A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians.

[Correction Notice: An erratum for this article was reported in Vol 1(3) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2009-18612-003). Author Ruth Lanius’s name was misspelled as Ruth Lanins; author Scot McNary’s name was misspelled Scott McNary; author Clare Pain’s name was misspelled Claire Pain; and the affiliation for Richard Loewenstein should have read Sheppard Pratt Health System.] The goals of this naturalistic, cross-sectional study were to describe the patient, therapist, and therapeutic conditions of an international sample of dissociative disorder (DD) patients treated by community therapists and to determine if community treatment for DD appears to be as effective as treatment for chronic PTSD and conditions comorbid with DD. Analyses found that across both patient (N = 280) and therapist (N = 292) reports, patients in the later stages of treatment engaged in fewer self-injurious behaviors, had fewer hospitalizations, and showed higher levels of various measures of adaptive functioning (e.g., GAF) than those in the initial stage of treatment. Additionally, patients in the later stages of treatment reported lower symptoms of dissociation, posttraumatic stress disorder, and distress than patients in the initial stage of treatment. The effect sizes for Stage 5 versus Stage 1 differences in DD treatment were comparable to those published for chronic PTSD associated with childhood trauma and depression comorbid with borderline personality disorder. Given the prevalence, severity, chronicity, and high health care costs associated with DD, these results suggest that extended treatment for DD may be beneficial and merits further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiating attention-deficit/hyperactivity disorder from pervasive developmental disorder not otherwise specified

To discriminate between the various compressing vessels of the facial nerves in patients with hemifacial spasm, pre-operative oblique sagittal gradient-echo MR imaging was performed. Forty-two patients underwent pre-operative MR imaging and microvascular decompression. The MR images were divided according to findings into three groups as follows: Group A, a thick and/or long high-intensity line along the root exit zone (REZ) of the facial nerve; Group B, a thin and/or short high-intensity line along the REZ; and Group C, an unreliable image around the REZ. Fifteen images were classified as Group A, 19 as Group B, and 8 as Group C. In Group A, vertebral artery (VA) compression was confirmed intra-operatively in 12 cases and posterior inferior cerebellar artery (PICA) or anterior inferior cerebellar artery (AICA) compression in 3. In Group B, PICA or AICA compression was confirmed intra-operatively in all cases. In Group C, PICA or AICA compression was confirmed intra-operatively in 7 cases and no compression in one. In all cases of VA compression of the facial nerve, the oblique sagittal gradient-echo images demonstrated a thick and/or long high intensity line along the REZ. Oblique sagittal gradient-echo MR imaging is a useful preoperative planning aid, which can predict the possibility of VA compression prior to microvascular decompression for hemifacial spasm.     

"A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians": Correction to Brand et al. (2009).

Reports an error in A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians by Bethany Brand, Catherine Classen, Ruth Lanins, Richard Loewenstein, Scott McNary, Claire Pain and Frank Putnam (Psychological Trauma: Theory, Research, Practice, and Policy, 2009[Jun], Vol 1[2], 153-171). Author Ruth Lanius’s name was misspelled as Ruth Lanins; author Scot McNary’s name was misspelled Scott McNary; author Clare Pain’s name was misspelled Claire Pain; and the affiliation for Richard Loewenstein should have read Sheppard Pratt Health System. (The following abstract of the original article appeared in record 2009-08949-005.) The goals of this naturalistic, cross-sectional study were to describe the patient, therapist, and therapeutic conditions of an international sample of dissociative disorder (DD) patients treated by community therapists and to determine if community treatment for DD appears to be as effective as treatment for chronic PTSD and conditions comorbid with DD. Analyses found that across both patient (N = 280) and therapist (N = 292) reports, patients in the later stages of treatment engaged in fewer self-injurious behaviors, had fewer hospitalizations, and showed higher levels of various measures of adaptive functioning (e.g., GAF) than those in the initial stage of treatment. Additionally, patients in the later stages of treatment reported lower symptoms of dissociation, posttraumatic stress disorder, and distress than patients in the initial stage of treatment. The effect sizes for Stage 5 versus Stage 1 differences in DD treatment were comparable to those published for chronic PTSD associated with childhood trauma and depression comorbid with borderline personality disorder. Given the prevalence, severity, chronicity, and high health care costs associated with DD, these results suggest that extended treatment for DD may be beneficial and merits further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-occurrence of avoidant personality disorder and child sexual abuse predicts poor outcome in long-standing eating disorder.

