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The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry

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초록

It has been claimed that the progress of psychiatry has lagged behind that of other medical disciplines over the last few decades. This may suggest the need for innovative thinking and research in psychiatry, which should consider neglected areas as topicsof interest in light of the potential progress which might be made in this regard. This review is concerned with one such fieldof psychiatry: dissociation and dissociative disorders. Dissociation is the ultimate form of human response to chronic developmentalstress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglectamong all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociativeamnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathologywhich constitute a single dimension characterized by a spectrum of severity. While dissociative identity disorder (DID)is the most pervasive condition of all dissociative disorders, partial representations of this spectrum may be diagnosed as dissociativeamnesia (with or without fugue), depersonalization disorder, and other specified dissociative disorders such as subthresholdDID, dissociative trance disorder, acute dissociative disorders, and identity disturbances due to exposure to oppression. In addition to constituting disorders in their own right, dissociation may accompany almost every psychiatric disorder and operateas a confounding factor in general psychiatry, including neurobiological and psycho-pharmacological research. While an anti-dissociative drug does not yet exist, appropriate psychotherapy leads to considerable improvement for many patients withdissociative disorders.

Abstract

It has been claimed that the progress of psychiatry has lagged behind that of other medical disciplines over the last few decades. This may suggest the need for innovative thinking and research in psychiatry, which should consider neglected areas as topicsof interest in light of the potential progress which might be made in this regard. This review is concerned with one such fieldof psychiatry: dissociation and dissociative disorders. Dissociation is the ultimate form of human response to chronic developmentalstress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglectamong all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociativeamnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathologywhich constitute a single dimension characterized by a spectrum of severity. While dissociative identity disorder (DID)is the most pervasive condition of all dissociative disorders, partial representations of this spectrum may be diagnosed as dissociativeamnesia (with or without fugue), depersonalization disorder, and other specified dissociative disorders such as subthresholdDID, dissociative trance disorder, acute dissociative disorders, and identity disturbances due to exposure to oppression. In addition to constituting disorders in their own right, dissociation may accompany almost every psychiatric disorder and operateas a confounding factor in general psychiatry, including neurobiological and psycho-pharmacological research. While an anti-dissociative drug does not yet exist, appropriate psychotherapy leads to considerable improvement for many patients withdissociative disorders.

참고문헌 (81)

