Dissociative Symptoms in Anxiety Disorders

Yıl 2014, Cilt: 6 Sayı: 4, 330 - 339, 06.11.2014

Merve Tekin Atilla Tekin

https://doi.org/10.5455/cap.20140210075959

Öz

Dissosiyasyon, belirli koşullar altında herkeste ortaya çıkabilecek uyumsal bir mekanizmadır. Başlangıçta travmatik yaşantıların üstesinden gelme amacıyla kullanılırken zamanla patolojik bir sürece dönüştüğü ve bir bozukluk olarak nitelendirildiği düşünülmektedir. Başta derealizasyon ve depersonalizasyon olmak üzere, çeşitli dissosiyatif belirtiler anksiyete bozuklukları arasında görülen yaygın semptomlardandır. Bu çalışma anksiyete bozukluklarında eşlik eden dissosiyatif belirtilerin ele alınmasını, dissosiyasyonun anksiyete bozukluklarında klinik seyri nasıl etkilediğini, dolayısıyla da tedaviye yönelik kuramsal bilgileri ve bu alanda yapılan çalışmaların sonuçlarını içermektedir.

Anahtar Kelimeler

Anxiety disorders; clinical course; dissociative symptoms

Anksiyete Bozukluklarında Dissosiyatif Belirtiler

Öz

Dissociation is an adaptive mechanism that may arise in everyone under certain conditions. It was first thought to be used to overcome traumatic experiences initially but over time it was thought that it turned into a pathological process and was interpreted as a disorder. There are severel dissociative symptoms that are commonly seen in anxiety disorders and the most common ones are depersonalization and derealization. The aim of this study is to see how dissociative symptoms associate with anxiety disorders and how they affect the clinical course in anxiety disorders. Therefore, the study includes the theoretical knowledge for the treatment and the results of the studies that were established in this area.

