Objective: COVID-19 pandemic brought signi cant challenges for college students. This study aimed... more Objective: COVID-19 pandemic brought signi cant challenges for college students. This study aimed to investigate changes in psychiatric symptomatology among them compared to the pre-pandemic period alongside their determinants. Methods: Data were collected before and three months after the onset of the pandemic from 168 students who had applied to a college mental health center. Psychiatric symptomatology was assessed by Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Adult Attention De cit Hyperactivity Disorder Self-Report Scale (ASRS). Possible vulnerability factors were screened by a survey on COVID-19-related health and social isolation status, Fear of COVID-19 Scale, Social Media Use Disorder Scale (SMDS), Distress Thermometer, Scoff Eating Questionnaire, and International Physical Activity Questionnaire Short-Form (IPAQ). Results: PHQ-9, GAD-7 and ASRS scores signi cantly declined in the follow up. Even though the screen time increased, SMDS scores signi cantly declined. SMDS had a direct effect on PHQ-9 and ASRS levels, in addition to an indirect effect through Stress Thermometer. Higher SMDS scores predicted higher anxious and depressive symptomatology in repeated assessments. Fear of COVID-19 scores had a direct effect on GAD-7 scores only. Conclusion: This study suggested that stress level and psychiatric symptomatology of the students decreased signi cantly in the early phases of the pandemic. Level of social media use disorder should be taken into account while following college students with mental health symptoms.
This study attempted to determine the prevalence of dissociative identity disorder in the general... more This study attempted to determine the prevalence of dissociative identity disorder in the general population. The Dissociative Experiences Scale (DES) was administered to 994 subjects in 500 homes who constituted a representative sample of the population of Sivas City, Turkey. The mean DES score was 6.7+/-6.1 (mean +/- SD). Of the 62 respondents who scored above 17 on the DES, 32 (51.6%) could be contacted during the second phase of the study. They were matched for age and gender with a group of respondents who scored below 10 on the scale, and the Dissociative Disorders Interview Schedule (DDIS) was then administered to both groups. Seventeen subjects (1.7%) received a diagnosis of dissociative disorder according to the structured interview. In the third phase, eight of 17 subjects who had a dissociative disorder on the structured interview could be contacted for a clinical evaluation. They were matched with a nondissociative control group and interviewed by a clinician blind to the structured interview diagnosis. Four of eight subjects were diagnosed clinically with dissociative identity disorder, yielding a minimum prevalence of 0.4%. Dissociative identity disorder is not rare in the general population. Self-rating instruments and structured interviews can be used successfully for screening these cases. Our data, derived from a population with no public awareness about dissociative identity disorder and no exposure to systematic psychotherapy, suggest that dissociative identity disorder cannot be considered simply an iatrogenic artifact, a culture-bound syndrome, or a phenomenon induced by media influences.