  1. American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders" (1994), American Psychiatric Press
  2. Dalenberg C, "Scientific study of the dissociative disorders", Psychother Psychosom, 76, pp.400~401 (2007)
  3. Sar V., "The scope of dissociative disorders: an international perspective", Psychiatr Clin North Am, 29, pp.227~244 (2006)
  4. Sar V, "Dissociation and the dissociative disorders: DSM-V and beyond", pp.693~708 (2009), Routledge
  5. Sar V, "Dissociative disorders as a confounding factor in psychiatric research", Psychiatr Clin North Am, 29, pp.129~144 (2006)
  6. American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders" (2013), American Psychiatric Press
  7. Ross CA., "Schizophrenia: innovations in diagnosis and treatment" (2004), Haworth Press
  8. Sar V., "Female Turkish migrants with recurrent depression", pp.112~124 (2011), Studia
  9. Kluft RP., "Clinical presentations of multiple personality disorder", Psychiatr Clin North Am, 14, pp.605~629 (1991)
  10. Sar V., "Epidemiology of dissociative disorders: an overview", Epidemiol Res Int, 2011, pp.404538~ (2011)
  11. Brewin CR., "A cognitive neuroscience account of posttraumatic stress disorder and its treatment", Behav Res Ther, 39, pp.373~393 (2001)
  12. Sar V, "What is trauma and dissociation?", J Trauma Practice, 4, pp.7~20 (2006)
  13. Nijenhuis ER, "Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma", J Trauma Stress, 11, pp.711~730 (1998)
  14. Spiegel D, "Dissociative disorders in DSM-5", Depress Anxiety, 28, pp.824~852 (2011)
  15. Öztürk E, "The "Apparently normal" family: a contemporary agent of transgenerational trauma and dissociation", J Trauma Practice, 4, pp.287~303 (2005)
  16. Ford J., "Dissociation and dissociative disorders. DSM-V and beyond", pp.471~483 (2009), Routledge
  17. Sar V., "Developmental trauma, complex PTSD, and the current proposal of DSM-5", Eur J Psychotraumatol, 2 (2011)[DOI]
  18. Sar V, "Dissociative depression among women in the community", J Trauma Dissociation, 14, pp.423~438 (2013)
  19. Bülbül F, "Childhood trauma in recurrent and first episode depression", Anatolian J Psychiatry, 14, pp.93~99 (2013)
  20. Kilic O, "Dissociative depression among women with fibromyalgia or rheumatoid arthritis", J Trauma Dissociation (2013)
  21. van der Kolk BA, "Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma", Am J Psychiatry, 153(7 Suppl), pp.83~93 (1996)
  22. Steinberg M., "Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R)" (1994), American Psychiatric Press
  23. Sar V, "The Axis-I dissociative disorder comorbidity of borderline personality disorder among psychiatric outpatients", J Trauma Dissociation, 4, pp.119~136 (2003)
  24. Sar V, "Axis I dissociative disorder comorbidity in borderline personality disorder and reports of childhood trauma", J Clin Psychiatry, 67, pp.1583~1590 (2006)
  25. Meares R., "A dissociation model of borderline personality disorder" (2012), Norton
  26. Ross CA, "Paranormal experiences in the general population", J Nerv Ment Dis, 180, pp.357~361 (1992)
  27. Sar V, "Experiences of possession and paranormal phenomena among women in the general population: Are they related to traumatic stress and dissociation?", J Trauma Dissociation (2013)
  28. Ross CA., "Possession experiences in dissociative identity disorder: a preliminary study", J Trauma Dissociation, 12, pp.393~400 (2011)
  29. Sar V, "The prevalence of conversion symptoms in women from a general Turkish population", Psychosomatics, 50, pp.50~58 (2009)
  30. Sar V, "Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder", Am J Psychiatry, 161, pp.2271~2276 (2004)
  31. Tezcan E, "Dissociative disorders in Turkish inpatients with conversion disorder", Compr Psychiatry, 44, pp.324~330 (2003)
  32. Şar V, "Differentiating dissociative disorders from other diagnostic groups through somatoform dissociation in Turkey", J Trauma Dissociation, 1, pp.67~80 (2000)
  33. Martinez-Taboas A, "Gates and Rowan's nonepileptic seizures", pp.127~137 (2010), Cambridge University Press
  34. Lewis-Fernandez R, "Cross-cultural assessment of psychological trauma and PTSD", pp.289~318 (2007), Springer
  35. Sar V, "Psychosis, trauma and dissociation: emerging perspectives on severe psychopathology", pp.165~175 (2008), Wiley Press
  36. Sar V, "Dissociation and dissociative disorders: DSM-V and beyond", pp.535~545 (2009), Routledge
  37. Tutkun H, "Dissociative identity disorder presenting as hysterical psychosis", Dissociation, 9, pp.244~252 (1996)
  38. Sar V, "Dissociative disorders in the psychiatric emergency ward", Gen Hosp Psychiatry, 29, pp.45~50 (2007)
  39. Sar V, "Dissociative identity disorder among adolescents: Prevalence in a university psychiatric outpatient unit", J Trauma Dissociation (2013)
  40. Akyuz G, "Reported childhood trauma, attempted suicide and self-mutilative behavior among women in the general population", Eur Psychiatry, 20, pp.268~273 (2005)
  41. Zoroglu SS, "Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation", Psychiatry Clin Neurosci, 57, pp.119~126 (2003)
  42. Kluft RP., "Six completed suicides in dissociative identity disorder patients: clinical observations", Dissociation, 8, pp.104~111 (1995)
  43. Sar V, "Prevalence of dissociative disorders among women in the general population", Psychiatry Res, 149, pp.169~176 (2007)
