Dissociative symptoms in generalized anxiety disorder and panic disorder and its relationship with temperament-character features

Abstract

Amaç: Anksiyete ve dissosiyatif semptomlar arasındaki ilişki sıklıkla belirtilir, ancak anksiyete bozukluğu olan tüm hastalarda dissosiyatif semptomlar görülmez. Bu çalışmanın amacı anksiyete bozukluğu olan hastalarda görülen dissosiyatif belirtilerin mizaç-karakter özellikleriyle ilişkisini araştırmaktır. Yöntem: Çalışmanın örneklemini DSM-5'e göre yaygın anksiyete bozukluğu (YAB) ve panik bozukluğu (PB) tanısı alan 75 hasta ve kontrol grubu (KG) için 75 sağlıklı birey oluşturmuştur. Şikayetlerinin şiddeti Hamilton Anksiyete ve Depresyon Derecelendirme Ölçekleri (HAM-A, HAM-D) kullanılarak değerlendirildi. Her katılımcı için sosyodemografik veri formu, Disosiyatif Yaşantılar Ölçeği (DES), Disosiyasyon Ölçeği (DIS-Q) ve Mizaç-Karakter Envanteri (TCI) dolduruldu. Bulgular: Gruplar arasında HAM-A, HAM-D, DES ve DIS-Q skorları (PB> YAB> KG) açısından anlamlı fark vardı. DES ve DIS-Q skorlarını etkileyen faktörler; yüksek HAM-A skorları, tanı, düşük kendini yönetme(KY) ve yüksek kendini aşma(KA) skorlarıdır ve tanı kontrol edildiğinde DES ve DIS-Q skorları HAM-A'dan, KY ve KA skorlarından etkilenmeye devam etmiştir. Sonuç: Anksiyete bozukluğu olan hastalarda dissosiyatif semptomların yüksek prevalansı doğrulandı. Düşük KY ve yüksek KA karakter özelliklerinin dissosiyatif semptomların gelişimine yatkınlık oluşturabileceği, mizaç özelliklerinin dissosiyatif semptomlar üzerinde etkili olmadığı gözlenmiştir. Bu sonuçlar, dissosiyasyonun sadece travma ile ilgili olmayabileceğini düşündürmektedir.

Keywords

• Anxiety
• dissociation
• temperament
• character

Dissociative symptoms in generalized anxiety disorder and panic disorder and its relationship with temperament-character features

Abstract

Introduction: The relationship between anxiety and dissociative symptoms is frequently mentioned, but dissociative symptoms are not seen in all patients with anxiety disorder. The aim of this study is to investigate the relationship between dissociative symptoms and temperament-character features in patients with anxiety disorders. Methods: The study sample consisted of 75 patients diagnosed with generalized anxiety disorder (GAD) and panic disorder (PD) according to DSM-5 and 75 healthy individuals for the control group (HC). The severity of their complaints were assessed using Hamilton Anxiety and Depression Rating Scales (HAM-A, HAM-D). Sociodemographic data form, Dissociative Experiences Scale (DES), Dissociation Scale (DIS-Q) and Temperament-Character Inventory (TCI) were filled for every participant. Results: There was a significant difference between the groups in terms of HAM-A, HAM-D, DES and DIS-Q scores (PD> GAD> HC). The factors affecting DES and DIS-Q scores were high HAM-A scores, diagnosis, low self-directedness(SD) and high self-transcendence(ST) scores, and when the diagnosis was checked, DES and DIS-Q scores continued to be affected by HAM-A, SD and ST scores. Conclusion: The high prevalence of dissociative symptoms was confirmed in patients with anxiety disorder. It was observed that character traits of low SD and high ST may be predisposing for the development of dissociative symptoms, while temperament traits were not influential on dissociative symptoms. These results may suggest that dissociation is not only related to trauma.

Keywords

• Anxiety
• dissociation
• temperament
• character

References

1. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub, 2013.
2. Spiegel D. Trauma, dissociation, and memory. Annals of the New York Academy of Sciences 1997, 821:225-237. doi: 10.1111/j.1749-6632.1997.tb48282.x
3. Wolfradt U, Meyer T. Interrogative suggestibility, anxiety and dissociation among anxious patients and normal controls. Personality and Individual Differences 1998, 25:425-432. doi.org/10.1016/S0191-8869(98)00023-3
4. Mendoza L, Navines R, Crippa JA, et al. Depersonalization and personality in panic disorder. Compr Psychiatry 2011, 52:413-419. doi: 10.1016/j.comppsych.2010.09.002.
5. Segui J, Marquez M, Garcia L, et al. Depersonalization in panic disorder: a clinical study. Comprehensive Psychiatry 2000, 41:172-178. doi: 10.1016/s0010-440x(00)90044-0.
6. Butler LD, Duran RE, Jasiukaitis P, et al. Hypnotizability and traumatic experience. The American journal of psychiatry 1996, 153:42-63. doi: 10.1176/ajp.153.8.A42.
7. Grabe H-J, Spitzer C, Freyberger HJ. Relationship of dissociation to temperament and character in men and women. American Journal of Psychiatry 1999, 156:1811-1813. doi: 10.1176/ajp.156.11.1811.
8. Romans SE, Martin JL, Morris E, et al. Psychological defense styles in women who report childhood sexual abuse: A controlled community study. American Journal of Psychiatry 1999, 156:1080-1085. doi:10.1176/ajp.156.7.1080.

