Dissociative Experiences In Psychiatric Inpatients

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Journal of Psychology and Clinical PsychiatryDissociative Experiences in Psychiatric InpatientsResearch ArticleAbstractDissociative disorders are conditions that involve disruptions of memory,awareness, identity, or perception. Data collected in diverse geographic locationsunderline the consistency in clinical symptoms of dissociative disorders. In thiscross-sectional descriptive study, prevalence of dissociative experiences hasbeen screened in hospitalized patients in psychiatric wards of Shiraz Universityof Medical Sciences in Iran. One hundred and sixty patients in two hospitalsentered the study. Our tool to screen the prevalence of dissociative experienceswas Dissociative Experience Scale (DES). Linear regression analysis shows thatgender and age are predictors of high DES scores to some extent while psychiatricdisorders are not good predictors. Age, gender and psychiatric disorders are poorpredictors (almost 7%) of high DES scores in this study (R square 0.69). In thisstudy, patients with Borderline Personality Disorder had higher dissociativeexperiences based on DES score (Mean: 56.44), followed by Schizophrenicpatients (Mean: 28.22) and patients with Bipolar Personality Disorder (Mean:25.18). This study showed that we might be able to create a new category inpsychological disorders based on dissociative experiences. As age, gender andpsychological disorders were poor predictors of dissociative experiences,stronger predictors such as positive childhood psychological traumas could beresponsible for dissociative disorders.Volume 6 Issue 6 - 2016Department of Psychiatry, Hafez Hospital, Shiraz University ofMedical Sciences, USA*Corresponding author: Soroush Pakniyat Jahromi,Department of Psychiatry, Hafez Hospital, Shiraz Universityof Medical Sciences, Shiraz, 448 Palisade Ave. Apt#106,Cliffside Park, New Jersey, USA, Tel: 224-409-6841; Email:Received: February 02, 2016 Published: November 22,2016Keywords: Dissociation; Schizophrenia; Borderline personality disorder;Multicultural studies.Abbreviations: DES: Dissociative Experience Scale; PTSD: PostTraumatic Stress Disorder; SCID: structured clinical interviewfor DSM-IV; CIDI: Composite International Diagnostic Interview;DDIS: Dissociative Disorders Interview Schedule; MDD: MajorDepressive Disorder; OCD: Obcessive Compulsive Disorder;SPSS: Statistical Package for Social Sciences; ANOVA: Analysis OfVariance; LSD: Least Significant DifferenceIntroductionDissociation is defined as a perceived detachment of the mindfrom the emotional state or even from the body and it describes awide array of experiences from mild detachment from immediatesurroundings to more severe detachment from physical andemotional experience. Dissociative disorders are conditionsthat involve disruptions or breakdowns of memory, awareness,identity, or perception [1]. Dissociation may be sudden or gradual,transient, or chronic. Many studies in different geographiclocations such as North America (2), Puerto Rico (3), WesternEurope (4), Turkey (5), and Australia (6) have highlighed theconsistency in clinical symptoms of dissociative disorders. Theseclinical case series have also underlined the association betweenchildhood psychological trauma and dissociative disordersamong all psychiatric disorders. Childhood sexual (57.1%–90.2%), emotional (57.1%), and physical (62.9%–82.4%) abuseand neglect (62.9%) are among them [2-6]. Although dissociationconstitutes a diagnostic category seperately, dissociativesymptoms may be evident in almost all psychiatric disorders[7] including borderline personality disorder [8,9], conversionSubmit Manuscript http://medcraveonline.comdisorder [10], and obsessive-compulsive disorder [11]. In thosecases, dissociation is usually linked to childhood trauma history,suicidal attempt and self-mutilation behavior regardless of themain diagnosis [7]. Dissociative subtypes have been proposed forpsychiatric disorders such as PTSD [8] and schizophrenia [12,13].Different tools such as structured clinical interview for DSM-IV[SCID] and composite international diagnostic interview (CIDI)have not been suitable to screen dissociative disorders [14,15] andmany large-scale studies using general psychiatric instrumentshave failed to diagnose dissociative disorders appropriately andhave led to biased reports [16-18]. Studies using assessment toolsscreening dissociative disorders have been useful to resolve thismatter. Dissociative experiences scale (DES) which is a subjectivemeasure [19] and structured diagnostic interviews such asdissociative disorders interview schedule (DDIS), [20] andstructured clinical interview for dissociative disorders (SCID-D),[21] are the most popular tools frequently used. Similar studieshave taken place in other geographical locations worldwide andconducting this study together with the studies in Turkey is ofgreat value to reflect the dissociative experiences of the region.Materials and MethodsIn this cross-sectional descriptive study, prevalence ofdissociative experiences has been screened in hospitalizedpatients in psychiatric wards of Shiraz University of MedicalSciences in Iran. The goal of this survey is to screen the prevalenceof Dissociative experiences in inpatients of two teachinghospitals and to evaluate and compare the prevalence of thisJ Psychol Clin Psychiatry 2016, 6(6): 00383

