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Dissociation in Aging Holocaust Survivors
Abstract
This study explored relationships among dissociation, trauma, and posttraumatic stress disorder (PTSD) in elderly Holocaust survivors with and without PTSD and in a demographically comparable group of nontraumatized subjects.
Holocaust survivors with PTSD (N = 35) and without PTSD (N = 25) who had been recruited from the community and a comparison group (N = 16) were studied. Dissociation was evaluated with the Dissociative Experiences Scale. Past cumulative trauma and recent stress were evaluated with the Antonovsky Life Crises Scale and the Elderly Care Research Center Recent Life Events Scale, respectively. PTSD symptoms were assessed with the Clinician-Administered PTSD Scale.
The Holocaust survivors with PTSD showed significantly higher levels of current dissociative experiences than did the other groups. However, the extent of dissociation was substantially less than that which has been observed in other trauma survivors with PTSD. Dissociative Experiences Scale scores were significantly associated with PTSD symptom severity, but the relation between Dissociative Experiences Scale scores and exposure to trauma was not significant.
Possible explanations for this finding include the age of the survivors, the length of time since the traumatic event, and possible unique features of the Holocaust survivor population. Nevertheless, the findings call into question the current notion that PTSD and dissociative experiences represent the same phenomenon. The findings suggest that the relationships among dissociation, trauma, and PTSD can be further clarified by longitudinal studies of trauma survivors.
... Furthermore, Yehuda et al. (1996) focused on how dissociation plays a role in the aging survivor. Dissociation is defined as a disruption in the usually integrated functions of consciousness, memory, identity or perception which may be sudden or gradual (American Psychiatric Association, 2000). ...
... Van der Kolk and Van der Hart (1989) theorized that trauma led to dissociation. Yehuda et al. (1996) aimed to test this hypothesis as it relates to the relationship among dissociation, trauma, and posttraumatic stress disorder in elderly Holocaust survivors. ...
... As the literature review revealed, research on first generation survivors yielded multiple stress related themes including psychological diagnosis, survivor's syndrome, and physical diagnosis. Researchers studying the first generation focused their attention on PTSD, Major Depressive Disorder, Sleep Disorders, and Dissociation (Kuch & Cox, 1992, Yehuda et al. 1996, Yehuda et al. 1997, Golier et al. 2002, and Yehuda et al. 1994). The first generation survivors were found to have survivor's syndrome due to being physically exposed to the traumas of the Holocaust (Krystal, 1968;Meerloo, 1963;Niederland, 1968;1981). ...
Over sixty-five years ago the Jewish people were liberated from Nazi Europe. Since that time, researchers have found that the Holocaust has had a psychological, social, and cultural effect on first and second generation survivors. Despite the significant amount of research that has been done on Holocaust survivors and their offspring, little has been investigated about when, why and how surviving generations begin to move past pathological symptoms. This study explored the impact the Holocaust had on third generation survivors through administering an eight item semi-structured questionnaire called, The Third Generation Questionnaire, which was created for the purpose of this study. The questions emerged from the literature as well as the search for perceptions and meanings and utilized Vikor Frankl’s existential theory. The questionnaire was administered to a purposive sample of (N=30) of third generation survivors through REDCap, an online survey database. Previous research points to the transmission of pathologic symptoms; this study strongly suggests that among third generation survivors, pride, strength, and gratitude are as much a part of the legacy as the negative effects of the experience. The third generation appears to be reconstructing their grandparents’ history, resurfacing their legacy, and in doing so they are realizing the strength and heroic battles their grandparents fought in order to get to the place they are today. Findings indicate that rather than ruminating on the pain of their ancestors, focusing attention on their strength may result in the ability to move past the pathological symptoms. Focusing this study on third generation survivors expands scientific knowledge regarding transmission of trauma and provides direction to clinical social workers treating individuals who may have a history of intergenerational trauma.
... Thirty-three percent of survivors reported three or more areas of distress, compared with 25% among respondents in the comparison group. Specific psychological problems, such as sleep disturbances (Lavie, 2001) and dissociations (Yehuda et al., 1996) have been documented among Holocaust survivors. ...
... Our data raise some very important questions about approaches of the mental health literature that categorizes people, based on meeting criteria of various diagnostic entities, such as Post Traumatic Stress Disorder or depression. According to these psychiatric approaches, one could either be mentally ill or have an absence of mental illness (Yehuda et al., 1996). A second approach, that is more prevalent in social science research, takes an incremental view of mental health symptomatology. ...
Based on a unique research study, this volume examines the later life development of Holocaust survivors from Israel and the U.S. Through systematic interviews, the authors -- noted researchers and clinicians -- collected data about the lives of these survivors and how they compared to peers who did not share this experience. The orientation of the book synthesizes several conceptual approaches â€" gerontological and life span development, stress research, and traumatology, and also reflects the varied disciplines of the authors, spanning psychology, social work, and sociology. The result is a multi-faceted view of their subject with an understanding of the individual, society, and the interaction of the two, tempered by the authors; own Holocaust experiences. Chapters cover a range of areas including stress and coping of these survivors, reviews of their heath and mental health, an examination of their social integration, as well as a review of the multiple predictors of psychological well being and adaptation to aging. This book will be of interest to psychologists, social workers, sociologists, psychiatrists and all those who study both trauma and aging.
... Even though there is little data available on such effects in OHS, we may assume that such effects are substantial. Eitinger (1993) reported on a study from 1948 of newborn children of camp survivors with a higher percentage of congenital malformations. The challenging physical conditions which mothers endured during pregnancy, in addition to early childhood experiences, severely affected their offspring (Keinan-Boker, 2014). ...
For almost seventy years, observational and empirical data have been collected on a unique population at risk because of their parents' wartime experiences, resulting in extensive and sometimes confusing findings on the intergenerational transmission of Holocaust trauma in survivor families. This paper presents a critical overview of past research, discusses the current shift from a psychosocial to a neurobiological focus, and delineates the essential variables in future research on trauma transmission. Such variables include particular parents who transmit various influences to certain individual children under specific circumstances and during different critical time periods. A more integrative conceptual model of trauma transmission is suggested from a psychosocial and neurobiological life-course developmental perspective that may guide future research in this field with a variety of populations. Offspring who were earlier regarded as being either vulnerable or resilient are now viewed as being more or less biologically susceptible to a more or less accommodating environment. Can parental traumatization be transmitted to their offspring? This question has been asked repeatedly ever since the Second World War in connection to the offspring of Holocaust survivors (OHS). This population has been regularly studied almost since they were born; from infancy, childhood, adolescence, throughout their early adulthood and midlife, to the present stage of mature adulthood and old age. For almost seventy years, qualitative and quantitative data have been collected, resulting in a sizeable cumulative database that provides a unique long-term perspective of a population at risk due to their parents' wartime experiences. The knowledge gained from Holocaust trauma transmission (HTT) has substantial translational applications since it is relevant also for the offspring of survivors from a
... For over a century, dissociation has been theorized to relate to trauma (see van der Hart & Horst, 1989) and higher rates of dissociation are found for those with trauma-related pathology (i.e., PTSD) compared to other pathological and nonpathological groups (e.g., Bremner et al., 1992;Carlson, Dalenberg, & McDade-Montez, 2012;Yehuda et al., 1996). Long-held clinical theory suggests that dissociation relates to fragmented trauma memories and leads to PTSD through disrupting processing of trauma memories (van der Kolk, van der Hart, & Marmar, 1996). ...
Objective:
With the inclusion of a dissociative subtype, recent changes to the DSM-5 diagnosis of posttraumatic stress disorder (PTSD) have emphasized the role of dissociation in the experience and treatment of the disorder. However, there is a lack of research exploring the clinical impact for highly dissociative groups receiving treatment for PTSD. The current study examined the presence and clinical impact of a dissociative subtype in a sample of individuals receiving treatment for chronic PTSD.
Method:
This study used latent transition analyses (LTA), an expanded form of latent profile analyses (LPA), to examine latent profiles of PTSD and dissociation symptoms before and after treatment for individuals (N = 200) receiving prolonged exposure (PE) or sertraline treatment for chronic PTSD.
Results:
The best fitting LTA model was one with a 4-class solution at both pretreatment and posttreatment. There was a latent class at pretreatment with higher levels of dissociative symptoms. However, this class was also marked by higher reexperiencing symptoms, and membership was not predicted by chronic child abuse. Further, although those in the class were less likely to transition to the responder class overall, this was not the case for exposure-based treatment specifically.
Conclusion:
These findings are not in line with the dissociative-subtype theoretical literature that proposes those who dissociate represent a clinically distinct group that may respond worse to exposure-based treatments for PTSD. (PsycINFO Database Record
... Our results indicate few between-group differences. For instance, somatic symptoms do not appear to differ across groups in contrast to early research suggesting increased levels of somatization by HS (Yehuda, Elkin, Binder-Brynes, & Kahana, 1996). However, HS appear to experience greater depressive affect and absence of wellbeing compared to older Canadians and other Israelis. ...
