Childhood Traumatic Experiences, Dissociative Symptoms, and Dissociative Disorder Comorbidity Among Patients With Panic Disorder: A Preliminary Study

Abstract

This study assessed childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with panic disorder (PD). A total of 92 psychotropic drug-naive patients with PD, recruited from outpatient clinics in the psychiatry department of a Turkish hospital, were involved in the study. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), Dissociation Questionnaire, Panic and Agoraphobia Scale, Panic Disorder Severity Scale, and Childhood Trauma Questionnaire. Of the patients with PD, 18 (19%) had a comorbid dissociative disorder diagnosis on screening with the SCID-D. The most prevalent disorders were dissociative disorder not otherwise specified, dissociative amnesia, and depersonalization disorders. Patients with a high degree of dissociation symptoms and dissociative disorder comorbidity had more severe PD than those without (p < .05). All of the childhood trauma subscales used were correlated with the severity of symptoms of dissociation and PD. Among all of the subscales, the strongest relationship was with childhood emotional abuse. Logistic regression analysis showed that emotional abuse and severity of PD were independently associated with dissociative disorder. In our study, a significant proportion of the patients with PD had concurrent diagnoses of dissociative disorder. We conclude that the predominance of PD symptoms at admission should not lead the clinician to overlook the underlying dissociative process and associated traumatic experiences among these patients.

Modern faces of hysteria, or some of the dissociative disorders

“…The strongest association was observed with Childhood Emotional Abuse. An analysis of the results of the study confirmed the relationship between childhood experiences of emotional abuse and severity of panic disorder on the one hand and dissociative disorders, on the other [8].…”

“…Among the causative factors, there is also severe psychological trauma that may occur as a result of a direct threat to health or life [1]. The literature most frequently mentions traumatic experiences from early childhood [8], a dramatic loss of loved ones [9], violence [10], sexual abuse, catastrophes, war, natural disasters, traumatic experiences associated with pregnancy and the perinatal period [6], and protracted interpersonal and intrapsychic problems. [7,11,12,13,14,15].…”

Dissociative experiences and health anxiety in panic disorder

“…In the study by Pastucha et al .,[ 6 ] patients with panic disorder had similar DES scores when compared to healthy controls, but they had more frequent severe dissociative states and level of dissociation correlated with severity of anxiety symptoms. In another study,[ 2 ] 19% of patients with panic disorder had the comorbid dissociative disorder and patients with a high degree of dissociative symptoms and dissociative disorder comorbidity had more severe panic symptoms. The wide variability in the DES scores in panic disorder can probably be explained by a difference in the conceptualization of dissociation as comprising only of depersonalization-derealization during panic attacks or more broadly as disturbances in integrity of memory, cognition, and awareness.…”

“…[ 1 ] Dissociative experiences (dissociative disorder not otherwise specified, dissociative amnesia, and depersonalization) have been reported in patients with panic disorder. [ 2 ] Depersonalization-derealization, which is often present in panic disorder, may be a manifestation of dissociative experiences. [ 3 ] Conversely, acute dissociation may be associated with symptoms of panic disorder.…”

The differences between patients with panic disorder and healthy controls in psychophysiological stress profile

“… 17 , 18 They showed a high level of dissociation too. 19 , 20 Nevertheless, during psychotherapy, they typically start to recognize several triggers of panic attacks, which are connected with stressful inner experiences and thoughts. 21 , 22 …”