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 |