Growing Not Dwindling: Worldwide Phenomenon of Dissociative Disorders, Disinformation About Dissociation Dr Joel Paris’s Notions About Dissociative Identity Disorder

April 4, 2013 Comments Off on Growing Not Dwindling: Worldwide Phenomenon of Dissociative Disorders, Disinformation About Dissociation Dr Joel Paris’s Notions About Dissociative Identity Disorder

LETTERS TO THE EDITOR  The Journal of Nervous and Mental Disease & Volume 201, Number 4, April 2013 http://www.jonmd.com p. 353 – 358

Growing Not Dwindling: Worldwide Phenomenon of Dissociative Disorders

To the Editor:

In the December 2012 issue of the Journal, Joel Paris, MD, wrote an article about the current status of dissociative identity disorder (DID) and the dissociative disorder field in general. He suggests that DID is merely a ‘‘fad’’ and that there is no credible evidence to connect traumatic experiences with the development of DID. We refute several of the claims made by Dr Paris.

Our biggest concern as non-North American researchers is that Dr Paris does not reference a single international study related to dissociative disorders and DID, despite the considerable and increasing empirical literature from around the world. His speculation that DID is not diagnosed outside clinics that specialize in treating dissociation is not consistent with current data. DID and dissociative disorders have been reliably found in general psychiatric hospitals; psychiatric emergency departments; and private practices in countries including England, the Netherlands, Turkey, Puerto Rico, Northern Ireland, Germany, Finland, China, and Australia, among many others….

Much of the international research, using sophisticated epidemiological and clinical research methods, has replicated dozens of times the finding that dissociative processes and disorders (including DID) can be reliably detected in a wide spectrum of different societies. Epidemiological general population studies indicate that 1.1% to 1.5% meet diagnostic criteria for DID; and 8.6% to 18.3%, for any DSM-IV dissociative disorder  (Johnson et al., 2006; Sar et al., 2007a). The international literature on DID and dissociative disorders has been widely published in mainstream journals of psychiatry and psychopathology and is inconsistent with Dr Paris’s conclusions….

Dr Paris also opines that there is only a ‘‘weak link’’ between child abuse and psychopathology, quoting an article published 17 years ago. Current research illustrates a very different picture. Persons with early abusive experiences demonstrate increased illnesses (Green and Kimerling, 2004), impaired work functioning (Lee and Tolman, 2006), serious interpersonal difficulties (Van der Kolk and d’Andrea, 2010), and a high risk for traumatic revictimization (Rich et al., 2004). The Adverse Childhood Experiences Study, an American epidemiological study, has provided retrospective and prospective data from more than 17,000 individuals on the effects of traumatic experiences during the first 18 years of life.

In conclusion, Dr Paris’s assessment of the supposedly dwindling fad of DID and dissociative disorders is not in keeping with current peer-reviewed international research. The dissociative disorder field has been producing solid and consistent evidence that provides guidance to clinicians and researchers about the epidemiology, phenomenology, diagnosis, and treatment of DID (and closely related conditions).

Alfonso Marti´nez-Taboas, PhD  Department of Psychology
Carlos Albizu University San Juan, Puerto Rico

Martin Dorahy, PhD Department of Psychology University of Canterbury
Christchurch, New Zealand

Vedat Sar, MD Department of Psychiatry Istanbul University Istanbul, Turkey
Warwick Middleton, MD Department of Psychiatry University of Queensland
St Lucia, Australia

Christa Kru¨ger, MD Department of Psychiatry University of Pretoria
Pretoria, South Africa

Journal of Nervous & Mental Disease: April 2013 – Volume 201 – Issue 4 – p 353–354  doi: 10.1097/NMD.0b013e318288d27f
Letters to the Editor
http://journals.lww.com/jonmd/Citation/2013/04000/Growing_Not_Dwindling__International_Research_on.15.aspx

Disinformation About Dissociation Dr Joel Paris’s Notions About Dissociative Identity Disorder

To the Editor:
We write to record our objections to both the form and the content of Dr Joel Paris’s recent article entitled The Rise and Fall of Dissociative Identity Disorder (Paris, 2012). His claim that dissociative identity disorder (DID) is a ‘‘medical fad’’ is simply wrong, and he provides no substantive evidence to support his claim. From the mistaken identification of Pierre Janet as a psychiatrist in the first line (Janet was the most famous psychologist of his day), it is replete with errors, false claims, and lack of scholarship and just plainly ignores the published literature. Dr Paris provided a highly biased article that is based on opinion rather than on science. His review of the literature is extremely selective. Of 48 references, Dr Paris cites exactly 7 peer-reviewed articles published from 2000 onward (7/48 references equals 14%) and only 8 peer-reviewed, data-driven articles from before 2000 (8/48 equals 16%). Rather than relying on the recent peer-reviewed, scientific literature, Paris relied almost entirely on the non-peer-reviewed books, including a popular press book written by a journalist whose methods and conclusions have been strongly challenged.