Few consistent predictive factors for eating disorder have been identified across studies. In the current 5-year prospective study, the objective was to examine whether (a) personality disorder and child sexual abuse predict the course of severity of eating disorder symptoms after inpatient treatment and (b) how the predictors interact. A total of 74 patients with long-standing eating disorder and mean age of 30 years were assessed at the beginning and end of inpatient therapy and at 1-, 2-, and 5-year follow-up. A mixed model was used to examine the predictors. Avoidant personality disorder and child sexual abuse interacted in predicting high levels of eating disorder over a long-term course. These results suggest that eating disorder, avoidant personality disorder, and sequelae after child sexual abuse are potential targets for treatment that need further investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental personality factors in child abuse.

Studied whether abusing parents differ from nonabusing parents in personality variables by administering the Michigan Screening Profile of Parenting to 6 groups of mothers: (a) adjudicated abusers, (b) spouses of adjudicated abusers, (c) mothers convicted of child neglect, (d) nonabusing mothers from a college student population, (e) nonabusing mothers from a middle socioeconomic level, and (f) nonabusing mothers from a lower socioeconomic level. 107 Ss were studied, all of whom had at least one child under 5 yrs of age. Major differences occurred when comparison was made of 1 or more of the 1st 3 groups with 1 of the latter 3 groups. The groups differed significantly on 6 factor-analyzed cluster categories: (a) relationship to one's own parents, (b) tendency to becoming upset and angry, (c) tendency toward isolation and loneliness, (d) expectations of one's own children, (e) inability to separate parental and child feelings, and (f) fear of external threat and control. In all of the cases, the 1st 3 groups scored at levels of higher risk than did the latter 3 groups, whereas the abusers scored at the highest risk levels throughout. It is suggested that a therapist who helps a parent develop the ability to maintain equanimity under stress, by helping reduce deviations from the norm in characteristics related to abuse potential, is ultimately helping to reduce actual abusive behavior. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sertoli cell tumors of the testis, not otherwise specified: a clinicopathologic analysis of 60 cases

Sixty Sertoli cell tumors of the testis, excluding large cell calcifying and sclerosing subtypes, are described. Patient age ranged from 15 to 80 years (mean, 45 years). The initial manifestation was usually a testicular mass; in 14 cases it had been enlarging slowly for a period of up to 14 years (mean 3.7 years). Only five patients had testicular pain. Four patients had metastatic disease at the time of presentation. All the tumors were unilateral and ranged from 0.3 cm to 15 cm (mean 3.6 cm). They were typically well circumscribed. Sectioning usually disclosed firm, tan-gray, white, or yellow tissue with areas of hemorrhage and a minor cystic component in approximately one third. Microscopic evaluation usually revealed diffuse sheets or large, nodular aggregates of tumor cells, within which solid or hollow, sometimes dilated, tubules and, less often, cords were usually at least focally identifiable. A relatively acellular, often vascular, fibrous to hyalinized stroma was frequently conspicuous. The tumor cells typically had moderate amounts of pale to lightly eosinophilic cytoplasm, but 10 tumors had cells with abundant eosinophilic cytoplasm. Large cytoplasmic vacuoles were prominent in 26 tumors. Nuclear atypicality was absent or mild in 54 cases, moderate in 4 cases, and marked in 2 cases. Mitotic rate ranged from less than 1 to 21 per 10 high power fields, with 50 tumors having no or only rare mitoses. Vascular space invasion was present in 11 cases and was prominent in 8. Follow-up of more than five years (average 8.4 years), or until evidence of metastasis was seen, was available for 16 patients. Nine were alive and well with no evidence of disease. Four were alive with disease and three died of disease. The pathologic features that best correlated with a clinically malignant course were as follows: a tumor diameter of 5.0 cm or greater, necrosis, moderate to severe nuclear atypia, vascular invasion and a mitotic rate of more than 5 mitoses per 10 high power fields. Only one of nine benign tumors for which follow-up data of 5 years or more were available had more than one of these features, whereas five of seven malignant tumors had at least three.     