Objectives: Existing research indicates that early life trauma increases the likelihood of depression in later life. This includes children who survived the Nazi Holocaust living in Israel today. For this study, we set out to examine whether early life trauma affects both levels of depression symptomatology and the relative prominence of certain facets of depression as compared to other older adults in Israel and Canada. Method: For this study we recruited 295 Holocaust survivors (HS), 205 other Israelis and 335 older Canadians each of whom completed Radloff’s (1977) Center for Epidemiological Studies – Depression Scale (CES-D). The CES-D measures four distinct factors: Depressive affect, absence of well-being, somatic symptoms, and interpersonal rejection. Israeli and Canadian comparison participants were screened to ensure they had not experienced early life trauma. Results: As anticipated, levels of depressive symptoms reported by HS were significantly greater than other Israelis and older Canadians. Moreover, the latent structure of depression as measured by the CESD
differs for HS. Depressive affect and the absence of well-being appear to distinguish depression among HS. Somatic symptoms do not differ, however, and interpersonal rejection seems less germane to depression as experienced by HS compared to both comparison samples. Conclusion: Findings support our assertion that early life trauma affects not only levels of depressive symptoms but also that these survivors of genocide experience depression differently than other Israelis and older Canadians. We discuss the implications of early life trauma for mental health in later life.
... In a previous report, Holocaust survivors with posttraumatic stress disorder (PTSD) were found to have higher scores on the Dissociative Experiences Questionnaire 1 (DES), than Holocaust survivors without PTSD or nonexposed, demographically comparable Jewish subjects. 2 However, the extent of dissociation was substantially less than that which has been observed in other trauma survivors with PTSD. Age of survivors was hypothesized as one of several possible explanations for these findings. ...
The trajectory of posttraumatic stress disorder (PTSD) and PTSD-related symptoms in relation to aging is not well understood. We previously observed higher levels of dissociation as measured by the Dis-sociative Experiences Scale (DES) among older Holocaust survivors with, compared to those without, PTSD, though scores on the DES in Holo-caust survivors were markedly lower than those that had been reported for younger cohorts. We undertook a longitudinal evaluation of dissocia-tion in Holocaust survivors. Twenty-six Holocaust survivors with current PTSD, 30 Holocaust survivors without current PTSD, and 19 nonexposed were evaluated at the initial evaluation and subsequently 8.11 years later. Repeated measures analysis of variance (ANOVA) on the DES scores from these times demonstrated a significant main effect for time and a significant group by time interaction, reflecting a marked decline in Holocaust survivors, particularly those with PTSD. Controlling for age obliterated the effect of time, but not the group by time interaction. A similar pattern was shown with The Clinician Administered PTSD Scale (CAPS) scores. Different symptoms related to PTSD show different trajectories of change with age, with dissociation appearing to be less prominent with age.
... Individuals with PTSD frequently have other comorbid mental symptoms and disorders, such as social anxiety (e.g., Crowson, Frueh, Beidel, & Turner, 1998), other anxiety and mood disorders (e.g., Breslau & Davis, 1992), suicide attempts (e.g., Davidson, Hughes, Blazer, & George, 1991), dissociative symptoms (Yehuda et al., 1996), substance abuse (e.g., Cottler, Compton, Mager, Spitznagel, & Janca, 1992;Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), and personality disorders (e.g., Southwick, Yehuda, & Giller, 1993). ...
... In three studies the DES, which taps the field of dissociation and includes several (Yehuda et al., 1996), in The Netherlands on three samples of people who were victimized in the Netherlands Indies during World War II (Mooren & Kleber, 1996), and in ...
People who went through the horrors of the Holocaust struggle with their memories in different ways. Many experience overwhelming and intrusive recollections accompanied by strong emotions, even more so fifty years after the end of the war than earlier. Others have tried to silence their memories by attempts to keep the memories away or by dissociating themselves from the memories. Not much has been written about this other side of the coping process, that is, to what extent do survivors of the Holocaust succeed to distance themselves from their experiences. Forgetting in the form of repression, denial, and dissociation is a common phenomenon in the aftermath of other traumatic instances (Kleber & Brom, 1992), and amnesia has also been demonstrated after combat experiences (Karon & Widener, 1997; Van der Hart et al., 1999).
... Whether or not such psychogenetic amnesia exists, is doubtful. For instance, concentration camp survivors make all kinds of errors in their recollections, but do not show amnesia for the time they were incarcerated in the concentration camp (Yehuda et al., 1996). A psychological originating amnesia is at least very rare and short lived, if it exists at all (McNally, 2003, p. 210;Schacter, 1996, p. 225). ...
... Dissosiyatif belirtilerle travmatik yaşantılar arasında nedensel bir bağlantı bulunmaktadır (14). Doğal afetler, işkence, silahlı çatışma, tecavüze uğrama gibi travmatik olaylar başlıca dissosiyatif yaşantı nedenleridir (15)(16)(17)(18)(19)(20) ...
Aggression is associated with the hyper arousal symptoms in Post- Traumatic Stress Disorder (PTSD). Biological and psychological factors play a role in the etiology of aggressive behavior. In this study, we aimed to investigate the relationship between dissociation and aggressive behavior in patients with PTSD. 42 patients with a diagnosis of PTSD according to DSM-IV criteria and 41 healthy subjects were enrolled to the study. Socio-demographic data form, the Clinician-Administered PTSD Scale (CAPS), Dissociative Experiences Scale (DES) and the Buss Perry Aggression Scale tests were administered to the participitants. DES scores, CAPS hyper arousal scores and number of experienced trauma were higher in the PTSD patients with high levels of aggression than the PTSD patients with low levels of aggression. The results suggested that dissociative symptoms should be screened carefully in PTSD patients who had aggressive behaviours prominently.
... The long-term epigenetic effects of such exposure to early-life stress on the offspring were profound (Provençal & Binder, 2015a;Yao et al., 2014). Such harmful influence was observed already in 1948 by a gynecologist in Munich who found a high percentage of congenital malformations in the newborn babies (Eitinger, 1993). It was as if these mothers were symbolically feeding their babies with war-tainted milk, if they had any milk at all. ...
Abstract
Transgenerational transmission of trauma (TTT) renders some children of survivors vulnerable to stress while others become more resilient. TTT was previously assumed to be caused primarily by environmental factors, such as the parents’ child-rearing behavior. Recent research findings, reviewed in this paper, suggest that it may also be inherited through epigenetic mechanisms. New data indicate that the glucocorticoid receptor gene may cause the stress hormones of the child to become allostatic rather than resilient. Six clinical case anecdotes on suicidality, depression and PTSD, as well as on certain olfactory, cardiac and pulmonary problems, are presented to illustrate such possible epigenetic transgenerational transmission of Holocaust trauma. Further studies may justify the introduction of a new diagnostic entity -- transgenerational stress disorder -- with immediate relevance for the assessment, prevention, and treatment of the offspring of many kinds of trauma survivors.
... Indeed, numerous studies demonstrated the correlation between dissociative symptoms and personal reports of traumatic experience (21,22) and between PTSD and dissociation. Thus, for example, people diagnosed with PTSD also revealed higher scores on the Dissociative Experiences Scale (DES) designed to evaluate dissocia-tive characteristics, compared to people without a PTSD diagnosis (23,24). ...
Post traumatic patients experience a wide range of symptoms, some of them existential in nature which we term "dissociative being." Many varied psychotherapeutic approaches are available for the treatment of post traumatic patients. Nevertheless, in view of this disorder's complexity, therapists face shortcomings when employing each of these therapeutic interventions. In order to understand this, we posit the principle we call "dissociative reality" for the treatment of trauma survivors. Our proposed method "speaks the patient's own language," harnessing dissociative elements to help individuals recall, re-enact and integrate traumatic experiences, where words are insufficient, while still upholding reality. We believe that this may be seen as an effective part of the therapeutic dialogue, and suggest that therapists may consider supplementing this approach in their treatment "toolkit" for patients with post traumatic stress and other trauma related disorders, irrespective of their declared therapeutic approach.
... The third category of study correlates trait dissociation with PTSD: if trait dissociation is stable over time and is not affected by the occurrence of trauma or the presence of PTSD then a correlation indicates that it is involved in the development of PTSD. Many studies have shown trait dissociation to be correlated with PTSD symptoms or to be higher in groups of patients with PTSD than in similar groups without PTSD, including Vietnam veterans (Hyer, Albrecht, Boudewyns, Woods, & Brandsma, 1993;Marmar et al., 1994;Tichenor et al., 1996); and in a group of 35 Holocaust survivors with PTSD compared to a group of 25 without PTSD 50 years after the trauma (Yehuda et al., 1996). The major problem with concluding about the relationship between dissociation and PTSD from this type 33 of study is that trait dissociation may alter following a trauma and the degree of alteration may be related to PTSD symptom severity: if this is the case then a correlation between trait dissociation and PTSD may merely reflect the fact that trait dissociation is increased by the presence of PTSD, rather than that trait dissociation is involved in causing PTSD. ...