9. Korzekwa MI, Dell PF, Links PS, et al. Dissociation in borderline personality disorder: a detailed look. Journal of Trauma & Dissociation 2009, 10:346-367.doi: 10.1080/15299730902956838.
10. Marchesi C, Cantoni A, Fonto S,et al. The effect of temperament and character on response to selective serotonin reuptake inhibitors in panic disorder. Acta Psychiatrica Scandi- navica 2006, 114:203-210. doi: 10.1111/j.1600-0447.2006.00772.x.
11. Yazıcı MK DB, Tanrıverdi N, Karaağaoğlu E, ve ark. Hamilton Anksiyete Değerlendirme Ölçeği, derecelendiriciler arası güvenilirlik ve geçerlilik çalışması. Türkiye Psikiyatri Dergisi 1998, 9:114-117
12. Akdemir A, Örsel S, Dağ İ, ve ark. Hamilton Depresyon Derecelendirme Ölçeği (HDDÖ)’nin geçerliği, güvenirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi 1996, 4:251-259.
13. Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. Journal of nervous and mental disease 1986, 174(12):727-735. doi: 10.1097/00005053- 198612000-00004.
14. Yargic LI, Tutkun H, Sar V. Reliability and validity of the Turkish version of the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders 1995, 8(1):10-13.
15. Vanderlinden J, Van Dyck R, Vandereycken W, et al. The dissociation questionnaire (DIS‐Q): Development and characteristics of a new self‐report questionnaire. Clinical Psychology & Psychotherapy 1993, 1:21-27. doi:10.1002/cpp.5640010105
16. Şar V. Dissosiyasyon Ölçeği(DIS-Q)-Türkçe Versiyon (Uyarlama). İstanbul Tıp Fakültesi Psikiyatri Anabilim Dalı Klinik Psikoterapi Birimi, İstanbul 1996.
17. Cloninger CR, Przybeck TR, Svrakic DM, et al. The Temperament and Character Inventory (TCI): A guide to its development and use. 1994.
18. Arkar H, Sorias O, Tunca Z, ver ark. Mizaç ve karakter envanteri’nin Türkçe formunun faktör yapısı, geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi 2005, 16:190-204.
19. Horwath E, Gould F, Weissman MM. Epidemiology of anxiety disorders. Textbook in psychiatric epidemiology 2011:311-328.
20. Hunter EC, Sierra M, David AS. The epidemiology of depersonalisation and derealisation. Social psychiatry and psychiatric epidemiology 2004, 39:9-18.doi: 10.1007/s00127- 004-0701-4.
21. Carlson EB, Putnam FW. An update on the dissociative experiences scale. Dissociation: progress in the dissociative disorders 1993, 6(1):16-27.
22. Svrakic DM, Przybeck TR, Cloninger CR. Mood states and personality traits. Journal of affective disorders 1992, 24:217-226. doi.org/10.1016/0165-0327(92)90106-G
23. Samochowiec J, Kucharska-Mazur J, Hajduk A, et al. Personality profile of patients with anxiety disorder, as studied with the 16PF Cattell’s questionnaire and Cloninger’s TCI. Psychiatria polska 2005, 39:527-536.
24. Simeon D, Guralnik O, Knutelska M, et al. Personality factors associated with dissociation: temperament, defenses, and cognitive schemata. American Journal of Psychiatry 2002, 159:489-491. doi: 10.1176/appi.ajp.159.3.489.
25. Praško J, Houbová P, Novák T, et al. Influence of personality disorder on the treatment of panic disorder-comparison study. Neuro Endocrinol Lett 2005, 26:667-674.
26. Bruno A, Muscatello MRA, Pandolfo G, et al. Does personality matter? Temperament and character dimensions in panic subtypes. Archives of Neuropsychiatry 2018, 55:325- 329. doi: 10.5152/npa.2017.20576
27. Brändström S, Schlette P, Przybeck TR, et al. Swedish normative data on personality using the Temperament and Character Inventory. Comprehensive psychiatry 1998, 39:122-128. doi: 10.1016/s0010-440x(98)90070-0.
28. Urgesi C, Aglioti SM, Skrap M, et al. The spiritual brain: selective cortical lesions modulate human self-transcendence. Neuron 2010, 65:309-319. doi: 10.1016/j.neuron.2010.01.026.
29. Blanke O, Mohr C, Michel CM, et al. Linking out-of-body experience and self processing to mental own-body imagery at the temporoparietal junction. Journal of Neuroscience 2005, 25:550-557. doi.org/10.1523/JNEUROSCI.2612-04.2005.
30. Irle E, Lange C, Weniger G, et al. Size abnormalities of the superior parietal cortices are related to dissociation in borderline personality disorder. Psychiatry Research: Neuroimaging 2007, 156:139-149. doi: 10.1016/j.pscychresns.2007.01.007.
31. Borg J, Andrée B, Soderstrom H, et al. The serotonin system and spiritual experiences. American Journal of Psychiatry 2003, 160:1965-1969. doi: 10.1176/appi.ajp.160.11.1965.
32. Freese TE, Miotto K, Reback CJ. The effects and consequences of selected club drugs. Journal of substance abuse treatment 2002, 23:151-156. doi.org/10.1016/S0740-5472(02)00267-2.