Copyright: 2016 Firoozabadi et al.Dissociative Experiences in Psychiatric Inpatientsdisorder in patients suffering from Schizophrenia, Bipolar, MajorDepressive Disorder (MDD), Obcessive-Compulsive Disorder(OCD), Conversion and Borderline Personality Disorders. Onehundred and sixty hospitalized patients in Psychiatric wards ofthe mentioned hospitals entered the study. After explaining thewhole procedure to all individuals, informed consent was signedby all subjects. All individuals had completed 8th grade educationand had no history of drug abuse. Mean age for individuals was33.91 (SD 9.89) with minimum of 15 and maximum of 60.There was no difference between the mean age of women andmen. The proportion of each mentioned disorder from the total160 individuals were as follow: Schizophrenia 31.9%, Bipolar16.9%, MDD 25.6%, OCD 10.6%, Conversion 7.5% and BorderlinePersonality Disorder 7.5%.All individuals filled out a registration form consisting oftheir age, gender, duration of hospitalization and numberof hospitalizations in Psychiatric wards. Our tool to screenthe prevalence of dissociative experiences was DissociativeExperience Scale (DES), which is a psychological self-assessmentquestionnaire consisting of 28 questions that is being usedworldwide for screening dissociative experiences in people. Ineach question individuals assess the degree of their experiencesfrom zero to 100 and the total score results from adding allthe scores in each question and dividing by 28. DES is used forscreening and not for diagnosis. In this study, scores equal andbelow 15 are considered normal, 16-20 mild, 21-30 moderate andscores above 30 are considered as severe. After completion, datawas analyzed and assessed by SPSS18 software, ANOVA and Chisquare tests and difference between groups were identified.Results and DiscussionOne hundred and sixty patients entered the study with DESscore ranging from 0-100 with a mean score of 22.95. Ninetyone patients (56.9%) scored higher than 15; Seventy-twopatients (45%) higher than 20; Sixty-one patients (38.1%) higherthan 25 and forty-eight patients (30%) higher than 30. Therewas a significant difference between the scores of Borderlinepersonality disorder versus other disorders. Breakdown ofpatients in normal, mild, moderate and severe categories isshown in Table 1. No difference was identified in both genders inthis regard (Table 2). Table 3 illustrates the severity in differentdisorders. The mean DES score was 22.95 (SD 20.73), highestscore belonged to patients with Borderline personality disorder(56.44) and Schizophrenic patients (28.22) and the minimumscore belonged to OCD patients (8.20), (Table 4). The Varianceanalysis of DES scores in each disorder is reflected in tables 5-10.Based on post hoc test (LSD) there is a significant differencebetween Borderline personality disorder patients and otherdisorders. On the other hand, there was no significant differencebetween Conversion disorder patients and other disorders,except Borderline personality disorder patients. No significantdifference was seen between patients of Borderline personalitydisorder and Schizophrenia, however there was a significantdifference between former two disorders and MDD patients. Asshown in Table 4, 61 women entered the study with mean score of19.11 (Min: 0, Max: 89) and 99 men entered the study with meanscore of 25.32 (Min: 0 and Max: 100). Correlation between gender,age and DES were analyzed by Pearson correlation. The result forgender and DES was 1.46 (p-value: 0.066), and this correlation2/5between age and DES was 1.98 (p-value: 0.012). Linear regressionanalysis shows that gender and age are predictors of high DESscores to some extent while psychiatric disorders are not goodpredictors (Tables 5-11). Age, gender and psychiatric disordersare poor predictors (almost 7%) of high DES scores in this study(R square 0.69) (Table 10).Table 1: DES r71172646Percentage44.410.616.228.8Table 2: DES categories based on 0%Table 3: DES categories in different psychiatric 0%100%100%100%Table 4: DES results in different Psychiatric eNo.MeanSD27121225.179656.447619.141741Citation: Firoozabadi A, Jahromi SP, Alizadeh NR (2016) Dissociative Experiences in Psychiatric Inpatients. J Psychol Clin Psychiatry 6(6): 00383. DOI:10.15406/jpcpy.2016.06.00383