Psychotic symptoms occur in some, but not all dissociative disorders. They are usually seen in di... more Psychotic symptoms occur in some, but not all dissociative disorders. They are usually seen in dissociative identity disorder (DID) and dissociative disorder not otherwise specifiedtype I (DDNOS-1, according to the DSM-IV), traditionally subsumed under the rubric of ‘complex’ dissociative disorders (Loewenstein, 1991). There are also patients who experience dissociative-based hallucinations, sometimes combined with depersonalization or dissociative amnesia, but in the absence of distinct personality states (Şar, Akyuz and Dogan, 2007). Further, some patients have transient (acute) dissociative disorders with auditory and visual hallucinations which may be combined with dissociative somatic (conversion) symptoms (Şar, Koyuncu et al., 2007), which would also likely be classed in the NOS category of dissociative disorders. Dissociative disorders may mimic psychotic disorders in many ways. While some have suggested ways of distinguishing dissociative from schizophrenic disorders (Ross et al., 1989a; Steinberg et al., 1994; Yargic et al., 1998), empirical studies of overlapping symptoms in psychotic and dissociative disorders are rare. One of the few was conducted by Steinberg et al. (1994) utilizing the SCID-D (Structured Clinical Interview for DSM-IV Dissociative Disorders, Revised; Steinberg et al., 1994). They demonstrated that patients Q1 with DID had significantly higher scores on five specific dissociative symptom clusters than patients with schizophrenia or schizoaffective disorder (Steinberg et al., 1994). These clusters are: dissociative amnesia, depersonalization, derealization, identity confusion and identity alteration. In accordance with the DSM-IV (American Psychiatric Association, 1994), the SCID-D does not assess dissociative somatic (conversion) phenomena, yet these symptoms are placed in the dissociative disorder section of the ICD-10 (World Health
There is a rising belief that considers happiness as an internal state to be achieved and control... more There is a rising belief that considers happiness as an internal state to be achieved and controlled by the individual. Paradoxically, this stance may cause distress due to the perceived pressure to achieve happiness. [3,4] Thus, positive emotions such as happiness are not experienced INTRODUCTION Fear of happiness is the belief that happiness may have negative consequences [1] implying that it should be
Societal conditions associated with overstimulation or understimulation may precipitate and maint... more Societal conditions associated with overstimulation or understimulation may precipitate and maintain oppression among individuals and communities by inducing dissociation. Distortion of reality and the flooding of everyday awareness with irrelevant information by mass media is a type of community-wide overstimulation. Alternatively, stimulus deprivation enables single-minded thinking to be narrowly preoccupied with rigid religious ideas, traditional rituals, and postmodern thought and behavior patterns. Provoked sex is utilized as a soothing tool for those who live in overstimulation and as an opportunity for transient enjoyment and rejuvenation for those who live in stimulus deprivation. Chronic exposure to disproportionate stimuli resurrects the trauma-based developmental detachment between the sociological and psychological selves of the individual at the cost of the latter. The enlarged sociological self of the individual is misused to induce a conforming identity transformation of individuals and entire communities that is a prerequisite to setting and maintaining an oppressive system. Constituting overstimulation itself, the enduring fear of chaos in a world akin to crisis enables deliberate acceptance of oppression to restore a sense of control. In fact, the expectancy of crisis triggers the trauma-related dissociative fears of individual internal chaos, which are misused, in turn, to aggravate fears of external chaos again. By facilitating the denial of internal fears rather than integrating them, psychological theories and practices of the past century have failed in addressing the problem of individual and societal oppression.
Fifty first-degree relatives of 24 Turkish dissociative patients and 50 Turkish non-clinical cont... more Fifty first-degree relatives of 24 Turkish dissociative patients and 50 Turkish non-clinical controls were screened for childhood traumas, dissociative experiences/disorders, and borderline personality disorder/criteria. The Dissociative Experiences Scale, the borderline personality disorder section of the Structured Clinical Interview for DSM-IV Personality Disorders, the Childhood Trauma Questionnaire, and a structured history form were admistered to all participants. Family members had dissociative experiences, borderline personality disorder criteria (subtreshold scores included), and childhood traumas more frequently than the normal control group. Family members with a Dissociative Experiences Scale score 25 and above (N = 3) were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders. None of the family members were diagnosed as having a dissociative disorder and/or borderline personality disorder on a clinical level. Our findings suggest that these apparently normal families of dissociative patients need to be evaluated for trauma-related family dynamics overall and for hidden subclinical psychopathology.
Psychology Research and Behavior Management, May 1, 2017
Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally s... more Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry.