... However, comparison data from the general Norwegian population at that time were not given. On the other hand, in Holocaust survivors, substance misuse was found to be less than that in other groups of trauma survivors (Yehuda et al., 1996). ...
Aims: The relationship between alcohol consumption, cigarette smoking and post-traumatic stress disorder (PTSD) was studied in 147 male former members of the civilian resistance against the Nazi occupation of Holland during World War II. Methods: The subjects were interviewed at home. Measures included rating of current PTSD and a self-report measure of smoking and alcohol use. Results: The weekly alcohol consumption reported by veterans was substantially below that of the general population. Furthermore, there was no significant difference in self-reported alcohol consumption between veterans with and without current PTSD. Cigarette smoking, however, was more prevalent in those with current PTSD. Conclusions: The absence in these veterans of a correlation between PTSD and alcohol consumption is contrary to the results of most studies on this subject. It may be related to the exclusion from organized resistance activities of people prone to the over-consumption of alcohol. It is hypothesized that, in trauma survivors, current substance use is associated with peri-traumatic patterns of psychological tension-reduction modes.
... Due to their personal histories (e.g., being forced to participate in medical experiments conducted by Nazi physicians in concentration camps [Paratz & Katz, 2011]), many Holocaust survivors have an understandable mistrust and fear of medical and public research (Ehrlich, 2004). Mistrust may become an even more prominent issue as Holocaust survivors cope with physiological changes brought on by aging and chronic medical conditions; they may interpret their old age or weakness as a sign of inevitable hardship or death (Baycrest, 2003). It has also been reported that some older adults perceive research to be intrusive through probing interviews or collecting medical samples (Cusack & O'Toole, 2013;Knechel, 2013). ...
Older adults are underrepresented in medical research for many reasons, including recruitment difficulties. Recruitment of older adults for research studies is often a time-consuming process and can be more challenging when the study involves older adults with unique exposures to traumatic events and from minority groups. The current article provides a brief overview of (a) challenges encountered while recruiting aging women Holocaust survivors for a case control study and (b) strategies used for meeting those challenges. The case group comprised women Holocaust survivors who were recently diagnosed with breast cancer and the control group comprised healthy women from a Holocaust-survivor community in Israel. [Res Gerontol Nurs. 20xx; x(xx):xx-xx.].
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... Traumatized refugees need to learn that they are allowed to demand and accept professional help to be able to live in peace with these memories. Memories can be suppressed to an extreme degree (Van der Hart & Brom, 2001) and, as evidenced with Holocaust survivors, blackouts can cover wide periods (Kestenberg & Brenner, 1996;Yehuda et al., 1996). The personal history since the beginning of the persecution can include multiple dissociative characteristics (Kluft, 1997;Van der Kolk et al., 1996). ...
Refugees often suffer from complex trauma including persecution in their home countries, flight and conditions of life in the host country. The body is directly involved in these traumatic experiences. Dance/movement therapy allows for the treatment of complex psychological trauma (torture, rape, war experiences) and contributes to the healing process directly on a body level. This chapter introduces work with traumatized refugees at the treatment center REFUGIO in Munich, Germany. The center offers a multifaceted therapeutic program in which it approaches therapy at the interface of dance and verbal psychotherapy. Examples from individual and group therapy show how the connection of the two therapeutic approaches can be employed in a facilitative and clinically meaningful way. The complex traumata in the life of refugees require creative therapeutic interventions on different levels. Individual and group cases illustrate therapeutic problems and possible solutions.
... Memories can be suppressed to an extreme degree ( Van der Hart & Brom, 2001) and, as evidenced for example with Holocaust survivors, blackouts can cover wide periods (Kestenberg & Brenner, 1996;Yehuda et al., 1996). The personal history since the beginning of the persecution can include multiple dissociative characteristics (Kluft, 1997;Van der Kolk et al., 1996). ...
Refugees often suffer from complex trauma including persecution in their home countries, flight, and
disadvantaged conditions of life in the host country. The body is directly involved in these traumatic
experiences. Dance/movement therapy allows for the treatment of complex psychological trauma (torture, rape, war experiences) and contributes to the healing process directly on a body level. The complex traumata in the life of refugees require creative therapeutic interventions on different levels. This article introduces work with traumatised refugees at the treatment center REFUGIO in Munich, Germany. The center offers a multifaceted therapeutic programand offers among other approaches an interface of dance and verbal psychotherapy. Individual and group cases illustrate how the connection of both therapeutic modalities can be employed in a facilitative and clinically meaningful way.
... If this line of reasoning were correct, one would expect that, for example, victims of concentration camps would also display amnesia for the horrifying events they have experienced. However, this is not the case (e.g., Kuch & Cox, 1992; Yehuda, Elkin, Binder-Brynes, Kahana, Southwick, Schmeidler & Giller, 1996). On a related note, eyewitnesses of extreme violence seldom develop amnesia for the events they witnessed (Porter et al., 2001 ). ...
Objective: Persons who claim memory loss for the crime of which they are suspected represent a problem for the legal system. When such claims emerge, the court often relies on expert testimonies. Mental health profession- als who act as experts in these cases often assume that the memory loss is caused by a combination of strong emotions and abundant substance use (e.g., alcohol). It is also common to gather arguments for such an inter- pretation by interviewing the offender or suspect. However, discriminating between different kinds of amnesia requires the use of sophisticated tests and tasks. Methods: By reviewing clinical, experimental, and psychomet- ric literature, this article addresses several forms of crime-related amnesia and discusses the difficulties that arise when expert testimony about this phenomenon is given. It also emphasizes the importance of technical knowledge about diagnostic quality parameters. Results: A review of the literature shows that dissociative amnesia is not the only or even the most prevalent form of offender amnesia. Experts should at least take the possibility of other forms of amnesia (i.e., organic amnesia; malingered amnesia) into account. Conclusion: Expert testimonies about crime-related amnesia should not rely exclusively on interviews or archival data. Rather such testimonies require tests and tasks combined with good diagnostic interviews (German J Psychia- try 2002; 5: 24-34)
... Instead, their traumatic experiences remained encapsulated, causing the survivors to lead a double life: a robot-like semblance to normality with incessant haunting by nightmares and flashbacks. Dissociation was a central finding in a study on elderly survivors of the Holocaust (Yehuda et al., 1996). The silence of the survivors never meant that the horror of their suffering was absent from behaviors, attachments, and parenting (Durst, 2003;Moskovitz, & Krell, 1990). ...
This essay covers the field of dissociation in Israel as re- flected in publications by Israeli contributors and their collaborators both in the Hebrew language and in the international literature. With 140 references, this article covers the 24-year history of the field in this Mid- dle Eastern country presenting documentations on dissociation in indig- enous Middle Eastern culture, dissociation and the trauma of the Holocaust, a discussion of the “memory wars” in Israel, a portrayal of Is- raeli training programs in the field, an account of writing and publicity on dissociative disorders, a report on the process of acceptance of the concept in Israel and the development of advocacy in the field, as well as information on controlled Israeli research and clinical publications on dissociation. This literature review seems to indicate that dissociation is a useful paradigm that has aided Israeli scholars in the understanding of disavowed experiences in a variety of contexts.
... On the other hand, if there were a big discrepancy between groups in terms of the threat, one would expect a variation in terms of the degree of dissociation that they experienced which would lead to variation in post-traumatic stress responses and coping strategies. Indeed, research shows us that dissociative experiences are significantly associated with post-traumatic stress symptom severity (Yehuda et al., 1996) in that people who report greater expo- sure to and perceived threat to life from a disaster tend to report greater dissociative symptoms, peri- traumatic dissociation and peri-traumatic emotional distress which, in turn, is a robust predictor to post- traumatic stress ( Birmes et al., 2003;Marmar et al., 1996;Morgan et al., 2001). We admit that the two foregoing explanations will remain speculations since robust measures and procedures need to be in place in order to verify them. ...
Debate persists about whether people of different ages react similarly to traumatic events, and whether elderly people are more vulnerable to such events, or better able to cope with them. The first aim of this paper was to shed light on this debate by comparing the post-traumatic responses of young, middle-aged and elderly community residents who had been exposed to technological disasters. The second aim was to differentiate between these three age groups in terms of coping strategies.
One hundred and forty-eight community residents, who were exposed to two technological disasters, participated in the study. They were assessed using the Impact of Event Scale (IES), the General Health Questionnaire (GHQ-28) and the Ways of Coping Checklists (WOC).
The results showed that in terms of IES, GHQ and WOC scores, no significant differences were found across the three age groups. However, main effects were found according to type of disaster and intensity of exposure to disaster. One significant interaction effect was that residents exposed to the aircraft crash used significantly more confrontive coping than those exposed to the train collision, in all three age groups. Correlation coefficients results showed that for all three age groups, on the whole, the more they experienced intrusive thoughts and avoidance behaviour, the more they experienced general health problems.