Copyright: 2016 Firoozabadi et al.Dissociative Experiences in Psychiatric InpatientsTable 5: DES results in Borderline Personality Disorder versus other disorders.Borderlinepersonality disorderCategoriesMean DifferenceStd. ErrorBipolar Disorder31.26787Major Depressive Disorder44.09506Conversion Disorder37.30583Obsessive Compulsive Disorder48.2475Schizophrenia28.21789Table 6: DES results in Bipolar Disorder versus other disorders.Bipolar 395.47627-31.2679Major Depressive Disorder12.82719Schizophrenia-3.04998Obsessive Compulsive .06229Major Depressive 627-17.1963-7.630429.5138-24.892195% Confidence Interval00.534Sig.Upper 040.534-6.23460.0016.435394.923664.78008Bipolar Disorder-12.8272Conversion .824695% Confidence Interval00.959Sig.Lower BoundUpper 72-57.4153Lower BoundStd. ErrorSchizophreniaSig.22.9563Mean DifferenceObsessive Compulsive Disorder0.020.975-9.3779CategoriesBorderline personality disorder0.0335.602046.96811-10.9417Table 9: DES in Major Depressive Disorder versus other disorders.0.9110.911Conversion Disorder-20.029695% Confidence .1278Bipolar Disorder-4.1524432.230605.92176Std. ErrorMajor Depressive Disorder1.7287-14.773523.12780Upper BoundMean Difference-48.2475-11.05180Lower BoundCategoriesBorderline personality disorder95% Confidence olar DisorderObsessive Compulsive Disorder12.413766.81965.92176Std. Error-37.305829.675457.4153Upper BoundMean DifferenceBorderline personality disorder17.1963Lower BoundCategoriesTable 8: DES results in Obsessive Compulsive Disorder versus other disordersMajor DepressiveDisorder14.1781Borderline personality disorderSchizophreniaObsessive CompulsiveDisorder5.92176Std. ErrorTable 7: DES results in Conversion Disorder versus other disorders.Conversion disorderUpper BoundMean Difference6.03796Sig.Lower BoundCategoriesConversion Disorder95% Confidence 0943/500.959Citation: Firoozabadi A, Jahromi SP, Alizadeh NR (2016) Dissociative Experiences in Psychiatric Inpatients. J Psychol Clin Psychiatry 6(6): 00383. DOI:10.15406/jpcpy.2016.06.00383

Copyright: 2016 Firoozabadi et al.Dissociative Experiences in Psychiatric InpatientsTable 10: DES in Schizophrenia versus other disorders.SchizophreniaCategoriesMean DifferenceStd. ErrorBipolar Disorder3.049984.062299.087945.47627Borderline personality disorder-28.2179Major Depressive Disorder15.87717Conversion DisorderObsessive Compulsive Disorder20.02961Table 11: Predictor variables in Dissociative Experiences in this study R 0.069.ModelUnstandardized CoefficientsBStd. 83-0.36895% Confidence IntervalSig.Lower BoundUpper 80086.2346Standardized .165-0.176-2.2310.027ConclusionThe goal of this study was to evaluate the dissociativeexperiences in psychiatric inpatients of Shiraz University ofMedical Sciences. This study and all similar studies are based onpersonal feedbacks of interviewees that play a big role in validityof such studies. In this study the opposite relationship that hadbeen proven before between age and degree of dissociativeexperiences [22] has been approved, therefore, we can concludethat this study has an acceptable validity and reliability. Accordingto DES scores in this study we can divide patients into two groupswith high dissociative experiences (Borderline personality,Bipolar disorders and Schizophrenia) and low dissociativeexperiences (Conversion, Obcessive-Compulsive and Majordepressive disorders). Since our target population were allinpatients, and inpatients of Borderline Personality Disorder hadsevere symptoms which had resulted in their hospitalization, itmay be translated in this way that this study divided patients withsevere psychiatric symptoms from patients with milder symptomsbased on DES score. This could be related to improper diagnosisin the hospitalized patients. Most probably by looking deeper andmaking better diagnosis among patients with high DES scores,some of them would be diagnosed as patients with Dissociativedisorders in the same line as previous mentioned studies.Dissociative experiences screened in this study (Mean DESscore: 22.95) are greater than previous studies in North America(Mean DES score: 14.6) [23,24], Switzerland (Mean DES score:13.7) [25], and Turkey (Mean DES score: 17.8) [26]. Also, 45%of patients in this study scored higher than 20 that is higher thanprevious study results in North America (30%) and Switzerland(20%) but less than the study results in Turkey (56%).As Sar, V. (2011) has mentioned [27], data collected in diversegeographic locations in the world has underlined the consistencyin clinical symptoms of dissociative disorders. Dissociative-0.16-2.0324/50.044patients report highest frequencies of childhood psychologicaltrauma such as childhood sexual, emotional, and physical abuseand neglect, among all psychiatric disorders. In this study, patientswith Borderline Personality Disorder had higher dissociativeexperiences based on DES score (Mean: 56.44), followed bySchizophrenic patients (Mean: 28.22) and patients with BipolarPersonality Disorder (Mean: 25.18). In this study there was nodifference in the Mean DES score between men and women. Inother studies in Germany [28] and Finland [29] there were alsono difference in this regard, however, in a study in Turkey, therewere twice the chance of higher score in women compared to men[30]. This difference could be justified by cultural difference anddifferent childhood psychological traumas in different countries.Linear regression analysis shows that gender and age arepredictors of high DES scores to some extent while psychiatricdisorders are not good predictors. This means that by controllingage and gender, there would be no difference in DES scorein different disorders. These three factors (age, gender anddisorder) are poor predictors (almost 7%) of high DES scoresin this study (R square 0.69) (Table 10). Similar studies haveconcluded that childhood psychological trauma is a strongvariable in predicting high DES scores. It may be concluded thatour diagnosis of disorders were not accurate and by a deeper lookand better diagnosis, some patients especially the ones with highDES scores and severe psychiatric symptoms would be diagnosedas “Dissociative Disorder” and would reflect positive childhoodhistory of psychological traumas.In other words, we may be able to define a subclass in eachdisorder based on childhood psychological traumas. Paying moreattention to such subclasses related to Dissociative disorderswould result in better management and treatment of suchdisorders. This study showed that we might be able to create anew category in psychological disorders based on dissociativeCitation: Firoozabadi A, Jahromi SP, Alizadeh NR (2016) Dissociative Experiences in Psychiatric Inpatients. J Psychol Clin Psychiatry 6(6): 00383. DOI:10.15406/jpcpy.2016.06.00383