Journal of Psychology & Clinical Psychiatry, Dec 7, 2016
This paper seeks to highlight phenomena related to resistance in the psychotherapy of dissociativ... more This paper seeks to highlight phenomena related to resistance in the psychotherapy of dissociative disorders and other trauma-and stress-related psychiatric disorders. The authors consider a particular psychological construct to be at the origin of resistance: the trauma-self. The resistances of the trauma-self consist of three main groups: Depressive manifestations, traumatic obsessions, and loss of psychosocial mutuality. Detemporalization, treating oneself as an object, suicidality, obsessions of abnormality, rupturing the mutuality of the patient-therapist relationship, and dissociative somatic crises are clues of these resistances. Succesful treatment is expected to minimize the resistances of the trauma-self. This is expected to be achieved through the careful contextualization of the trauma-self while conducting psychotherapy. Approaching the patient's experiences from multiple angles not only from the angle of the therapist but also from the patient's distinct perspectives are crucial in working through the resistances of the trauma-self.
... 12 TRAUMA AND DISSOCIATION IN A CROSS-CULTURAL PERSPECTIVE sive and involuntary urge (ie, the... more ... 12 TRAUMA AND DISSOCIATION IN A CROSS-CULTURAL PERSPECTIVE sive and involuntary urge (ie, the completion expectancy) and the repeti-tion tendency of ... It is crucial to stop the obses-sions and to take the person from this maladaptive process to an adaptive one. ...
A novel sociocognitive theory of dissociation and dissociative disorders is proposed. The model, ... more A novel sociocognitive theory of dissociation and dissociative disorders is proposed. The model, which is both theoretical and clinical, is based on "functional dissociation of the self." A new concept is introduced in this paper: the sociological self. While the sociological self may have cultural and societal dimensions, it is regarded here as a universal phenomenon rather than a culture-bound one; as an individual psychological instance rather than a sociological concept per se. It is proposed that the main sources of dissociation are trauma-related detachment of the sociological and psychological selves and the subsequent amplification of the sociological self. Thus, effective psychotherapy must curtail the enlargement of the sociological self and reactivate the psychological self. It is hoped that this conceptualization will contribute to efforts both toward understanding the everyday dissociation of the average contemporary individual and toward developing novel
Inaccurate diagnosis of dissociative disorders (DDs) remains a frequent problem. Misdiagnoses may... more Inaccurate diagnosis of dissociative disorders (DDs) remains a frequent problem. Misdiagnoses may lead to delayed or ineffective treatment, and subsequently poorer quality of life for those struggling with DDs, who frequently utilize mental health treatment and evidence high rates of self-harm and suicidality. This study's objective was to examine the magnitude of the effects with which the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) and revised version (SCID-D-R)henceforth referred to as the "SCID-D interviews"provide diagnoses of DDs and differentiate them from nondissociative disorders as well as factitious and simulated dissociative presentations. For inclusion, studies had to be empirical investigations comparing SCID-D data of DD populations with other populations. Using combined methods of searching for "SCID-D" in electronic indexing databases, seeking recommendations from experts, and reviewing reference sections of identified studies, 15 studies were identified and subjected to meta-analytic review. Analyses showed that the overall SCID-D interview score (effect size 3.12) as well as each of the five subscalesparticularly amnesia and identity alteration (effect sizes 2.16 and 2.87, respectively)significantly differentiated DD from non-DD. Findings suggest that the SCID-D interviews show good validity identifying and differentiating those with DDs as compared to those without DDs. The SCID-D interviews are valid instruments for diagnosing and differentiating DD from other psychiatric disorders and feigned presentations of DD. Clinicians, researchers, and forensic experts can use the SCID-D interviews with confidence to make differential diagnoses of DDs. Future research using the SCID-D interviews is discussed.
