The Dissociative Dimension in Psychopathology

The Dissociative Dimension in Psychopathology: Generalised and Specific Role of Dissociative Symptoms. M. Brasini, C. Ardovini, P. Castelli, C. Di Manna, R. Esposito, C. Iannucci, C. La Rosa, G. Liotti, G. Mantione, F. Monticelli, A. Muscetta, L. Pancheri, L. Tombolini, E. Pietropaoli, F. Scarcella, F. Valcella

INTRODUCTION The interest in dissociation as a key factor for psychopathology has constantly grown during the last two decades. On one hand, dissociative phenomena are considered typical of disorders with an acknowledged traumatic origin, such as dissociative disorders (DD), borderline personality disorder, (BPD) post-traumatic stress disorders (PTSD), and somatoform disorders (Classen et al. 2006; Haaland & Landro 2009; Lanius et al. 2010; Sar et al. 2004, Meares 2012). On the other hand, "some authors have put forward the idea that trauma-based dissociation may be considered a psychopathological dimension that may be associated to virtually all clinical disorders, worsening their severity" (Farina & Liotti, 2011, p.5). In this perspective, not only dissociative processes and symptoms could be viewed as the main feature of some specific disorders, but they can point to a more common traumaticdissociative pathogenetic mechanism (Liotti & Farina, 2011; Farina & Liotti, 2013). According to this perspective, we would expect a tendency to dissociative experiences to be an index of diagnostic relevance in terms of gravity, in virtually all clinical conditions. Furthermore, dissociative symptoms should maintain a more specific linkage with the aforementioned set of disorders in which the traumatic-dissociative dimension is prominent. The present study is aiming at investigating this hypothesis on a preliminary and exploratory basis, in a small sample of unselected patients from our own everyday private practice. METHOD 35 adult patients asking for private psychotherapeutic help (19 female and 16 male; age range 25-50; mean age = 33,6; std = 6,7); no inclusion-exclusion criteria. During the initial assessment phase (session 1-3), all participants were administered a set of self-report questionnaires. The assessment tools included: a) the Dissociative Experiences Scale (DES-II, Bernstein & Putnam, 1986); b) the Somatoform Dissociation Questionnaire (SDQ-20, Nijenhuis et al., 1996), c) the Symptom Checklist-90-R (SCL-90, Derogatis & Savitz, 2000), d) the Millon Clinical Multiaxial Inventory-III (MCMI-III, Millon et al, 2009); e) the Toronto Alexithymia Scale (TAS-20, Taylor et al., 1986). The scores at the DES-II were used to split the sample into two groups, above (N=13) and below (N=22) a screening cutoff for dissociative symptoms relevance (Steinberg et al. 1991). A preliminary set of ANOVA were conducted on the General Severity Index (GSI) of the SCL-90, on the SDQ-20 score and on the TAS-20 score, in order to test the hypothesis that a higher relevance of dissociative symptoms corresponds to a generally more severe psychopathological condition. Scores on the 10 Clinical Syndrome Scales and on the 14 Personality Disorder Scales of the MCMI-III were included in a set of MANOVA in order to verify : a) whether differences between groups tended to emerge, and b) if these differences would appear as a generic sign of symptom gravity or would they identify a subset of symptomatic areas. Finally, a multiple linear regression was conducted in order to verify the hypothesis that although more intense dissociative symptoms may co-occur with higher scores on many clinical conditions (such as mood and anxiety disorders), they also maintain a specific linkage with scores on a “traumatic-dissociative” area (PTSD, BPD, SD). RESULTS 1. General psychopathological severity. A first ANOVA on the DES-II scores confirmed a statistically significant difference between groups in terms of relevance of the dissociative symptoms (F(1,33) = 31,27, p