Somatoform Dissociation: Phenomena, Measurement, and Theoretical Issues

by Ellert R. S. Nijenhuis Ph.D.

Overview

The first comprehensive theory of somatoform dissociation.

Expanding the definition of dissociation in psychiatry, Nijenhuis presents a summary of the somatoform components of dissociation-how sensory and motor functions are affected by dissociative disorders. Founded in the current view of mind-body integration, this book is essential reading for all mental health professionals engaged in the diagnosis, treatment, and study of dissociative disorders, PTSD, and other trauma-related psychiatric disorders.

Product Details

ISBN-13:	9780393704600
Publisher:	Norton, W. W. & Company, Inc.
Publication date:	09/17/2004
Pages:	254
Product dimensions:	6.10(w) x 9.30(h) x 0.70(d)

About the Author

Ellert R. S. Nijenhuis, Ph.D., is a clinical psychologist, psychotherapist, and researcher. He is affiliated with Mental Health Care Drenthe, The Netherlands and collaborates with various Universities. He is a former director of the Executive Council of the International Society for the Study of Dissociation (ISSD).

Table of Contents

I	Introduction	1
Part I	The Somatoform Dissociation Questionnaire	9
II	Somatoform Dissociative Phenomena: A Janetian Perspective	11
	Introduction	11
	Mental Stigmata and Mental Accidents	13
	Mental Stigmata: Negative Dissociative Symptoms	14
	Anesthesia	15
	Amnesia	16
	Motor Disturbances	16
	Suggestibility	17
	Mental Accidents: Positive Dissociative Symptoms	17
	Subconscious Fixed Ideas and Hysterical Accidents	17
	Hysterical Attacks: Reexperiences of Traumatic Events	19
	Somnambulisms: Complex Dissociative (Identity) States	19
	Deliriums: Dissociative Psychotic Episodes	20
	Case Example	20
	Lisa's Mental Stigmata: Negative Dissociative Symptoms	21
	Anesthesia	21
	Amnesia	22
	Motor Disturbances	22
	Lisa's Mental Accidents: Positive, or Intrusion Symptoms	22
	Subconscious Fixed Ideas	22
	Hysterical Attacks	22
	Somnambulisms: Complex Dissociative (Identity) States	23
	Conclusion	23
	References	23
III	The Development and Psychometric Characteristics of the Somatoform Dissociation Questionnaire (SDQ-20)	26
	Introduction	26
	Methods	28
	Instrument Development	28
	Subjects and Procedure	29
	Instruments	29
	Data Analysis	30
	Results	30
	Discussion	32
	References	34
	Appendix A	38
	Appendix B	39
IV	The Development of the Somatoform Dissociation Questionnaire (SDQ-5) as a Screening Instrument for Dissociative Disorders	41
	Introduction	41
	Material and Methods	43
	Instrument Development	43
	Subjects and Procedure	44
	Instruments	45
	Data Analysis	45
	Results	47
	Implications for Screening and Clinical Use of the SDQ-5	49
	Discussion	49
	References	51
V	Psychometric Characteristics of the Somatoform Dissociation Questionnaire: A Replication Study	54
	Introduction	54
	Methods	56
	Subjects and Procedure	56
	Instruments	57
	Data Analysis	58
	Results	59
	Discussion	60
	References	62
	Appendix 1	65
VI	Somatoform Dissociation Discriminates among Diagnostic Categories over and above General Psychopathology	66
	Introduction	66
	Methods	70
	Subjects	70
	Instruments	71
	Procedure	72
	Data Analysis	72
	Results	72
	Discussion	75
	Conclusion	77
	References	78
VII	Dissociative Disorders and Somatoform Dissociation: Effects of Indoctrination? A Correspondence in the British Journal of Psychiatry	82
I	Dissociative Pathology Discriminates Between Bipolar Mood Disorder and Dissociative Disorder	82
	References	83
II	Merskey's Response	83
	References	84
III	Somatoform Dissociation is Unlikely to be a Result of Indoctrination by Therapists	84
	References	85
Part II	Trauma, somatoform dissociation, and defense	87
VIII	Degree of Somatoform and Psychological Dissociation in Dissociative Disorder is Correlated with Reported Trauma	89
	Introduction	89
	Methods	91
	Subjects	91
	Instruments	92
	Scoring and Data Analysis	93
	Results	94
	Prevalence of Specific Traumatic Experiences	94
	Trauma Composite Scores	94