This chapter explores the most pertinent research questions to understand and advance the study o... more This chapter explores the most pertinent research questions to understand and advance the study of dissociation. Drawing on specific themes, recommendations for future work are outlined at the end of each section. Our chapter in the first edition of this book still contains questions empirically unanswered (e.g., genetics and neurobiology of dissociative disorders, dissociation in other psychiatric disorders). We will focus in this chapter on the most pressing questions that currently need to inform the scientific understanding of dissociation. The Broader Field Definition The widely accepted definition of dissociation has been based on a disruption in one or more psychological functions which implies fragmentation, division, or disintegration (Van der Hart, Nijenhuis, & Steele, 2006). Nevertheless, there have been attempts to expand this definition. For example, although some authors consider absorption to lie outside the domain of dissociation, others claim that it involves dissociation as a narrowing of consciousness and/ or a trance state (Schimmenti & Şar, 2019). Liotti (1992) underlined the interpersonal aspect of dissociation. While in some cases dissociation takes the form of a disorder, it also appears to be a transdiagnostic phenomenon seen in several psychiatric conditions, such as eating disorder, borderline personality disorder, and somatic symptom disorders (Lyssenko et al., 2018). Dissociative symptoms and dissociative disorders are usually related to childhood adversities (Şar & Ross, 2006). Recommended Research 1. Studies addressing domains of dissociation to improve the definition of dissociation. 2. Exploration of personality characteristics of patients with dissociative disorders according to various (e.g., dimensional) models. 3. Trans-diagnostic studies inquiring into possible relationships of dissociation with other domains of psychopathology. Assessment Steinberg's (1994) Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) is widely used in the field. A meta-analysis of the studies using this instrument revealed it has good diagnostic reliability (Mychailyszyn et al., 2021). Ross and Browning (2017) provided a revised version of the Dissociative Disorders Interview Schedule (DDIS) adapted to the DSM-5 which yielded good reliability for the self-report version of the instrument. Many self-report and screening measures of dissociation now exist, including the Dissociative Experiences Scale (DES; Bernstein &
Objective: COVID-19 pandemic brought signi cant challenges for college students. This study aimed... more Objective: COVID-19 pandemic brought signi cant challenges for college students. This study aimed to investigate changes in psychiatric symptomatology among them compared to the pre-pandemic period alongside their determinants. Methods: Data were collected before and three months after the onset of the pandemic from 168 students who had applied to a college mental health center. Psychiatric symptomatology was assessed by Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Adult Attention De cit Hyperactivity Disorder Self-Report Scale (ASRS). Possible vulnerability factors were screened by a survey on COVID-19-related health and social isolation status, Fear of COVID-19 Scale, Social Media Use Disorder Scale (SMDS), Distress Thermometer, Scoff Eating Questionnaire, and International Physical Activity Questionnaire Short-Form (IPAQ). Results: PHQ-9, GAD-7 and ASRS scores signi cantly declined in the follow up. Even though the screen time increased, SMDS scores signi cantly declined. SMDS had a direct effect on PHQ-9 and ASRS levels, in addition to an indirect effect through Stress Thermometer. Higher SMDS scores predicted higher anxious and depressive symptomatology in repeated assessments. Fear of COVID-19 scores had a direct effect on GAD-7 scores only. Conclusion: This study suggested that stress level and psychiatric symptomatology of the students decreased signi cantly in the early phases of the pandemic. Level of social media use disorder should be taken into account while following college students with mental health symptoms.
This study attempted to determine the prevalence of dissociative identity disorder in the general... more This study attempted to determine the prevalence of dissociative identity disorder in the general population. The Dissociative Experiences Scale (DES) was administered to 994 subjects in 500 homes who constituted a representative sample of the population of Sivas City, Turkey. The mean DES score was 6.7+/-6.1 (mean +/- SD). Of the 62 respondents who scored above 17 on the DES, 32 (51.6%) could be contacted during the second phase of the study. They were matched for age and gender with a group of respondents who scored below 10 on the scale, and the Dissociative Disorders Interview Schedule (DDIS) was then administered to both groups. Seventeen subjects (1.7%) received a diagnosis of dissociative disorder according to the structured interview. In the third phase, eight of 17 subjects who had a dissociative disorder on the structured interview could be contacted for a clinical evaluation. They were matched with a nondissociative control group and interviewed by a clinician blind to the structured interview diagnosis. Four of eight subjects were diagnosed clinically with dissociative identity disorder, yielding a minimum prevalence of 0.4%. Dissociative identity disorder is not rare in the general population. Self-rating instruments and structured interviews can be used successfully for screening these cases. Our data, derived from a population with no public awareness about dissociative identity disorder and no exposure to systematic psychotherapy, suggest that dissociative identity disorder cannot be considered simply an iatrogenic artifact, a culture-bound syndrome, or a phenomenon induced by media influences.