Following exposure to technological disasters, young, middle-aged and elderly community residents could display similar post-traumatic responses and employ similar coping strategies, which contradicts the vulnerability hypothesis and the inoculation hypothesis.
... It is well documented that patients with PTSD typically have symptomatology and impairment in multiple domains, in addition to the aforementioned core symptoms. These include depression and other comorbid disorders [Kessler et al., 1995], dissociative symptoms [Carlier et al., 1996; Warshaw et al., 1993; Yehuda et al., 1996], interpersonal problems [Cloitre et al., 1997], work-related impairment [Blanchard et al., 1998; Davidson et al., 1991], somatic complaints [McFarlane et al., 1994], lower quality of life [Cordova et al., 1995], suicidality [Davidson et al., 1991; FerradaNoli et al., 1998], medical illness [McFarlane et al., 1994], negative body image [Wenninger and Heiman, 1998], impaired intimacy [Riggs et al., 1998], increased burden to spouse or partner [Beckham et al., 1996], and social dysfunction [Blanchard et al., 1998; D. Wagner et al., 1998]. Despite these findings, medication trials to date have focused almost entirely on PTSD symptoms and related anxiety and depression , and have largely ignored these other domains of psychopathology. ...
... It is well documented that patients with PTSD typically have symptomatology and impairment in multiple domains, in addition to the aforementioned core symptoms. These include depression and other comorbid disorders [Kessler et al., 1995], dissociative symptoms [Carlier et al., 1996; Warshaw et al., 1993; Yehuda et al., 1996], interpersonal problems [Cloitre et al., 1997], work-related impairment [Blanchard et al., 1998; Davidson et al., 1991], somatic complaints [McFarlane et al., 1994], lower quality of life [Cordova et al., 1995], suicidality [Davidson et al., 1991; FerradaNoli et al., 1998], medical illness [McFarlane et al., 1994], negative body image [Wenninger and Heiman, 1998], impaired intimacy [Riggs et al., 1998], increased burden to spouse or partner [Beckham et al., 1996], and social dysfunction [Blanchard et al., 1998; D. Wagner et al., 1998]. Despite these findings, medication trials to date have focused almost entirely on PTSD symptoms and related anxiety and depression , and have largely ignored these other domains of psychopathology. ...
This study evaluated the efficacy of paroxetine for symptoms and associated features of chronic posttraumatic stress disorder (PTSD), interpersonal problems, and dissociative symptoms in an urban population of mostly minority adults. Adult outpatients with a primary DSM-IV diagnosis of chronic PTSD received 1 week of single-blind placebo (N = 70). Those not rated as significantly improved were then randomly assigned to placebo (N = 27) or paroxetine (N = 25) for 10 weeks, with a flexible dosage design (maximum 60 mg by week 7). Significantly more patients treated with paroxetine were rated as responders (14/21, 66.7%) on the Clinical Global Impression-Improvement Scale (CGI-I) compared to patients treated with placebo (6/22, 27.3%). Mixed effects models showed greater reductions on the Clinician-Administered PTSD Scale (CAPS) total score (primary plus associated features of PTSD) in the paroxetine versus placebo groups. Paroxetine was also superior to placebo on reduction of dissociative symptoms [Dissociative Experiences Scale (DES) score] and reduction in self-reported interpersonal problems [Inventory of Interpersonal Problems (IIP) score]. In a 12-week maintenance phase, paroxetine response continued to improve, but placebo response did not. Paroxetine was well tolerated and superior to placebo in ameliorating the symptoms of chronic PTSD, associated features of PTSD, dissociative symptoms, and interpersonal problems in the first trial conducted primarily in minority adults.
... Against this background, crime-related amnesia is an unlikely outcome, given that an extensive body of memory literature shows that (1) people remember acts better than other types of information (e.g., words; action-superiority effect; Engelkamp & Zimmer, 1994), (2) people remember their own acts far better than acts they only have witnessed (self-reference effect; Symons & Johnson, 1997) and (3) people have recurrent thoughts about memories they try to suppress because they feel ashamed about them (white-bear effect; Wegner, Schneider, Carter & White, 1987). 4 Another finding that is difficult to reconcile with the idea of dissociative amnesia is that this phenomenon appears to be rare in people who have been the victims of evidently traumatizing events (e.g., concentration camps; Merckelbach, Dekkers, Wessel & Roefs, 2003 a, b;Yehuda, Elkin, Binder-Brynes, Kahana, Southwick, Schmeidler & Giller, 1996). On a related note, eyewitnesses to extreme violence only rarely report that they are amnesic for the events they have witnessed (Porter et al., 2001). ...
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... Similarly, changes associated with increased dependence on others may result in a sense of loss of control over one's life, triggering PTSD symptoms [76]. Therefore, in diagnosing severe disorders such as psychoses [77] or pseudodementia [78] their possible relationship with early trauma should be taken into account. ...
The paper presents a shift in the research focus concerning the Holocaust survivors – from investigating symptoms of post-traumatic stress disorder to discovering the sources of strength enabling their surviv-al. A brief chronological overview of studies on the Holocaust survivors is presented. Moreover, a number of psychological problems most often experienced by the survivors are identified, including their non-ac-ceptance of separation, fear of closeness, difficulty in defining personal and social identity, susceptibility to hurt feelings, and a sense of guilt.
Across various cultures, dissociative amnesic disorders have been shown to be triggered by psychological stress or trauma. In immigrant populations, stressful experiences can arise during pre-emigration, migration or post-migration phase. Preliminary data suggest that stresses related to various phases of migration and acculturation could trigger dissociative amnesic disorders via a dysregulation of hormonal stress responses. These findings are highly relevant in the era of increased globalization and call for culturally sensitive approaches, in order to accurately diagnose and optimally manage these conditions in the future.
The study of psychopathy has largely centered on samples of incarcerated offenders with a focus on primary psychopathy traits. Less is known, however, about how experiences of childhood betrayal trauma and dissociation influence the development of these traits in non-institutionalized individuals. In the present study, we utilized structural equation modeling to investigate the relationships among childhood betrayal trauma, adult dissociation, and adult psychopathy traits and callous affect traits in a community sample (N = 746). Childhood betrayal trauma was associated with psychopathy and callous affect traits, and mediated by dissociative experiences. These results are consistent with theory and prior empirical findings associating childhood betrayal trauma with dissociation, psychopathy, and callous affect traits. The results will help influence the design of future studies that can further inform the developmental course of psychopathy.
PTSD is not just a short-term or acute response to significant trauma. For many individuals diagnosed with PTSD, the disorder becomes recurrent and/or chronic affecting the individual throughout their life. The negative effects of PTSD on the ability to function normally (a major part of the diagnostic criteria) can lead to the loss of an individual’s support system as well as the loss of access to care. An individual with PTSD is more likely than most others to have comorbid problems with chronic pain, substance abuse, and depression, problems that affect response to care and require disease-specific therapy. The United States is currently experiencing widespread epidemics of opiate overdose and suicide, negative factors that affect a large cohort of the population diagnosed with PTSD. At times of stress and/or re-traumatization, individuals diagnosed with PTSD are likely to go through periods of functional and psychiatric decompensation. A designed treatment protocol is presented emphasizing the need to protect the patient from danger to self and others, as well as the need to provide and maintain support systems during the period of decompensation.
Für den Buchinhalt wesentliche Grundbegriffe werden herausgearbeitet und definiert, u. a die Termini Homöostase, Wohlbefinden, Zufriedenheit, psychische Gesundheit. Ein weiterer zentraler Begriff ist die Gehirnplastizität. Gehirnplastizität wird per se, aber auch in Zusammenhang mit Epigenetik und Stress – den beiden zentralen Einflussgrößen auf die Gehirnplastizität – dargestellt. Gehirnplastizität hält grundsätzlich über die gesamte Lebensspanne an und kann durch externe und interne Faktoren verändert werden. Eine bedeutende Veränderung geschieht durch Hormone: Bindungshormone stärken die soziale Interaktion, Stresshormone – insbesondere über längere Zeiträume oder kaskadenartig freigesetzte – reduzieren sie. Umwelteinflüsse können unser Genom verändern und so zu langfristigen Neujustierungen führen und die Fähigkeit zu Empathie und Mitgefühl ändern (Epigenetik). Die Konstanz des Selbst wird durch diese Einflussgrößen in Frage gestellt und Grundbedürfnisse ändern sich.