	Relationship of Trauma Composite Scores to Somatoform and Psychological Dissociation	96
	Age at Onset of Trauma, its Duration, Perpetrators, and Posttraumatic Support	98
	Repeated Analyses with Women Only	99
	Comparisons Between Dissociative Disorder Patients with and Without Reported Corroborative Evidence of Traumatic Memories	99
	Repeated Analyses Deleting Subjective Estimation of Impact from the Composite Scores	99
	Discussion	99
	References	103
IX	Animal Defensive Reactions as a Model for Trauma-induced Dissociative Reactions	108
	Introduction	108
	Animal Defensive States	109
	Pre-encounter Defense	110
	Post-encounter Defensive Behavior: Flight, Freeze, and Fight	110
	Circa-strike Defense: Analgesia, Emotional Numbing, and the Startle Response	111
	Post-strike Behavior: Pain and Recuperation	111
	Inescapable Shock	112
	Defense in Social Conflict Situations, and Pain	113
	Early Availability and Rapid Maturation of Defensive Responses in Animals	113
	Symptoms of Traumatized Individuals and Those with Dissociative Disorders as Related to Animal Defensive and Recuperative Response-sets	114
	Freezing	115
	Analgesia, Anesthesia, and Emotional Numbing	116
	Pain	116
	Early Availability and Maturation of Human Defense	116
	Summary and Discussion	118
	References	119
X	Somatoform Dissociative Symptoms as Related to Animal Defensive Reactions to Predatory Imminence and Injury	125
	Introduction	125
	Methods	129
	Participants and Procedure	129
	Instruments	130
	Data Analysis	131
	Results	131
	Discussion	137
	References	141
XI	Evidence for Associations Among Somatoform Dissociation, Psychological Dissociation, and Reported Trauma in Chronic Pelvic Pain Patients	146
	Introduction	146
	Methods	149
	Subjects	149
	Measurements	149
	Procedure	151
	Data Analysis	151
	Results	152
	Discussion	156
	References	158
XII	Peritraumatic Somatoform and Psychological Dissociation in Relation to Recall of Childhood Sexual Abuse	161
	Introduction	161
	Current and Peritraumatic Psychological Dissociation and Trauma	162
	Current and Peritraumatic Somatoform Dissociation and Threat to Bodily Integrity	163
	Peritraumatic Dissociation and Recall of Trauma	164
	Methods	165
	Participants	165
	Instruments	165
	Procedure	167
	Data Analysis	167
	Results	168
	The SDQ-P	168
	Prevalence of Types of CSA Recall and the Relationship of Recall with Peritraumatic Dissociation	168
	Prevalence of Trauma, Composite Trauma Scores, and Types of Recall	169
	Composite Trauma Scores and Peritraumatic Dissociation	169
	Peritraumatic Dissociation and Reported Severity of Childhood Sexual Abuse: Interview Data	171
	Peritraumatic Somatoform Dissociation, Reported CSA, and Reported Physical Abuse	171
	Corroboration of Reported Childhood Sexual Abuse	171
	Discussion	172
	References	174
XIII	The Psychometric Characteristics of the Traumatic Experiences Checklist (TEC): First Findings Among Psychiatric Outpatients	179
	Introduction	179
	Methods	182
	Demographics	182
	Instruments	182
	Procedure	185
	Data Analysis	185
	Results	185
	TEC Reliability	185
	Reported Trauma Among Men and Women	186
	TEC Concurrent Validity	187
	TEC Criterion-Related Validity	188
	TEC Trauma Area Presence Scores	188
	Trauma Area Severity Scores	189
	Discussion	189
	References	191
XIV	Summary, Discussion, and Future Directions	195
Part I195
	The Somatoform Dissociation Questionnaire	195
	Somatoform Dissociation in Various Diagnostic Categories and Among Various Cultures	198
	The SDQ-20 as a Therapy Evaluation Instrument	201
	Somatoform Dissociation and Iatrogenesis	201
Part II201
	Somatoform Dissociation and Trauma	201
	Somatoform Dissociation and Defense	202
	Chronic Pelvic Pain, Somatoform Dissociation, and Reported Trauma	205
	Dissociation: A Dimensional or Typological Phenomenon?	207
	Are Dissociative Symptoms State-Dependent?	210
	Conclusion	211
	References	212
	Appendices
1	Somatoform Dissociation Questionnaire (SDQ-20)	216
2	Somatoform Dissociation Questionnaire (SDQ-5)	220
3	Traumatic Experiences Checklist (TEC)	223
	Index	231