Psychotic symptoms occur in some, but not all dissociative disorders. They are usually seen in di... more Psychotic symptoms occur in some, but not all dissociative disorders. They are usually seen in dissociative identity disorder (DID) and dissociative disorder not otherwise specifiedtype I (DDNOS-1, according to the DSM-IV), traditionally subsumed under the rubric of ‘complex’ dissociative disorders (Loewenstein, 1991). There are also patients who experience dissociative-based hallucinations, sometimes combined with depersonalization or dissociative amnesia, but in the absence of distinct personality states (Şar, Akyuz and Dogan, 2007). Further, some patients have transient (acute) dissociative disorders with auditory and visual hallucinations which may be combined with dissociative somatic (conversion) symptoms (Şar, Koyuncu et al., 2007), which would also likely be classed in the NOS category of dissociative disorders. Dissociative disorders may mimic psychotic disorders in many ways. While some have suggested ways of distinguishing dissociative from schizophrenic disorders (Ross et al., 1989a; Steinberg et al., 1994; Yargic et al., 1998), empirical studies of overlapping symptoms in psychotic and dissociative disorders are rare. One of the few was conducted by Steinberg et al. (1994) utilizing the SCID-D (Structured Clinical Interview for DSM-IV Dissociative Disorders, Revised; Steinberg et al., 1994). They demonstrated that patients Q1 with DID had significantly higher scores on five specific dissociative symptom clusters than patients with schizophrenia or schizoaffective disorder (Steinberg et al., 1994). These clusters are: dissociative amnesia, depersonalization, derealization, identity confusion and identity alteration. In accordance with the DSM-IV (American Psychiatric Association, 1994), the SCID-D does not assess dissociative somatic (conversion) phenomena, yet these symptoms are placed in the dissociative disorder section of the ICD-10 (World Health
There is a rising belief that considers happiness as an internal state to be achieved and control... more There is a rising belief that considers happiness as an internal state to be achieved and controlled by the individual. Paradoxically, this stance may cause distress due to the perceived pressure to achieve happiness. [3,4] Thus, positive emotions such as happiness are not experienced INTRODUCTION Fear of happiness is the belief that happiness may have negative consequences [1] implying that it should be
Societal conditions associated with overstimulation or understimulation may precipitate and maint... more Societal conditions associated with overstimulation or understimulation may precipitate and maintain oppression among individuals and communities by inducing dissociation. Distortion of reality and the flooding of everyday awareness with irrelevant information by mass media is a type of community-wide overstimulation. Alternatively, stimulus deprivation enables single-minded thinking to be narrowly preoccupied with rigid religious ideas, traditional rituals, and postmodern thought and behavior patterns. Provoked sex is utilized as a soothing tool for those who live in overstimulation and as an opportunity for transient enjoyment and rejuvenation for those who live in stimulus deprivation. Chronic exposure to disproportionate stimuli resurrects the trauma-based developmental detachment between the sociological and psychological selves of the individual at the cost of the latter. The enlarged sociological self of the individual is misused to induce a conforming identity transformation of individuals and entire communities that is a prerequisite to setting and maintaining an oppressive system. Constituting overstimulation itself, the enduring fear of chaos in a world akin to crisis enables deliberate acceptance of oppression to restore a sense of control. In fact, the expectancy of crisis triggers the trauma-related dissociative fears of individual internal chaos, which are misused, in turn, to aggravate fears of external chaos again. By facilitating the denial of internal fears rather than integrating them, psychological theories and practices of the past century have failed in addressing the problem of individual and societal oppression.