The human being since their inception on the planet earth have
been continuously utilizing their cognitive and behavioural
processes for exploiting natural resources in a judicious way so
as to attain La Dolce Vita, an Epicurean Philosophy of passing
sweet life. Never before in the history, the human beings have
become as capable as are today (Sadhguru, 2012) due to
advancement in education in general as well as science and
technology in particular. Although the paces of the development
in primitive societies were not so significant, yet it fuelled,
progressed, polished and flourished with the advent of science
and technology in the contemporary scenarios. Its example is our
own country that before independence was under food deficit
now is in the path of prosperity (Roy, 1999). The people of
Himachal Pradesh according to State Re-organization
Commission were one of the most backward (Sharma,1987, p.45)
and conservative in outlook (Singh,1985) and those now are
experiencing a radical change in every gamut of life (Box &
Engelhard, 2006; Dreze, Samson, & Singh,1997). The developed
countries have reached at a zenith in exploiting the natural
resources like hydro energy whereas the developing nations are
also becoming a regional hub in the areas of hydel energy that
one time was described as “dreams of the 1970s, realities but
luxuries of 2000, now is the necessities by the year 2020 by the
people on the planet.
Im deutschen Sprachgebrauch ist Handeln im Normalfall zielgerichtetes Agieren, während in anderen, auf dem Lateinischen basierenden Sprachen, die Differenzierung zwischen zielgerichtetem und nicht zielgerichtetem Agieren entfällt (agere, to act). Ursachen und Motive von Handlungen zu erforschen ist Ziel mehrerer Wissenschaftsdisziplinen. Die Neurowissenschaften haben den Rahmen der Handlungsuntersuchungen noch erweitert, indem sie von exekutiven Funktionen sprechen und damit auch die theoretische Planung von Handlungen und das dazu notwendige vorausschauende Denken einbeziehen.
Hysterie als pathologische Kategorie beinhaltet eine Reihe an Syndromen, dabei scheint der Begriff selbst gegenwärtig aus der Psychiatrie eliminiert bzw. in verschiedenen Störungsgruppen aufgeteilt zu sein. Historisch gesehen wechselt die Hysterie ihren Ausdruck und ihre Bedeutung in Abhängigkeit von sozialökonomisch, kulturell, politisch und weltanschaulich geprägten Lebensbedingungen. Inwiefern unterliegen hysterische Phänomene Veränderungen im betroffenen Individuum über die Zeitspanne seines Lebens? Inwieweit spielen dabei Entwicklung und Reifung der Person eine Rolle? Welchen Stellenwert nimmt dabei die Behandlung ein?
The Nazi Holocaust is recognized as representing the ultimate culture of terror (Lewin, 1993). It has been argued that the effects of torture and maltreatment entered the scientific consciousness in its aftermath (Engdahl & Eberly, 1990). The enormity of the suffering of survivors of Nazi concentration camps and other atrocities has led to pioneering research on the long-term effects of massive psychic trauma. The history and contributions of the literature on survivors of the Nazi Holocaust also poignantly illustrate the complexities, ethical dilemmas, and scientific challenges inherent in understanding and documenting the role of perpetrators, bystanders, rescuers, and healers at various points in the experience and aftermath of trauma (Hilberg, 1992). The ethical and moral implications of focusing on alternative perspectives must also be acknowledged. A focus on documenting adverse impacts may serve to revictimize survivors, whereas a focus on their adaptability, strength, and resiliency may be construed as trivializing the horrors that they have endured (Davidson & Charny, 1992).
Patienten mit posttraumatischer Belastungsstörung (PTBS) weisen im Vergleich zu Traumatisierten ohne PTBS und im Vergleich zu Patienten mit anderen psychiatrischen Diagnosen zumeist höhere Dissoziationswerte auf. Ausgeprägte dissoziative Symptome finden sich bei einer Subgruppe von etwa 20 % der PTBS-Patienten. Diese Subgruppe konnte in epidemiologischen, experimentellen sowie neurobiologischen Untersuchungen differenziert werden und wurde als Subtyp der PTBS in das DSM-5 aufgenommen. Zu der Annahme, dass Dissoziation generell einen negativen Einfluss auf den Behandlungserfolg einer traumafokussierenden Behandlung hat, ist die Datenlage noch gering. Es finden sich jedoch erste Hinweise für ein differenzielles Ansprechen auf therapeutische Interventionen in Abhängigkeit vom Ausmaß der Dissoziation.
This chapter reviews the current state of knowledge regarding anxiety disorders assessment in older adults. Anxiety disorders, whether in older or younger adults, remain the most frequently occurring diagnoses across all age groups including those aged 60 and above. Despite the prevalence of these disorders, they remain largely understudied in this older cohort. The assessment of anxiety in older persons has likewise not been a focus of attention in the literature. Anxiety assessment in geriatric samples may pose issues not found when evaluating younger individuals, such as how social, developmental, and medical contexts influence the extent to which specific symptoms or behaviors represent pathology and the influence of significant, but subsyndromal anxiety. The situation is further complicated given the dearth of normative data regarding anxiety assessment in older adults, as well as by the fact that the majority of psychometric instruments used to study anxiety have been developed for use with younger populations and the psychometric properties of these instruments have remained largely uninvestigated with regard to geriatric samples.
The literature describing the effects of the Holocaust on offspring of survivors has developed in a parallel fashion to the literature describing the effects of the Holocaust on its survivors. Early descriptions of the “Survivor Syndrome” arose as clinicians began to realize that classical psychoanalytic views of depression, mourning, and responses to trauma did not provide an adequate framework for understanding and treating Holocaust survivors. The classic observations describing severe symptomatology, maladjustment, and impairment of functioning were made on treatment-seeking individuals, many of whom were being evaluated for compensation or reparations, who did not benefit from psychoanalytic therapy (e.g., Chodoff, 1963; Eitinger, 1961; Krystal, 1968; Neiderland, 1969).
Studies have shown that many children of Holocaust survivors suffer from the experiences of their traumatized parents. Indeed, many of these children call themselves second-generation survivors. Drawing on over 250 interviews with Holocaust survivors from the Fortunoff Video Archive at Yale University, as well as interviews with the children of survivors, this manuscript argues that the transmission of historical trauma from one generation to another is best explained in terms of how trauma disrupts the attachment system. Children want and need to experience their parents’ trauma. However, they need to do so in an age-appropriate way, and in a way that is adequately symbolized. To be excluded from their parents’ subjectivity is as damaging as being overwhelmed by unintegrated parental experience. Attachment theory turns out to be an especially good medium for making sense of this delicate balance.
This study compared daily-versus-monthly self-ratings of post-traumatic symptoms using two similar but not wholly identical measures. The rationale was to determine whether (1) posttraumatic dissociation and/or minimization or (2) certain biases (more recent symptoms, more severe symptoms, practice effect, Hawthorne effect) might undermine symptom recall. Seventeen voluntary participants provided daily self-ratings for an average of 11.6 months. Nine male veterans had combat trauma; one also experienced sexual trauma. Four women had experienced sexual assault, and four women had other trauma. The monthly measure consisted of the self-rated Posttraumatic Stress Disorder (PTSD) Checklist (PCL), and daily ratings employed the self-rated PTSD Life Chart that we devised. These data revealed that people with Posttraumatic Stress Disorder (PTSD) produced monthly ratings that reflected their day-to-day symptom experience over the previous month, despite the dissociation and minimization that often accompanies PTSD. Initial practice effect occurred in the first month, but other biases (recent symptoms, severe symptoms, Hawthorne effect) were not demonstrated.
Published by Elsevier Ireland Ltd.
ously rapid succession and telecast and watched repeatedly around the world. Catastrophic events of war and organized violence, including terrorism, dramatically disrupt the fabric and order of a society, presenting vivid proof of the vulnerability of its members, threatening psychological adaptation and mental health, and cultivating a culture of fear. Research documents high rates of psychological difficulties in the majority of individuals exposed to such events, including depression, anxiety, guilt, pathological grief reactions, restlessness, sleep disturbances, psychosomatic com plaints, and posttraumatic stress disorder. The relatively new diagnosis of Posttraumatic Stress Disorder, or PTSD, has received much attention in analysis of the mental health impact of the events of September 11. In this paper, research on PTSD is reviewed and related to the terrorist attacks of September 11, and some
Much research on deceptive behaviour concerns differences between truthful and deceptive verbal and non-verbal responses. This chapter has a different angle in that we focus on stories that liars don't tell. Thus, this chapter is concerned with lying in the sense of concealing information by evading questions or omitting detail information. More specifically, we focus on homicide offenders who claim memory loss (i.e., amnesia) for their crime, and on whether such memory loss is genuine or feigned. There are several reasons for investigating offenders' memory of violent crimes. One is that claims of amnesia for violent crimes, including murder, are very common. Obviously, some guilty suspects deny involvement in the crime or claim amnesia to avoid punishment. About 25–40 per cent of those who are found guilty of homicide claim to be amnesic or to have a complete memory loss (Schacter, 1986; Taylor and Kopelman, 1984), and the large majority of these claims are circumscribed to the crime itself (Bradford and Smith, 1979). In clinical literature, various taxonomies of amnesia can be found. A common distinction is that between amnesia due to organic factors (organic amnesia) and amnesia due to psychological factors (e.g., malingering, emotional stress). As previous research has shown, different memory patterns emerge when amnesia originates from brain trauma, malingering, or severe emotional stress. Thus, the main question here is whether patterns of remembering and forgetting in an offender give hints as to whether his amnesia is genuine or malingered.