Rethinking the comparison of borderline personality disorder and multiple personality disorder

This article has made a number of points that assert what is today a minority position within the fields of MPD/DID and BPD. We hope our views will stimulate attempts by others to rethink their positions and test our assertions, so that issues surrounding these two disorders can be sharpened. For the sake of the clarity of future work, we summarize in outline form the essence of our viewpoint. 1. BPD and MPD/DID have similar appearing symptoms, such as identity problems, unstable affect modulation, self-destructive behaviors, chaotic impulse control, and troubled interpersonal relationships, but they have decisive differences in underlying dynamics, process, and structure. 2. DSM tends to blur these two disorders by its emphasis on phenomenology over inner structure, thus fostering misleading conclusions when DSM criteria are used to test for comorbidity or overlap between BPD and MPD/DID. 3. BPD and MPD/DID are both described dynamically as using the defense of splitting, but we contend that the splitting in each disorder is fundamentally different from the splitting in the other. BPD uses a polarization form of splitting, whereas MPD/DID uses ego splitting or identity division. 4. Both disorders partake in the process of dissociation, but the quality of dissociation in BPD is a "low-tech" spaced out type, whereas that of MPD/DID is a "high-tech" waking dream. 5. BPD structure is also "low tech," with polarization of self, object, and relationship. MPD/DID structure is "high tech," with heavily symbolic, highly nuanced variations of self, object, and relationship. 6. Although both conditions have etiologic elements of trauma, BPD has a larger degree of developmental deficiency, with a failure to complete the task of entering a repression hierarchy of defenses. MPD/DID, by use of primary process-linked symbolic dissociation, is able to continue development to the repression hierarchy, although at a profound cost of simultaneous suspension of reality testing. BPD patients suffer from the rigid use of too few defenses; MPD/DID patients suffer from the obsolete use of too many defenses. 7. BPD patients grow up in homes in which overtly expressed aggression is more tolerated, or at least more openly experienced. MPD/DID patients grow up in homes in which the fact of aggression is kept a secret. This has consequences for the formation of psychic structure in each disorder.(ABSTRACT TRUNCATED AT 400 WORDS)     

The evolution of alter personality states in dissociative identity disorder.

Though several theories have been proposed to explain the manifestation of alter personality states in dissociative identity disorder (DID), the majority have failed to explain how alters develop over the life span and why the disorder becomes more complex after childhood. Expanding on S. S. Marmer (1991) and F. W. Putnam's (1995) concept of a developmental window of vulnerability for DID, this article proposes a 3-stage model of alter personality formation, integrating theory and research on hypnotizability and imaginary companionship with perspectives on individuation and identity formation in adolescence. The author also speculates about possible courses of development leading to other trauma-related disorders. The author proposes that alters evolve out of childhood imaginary companions that merge with dissociative states of consciousness before individuating into distinct personality states during adolescence. Treatment considerations are raised emphasizing the need to diagnose DID early in its course of development before the alters have become invested in their separateness and begun fighting for control over the body. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamics of childhood and adolescent personality traits and adolescent drug use.