Fifty first-degree relatives of 24 Turkish dissociative patients and 50 Turkish non-clinical cont... more Fifty first-degree relatives of 24 Turkish dissociative patients and 50 Turkish non-clinical controls were screened for childhood traumas, dissociative experiences/disorders, and borderline personality disorder/criteria. The Dissociative Experiences Scale, the borderline personality disorder section of the Structured Clinical Interview for DSM-IV Personality Disorders, the Childhood Trauma Questionnaire, and a structured history form were admistered to all participants. Family members had dissociative experiences, borderline personality disorder criteria (subtreshold scores included), and childhood traumas more frequently than the normal control group. Family members with a Dissociative Experiences Scale score 25 and above (N = 3) were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders. None of the family members were diagnosed as having a dissociative disorder and/or borderline personality disorder on a clinical level. Our findings suggest that these apparently normal families of dissociative patients need to be evaluated for trauma-related family dynamics overall and for hidden subclinical psychopathology.
Psychology Research and Behavior Management, May 1, 2017
Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally s... more Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry.
Journal of Psychology & Clinical Psychiatry, Dec 7, 2016
This paper seeks to highlight phenomena related to resistance in the psychotherapy of dissociativ... more This paper seeks to highlight phenomena related to resistance in the psychotherapy of dissociative disorders and other trauma-and stress-related psychiatric disorders. The authors consider a particular psychological construct to be at the origin of resistance: the trauma-self. The resistances of the trauma-self consist of three main groups: Depressive manifestations, traumatic obsessions, and loss of psychosocial mutuality. Detemporalization, treating oneself as an object, suicidality, obsessions of abnormality, rupturing the mutuality of the patient-therapist relationship, and dissociative somatic crises are clues of these resistances. Succesful treatment is expected to minimize the resistances of the trauma-self. This is expected to be achieved through the careful contextualization of the trauma-self while conducting psychotherapy. Approaching the patient's experiences from multiple angles not only from the angle of the therapist but also from the patient's distinct perspectives are crucial in working through the resistances of the trauma-self.
... 12 TRAUMA AND DISSOCIATION IN A CROSS-CULTURAL PERSPECTIVE sive and involuntary urge (ie, the... more ... 12 TRAUMA AND DISSOCIATION IN A CROSS-CULTURAL PERSPECTIVE sive and involuntary urge (ie, the completion expectancy) and the repeti-tion tendency of ... It is crucial to stop the obses-sions and to take the person from this maladaptive process to an adaptive one. ...
A novel sociocognitive theory of dissociation and dissociative disorders is proposed. The model, ... more A novel sociocognitive theory of dissociation and dissociative disorders is proposed. The model, which is both theoretical and clinical, is based on "functional dissociation of the self." A new concept is introduced in this paper: the sociological self. While the sociological self may have cultural and societal dimensions, it is regarded here as a universal phenomenon rather than a culture-bound one; as an individual psychological instance rather than a sociological concept per se. It is proposed that the main sources of dissociation are trauma-related detachment of the sociological and psychological selves and the subsequent amplification of the sociological self. Thus, effective psychotherapy must curtail the enlargement of the sociological self and reactivate the psychological self. It is hoped that this conceptualization will contribute to efforts both toward understanding the everyday dissociation of the average contemporary individual and toward developing novel
Inaccurate diagnosis of dissociative disorders (DDs) remains a frequent problem. Misdiagnoses may... more Inaccurate diagnosis of dissociative disorders (DDs) remains a frequent problem. Misdiagnoses may lead to delayed or ineffective treatment, and subsequently poorer quality of life for those struggling with DDs, who frequently utilize mental health treatment and evidence high rates of self-harm and suicidality. This study's objective was to examine the magnitude of the effects with which the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) and revised version (SCID-D-R)henceforth referred to as the "SCID-D interviews"provide diagnoses of DDs and differentiate them from nondissociative disorders as well as factitious and simulated dissociative presentations. For inclusion, studies had to be empirical investigations comparing SCID-D data of DD populations with other populations. Using combined methods of searching for "SCID-D" in electronic indexing databases, seeking recommendations from experts, and reviewing reference sections of identified studies, 15 studies were identified and subjected to meta-analytic review. Analyses showed that the overall SCID-D interview score (effect size 3.12) as well as each of the five subscalesparticularly amnesia and identity alteration (effect sizes 2.16 and 2.87, respectively)significantly differentiated DD from non-DD. Findings suggest that the SCID-D interviews show good validity identifying and differentiating those with DDs as compared to those without DDs. The SCID-D interviews are valid instruments for diagnosing and differentiating DD from other psychiatric disorders and feigned presentations of DD. Clinicians, researchers, and forensic experts can use the SCID-D interviews with confidence to make differential diagnoses of DDs. Future research using the SCID-D interviews is discussed.