Führen früh erfahrene, multiple und mitunter anhaltende traumatische Ereignisse über die Lebensspanne hinweg zu negativen Konsequenzen? Lassen sich traumatisierende Erfahrungen in Typ-1- und Typ-2-Traumatisierung einteilen, welche jeweils spezifisch zu unterschiedlichen maladaptiven Outcomes führen? Stellt das Störungskonzept der komplexen posttraumatischen Belastungsstörung eine sinnvolle Ergänzung bisheriger Störungskataloge dar? Welches Instrumentarium ist passend um diese komplexe Symptomatik zu erfassen? Bestehende Literatur wies wiederholt auf den zentralen Stellenwert von sozial-interpersonellen Faktoren hin – wie relevant sind diese bei Typ-1- verglichen mit Typ-2- Traumatisierungen? Bestehen bestimmte Pfade, entlang welchen sie salutogen agieren?
Das vorliegende Dissertationsprojekt untersuchte diese Fragestellungen und veröffentlichte die Ergebnisse in drei Publikationen. Dabei wurde in der ersten Publikation auf eine Stichprobe ehemals politisch Inhaftierter während der DDR aufgebaut, von welcher angenommen wurde dadurch Typ-1 traumatisiert zu sein. Es interessierte der Stellenwert einer Reihe theoretisch selektierter sozial- interpersoneller Faktoren und deren Interaktionen zur Prädiktion von klassischer PTB-Symptomatik. Für die zweite und dritte Publikation wurde eine Stichprobe ehemaliger Verding- und/oder Heimkinder rekrutiert. Ziel dabei war die testpsychometrische Untersuchung eines Instrumentariums zur Erfassung von komplexer Traumafolgesymptomatik nach Typ-2-Traumatisierung sowie vergleichend zur ersten Publikation die Untersuchung des Stellenwerts sozial-interpersoneller Faktoren für das komplexe posttraumatische Geschehen.
Es zeigte sich eine Reihe hypothesengerechter Effekte. Typ-1- Traumatisierung in Publikation 1 führte zu klassischer, während Typ-2-Traumatisierung in Publikation 3 zu komplexer PTB-Symptomatik führte. Das Trauma Symptom Inventory erwies sich als sinnvolles Instrumentarium zur Erfassung komplexer Folgesymptomatik. Sozial-interpersonelle Faktoren zeigten sich als eng in Zusammenhang stehend mit klassischer sowie mit komplexer PTB-Symptomatik, wobei traumaspezifische und traumaunspezifische Faktoren identifiziert wurden. Das sozial-interpersonelle Kontext-Modell bot einen adäquaten theoretischen Rahmen für diese Effekte.
Acknowledgment:The authors wish to acknowledge the following individuals who have contributed to the studies of Holocaust survivors that provided the basis for these investigations: Drs.
The study aims to identify rational and irrational beliefs, as well as coping mechanisms, as expressed spontaneously by Transylvanian Holocaust survivors during an oral history research. The participants (n = 22) were born between 1917 and 1928 and were detained in concentration camps for at least six months. 95.4% of the participants expressed irrational beliefs; 63.6% expressed rational beliefs. 72.7% of the participants had emotion-focused coping; 54.5% displayed problem-solving coping strategy. The most common irrational beliefs were awfulizing (81.8%) and global evaluation of others (59.1%). This study provides first information on cognitions and their association with coping strategies adopted by Holocaust survivors.
This study ex am ined the prev a lence of acute dissociative re ac tions to a re cent stress ful event among 102 male Viet nam vet er ans seek ing help for posttraumatic stress dis or der (PTSD) at a Vet erans Affairs treat ment cen ter. Prior to treat ment, pa tients com pleted a bat tery of ques tion naires, in clud ing the Stan ford Acute Stress Re ac tion Ques tion-naire to assess acute dissociative experiences in reaction to a recent stress ful event. Most (80%) com bat vet er ans re ported ex pe ri enc ing five acute dissociative symptoms in the previous month in reaction to this event. These symp toms were pos i tively as so ci ated with be ing Af ri can American or Hispanic/Latino, hav ing been phys i cally abused in childhood, choosing acom bat-related intrusion ex peri ence as themost stressful re cent event, com bat-re lated trau matic stress symp toms, and hav ing service connected disability. These results have both theoretical and clinicalimplications.
We investigated mediational relations among trauma, dissociation, psychopathology (e.g., PTSD, borderline personality disorder, bulimic behaviors), and fears about death and lacking control in a sample of 325 non-treatment-seeking women. With the use of structural equation modeling, findings indicated that: (1) dissociation accounted for 27% of variance in the trauma-psychopathology relation (significant partial mediation), and (2) general ongoing fears about death and control accounted for an additional 20% of variance in the trauma-psychopathology relation beyond what was already accounted for by dissociation (total of 47% of variance explained in the trauma-psychopathology relation; significant partial mediation). Findings are discussed, and postulations about relations are proposed.
The inbetweenness of those who migrate is not easily captured in the models that dominate the anthropology of emotions. This chapter examines situations in which this inbetweenness is foregrounded: the medical clinic, where many migrants seek help in managing the stresses of migration; the emotional structurings of the memory of home; and the relationships between first and second generations, in which emotional structures and identities are transmitted across a gulf of cultural difference.
Reviewed in this chapter are the concepts of stress and trauma. Included within the chapter are such mental disorders as post-traumatic stress disorder (PTSD), complex PTSD, acute stress disorder, dissociative disorders (dissociative identity, amnesia, fugue, and depersonalization), and conversion disorder. These disorders are classified within three different sections of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, but they are conceptualized within this chapter as sharing a common etiology and pathology (and ultimately treatment implications). Extreme stress or trauma can have only a transient effect and it may even have for some a life-transforming positive effect (e.g., greater investment in and appreciation of life). However, for many persons it can shatter their sense of security, attachment, and safety, contributing to the development of clinically significant anxiety, dissociative, and somatoform psychopathology. The dissociative disorders have been particularly controversial but compelling systematic research has documented well their validity and clinical importance.
Administered a dissociative experiences scale (DES) to 12 male patients with severe chronic epilepsy (SCE), 9 male patients with multiple personality disorder (MPD), and 36 male combat veteran patients with posttraumatic stress disorder (PTSD). MPD and PTSD Ss were significantly different from SCE Ss on median DES scores and all DES subscale scores. MPD and PTSD Ss were more similar on the DES, although MPD Ss had significantly higher scores on the dissociation/psychogenic amnesia subscale of the DES. It is concluded that there is little data to support a relationship between MPD, dissociation, and epilepsy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Survivors of the Holocaust are expected to be at risk for posttraumatic stress disorder (PTSD), but few empirical data are available. This study investigated PTSD symptoms in Holocaust survivors with well-documented exposure to trauma.
The German files of 124 Jewish Holocaust survivors who were judged to be free from bipolar affective disorder, obsessive-compulsive disorder, and organic brain syndrome were selected from those of 145 applicants to West German compensation boards. The psychiatric assessments were reexamined for explicit descriptions of current PTSD symptoms according to the DSM-III-R diagnostic criteria. A subgroup of 20 Auschwitz survivors with tattooed identification numbers were also compared with the 45 survivors who had not been in concentration camps.
Sixty-three percent of the total sample had been detained in concentration camps, and an average of 78% of their first-degree relatives were reported killed in the Holocaust. Forty-six percent of the total sample met the DSM-III-R criteria for PTSD. The most common symptoms were sleep disturbance, recurrent nightmares, and intense distress over reminders. The tattooed Auschwitz survivors had significantly more symptoms and were three times more likely to meet diagnostic criteria for PTSD than the survivors who had not been in concentration camps.
The results suggest a greater risk of chronic PTSD in survivors who were exposed to atrocities. Most survivors had not received adequate psychiatric care.
This study compared current dissociative symptoms and dissociation at the time of specific traumatic events in Vietnam combat veterans with posttraumatic stress disorder (PTSD) and Vietnam combat veterans without PTSD.
Vietnam combat veterans who sought treatment for PTSD (N = 53) were compared to Vietnam combat veterans without PTSD (N = 32) who sought treatment for medical problems. Dissociative symptoms were evaluated with the Dissociative Experiences Scale. Dissociation at the time of a combat-related traumatic event was evaluated retrospectively with the modified Dissociative Experiences Questionnaire. The Combat Exposure Scale was used to measure level of combat exposure.
There was a significantly higher level of dissociative symptoms, as measured by the Dissociative Experiences Scale, in patients with PTSD (mean = 27.0, SD = 18.0) than in patients without PTSD (mean = 13.7, SD = 16.0). This difference persisted when the difference in level of combat exposure was controlled with analysis of covariance. PTSD patients also reported more dissociative symptoms at the time of combat trauma, as measured retrospectively by the Dissociative Experiences Questionnaire (mean = 11.5, SD = 1.6) than non-PTSD patients (mean = 1.8, SD = 2.1).