  44. Sar V, "Childhood trauma and dissociation in schizophrenia", Psychopathology, 43, pp.33~40 (2010)
  45. Karadag F, "Dissociative disorders among inpatients with drug or alcohol dependency", J Clin Psychiatry, 66, pp.1247~1253 (2005)
  46. Tamar-Gurol D, "Childhood emotional abuse, dissociation, and suicidality among patients with drug dependency in Turkey", Psychiatry Clin Neurosci, 62, pp.540~547 (2008)
  47. Lochner C, "Dissociative experiences in obsessive-compulsive disorder and trichotillomania: clinical and genetic findings", Compr Psychiatry, 45, pp.384~391 (2004)
  48. Kuşkonmaz E, "Treatment of a case with dissociative identity disorder presenting as vaginismus", Anatolian J Psychiatry, 1, pp.48~57 (2000)
  49. Dorahy MJ, "Dissociative identity disorder: an empirical overview", Austr N Z J, 48, pp.402~417 (2014)
  50. Sar V, "Frontal and occipital perfusion changes in dissociative identity disorder", Psychiatry Res, 156, pp.217~223 (2007)
  51. Dale KY, "Dissociative identity disorder and prepulse inhibition of the acoustic startle reflex", Neuropsychiatr Dis Treat, 4, pp.653~662 (2008)
  52. Ellason JW, "Axis I and II comorbidity and childhood trauma history in chemical dependency", Bull Menninger Clin, 60, pp.39~51 (1996)
  53. Forrest KA., "Toward an etiology of dissociative identity disorder: a neurodevelopmental approach", Conscious Cogn, 10, pp.259~293 (2001)
  54. Shore AN., "Affect dysregulation and disorders of the self", pp.5~35 (2003), Norton
  55. Sar V, "HMPAO SPECT study of regional cerebral blood flow in dissociative identity disorder", J Trauma Dissociation, 2, pp.5~25 (2001)
  56. Lanius RA, "A review of neuroimaging studies in PTSD: heterogeneity of response to symptom provocation", J Psychiatr Res, 40, pp.709~729 (2006)
  57. Vermetten E, "Hippocampal and amygdalar volumes in dissociative identity disorder", Am J Psychiatry, 163, pp.630~636 (2006)
  58. Ehling T, "Volume of discrete brain structures in complex dissociative disorders: preliminary findings", Prog Brain Res, 167, pp.307~310 (2008)
  59. Yargiç LI, "Comparison of dissociative identity disorder with other diagnostic groups using a structured interview in Turkey", Compr Psychiatry, 39, pp.345~351 (1998)
  60. Mesulam MM., "Dissociative states with abnormal temporal lobe EEG. Multiple personality and the illusion of possession", Arch Neurol, 38, pp.176~181 (1981)
  61. Saxe GN, "SPECT imaging and multiple personality disorder", J Nerv Ment Dis, 180, pp.662~663 (1992)
  62. Lapointe AR, "Similar or disparate brain patterns? The intra-personal EEG variability of three women with multiple personality disorder", Clin EEG Neurosci, 37, pp.235~242 (2006)
  63. Cocker KI, "Electrophysiological changes under hypnosis in multiple personality disorder: A two-case exploratory study", Austr J Clin Exp Hypn, 22, pp.165~176 (1994)
  64. Hughes JR, "Brain mapping in a case of multiple personality", Clin Electroencephalogr, 21, pp.200~209 (1990)
  65. Hopper A, "EEG coherence and dissociative identity disorder", J Trauma Dissociation, 3, pp.75~88 (2002)
  66. Reinders AA, "One brain, two selves", Neuroimage, 20, pp.2119~2125 (2003)
  67. Reinders AA, "Psychobiological characteristics of dissociative identity disorder: A symptom provocation study", Biol Psychiatry, 60, pp.730~740 (2006)
  68. Schlumpf YR, "Dissociative partdependent biopsychosocial reactions to backward masked angry and neutral faces: An fMRI study of dissociative identity disorder", Neuroimage Clin, 3, pp.54~64 (2013)
  69. Tsai GE, "Functional magnetic resonance imaging of personality switches in a woman with dissociative identity disorder", Harv Rev Psychiatry, 7, pp.119~122 (1999)
  70. Reinders AA, "Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states", PLoS One, 7, pp.e39279~ (2012)
  71. Savoy RL, "Voluntary switching between identities in dissociative identity disorder: A functional MRI case study", Cogn Neurosci, 3, pp.112~119 (2012)
  72. Wolk PC, "The neural correlates of vertical splitting in a single case study", Neuropsychoanalysis, 14, pp.157~163 (2012)
  73. Waldvogel B, "Sighted and blind in one person: a case report and conclusions on the psychoneurobiology of vision", Nervenarzt, 78, pp.1303~1309 (2007)
  74. Kluft RP., "The difficultto-treat psychiatric patient", pp.209~242 (2001), American Psychiatric Publishing
  75. Kluft RP., "The older female patient with a complex chronic dissociative disorder", J Women Aging, 19, pp.119~137 (2007)
  76. Kluft RP., "Childhood antecedents of multiple personality", pp.197~238 (1985), American Psychiatric Press
  77. Kluft RP., "Treating the patient who has been sexually exploited by a previous therapist", Psychiatr Clin North Am, 12, pp.483~500 (1989)
  78. Chu JA, "International Society for the Study of Trauma and Dissociation. Guidelines for treating dissociative identity disorder in adults, third revision", J Trauma Dissociation, 12, pp.115~187 (2011)
  79. Cronin E, "The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders", Eur J Psychotraumatol, 5 (2014)[DOI]
  80. Brand BL, "A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified", Psychological Trauma: Theory, Research, Practice, and Policy, 4, pp.490~500 (2012)
  81. Schwartz RC., "Internal family systems therapy" (1995), Guilford Press

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