociative Disorders (DDs) suggests that these individuals require long-term and specialized treatment to achieve stabilization and functionality. There is considerable empirical support for specialized phasic, dissociation-focused treatment in reducing a myriad of psychological symptoms and self-harm in this population. However, until recently, there has been a paucity of longitudinal treatment research on DD patients.Method: In the present six-year follow-up study, 61 therapists who participated in the initial phase of the Treatment of Patients with Dissociative Disorders (TOP DD) study answered questionnaires about their study patient’s stressors, quality of life, global functioning, victimization, and safety. These results provided a view of patients’ progress six years since the beginning of the TOP DD study.Results: Longitudinal analyses demonstrated patients had significantly fewer stressors (Χ2(6) = 18.76, p < .01, canonical r = .48, N = 76), ins...
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Dissociative Disorders in children behavioral profiles and problems
Child Abuse & Neglect, 1993Co-Authors: Frank W PutnamAbstract:Transient Dissociative episodes are a common and normative phenomenon during childhood that generally decrease during adolescence to relatively low levels in adults. Retrospective clinical research has firmly established a connection between childhood trauma and the development of Dissociative Disorders in adults. A growing number of clinicians are now identifying Dissociative symptoms in abused children, and there is increasing evidence that Dissociative Disorders represent a significant and hitherto unrecognized form of psychopathology in traumatized children. Pathological dissociation is a complex psychobiological process that results in a failure to integrate information into the normal stream of consciousness. It produces a range of symptoms and behaviors including: (a) amnesias; (b) disturbances in sense of self; (c) trance-like states; (d) rapid shifts in mood and behavior; (e) perplexing shifts in access to knowledge, memory, and skills; (f) auditory and visual hallucinations; and (g) vivid imaginary companionship in children and adolescents. Many of these symptoms and behaviors are misdiagnosed as attention, learning or conduct problems, or even psychoses. Early identification and therapeutic intervention appear to be particularly efficacious in children in contrast to adults, although systematic studies of treatment and outcome are presently lacking.
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Clinical phenomenology of child and adolescent Dissociative Disorders
Journal of the American Academy of Child and Adolescent Psychiatry, 1992Co-Authors: Nancy L. Hornstein, Frank W PutnamAbstract:Abstract A comparison of two separately diagnosed samples of children and adolescents with Dissociative Disorders demonstrates good construct validity for these diagnoses in childhood. Descriptive analyses of the total sample reveal a clinical profile characterized by a plethora of affective, anxiety, conduct, posttraumatic, and Dissociative symptoms. Children with multiple personality disorder (MPD) differ from those with Dissociative disorder not otherwise specified (DDNOS) in having more amnesias, identity disturbances, and hallucinations. Adolescents were more symptomatic than children age 11 or younger and more likely to receive a diagnosis of multiple personality disorder.
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Dissociative Disorders in children and adolescents a developmental perspective
Psychiatric Clinics of North America, 1991Co-Authors: Frank W PutnamAbstract:Childhood and adolescent Dissociative Disorders are being diagnosed increasingly by mental health professionals who work with traumatized children. The identification of these conditions is hampered by the high background level of normal Dissociative behavior observed in children and adolescents. An awareness of the underlying developmental processes and issues can aid in the identification of pathologic dissociation.
Emre Kiziltan - One of the best experts on this subject based on the ideXlab platform.
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differentiating Dissociative Disorders from other diagnostic groups through somatoform dissociation in turkey
Journal of Trauma & Dissociation, 2001Co-Authors: Vedat Sar, Turgut Kundakci, Bahadir Bakim, Emre Kiziltan, Oya BozkurtAbstract:Abstract This study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the Somatoform Dissociation Questionnaire (SDQ-20). In this context, it investigated whether somatoform dissociation differentiates Dissociative Disorders from other diagnostic groups and non-clinical individuals. The Turkish Version of the SDQ-20 was administered to 50 patients with a Dissociative disorder, 94 patients with psychiatric Disorders other than Dissociative disorder, and 175 non-clinical participants. To confirm the clinical diagnosis, all patients in the Dissociative disorder group had been evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders. The internal consistency and the test-retest correlation of the SDQ-20 were excellent. The scale had strong correlations with the DES and the DIS-Q. There was a statistically significant difference between Dissociative patients and other diagnostic groups on the SDQ-20 total score. The discriminative p...