Dissociative symptoms are an important element of the long-term psychopathological response to trauma.
We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.
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.
In this reappraisal of the work of Pierre Janet at the centenary of the publication of L'automatisme psychologique, the authors review his investigations into the mental processes that transform traumatic experiences into psychopathology. Janet was the first to systematically study dissociation as the crucial psychological process with which the organism reacts to overwhelming experiences and show that traumatic memories may be expressed as sensory perceptions, affect states, and behavioral reenactments. Janet provided a broad framework that unifies into a larger perspective the various approaches to psychological functioning which have developed along independent lines in this century. Today his integrated approach may help clarify the interrelationships among such diverse topics as memory processes, state-dependent learning, dissociative reactions, and posttraumatic psychopathology.
The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N = 23); major depression, bipolar disorder--depressed, and dysthymic disorder (N = 56); and generalized anxiety disorder (N = 18) and the control sample (N = 83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.
Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. Scale items were developed using clinical data and interviews, scales involving memory loss, and consultations with experts in dissociation. Pilot testing was performed to refine the wording and format of the scale. The scale is a 28-item self-report questionnaire. Subjects were asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. In addition, demographic information (age, sex, occupation, and level of education) was collected so that the connection between these variables and scale scores could be examined. The mean of all item scores ranges from 0 to 100 and is called the DES score. The scale was administered to between 10 and 39 subjects in each of the following populations: normal adults, late adolescent college students, and persons suffering from alcoholism, agoraphobia, phobic-anxious disorders, posttraumatic stress disorder, schizophrenia, and multiple personality disorder. Reliability testing of the scale showed that the scale had good test-retest and good split-half reliability. Item-scale score correlations were all significant, indicating good internal consistency and construct validity. A Kruskal-Wallis test and post hoc comparisons of the scores of the eight populations provided evidence of the scale's criterion-referenced validity.(ABSTRACT TRUNCATED AT 250 WORDS)
This study compared dissociative symptom areas in Vietnam combat veterans with posttraumatic stress disorder (PTSD) and in Vietnam combat veterans without PTSD.
The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) was used to compare dissociative symptoms in 40 Vietnam combat veterans with PTSD and 15 Vietnam combat veterans without PTSD. The SCID-D yields a total score and scores in five symptom areas: amnesia, depersonalization, derealization, identity confusion, and identity alteration.
The PTSD patients had more severe dissociative symptoms in each of the five symptom areas of the SCID-D and higher total symptom scores. Amnesia was the symptom area with the greatest difference in scores between the PTSD patients (mean = 3.68, SD = 0.73) and the non-PTSD veterans (mean = 1.06, SD = 0.26).
The finding of higher levels of dissociative symptoms in Vietnam combat veterans with PTSD than in Vietnam veterans without PTSD is consistent with a level of dissociative symptoms in PTSD similar to that in dissociative disorders.
The critical role of early incestuous abuse in the development of high levels of dissociative symptoms has been suggested. The present study examines the reliability and validity of the Dissociative Experiences Scale for use with an outpatient population and compares the frequency of dissociative experiences in adult female outpatients with and without histories of early incestuous abuse. The Dissociative Experiences Scale (DES) and a Background Information Question naire (BIQ) were administered to a sample of 84 adult female outpatients from four diagnostic categories: Affective Disorder, Post-traumatic Stress Disorder (ITSD), Panic Disorder, and Schizophrenia, Cronbach's alpha within each diagnostic category (range .88 - .94) indicated good internal consistency for the DES with this sample. The Kruskal Wallis analysis, X2 = 8.49(N = 84, df= 3, p <.05), demonstrated support for criterion-related validity of the DES by indicating a significant difference among diagnostic categories. Ryan's procedure demonstrated a distinction between Affective Disorder and PTSD and between Affective Disorder and Schizophrenia (p >,01), Forty-four % (N = 37) of the subjects reported incestuous abuse before 16 years of age. Seventy-one % (N = 60) reported sexual or physical abuse, rape, or assault, at some lime during their lives. Subjects mill histories of early incestuous abuse scored significantly higher, X2 = 10. 79 (N = 84, df=1t p <. 001), on the DES than thosexvho reported no history of early incestuous abuse. When matched on diagnostic category and age, DES scores remained significantly higher, X2 = 5.00 (N = 20, df= 1, p <.01), in the subjects with histories of early incestuous abuse than in those without such histories. The results of the present study support the need for exploration of dissociative symptoms in incest survivors.
Two studies show that individual differences in dissociation (DIS) in undergraduates are positively related to differences in self-reported stressful or traumatic experiences in youth. In Study 1, 309 undergraduates completed a childhood stress inventory and a dissociative experiences scale (DES). Differences in the degree of stress or unpredictable physical violence experienced in childhood or early adolescence were related to scores on the DES. Study 2, with 337 undergraduates, replicated these relationships and extended them to another DIS measure. Both DIS measures correlate positively with reported physical and psychological abuse. These findings for a nonclinical population are discussed in relation to the etiology of DIS in clinical groups. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Administered the Dissociative Experiences Scale (DES) of E. M. Bernstein and F. W. Putnam (see record
1987-14407-001) to 28 medical student controls, 17 patients with multiple personality disorder (MPD), 20 with schizophrenia, 13 with panic disorder, and 24 with chemical dependency. MPD Ss scored significantly higher than the other clinical groups and the medical student controls. Findings replicate those of Bernstein and Putnam and further validate the DES. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study was designed to explore several aspects of depressive phenomenology, including current symptoms, dependency (anaclitic) and self-criticism (introjective) themes, and issues of self-efficacy, in Holocaust survivors with and without posttraumatic stress disorder (PTSD). The Depressive Subscale of the Symptom Checklist-90 (SCL-90) and the Depressive Experiences Questionnaire (DEQ) were administered to 23 Holocaust survivors and 18 demographically-matched controls. Holocaust survivors with PTSD scored significantly higher on the SCL-90 depression scale, and portrayed more self-criticism on the DEQ, than Holocaust survivors without PTSD and demographically-matched non-exposed subjects. The data suggest that depressive symptoms in individuals who have been severely traumatized are more severe when associated with a concurrent PTSD. Furthermore, groups suffering different types of trauma may show similarities in psychological dimensions of depression.
Childhood psychic trauma appears to be a crucial etiological factor in the development of a number of serious disorders both in childhood and in adulthood. Like childhood rheumatic fever, psychic trauma sets a number of different problems into motion, any of which may lead to a definable mental condition. The author suggests four characteristics related to childhood trauma that appear to last for long periods of life, no matter what diagnosis the patient eventually receives. These are visualized or otherwise repeatedly perceived memories of the traumatic event, repetitive behaviors, trauma-specific fears, and changed attitudes about people, life, and the future. She divides childhood trauma into two basic types and defines the findings that can be used to characterize each of these types. Type I trauma includes full, detailed memories, "omens," and misperceptions. Type II trauma includes denial and numbing, self-hypnosis and dissociation, and rage. Crossover conditions often occur after sudden, shocking deaths or accidents that leave children handicapped. In these instances, characteristics of both type I and type II childhood traumas exist side by side. There may be considerable sadness. Each finding of childhood trauma discussed by the author is illustrated with one or two case examples.
The authors' goal was to determine the levels of trauma and psychiatric symptoms in a randomly selected group of Cambodian refugees and to determine the relationship between the amount of trauma experienced and subsequent psychiatric symptoms.
Data on traumatic experiences and symptoms of posttraumatic stress, dissociation, depression, and anxiety were collected on 50 randomly selected Cambodian refugees who had resettled in the United States.
Subjects experienced multiple and severe traumas and showed high levels of all symptoms measured. Forty-three (86%) of the subjects met DSM-III-R criteria for posttraumatic stress disorder, 48 (96%) had high dissociation scores, and 40 (80%) could be classified as suffering from clinical depression. Correlations between trauma scores and symptom scores and among symptom scores were moderate to large.
These results indicate that a high proportion of Cambodian refugees who are not psychiatric patients suffer from severe psychiatric symptoms and that there is a relationship between the amount of trauma they experienced and the severity of these symptoms.
To test the hypothesis that dissociation in adolescence is positively correlated with stress or abuse experienced earlier, the authors assessed dissociation in a heterogeneous group of disturbed adolescents and examined the relationship between the degree of dissociation and the degree of reported childhood stress, abuse, or trauma.
The subjects were 47 adolescents, 13-17 years old, who were institutionalized for periods of 1-13 weeks in a private mental hospital; 35 were girls and 12 were boys. Participants completed the Dissociative Experiences Scale and a child abuse and trauma questionnaire. The hospital records of 40 of the 47 adolescents were also available.
Scores on the Dissociative Experiences Scale correlated significantly with self-reported physical abuse or punishment, sexual abuse, psychological abuse, neglect, and negative home atmosphere but not with abuse ratings made from hospital records.
