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Am J Psychiatry 1993; 150:1037-1042
Copyright © 1993 by American Psychiatric Association
Dissociative disorders in psychiatric inpatients
GN Saxe, BA van der Kolk, R Berkowitz, G Chinman, K Hall, G Lieberg and J Schwartz
Trauma Clinic, Harvard Medical School, Department of Psychiatry, Massachusetts Mental Health Center, Boston.
OBJECTIVE: This study attempted to determine 1) the prevalence of
dissociative disorders in psychiatric inpatients, 2) the degree of reported
childhood trauma in patients with dissociative disorders, and 3) the degree
to which dissociative experiences are recognized in psychiatric patients.
METHOD: A total of 110 patients consecutively admitted to a state
psychiatric hospital were given the Dissociative Experiences Scale.
Patients who scored above 25 were matched for age and gender with a group
of patients who scored below 5 on the scale. All patients in the two groups
were then interviewed in a blind manner, and the Dissociative Disorders
Interview Schedule, the Traumatic Antecedent Questionnaire, and the
posttraumatic stress disorder (PTSD) module of the Structured Clinical
Interview for DSM-III-R, Nonpatient Version, were administered. Chart
reviews were also conducted on all patients. RESULTS: Fifteen percent of
the psychiatric patients scored above 25 on the Dissociative Experiences
Scale; 100% of these patients met DSM-III criteria for a dissociative
disorder. These patients had significantly higher rates of major
depression, PTSD, substance abuse, and borderline personality than did the
comparison patients, and they also reported significantly higher rates of
childhood trauma. Chart review data revealed that dissociative symptoms
were largely unrecognized. CONCLUSIONS: A high proportion of psychiatric
inpatients have significant dissociative pathology, and these symptoms are
underrecognized by clinicians. The proper diagnosis of these patients has
important implications for their clinical course.
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