He claims that interest and research in DID have waned, yet he fails to cite the multitude of studies that have been conducted about it. In fact, Dalenberg et al. (2007) documented evidence of the exact opposite pattern described by Paris: ‘‘A search of the PILOTS database offered by the National Center for Posttraumatic Stress Disorder for articles on dissociation reveals 64 studies in 1985-1989, 236 published in 1990-1994, 426 published in 1995-1999 and 477 in the last 5-year block (2000-2004)’’ (p. 401)….

In addition, he fails to cite a variety of neurobiological and psychophysiological studies of DID documenting similar brain morphology abnormalities in patients with DID to those of other traumatized patients (Reinders et al., 2006; Vermetten et al., 2006). Despite failing to review this and other relevant research, Dr Paris made the claim that ‘‘Neither the theory behind the diagnosis nor the methods of treatment are consistent with the current preference for biological theories’’ (p. 1078). Furthermore, he fails to cite any research that has been done by researchers outside North America. For example, Vedat Sar, MD, in Turkey has published more than 70 articles and chapters on dissociative disorders and trauma (http://vedatsar.com/ index_2.htm), but Dr Paris failed to mention a single one….

A recent review in Psychological Bulletin by 2012) found strong support for the etiological relationship of trauma and dissociation. These included several large meta-analyses, some of which focused on patients with DID. Dalenberg et al. (2012) found an effect size of r = 0.52 and 0.54 for the relationship between childhood physical abuse and sexual abuse, respectively, in studies that compared individuals with dissociative disorders with those without dissociative disorders. In addition, Dalenberg et al. (2012) tested eight different predictions of the trauma versus the fantasy (sociocognitive/iatrogenic) model of dissociation. On each, careful of reviews of the literature, including meta-analyses, on memory, suggestibility, and neurobiology, among others, Dalenberg et al. (2012) found minimal scientific evidence to support the fantasy model. Further, reviews have shown that there are no research studies in the literature in any population studied to support the iatrogenic/sociocognitive etiology of DID promulgated by Dr Paris (Brown et al., 1999; Loewenstein, 2007)….

Dr Paris’s article does not provide scholarly criticism based upon peer reviewed research, scientific data, or accurate discussion of the history of psychiatry. His point of view is incorrect and outmoded. It is the so-called false-memory, iatrogenesis model of the dissociative disorders that is the fallen fad, buried under the weight of rigorous data that contradict it. Dissociative disorders have not risen and fallen. These existed before the fields of psychiatry and psychology did….

Bethany Brand, PhD Department of Psychology Towson University, MD

Richard J. Loewenstein, MD The Trauma Disorders Program Sheppard Pratt Health System Baltimore, MD Department of Psychiatry University of Maryland School of Medicine Baltimore

David Spiegel, MD Department of Psychiatry and Behavioral Sciences
Stanford University School of Medicine CA

Journal of Nervous & Mental Disease: April 2013 – Volume 201 – Issue 4 – p 354–356 doi: 10.1097/NMD.0b013e318288d2ee Letters to the Editor
http://journals.lww.com/jonmd/Citation/2013/04000/Disinformation_About_Dissociation__Dr_Joel_Paris_s.16.aspx

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Epidemiology of Dissociative Disorders: An Overview

January 7, 2013 Comments Off on Epidemiology of Dissociative Disorders: An Overview

Epidemiology of Dissociative Disorders: An Overview

Vedat Sar – Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey 2011

General psychiatric assessment instruments do not cover DSM-IV dissociative disorders. Many large-scale epidemiological studies led to biased results due to this deficit in their methodology. Nevertheless, screening studies using diagnostic tools designed to assess dissociative disorders yielded lifetime prevalence rates around 10% in clinical populations and in the community. Special populations such as psychiatric emergency ward applicants, drug addicts, and women in prostitution demonstrated the highest rates. Data derived from epidemiological studies also support clinical findings about the relationship between childhood adverse experiences and dissociative disorders. Thus, dissociative disorders constitute a hidden and neglected public health problem. Better and early recognition of dissociative disorders would increase awareness about childhood traumata in the community and support prevention of them alongside their clinical consequences.

http://downloads.hindawi.com/journals/eri/2011/404538.pdf

excerpts:

“Most of the published clinical case series are focused on chronic and complex forms of dissociative disorders.

