It has been claimed that the progress of psychiatry has lagged behind that of other medical disciplines over the last few decades. This may suggest the need for innovative thinking and research in psychiatry, which should consider neglected areas as topics of interest in light of the potential progress which might be made in this regard. This review is concerned with one such field of psychiatry: dissociation and dissociative disorders. Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity. While dissociative identity disorder (DID) is the most pervasive condition of all dissociative disorders, partial representations of this spectrum may be diagnosed as dissociative amnesia (with or without fugue), depersonalization disorder, and other specified dissociative disorders such as subthreshold DID, dissociative trance disorder, acute dissociative disorders, and identity disturbances due to exposure to oppression. In addition to constituting disorders in their own right, dissociation may accompany almost every psychiatric disorder and operate as a confounding factor in general psychiatry, including neurobiological and psycho-pharmacological research. While an anti- dissociative drug does not yet exist, appropriate psychotherapy leads to considerable improvement for many patients with dissociative disorders.
Amnesia ; Depersonalization ; Diagnosis ; Dissociative Disorders ; Humans ; Multiple Personality Disorder ; Neurobiology ; Psychopathology ; Psychotherapy ; Thinking

Although dissociative identity disorder (DID), the most severe of the dissociative disorders, has retained its own diagnostic entity since its introduction in the DSM-III, cases of DID are rarely seen in South and East Asia, likely due to the higher prevalence of possession disorder. We report two patients with DID who were recently admitted to our inpatient psychiatric unit and demonstrated distinct transitions to several identities. Their diagnoses were confirmed through a structured interview for dissociative disorders and possible differential diagnoses were ruled out by psychological, neuroimaging, and laboratory tests. The rapid transition to a Westernized, individualized society along with an increase in child abuse, might contribute to an increase in DID, previously under-diagnosed in this region.
Asia ; Child ; Child Abuse ; Diagnosis ; Diagnosis, Differential ; Diagnostic and Statistical Manual of Mental Disorders ; Dissociative Disorders ; Far East ; Humans ; Inpatients ; Korea* ; Multiple Personality Disorder ; Neuroimaging ; Prevalence

PURPOSE: To evaluate the outcomes of surgical treatment modality in unstable sacral fractures combined with spinal and pelvic ring injury depending on the presence of spino-pelvic dissociations. MATERIALS AND METHODS: The subjects were 16 patients, with unstable sacral fractures combined with spinal and pelvic ring injuries, were operated from July 2004 to January 2011. The patients were divided into 2 groups depending on the presence of spino-pelvic dissociations: those with dissociations were group 1, and those without dissociations were group 2. Group 1 was treated with spino-pelvic fixations using iliac screw, while group 2 was treated with percutaneous iliosacral screw fixations. The availability of the radiological bony union with its application periods, and clinical results using visual analogue scale (VAS) and oswestry disability index (ODI) were evaluated, retrospectively. RESULTS: Out of 16 patients, 8 patients in group 1 were treated with spino-pelvic fixation using iliac screw, and 8 patients in group 2 were treated with percutaneous iliosacral screw fixation. The mean bony union period was 17.4 weeks in group 1, and 19.6 weeks in group 2. The Mean VAS and ODI scores on the last follow-up were 2.5 points and 15.6 points in group 1, 2 points and 18.8 points in group 2, respectively. Both groups had favorable clinical results at the last follow-up. CONCLUSION: For surgical treatments of unstable sacral fractures, spino-pelvic fixation using iliac screws is advised for cases with combined spino-pelvic dissociation, while percutaneous iliosacral screw fixation is advised for cases without combined dissociation.
Dissociative Disorders ; Follow-Up Studies ; Humans

OBJECTIVES : Presently there exist conflicting results in terms of the relationship between hypnotic susceptibility and the dissociation experience in college-aged populations. The present investigation sought to explore the relationship among dissociation, coping style and hypnotizability using structural equation modeling (SEM). METHODS : 288 Korean undergraduates completed the Dissociation Experience Scale-Korean version (DES-K), Coping style assessment, and assessment of the eye roll sign which is a suggested biological marker of hypnotizability according to Spiegel. We divided the students into two groups (DES> or = 20, N=81; DES <20, N=207) to evaluate differences in these variables. The Pearson correlation test was used to investigate the relationship among the variables. We used SEM to investigate the mediating process in the relationship among hypnotizability coping style and dissociation. RESULTS : In the high DES-K group, scores of passive coping strategies (emotionally focused and wishful thinking) were higher than low DES-K group. There were statistically significant but weak correlations between hypnotizability and wishful thinking and between passive coping strategies and dissociation. The mediating role of passive coping style between hypnotizability and dissociation was confirmed in university students. CONCLUSION : These results suggested there was no direct relationship between hypnotizability and dissociation and passive coping strategies mediating the relationship between hypnotizability and dissociation. This study cautions against equating dissociative capacity with hypnotizability.
Biomarkers ; Dissociative Disorders ; Eye ; Humans ; Negotiating ; Thinking