This chapter explores the most pertinent research questions to understand and advance the study o... more This chapter explores the most pertinent research questions to understand and advance the study of dissociation. Drawing on specific themes, recommendations for future work are outlined at the end of each section. Our chapter in the first edition of this book still contains questions empirically unanswered (e.g., genetics and neurobiology of dissociative disorders, dissociation in other psychiatric disorders). We will focus in this chapter on the most pressing questions that currently need to inform the scientific understanding of dissociation. The Broader Field Definition The widely accepted definition of dissociation has been based on a disruption in one or more psychological functions which implies fragmentation, division, or disintegration (Van der Hart, Nijenhuis, & Steele, 2006). Nevertheless, there have been attempts to expand this definition. For example, although some authors consider absorption to lie outside the domain of dissociation, others claim that it involves dissociation as a narrowing of consciousness and/ or a trance state (Schimmenti & Şar, 2019). Liotti (1992) underlined the interpersonal aspect of dissociation. While in some cases dissociation takes the form of a disorder, it also appears to be a transdiagnostic phenomenon seen in several psychiatric conditions, such as eating disorder, borderline personality disorder, and somatic symptom disorders (Lyssenko et al., 2018). Dissociative symptoms and dissociative disorders are usually related to childhood adversities (Şar & Ross, 2006). Recommended Research 1. Studies addressing domains of dissociation to improve the definition of dissociation. 2. Exploration of personality characteristics of patients with dissociative disorders according to various (e.g., dimensional) models. 3. Trans-diagnostic studies inquiring into possible relationships of dissociation with other domains of psychopathology. Assessment Steinberg's (1994) Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) is widely used in the field. A meta-analysis of the studies using this instrument revealed it has good diagnostic reliability (Mychailyszyn et al., 2021). Ross and Browning (2017) provided a revised version of the Dissociative Disorders Interview Schedule (DDIS) adapted to the DSM-5 which yielded good reliability for the self-report version of the instrument. Many self-report and screening measures of dissociation now exist, including the Dissociative Experiences Scale (DES; Bernstein &
Identity has been a relatively underreferenced concept in psychiaty and clinical psychop... more Identity has been a relatively underreferenced concept in psychiaty and clinical psychopathology. It is of particular interest that the few diagnostic categories associated with some type of identity disturbance are related to chronic psychological traumatization in childhood such as abuse an/or neglect or deficiencies in secure interpersonal attachment. As developmental traumatization is usually associated with dissociation regardless the prevailing diagnostic pattern, models of mind considering the relationships between childhood adversities, dissociation, and identity are compelling not only for social scientists but also for clinicians who are exposed to Dissociative Identity Disorder (aka Multiple Personality Disorder), Borderline Personality Disorder, and Complex PTSD as conditions responding to psychotherapy rather than speficic drug regimens. This chapter is concerned with the Theory of “Functional Dissociation of Self” (Şar and Öztürk, 2007) which proposes such a model of mind. As newly introduced concepts, “Sociological Self “ and “Trauma-Self” (Symptomatic Self) are presented as elements of this model which have direct implications about disturbances of identity and psychotherapeutic interventions tailored to address them.
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Papers by Vedat Şar