Data collected in diverse geographic locations such as North America [2], Puerto Rico [3], Western Europe [4], Turkey [5], and Australia [6] underline the consistency in clinical symptoms of dissociative disorders. These clinical case series have also documented that dissociative patients report highest frequencies of childhood psychological trauma among all psychiatric disorders. Childhood sexual (57.1%–90.2%), emotional (57.1%), and physical (62.9%–82.4%) abuse and neglect (62.9%) are among them (2–6).”

“Several studies conducted on consecutive series of inpatients and outpatients in general psychiatric settings in diverse countries yielded
results depending on the hinterland of the particular institution (Table 1).

Two studies in North America demonstrated that 13.0–20.7 % of psychiatric inpatients had a dissociative disorder [22, 23]. Studies on dissociative disorders in Istanbul, Turkey, yielded a prevalence slightly above 10% among psychiatric inpatients and outpatients [8, 24, 25]. Although still considerable, these rates were lower in the Netherlands [26], Germany [18], and Switzerland [27] among inpatients, that is, between 4.3%–8.0%. A Finnish study [28] reported higher rates for psychiatric outpatients (14.0%) and inpatients (21.0%).

Emergency admissions of a university psychiatric clinic in Istanbul, Turkey yielded the highest rate in the country: 35.7% [29]. In a study from Zurich, Switzerland, among severely impaired psychiatric outpatients, prevalence of all dissociative disorders were 25.0% [30]. Two recent studies on inpatient and outpatient psychiatric units in North America reported higher rates than those of the previous studies [31, 32].”

Lawyer doesn’t remember stealing paintings – Dissociative Amnesia

August 18, 2012 Comments Off on Lawyer doesn’t remember stealing paintings – Dissociative Amnesia

Lawyer doesn’t remember stealing paintings Thu Aug 16, 2012

Michael Gerard Sullivan, 54, has pleaded guilty to stealing two paintings from the Katoomba Fine Art Gallery in December 2008….CCTV vision clearly shows Mr Sullivan stealing two James Willebrant paintings between courses.

During his court case Mr Sullivan’s lawyers tendered two psychiatric reports which concluded he had dissociative amnesia and his actions were totally out of character.

The court heard the disorder caused him to take on the identity of an art thief and not remember his actions

Judge Jennifer English accepted the diagnosis, saying Mr Sullivan had previously lived an exemplary life.

She did not record a conviction.
http://www.abc.net.au/news/2012-08-16/lawyer-does-not-remember-stealing-paintings/4202708

The Lawyer Who Forgot He Was a Thief
August 16, 2012 By Joe Palazzolo

Michael Gerard Sullivan, a lawyer in Sydney, Australia, was dining one night in 2008 at an art gallery restaurant when, according to the security cameras that recorded him, he excused himself between courses and stole two paintings worth $14,500.

Mr. Sullivan, who previously worked at some of the country’s top firms – including Freehills, Gadens and Mallesons (now King & Wood Mallesons after a big merger earlier this year) – pleaded guilty, with one caveat: He said he didn’t remember committing the crime….

The psychiatrists said Mr. Sullivan, who faced up to seven years in jail, was playing the character of an art thief. Australia’s ABC News reported Thursday that Judge English accepted Mr. Sullivan’s defense.

Judge English dismissed the charges but placed Mr. Sullivan on a two-year good behavior bond, saying he had lived an otherwise exemplary life, according to the ABC report.

The Cleveland Clinic, by the way, describes dissociative amnesia thus:

Dissociative amnesia occurs when a person blocks out certain information, usually associated with a stressful or traumatic event, leaving him or her unable to remember important personal information. With this disorder, the degree of memory loss goes beyond normal forgetfulness and includes gaps in memory for long periods of time or of memories involving the traumatic event.
http://blogs.wsj.com/law/2012/08/16/the-lawyer-who-forgot-he-was-a-thief/

Dissociative Amnesia
http://my.clevelandclinic.org/disorders/dissociative_disorders/hic_dissociative_amnesia.aspx

Brady under pressure as sex abuse victims talk of cover-up, The Parental Alienation Debate Belongs in the Courtroom, Not in DSM-5

May 2, 2012 Comments Off on Brady under pressure as sex abuse victims talk of cover-up, The Parental Alienation Debate Belongs in the Courtroom, Not in DSM-5

articles
– Brady under pressure as sex abuse victims talk of cover-up
– Fresh claims put pressure on Cardinal Brady
– The Parental Alienation Debate Belongs in the Courtroom, Not in DSM-5

Brady under pressure as sex abuse victims talk of cover-up
By Greg Harkin
Tuesday May 01 2012

CHURCH leaders will come under renewed pressure when a BBC documentary is screened tonight outlining the widespread cover-up of clerical sex abuse here.