Examined the relative impact of childhood and adolescent personality/behavioral attributes on the adolescent's stage of drug use. Mothers of 356 youngsters were interviewed concerning their child's personality, behavior, development and childrearing techniques, family structure, family health, and demographics when the child was 5–20 yrs of age (Time 1 [T1]) and again when the child was 13–18 yrs old (Time 2 [T2]). Adolescents also completed a self-report questionnaire concerning their personalities, behavior, and drug use at T2. As hypothesized, findings support a mediational model as best depicting the interrelation of the domains of childhood and adolescent personality and stage of drug use. Childhood personality attributes were related to adolescent personality attributes, which in turn were related to adolescents' stage of drug use. Across-time personality correlations suggested that substantial continuity exists in personality traits. However, there was also some evidence for the malleability of these traits. Results suggest the positive effects of protective (i.e., nondrug-conducive) personality traits in children can be weakened by the presence of risk factors during adolescence, leading to higher T2 drug stage, and that the negative impact of childhood risk personality traits can be ameliorated by protective personality traits during adolescence, resulting in lower drug stage. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

非特指型外周T细胞淋巴瘤FGR和TP73基因改变的研究

目的 研究非特指型外周T细胞淋巴瘤(PTCL-NOS)中FGR和TP73的基因改变,验证前期基于芯片的比较基因组杂交(a-CGH)研究结果,为PTCL-NOS的发生、发展提供科学依据.方法 间期双色荧光原位杂交(FISH)技术检测34例PTCL-NOS(其中19例经过a-CGH检测)中FGR和TP73的基因改变,所用探针为缺口平移法自制的FGR和TP73特异位点探针以及商品化1号染色体着丝粒探针(CEP1).结果 34例中出现基因改变者7例(20.6%),其中FGR扩增1例,TP73扩增2例;FGR和TP73同时出现基因改变4例(11.8%),其中同时杂合性缺失(LOH)1例,同时扩增3例.CEP1扩增4例(11.8%),与TP73/FGR基因扩增同时存在.Kaplan-Meier生存分析显示基因改变组较基因无改变组以及TP73改变组较TP73无改变组均有预后不良的趋势,但差异无统计学意义(均P>0.05).结论 FISH结果部分验证了前期a-CGH的研究发现;淋巴瘤相关基因FGR和TP73改变以及1号染色体多倍体可能在PTCL-NOS的发生、发展中起着重要的作用.     

Childhood abuse, personality disorder and chronic fatigue syndrome

In a recent article entitled, Requests "for inappropriate" treatment based on religious beliefs, Orr and Genesen claim that futile treatment should be provided to patients who request it if their request is based on a religious belief. I claim that this implies that we should also accede to requests for harmful or cost-ineffective treatments based on religious beliefs. This special treatment of religious requests is an example of special pleading on the part of theists and morally objectionable discrimination against atheists. It also provides an excellent illustration of how different the practices of religion and ethics are.     

Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia.

The validity of subtypes based on antisocial personality disorder (APD) or childhood conduct disorder without adult APD (CD only) in patients with schizophrenia (or schizoaffective disorder) and a substance use disorder (abuse or dependence) was examined. APD patients scored lower on personality measures related to socialization and higher on antisocial bebavior, psychopathy, and aggression. APD patients also reported higher rates of aggression and legal problems. APD, and to a lesser extent CD only, was associated with more severe psychiatric symptoms, an earlier age of onset of substance abuse, more severe symptoms of substance abuse, and a stronger family history of substance abuse and psychiatric hospitalization. The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family-of-origin interaction and adolescent mothers' potential for child abuse

This study examined the relationship between family-of-origin interaction and environment and the potential for young mothers to abuse their children. Females aged 14 to 21 from three teen parenting programs completed the Teen Parenting Questionnaire, the Family Environment Scale, and the Child Abuse Potential Inventory. Low scores on family cohesion were found to correlate with high scores on child abuse potential. This suggests that providing the teenager with an accepting and supportive atmosphere may assist her in building a positive identity as a mother. Increased understanding of how family-of-origin issues contribute to young mothers' potential to abuse their children will aid school and community professionals in providing better services for this population.     