Dissociative Experiences in Psychiatric InpatientsCopyright: 2016 Firoozabadi et al.5/5experiences. As age, gender and psychological disorders werepoor predictors of dissociative experiences, stronger predictorssuch as positive childhood psychological traumas could beresponsible for dissociative disorders.15. First MB, Gibbon M, Williams JB (1997) Structured Clinical Interviewfor DSM-IV Axis I Disorders (SCID-I), Clinician Version, User’s Guide.American Psychiatric Association, USA, pp. 1-140.Ali Firoozabadi, Soroush Pakniyat Jahromi, Nooshin RezaAlizadeh.17. Andrews G, Henderson S, Hall W (2001) Prevalence, comorbidity,disability and service utilization: overview of the AustralianNational Mental Health Survey. Br J Psychiatry 178: 145-153.AcknowledgementsReferences1.(1994) Diagnostic and Statistical Manual of Mental Disorders. (4thedn), American Psychiatric Association, USA, pp. 1-915.3.Martinez-Taboas A (1991) Multiple personality in Puerto Rico:analysis of fifteen cases. Dissociation 4(4): 189-192.2.4.5.6.7.8.9.Ross CA, Miller SD, Reagor P, Bjornson L, Fraser GA, et al. (1990)Structured interview data on 102 cases of multiple personalitydisorder from four centers. Am J Psychiatry 147(5): 596-601.Boon S, Draijer N (1993) Multiple personality disorder in TheNetherlands: a clinical investigation of 71 patients. Am J Psychiatry150(3): 489-494.Sar V, Yargiç LI, Tutkun H (1996) Structured interview data on 35cases of dissociative identity disorder in Turkey. Am J Psychiatry153(10): 1329-1333.Middleton W, Butler J (1998) Dissociative identity disorder: anAustralian series. Aust N Z J Psychiatry 32(6): 794-804.Sar V, Ross C (2006) Dissociative disorders as a confounding factorin psychiatric research. Psychiatr Clin North Am 29(1): 129-144.Kundakci SV, Turgut K, Kiziltan E, Yargic Il, Tutkun H, et al.(2003) The axis-I dissociative disorder comorbidity of borderlinepersonality disorder among psychiatric outpatients. Journal ofTrauma and Dissociation 4(1): 119-136.Sar V, Akyuz G, Kugu N, Ozturk E, Ertem-Vehid H (2006) AxisI dissociative disorder comorbidity in borderline pe

screening dissociative disorders have been useful to resolve this matter. Dissociative experiences scale (DES) which is a subjective measure [19] and structured diagnostic interviews such as dissociative disorders interview schedule (DDIS), [20] and structured clinical intervi

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