‘This World: The Shame of the Catholic Church’ is said to focus on Cardinal Sean Brady’s role in an ecclesiastical investigation that led to the silencing of two victims of Fr Brendan Smyth.

Victims of paedophile priests in Co Donegal will also tell how the church failed to deal with complaints which allowed one cleric to  continue to abuse more victims.

The broadcaster has refused to comment on the investigation by reporter Darragh Mac Intyre but BBC sources say the documentary has “powerful
testimony” from abuse victims. http://www.independent.ie/national-news/brady-under-pressure-as-sex-abuse-victims-talk-of-coverup-3096117.html

Fresh claims put pressure on Cardinal Brady
By Andy Martin BBC News
1 May 2012

Cardinal Brady became the Catholic Primate of all-Ireland in 1996, but the appointment that may define his career was made 21 years earlier.

As a Bishop’s secretary in 1975, he was tasked with investigating a complaint of sexual abuse made against a fellow priest, the man who would later be exposed as Ireland’s most prolific paedophile, Fr Brendan Smyth….

Following two major and damning reports into the handling of clerical abuse in Ireland, it emerged that Ireland’s most senior Catholic Priest had himself been involved in a process in which sex abuse was kept from the civil authorities….

However, McIntyre’s BBC investigation reveals that the teenage victim, Brendan Boland, had also told the then Father Brady and his colleagues, about other children who were being abused by Smyth.

He even furnished the investigating priest and his colleagues with their names and addresses.

Father Brady interviewed one of those boys, who corroborated each of Brendan Boland’s claims before being sworn to secrecy.

Father Brady however, failed to inform any parent of the children in the group that they had been abused. Nor were the police told of Smyth’s crimes against them. http://www.bbc.co.uk/news/uk-northern-ireland-17853126

The Parental Alienation Debate Belongs in the Courtroom, Not in DSM-5
Timothy M. Houchin, MD, John Ranseen, PhD, Phillip A. K. Hash, DO, PhD and Daniel J. Bartnicki, JD
J Am Acad Psychiatry Law 40:1:127-131 (January 2012) – the American Academy of Psychiatry and the Law.

The DSM-5 Task Force is presently considering whether to adopt parental alienation disorder (PAD) as a mental illness. Although controversy has surrounded PAD since its inception in 1985, pro-PAD groups and individuals have breathed new life into the push to establish it as a mental health diagnosis. In this analysis, we argue that it would be a serious mistake to adopt parental alienation disorder as a formal mental illness in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)….

The Origin of PAS

Richard Gardner, formerly a psychoanalyst and child psychiatrist on the clinical faculty at Columbia University, introduced the term parental alienation syndrome in his 1985 debut article on the subject….he openly supported abolishing child abuse reporting laws and controversially declared that sexual abuse cases are “turn-ons” for those involved in the court process, including lawyers and judges. Despite these unusual claims, Gardner was highly sought as an expert witness, testifying in over 400 child custody cases before the end of his career….

Controversial since its inception, PAS has compelled many scholars to write articles critical of Gardner’s theory. Kelly and Johnston have been noteworthy critics of PAS, writing in their 2001 article, “The Alienated Child, A Reformulation of Parental Alienation Syndrome, ” that “PAS terminology has led to widespread confusion and misunderstanding in judicial, legal, and psychological circles” (Ref. 9, p 250). They also highlighted the lack of empirical support for PAS as a psychiatric diagnosis and the barring of PAS testimony in many courtrooms….

Criticisms of PAS have not been limited to mental health professionals, as legal scholars have also been loath to accept the premise that parental alienation should be formally classified as a mental illness. For example, in her 2002 article, “Parental Alienation Syndrome and Alienation: Getting it Wrong in Child Custody Cases,”12 Carol S. Bruch, JD, voiced concern with Gardner’s tendency to cite his own, non-peer-reviewed books and publications on PAS. She noted that in one typical article, Gardner cited 10 sources: 9 writings of his own and 1 by Sigmund Freud. She further refuted Gardner’s suggestion that PAS was a generally accepted psychiatric phenomenon by pointing out that, when the validity of PAS was challenged in court, his testimony was often excluded.

In our opinion, Gardner’s approach of self-publishing books and then citing himself as an authoritative reference in the scholarly literature went beyond simple self-aggrandizement; it was frankly misleading. We agree with Ms. Bruch that the inaccurate portrayal of PAS as an accepted and credible diagnosis gets it wrong on many levels. http://www.jaapl.org/content/40/1/127.full

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