Several unusual cases of child abuse

All childhood deaths which occurred in New Mexico during 1974 and 1975 were reviewed. Nine fatal instances of abuse were identified representing the entire spectrum of physical abuse: neglect, abuse in a single episode of injury, repetitive abuse, or sexual abuse. Several cases are summarized. These are unusual either in the distribution of pathologic findings or in the problems encountered in court presentation.     

Potential liability in cases of child abuse and neglect

Effects of thyrotropin hormone (TSH) and anti-TSH receptor antibodies on the plasma membrane potential of polymorphonuclear granulocytes (PMN) were analyzed by means of flow cytometry. Both TSH and the autoantibody caused a rapid, dose-dependent hyperpolarization of the plasma membrane of PMNs. TSH was also able to mask (revert) the depolarizing effect of a chemotactic peptide, fMLP, on PMNs. No detectable rise in the cytosolic free calcium level accompanied the observed hyperpolarization. Quinine, a blocker of Ca(2+)-activated and voltage-gated K+ channels did not affect the hyperpolarization by TSH and antibodies. Decreasing the [K+] gradient across the plasma membrane by valinomycin, however, blocked the hyperpolarizing effect. Peptide362-376 (derived from the extracellular domain of TSH receptor) also blocked the hyperpolarization induced by both TSH and anti-TSHR antibodies. These data suggest that the observed hyperpolarization is a specific, receptor-mediated early signal during interaction of PMNs with TSH or anti-TSHR antibodies.     

Professional skepticism of multiple personality disorder.

If you saw a patient who appeared to have more than one personality, what diagnosis would you make? And how would you vary your clinical approach? Data from 425 respondents indicated that the majority of psychologists believed multiple personality disorder (MPD) to be a valid but rare clinical diagnosis. Respondents cited extreme child abuse as the foremost cause of MPD. Approximately one-half of all respondents believed that they had encountered a client with MPD, whereas less than one-third believed that they had encountered a client who feigned MPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attribution of antisocial symptoms in coexistent antisocial personality disorder and substance abuse

Two methods for diagnosing antisocial personality disorder (ASPD) were compared based on whether antisocial symptoms that occurred when subjects also experienced alcohol- or other drug-related problems were counted toward the diagnosis of ASPD. From a family study of alcoholism and ASPD, 93 male subjects who met ASPD criteria in the absence of substance-related problems were contrasted with 312 subjects who were diagnosed with ASPD regardless of whether criterion symptoms occurred along with substance-related problems. Subjects did not differ in types of antisocial behaviors, age of onset of behaviors, or comorbid psychiatric disorders except for alcoholism and drug abuse. A subgroup was contrasted on family history of psychiatric illness, with no differences noted between groups. Counting antisocial symptoms toward the diagnosis of ASPD regardless of whether symptoms occur during periods of substance abuse increases the observed population prevalence of the disorder, but does not change the observed phenomenology of ASPD or affect commonly accepted indicators of validity of diagnosis.     

Personality differences on the Rorschach of dissociative identity disorder, borderline personality disorder, and psychotic inpatients.

Patients with dissociative identity disorder (DID) are often diagnosed with borderline personality disorder (BPD) and misdiagnosed with psychotic illnesses. This study is designed to determine whether the Rorschach protocols of 67 patients with DID differ from those of 40 patients with BPD and 43 patients with psychotic disorder (PSD) in variables reflecting capacity for working alliance, complexity of experience, and ability to reason despite traumatic flooding. As theoretically and clinically predicted, the DID group could be distinguished from the PSD sample by the DID group’s significantly higher level of traumatic associations alongside their more logical reasoning (e.g., Trauma Content Index [TCI], WSUM6). In comparison to the BPD group who, by definition, were also likely to dissociate and struggle with other trauma based symptoms, the DID sample showed greater social interest (Sum H), self-reflective capacity (FD; Form Dimension), ability to perceive more accurately and think more logically (X-, WSUM6). The authors discuss the treatment applications of these findings and make suggestions for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)