Anahtar Kelimeler

Anksiyete bozuklukları; klinik seyir; dissosiyatif belirtiler

Kaynakça

• Amerikan Psikiyatri Birliği. Mental Bozuklukların Tanısal ve Sayımsal El Kitabı (DSM- IV- TR), Yeniden gözden geçirilmiş 4. Baskı (Çev. E Köroğlu). Ankara, Hekimler Yayın Birliği, 2007.
• Şar V. The scope of dissociative disorders: an international perspective. Psychiatr Clin North Am 2006; 29:227-244. Holmes EA, Brown RJ, Mansell W, Fearon RP, Hunter ECM, Frasquilho F, et al. Are there two qualitatively distinct forms of dissociation? A review and some clinical implications. Clin Psychol Rev 2005; 25:1–23.
• Nuller YL. Depersonalisation: symptoms, meaning, therapy. Acta Psychiatr Scand 1982; 66:451-458.
• Pego JM, Morgado P, Pinto LG, Cerqueira JJ, Almeida OFX, Sousa N. Dissociation of the morphological correlates of stress ‐ induced anxiety and fear. Eur J Neurosci 2008; 27:1503-1516.
• Ohman A. Fear and anxiety: overlaps and dissociations. In Handbook of Emotions, 3rd edition (Eds M Lewis, JMH Jones, LF Barrett):709-729. New York: The Guilford Press, 2008.
• Curtis GC, Magee WJ, Eaton WW, Wittchen HU, Kessler RC. Specific fears and phobias: epidemiology and classification. Br J Psychiatry, 1998; 173:212-217.
• Brunet A, Holowka DW, Laurence JR. Dissociation. In Encyclopedia of the Neurological Sciences (Eds MJ Aminoff, RB Daroff):304-307. San Diego, Academic Press,2001.
• Gabbard GO. Psychodynamic Psychiatry in Clinical Practice, 3rd edition. Washington DC, American Psychiatric Publishing, 2000.
• Ross CA. Epidemiology of multiple personality disorder and dissociation. Psychiatr Clin North Am 1991; 14:503-517. Yargıç İ. Dissosiyatif bozukluklarda klinik muayene: semptomatoloji ve tanısal değerlendirme. Ege Psikiyatri Süreli Yayınları 1998; 3:619-640.
• Şar V. Trauma and dissociation in context: personal life, social process, and public health. J Trauma Dissociation 2008; 9:1
• Loewenstein RJ, Putnam FW. The dissociative disorders. In Comprehensive Textbook of Psychiatry ,8th ed. (Eds BJ. Kaplan, VA. Sadock):1844-1901. Baltimore, MD, Williams and Wilkins, 2004.
• Waller N, Putnam FW, Carlson EB. Types of dissociation and dissociative types: a taxometric analysis of dissociative experiences. Psychol Methods 1996:1:300-321.
• Van der Kolk BA. Developmental trauma disorder.A new,rational diagnosis for children with complex trauma histories. Psychiatr Ann, 2005; 35:401-408.
• Foa EB, Hearst-Ikeda D. Emotional dissociation in response to trauma: an information-processing approach. In Handbook of Dissociation: Theoretical, Empirical and Clinical Perspectives (Eds LK Michelson, WJ Ray):207-224, New York, Plenum Press,1996.
• Bremner JD, Brett E. Trauma-related dissociative states and longterm psychopathology in posttraumatic stress disorder. J Trauma Stress 1997; 10:37 -54.
• Katoch V, Jhingan HP, Saxena S. Level of anxiety and dissociation in patients with conversion and dissociative disorders. Indian J Psychiatry 1994; 36:67-69.
• Gershuny BS, Thayer JF. Relations among psychological trauma, dissociative phenomena, and trauma-related distress: a review and integration. Clin Psychol Rev 1999; 19:631-657.
• Kihlstrom JF. Dissociative disorders. Annu Rev Clin Psychol 2005; 1:227-253.
• Dorahy MJ, McCusker CG, Loewenstein RJ, Colbert K, Mulholland C. Cognitive inhibition and interference in dissociative identity disorder: The effects of anxiety on specific executive functions. Behav Res Ther 2006; 44:749-764.
• Hoyer J, Braeuer D, Crawcour S, Klumbies E, Kirscbaum C. Depersonalization/derealization during acute social stres in social phobia. J Anxiety Disord 2013; 27:178-187.
• Wolfradt U, Meyer T. Interrogative suggestibility, anxiety and dissociation among anxious patients and normal controls. Pers Indiv Diff 1998; 25:425-432.
• Cassano GB, Petracca A, Perugi G, Toni C, Tundo A, Roth M. Derealization and panic attacks: A clinical evaluation on 150 patients with panic disorder/agoraphobia. Compr Psychiatry 1989; 30:5-12.
• Roth M: The phobic anxiety-depersonalization syndrome and some general aetiological problems in psychiatry. J Neuropsychiatry 1960; 1:293–306.
• Seguí J, Márquez M, García L, Canet J, Salvador-Carulla L, Ortiz M. Depersonalization in panic disorder: a clinical study. Compr Psychiatry 2000; 41:172-178.
• Mendoza L, Navinés R, Crippa JA, Fagundo AB, Gutierrez F, Nardi AE et al. Depersonalization and personality in panic disorder. Compr Psychiatry 2011; 52:413–419.
• Ball S, Robinson A, Shekhar A, Walsh K. Dissociative symptoms in panic disorder. J Nerv Ment Dis 1997; 185:755-760. Simeon D, Knutelska M, Nelson D, Guralnik O. Feeling unreal: a depersonalization disorder update of 117 cases. J Clin Psychiatry 2003; 64:990-997.