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Frequency of Dissociative Disorders Among Psychiatric Inpatients in a Turkish University Clinic
The American journal of psychiatry, 1998Co-Authors: Hamdi Tutkun, Vedat Sar, L. Ilhan Yargic, Tuba Özpulat, Medaim Yanik, Emre KiziltanAbstract:OBJECTIVE: The aim of this study was to determine the rate of Dissociative Disorders among psychiatric inpatients in a university clinic in Turkey. METHOD: The Dissociative Experiences Scale was used to screen 166 consecutive inpatients admitted to the psychiatry clinic of a university hospital. The patients who had scores higher than 30 were matched for age and gender with 19 of the patients who scored below 10 on the scale. The patients in both groups were then interviewed with the Dissociative Disorders Interview Schedule by interviewers who were blind to their diagnoses and scores on the Dissociative Experiences Scale. Patients who were diagnosed as having a Dissociative disorder according to the Dissociative Disorders Interview Schedule were then interviewed by a clinician. RESULTS: Twenty-four (14.5%) of the 166 patients had a score higher than 30 on the Dissociative Experiences Scale; 17 patients (10.2%) were diagnosed as having a Dissociative disorder according to the Dissociative Disorders Interv...
Nancy L. Hornstein - One of the best experts on this subject based on the ideXlab platform.
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Dissociative Disorders in Children and Adolescents
Handbook of Dissociation, 1996Co-Authors: Nancy L. HornsteinAbstract:The clinical evolution of the recognition and treatment of Dissociative Disorders occurring during childhood and adolescence owes a debt of gratitude to several bodies of research and clinical literature that have accumulated over the last two decades, including posttraumatic stress, the psychological sequelae of trauma and child abuse, child development, and the study of Dissociative Disorders in adults. The complexities of symptomatic presentation and underlying deficits that accompany overt “dissociation” are perhaps nowhere as remarkable as they are during the process of ongoing development in children. The evolution of knowledge in these overlapping areas of investigation has created a framework for the conceptualization and recognition of childhood Dissociative Disorders among those suffering from the psychological sequelae of trauma.
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Clinical phenomenology of child and adolescent Dissociative Disorders
Journal of the American Academy of Child and Adolescent Psychiatry, 1992Co-Authors: Nancy L. Hornstein, Frank W PutnamAbstract:Abstract A comparison of two separately diagnosed samples of children and adolescents with Dissociative Disorders demonstrates good construct validity for these diagnoses in childhood. Descriptive analyses of the total sample reveal a clinical profile characterized by a plethora of affective, anxiety, conduct, posttraumatic, and Dissociative symptoms. Children with multiple personality disorder (MPD) differ from those with Dissociative disorder not otherwise specified (DDNOS) in having more amnesias, identity disturbances, and hallucinations. Adolescents were more symptomatic than children age 11 or younger and more likely to receive a diagnosis of multiple personality disorder.
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Inpatient treatment of children with multiple personality/Dissociative Disorders and their families.
The Psychiatric clinics of North America, 1991Co-Authors: Nancy L. Hornstein, Sheryl TysonAbstract:This article discusses the incidence of childhood Dissociative Disorders among admissions to a university-based children's (age 6-13) inpatient unit. Relevant historical data on 17 patients with Dissociative diagnoses are presented. Detailed discussions of indications for hospitalization, complexities of inpatient diagnostic evaluation, and guidelines for treatment of children with Dissociative Disorders and their families are given.