Together with the authors' previous work showing a relation between childhood stress and later dissociation in normal college students, these findings support the view that dissociation represents a reaction to early negative experience and places multiple personality disorder at the extreme end of a continuum of dissociative sequelae of childhood trauma. Researchers should continue to try to identify psychiatric patients with prominent dissociative characteristics or symptoms and attempt to correlate this phenomenology with negative earlier experiences.
The Dissociative Experiences Scale was administered to a random sample of 1,055 adults in the city of Winnipeg. Results showed that scale scores did not differ between men and women and were not influenced by income, employment status, education, place of birth, religious affiliation, or number of persons in the respondent's household. Dissociative experiences are common in the general population and decline with age. The findings suggest that dissociative disorders may also be common in the general population.
Experiences of abuse and neglect were assessed in 24 adults diagnosed as having borderline personality disorder according to the Diagnostic Interview for Borderline Patients and in 18 depressed control subjects without borderline disorder. Significantly more of the borderline patients than depressed patients reported childhood sexual abuse, abuse by more than one person, and both sexual and physical abuse. There were no between-group differences for rates of neglect or physical abuse without sexual abuse. A stepwise logistic regression revealed that derealization, diagnostic group, and chronic dysphoria were the best predictors of childhood sexual abuse in this group of patients.
The clinical syndrome of multiple personality disorder (MPD) is an unusual dissociative condition that has been poorly characterized. In an attempt to better delineate the clinical phenomenology of MPD, 100 recent cases were collected on a 386-item questionnaire completed by clinicians involved in the treatment of MPD patients. This study documents the existence of a clinical syndrome characterized by a core of depressive and dissociative symptoms and a childhood history of significant trauma, primarily child abuse.
The authors' objective was to compare the urinary cortisol excretion of Holocaust survivors with posttraumatic stress disorder (PTSD) (N = 22) to that of Holocaust survivors without PTSD (N = 25) and comparison subjects not exposed to the Holocaust (N = 15).
Twenty-four-hour urine samples were collected, and the following day, subjects were evaluated for the presence and severity of past and current PTSD and other psychiatric conditions.
Holocaust survivors with PTSD showed significantly lower mean 24-hour urinary cortisol excretion than the two groups of subjects without PTSD. Multiple correlation analysis revealed a significant relationship between cortisol levels and severity of PTSD that was due to a substantial association with scores on the avoidance subscale.
The present findings replicate the authors' previous observation of low urinary cortisol excretion in combat veterans with PTSD and extend these findings to a non-treatment-seeking civilian group. The results also demonstrate that low cortisol levels are associated with PTSD symptoms of a clinically significant nature, rather than occurring as a result of exposure to trauma per se, and that low cortisol levels may persist for decades following exposure to trauma among individuals with chronic PTSD.
Several researchers have proposed that proneness to dissociation in adulthood is linked developmentally with experiences of traumatic events in childhood. Past investigation of this hypothesis, however, typically has focused on very narrow samples of childhood trauma. In this study, dissociative experiences in adulthood were analyzed in relation to a broad measure of childhood trauma. Standard regression analysis revealed three predictors of dissociation, namely familial loss in childhood, intrafamilial sexual abuse, and extrafamilial sexual abuse. The data call for greater cognizance of childhood loss in the investigation of the origins of dissociative defenses.
Despite a growing literature of cross-cultural research on mental illness, little is known about the universality of most psychiatric disorders. This study was designed to determine whether people from a very different culture have the same symptoms in response to traumatic experiences as do trauma survivors in the United States. We were also interested to find out if the severity of the current symptoms is related to the amount of trauma experienced. Furthermore, we gathered information about the perceived severity of traumatic experiences among refugees. Fifty Cambodian refugees living in the U.S. were asked about their traumatic experiences and their current symptoms of posttraumatic stress, dissociation, depression, and anxiety. High levels of all symptoms were found along with statistically significant relationships between each symptom measure and the amount of trauma experienced. We conclude that the basic symptom picture in this group was similar to that observed in U.S. trauma survivors.
The aim of this study was to determine the reliability and validity of a proposed measure of peritraumatic dissociation and, as part of that effort, to determine the relationship between dissociative experiences during disturbing combat trauma and the subsequent development of posttraumatic stress disorder (PTSD).
A total of 251 male Vietnam theater veterans from the Clinical Examination Component of the National Vietnam Veterans Readjustment Study were examined to determine the relationship of war zone stress exposure, retrospective reports of dissociation during the most disturbing combat trauma events, and general dissociative tendencies with PTSD case determination.
The total score on the Peritraumatic Dissociation Experiences Questionnaire--Rater Version was strongly associated with level of posttraumatic stress symptoms, level of stress exposure, and general dissociative tendencies and weakly associated with general psychopathology scales from the MMPI-2. Logistic regression analyses supported the incremental value of dissociation during trauma, over and above the contributions of level of war zone stress exposure and general dissociative tendencies, in accounting for PTSD case determination.
These results provide support for the reliability and validity of the Peritraumatic Dissociation Experiences Questionnaire--Rater Version and for a trauma-dissociation linkage hypothesis: the greater the dissociation during traumatic stress exposure, the greater the likelihood of meeting criteria for current PTSD.
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.
Early trauma in the form of childhood physical or sexual abuse has been associated with adult psychopathology. The purpose of this study was to compare rates of childhood abuse in Vietnam veterans with and without combat-related posttraumatic stress disorder (PTSD).
Premilitary stressful and traumatic events including childhood abuse and other potential predisposing factors were assessed in Vietnam combat veterans who sought treatment for PTSD (N = 38) and Vietnam combat veterans without PTSD who sought treatment for medical disorders (N = 28). Stressful and traumatic events including childhood physical abuse were assessed with the Checklist of Stressful and Traumatic Events and a clinician-administered interview for the assessment of childhood abuse. Level of combat exposure was measured with the Combat Exposure Scale.
Vietnam veterans with PTSD had higher rates of childhood physical abuse than Vietnam veterans without PTSD (26% versus 7%). The association between childhood abuse and PTSD persisted after controlling for the difference in level of combat exposure between the two groups. Patients with PTSD also had a significantly higher rate of total traumatic events before joining the military than patients without PTSD (mean = 4.6, SD = 4.5, versus mean = 2.8, SD = 2.9).
These findings suggest that patients seeking treatment for combat-related PTSD have higher rates of childhood physical abuse than combat veterans without PTSD. Childhood physical abuse may be an antecedent to the development of combat-related PTSD in Vietnam combat veterans.
The purpose of this study was to examine the relationships among cumulative lifetime trauma, recent stressful events, and presence and severity of current posttraumatic stress disorder (PTSD) symptoms in Holocaust survivors and nonexposed comparison subjects.
Lifetime trauma, recent stressful events, and presence and severity of PTSD were assessed in Holocaust survivors (N=72) and comparison subjects ( N=19).
Survivors with PTSD (N =40) reported significantly greater cumulative trauma and recent stress than survivors without PTSD (N=32) and comparison subjects. Severity of PTSD symptoms, cumulative trauma, and recent stress were significantly associated.
The presence and severity of current PTSD were related to having experienced stressful events in addition to the Holocaust.
Testimony: Crises of Witnessing in literature
- S Feldman
- D Laub
Feldman S, Laub D: Testimony: Crises of Witnessing in literature, Psychoanalysis and History. London, Routledge, Chapman
The Elderly Care Research Center Life Events Scale, Adaptation
- E Kahana
- T Fairchild
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Kahana E, Fairchild T, Kahana B: The Elderly Care Research
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The Civilian Mississippi Scale
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Keane T, Weathers F, Blake D: The Civilian Mississippi Scale.
Boston, National Center for Posttraumatic Stress Disorder, Be~avioral Science Division, 1990
Coping strategies in death camps
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Cronstron-Berskow S: Coping strategies in death camps. Int Forum on Logotherapy 1991; 14:92-96
Classifications of posttraumatic stress disorder in DSM-IV: anxiery disorder, dissociative disorder, or stress disorder? in Posttraumatic Stress Disorder: DSM-IV and Beyond
- Ea Brett
Brett EA: Classifications of posttraumatic stress disorder in
DSM-IV: anxiery disorder, dissociative disorder, or stress disorder? in Posttraumatic Stress Disorder: DSM-IV and Beyond. Edited by Davidson JRT, Foa EB. Washington, DC, American Psychiatric Press, 1993, pp 191-206
Clinician-Administered PTSD Scale (CAPS-I). Boston, National Center for Posttraumatic Stress Disorder
- D Blake
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- D Kaloupek
- G Lauminzer
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Blake D, Weathers F, Nagy L, Kaloupek D, Lauminzer G,
Charney D, Keane T: Clinician-Administered
PTSD Scale
(CAPS-I). Boston, National Center for Posttraumatic Stress Disorder, Behavioral Science Division, 1990