OBJECTIVES : Presently there exist conflicting results in terms of the relationship between hypnotic susceptibility and the dissociation experience in college-aged populations. The present investigation sought to explore the relationship among dissociation, coping style and hypnotizability using structural equation modeling (SEM). METHODS : 288 Korean undergraduates completed the Dissociation Experience Scale-Korean version (DES-K), Coping style assessment, and assessment of the eye roll sign which is a suggested biological marker of hypnotizability according to Spiegel. We divided the students into two groups (DES> or = 20, N=81; DES <20, N=207) to evaluate differences in these variables. The Pearson correlation test was used to investigate the relationship among the variables. We used SEM to investigate the mediating process in the relationship among hypnotizability coping style and dissociation. RESULTS : In the high DES-K group, scores of passive coping strategies (emotionally focused and wishful thinking) were higher than low DES-K group. There were statistically significant but weak correlations between hypnotizability and wishful thinking and between passive coping strategies and dissociation. The mediating role of passive coping style between hypnotizability and dissociation was confirmed in university students. CONCLUSION : These results suggested there was no direct relationship between hypnotizability and dissociation and passive coping strategies mediating the relationship between hypnotizability and dissociation. This study cautions against equating dissociative capacity with hypnotizability.
Biomarkers ; Dissociative Disorders ; Eye ; Humans ; Negotiating ; Thinking

Adolescent ; Humans ; Sex Factors ; Dissociative Disorders

PURPOSE: The purposes of the study were to investigate childhood traumatic experiences and social support that might influence dissociative symptoms in Marine soldiers. METHODS: A cross-sectional study design was used with participants who were soldiers (n=122) assigned to one Marine corps in Ganghwa Island in the study. Data were collected on September 2015 through self-report using the Childhood Trauma Questionnaire, Social Provisions Scale (SPS), and Dissociative Experience Scale. Descriptive analysis, t-test, ANOVA, Pearson's correlation coefficients and stepwise multiple regression were performed. RESULTS: A total of 11.5% self-reported experiencing over three types of trauma; emotional neglect 34.4%, physical neglect 32.8%, emotional abuse 11.5%, physical abuse 11.5%, and sexual abuse 9.8%. For all subscales of the SPS, means of item were as high as three out of four points. A total of 9.0% were likely to be dissociative disorder. Sexual abuse, attachment, and opportunity for nurturance were found to be significant factors influencing dissociative symptoms. CONCLUSION: Future military enlistment in Marines should include assessment of childhood trauma and dissociation to identify maladaptive soldiers. Because soldiers who experienced childhood sexual abuse are likely to show dissociative symptoms, military nurses should assess their social support and try to enhance attachment in order to prevent dissociative symptoms.
Cross-Sectional Studies ; Dissociative Disorders ; Humans ; Military Personnel* ; Sex Offenses

OBJECTIVE: The Adolescent Dissociative Experience Scale (A-DES) is a screening measure for dissociative experience in adolescents. The present study aimed to investigate the reliability, validity and psychometric properties of the Korean version of the Adolescent Dissociative Experience Scale. METHODS: The Korean version of the A-DES was administered to a normative group of 371 adolescents aged 12 to 18 years and a traumatized group of 33 adolescents aged 12 to 18 years with known trauma. RESULTS: The internal consistency was excellent (Cronbach's alpha=0.91) and the test-retest correlation of the A-DES was high (r=0.99). Correlation between the A-DES and other measures of dissociation was moderate (r=0.48). There were no significant age differences in mean total A-DES scores for the normative sample, or for boys or girls separately. Nor were there any significant gender differences for any age group. The mean total score of the A-DES was significantly higher in the traumatized group than in the normative group. There was a statistically significant difference between adolescents with self-reported trauma and those without a trauma history in the normative group. CONCLUSION: This study demonstrated that the Korean version of the A-DES is a reliable measure with excellent internal consistency and good stability over a 4-week test-retest interval with single factor structure. It can be used to screen for dissociative symptoms in Korean adolescents between the ages 12 and 18.
Adolescent ; Aged ; Dissociative Disorders ; Humans ; Mass Screening ; Psychometrics

Hypnosis is an altered state of consciousness that comprises of heightened absorption in focal attention, dissociation of peripheral awareness, and enhanced responsiveness to social cues. Hypnosis has a long tradition of effectiveness in controlling somatic symptoms, such as pain. Pain, the most common symptom in clinical practice, is a multi-dimensional experience, which includes sensory-discriminative, affective-emotional, cognitive and behavioral components. There is a growing recognition for hypnosis and related techniques in pain management. Psychological approaches to pain control, such as hypnosis, can be highly effective analgesics, but are underused in Korea. In this article, we would like to review the basic concepts of hypnosis, the mechanism, and the outcome data of the analgesic effects of hypnosis, and also, its limitations.
Absorption ; Analgesics ; Consciousness ; Cues ; Dissociative Disorders ; Hypnosis ; Korea ; Pain Management

PURPOSE: We wanted to evaluate the results of nonoperative treatment for acute, undisplaced, stable scaphoid fracture. MATERIALS AND METHODS: We retrospectively reviewed 24 cases of acute undisplaced scaphoid fracture that were treated at our department from May 1998 to January 2008. The immobilization method was a long or short arm cast. Flexion-extension exercise was permitted during the period of the short arm cast, but pronation-supination motion was prohibited. After the removal of the cast, active and passive range of motion exercise was started immediately. The result was assessed by the Maudsley scale. RESULTS: The twenty four cases were undisplaced or minimally displaced fracture (10 cases of Herbert type A1, 3 cases of A2 and 11 cases of B2) according to the Mayo classification. The average duration of immobilization was 7.16 weeks. According to the Maudsley scale, 19 cases had an excellent result and 4 cases had a good result. One case had a complication of scapho-lunate dissociation. CONCLUSION: We recommend conservative treatment with cast immobilization as the first treatment of choice for acute undisplaced scaphoid fracture.
Arm ; Dissociative Disorders ; Immobilization ; Range of Motion, Articular ; Retrospective Studies