• Michal M, Kaufhold J, Grabhorn R, Krakow K, Overbeck G, Heidenreich T. Depersonalization and social anxiety. J Nerv Ment Dis 2005; 193:629-632.
• Evren C, Sar V, Dalbudak E, Oncu F, Cakmak D. Social anxiety and dissociation among male patients with alcohol dependency. Psychiatr Res 2009; 165:273-280.
• Bryant RA, Brooks R, Silove D, Creamer M, O’Donnell M, McFarlane AC. Peritraumatic dissociation mediates the relationship between acute panic and chronic posttraumatic stress disorder. Behav Res Ther 2011; 49:346-351.
• Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003; 129:52–73.
• Bryant RA. Does dissociation further our understanding of PTSD?. J Anxiety Disord 2007; 21:183–191.
• Wabnitz P, Gast U, Catani C. Differences in trauma history and psychopathology between PTSD patients with and without co-occurring dissociative disorders. Eur J Psychotraumatol 2013; 26;4.
• Najavits LM, Walsh M. Dissociation, PTSD, and Substance Abuse: An Empirical Study. J Trauma Dissociation 2012; 13:1151
• Murray J, Ehlers A, Mayou RA. Dissociation and post-traumatic stres disorder: Two prospective studies of road traffic accident survivors. Br J Psychiatry 2002; 180:363-368.
• Harvey AG, Bryant, RA. Dissociative symptoms in acute stress disorder. J Trauma Stress. 1999; 12:673-680.
• Cardena E, Spiegel D. Dissociative reactions to the San Francisco bay area earthquake of. Am J Psychiatry 1993; 150:4744
• Özaltın M, Kaptanoğlu C, Aksaray G. Motorlu araç kazalarından sonra görülen akut stres bozukluğu ve travma sonrası stres bozukluğu. Turk Psikiyatri Derg 2004; 15:16-25.
• Hart O, Nijenhuis ERS, Steele K. Dissociation: an insufficiently recognized major feature of complex PTSD. J Trauma Stress 2005; 18:1-15.
• Shorvon H, Hill J, Burkitt E. The depersonalisation syndrome. J R Soc Med 1946; 39:779–792.
• Goff DC, Olin JA, Jenike MA, Baer L, Buttolph ML. Dissociative symptoms in patients with obsessive-compulsive disorder. J Nerv Ment Dis 1982; 180:332–337.
• Merckelbach H,Wessel I. Memory for actions and dissociation in obsessive compulsive disorder. J Nerv Ment Dis 2000; 188:846–848.
• Prasko J, Raszka M, Diveky T, Grambal A, Kamaradova D, Koprivova J et al. Obsessive-compulsive disorder and dissociation – comparison with healthy controls. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010; 154:179-183. Praško J, Raszka M, Adamcová K, Grambal A, Kopřivová J, Kudrnovská H et al. Predicting the therapeutic response to cognitive behavioural therapy in patients with pharmacoresistant obsessive-compulsive disorder. Neuroendocrinol Lett 2009; 30:615–623.
• Grabe HJ, Goldschmidt F, Lehmkuhl L, Gänsicke M, Spitzer C, Freyberger HJ. Dissociative symptoms in obsessivecompulsive dimensions. Psychopathology 1999; 32:319-324.
• Fontenelle LF, Domingues AM, Souza WF, Mendlowicz MV, de Menezes GB, Figueira IL et al. History of trauma and dissociative symptoms among patients with obsessive-compulsive disorder and social anxiety disorder. Psychiatr Q 2007; 78:241-250.
• Carlson EB, Putnam FW. An update on the dissociative experiences scale. Dissociation 1993; 6:16-27.
• Clark D, Wells A. A cognitive model of social phobia. In: Social Phobia: Diagnosis, Assessment and Treatment (Eds R Heimberg, M Liebowitz, D Hope, F Schneier):69–93. New York, Guilford, 1995.
• Raszka M, Praško J, Kopřivová J, Novák T, Adamcová K. Psychological dissociation in obsessive-compulsive disorder is associated with anxiety level but not with severity of obsessive-compulsive symptoms. Neuroendocrinol Lett 2009; 30:624–628.
• Rufer M, Fricke S, Held D, Cremer J, Hand I. Dissociation and symptom dimensions of obsessive-compulsive disorder: a replication study. Eur Arch Psychiatry Clin Neurosci 2006; 256:146–150.
• Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003; 129:52-73.
• Candel I, Merckelbach H. Peritraumatic dissociation as a predictor of post-traumatic stress disorder: a critical review. Compr Psychiatry 2004; 45:44-50.
• Lanius RA, Brand B, Vermetten E, Frewen PA, Spiegel D.The dissociative subtype of posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications. Depress Anxiety 2012; 29:1-8.
• Resick PA, Suvak MK, Johnides BD, Mitchell KS, Iverson KM. The impact of dissociation on PTSD treatment with cognitive processing therapy. Depress Anxiety, 2012; 29:718-730. Merve Tekin, Uzm.Dr., Cizre Selahattin Cizrelioğlu Devlet Hastanesi, Şırnak; Atilla Tekin, Uzm.Dr., Cizre Selahattin Cizrelioğlu Devlet Hastanesi, Şırnak. Yazışma Adresi/Correspondence: Merve Tekin, Cizre Selahattin Cizrelioğlu Devlet Hastanesi, Şırnak, Turkey. E-mail: [e-mail] Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The authors reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no4/ Çevrimiçi yayım / Published online 10 Şubat/February 10, 2014; doi: 10.5455/cap.20140210075959