Copyright 1992 by the American Psychological Association, Inc. 0021-843X/92/$3.00
Journal of Abnormal Psychology 1992, Vol. 101, No. 4, 717-723
Dissociative Experiences, Psychopathology and Adjustment, and Child and Adolescent Maltreatment in Female College Students
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
David A. Sandberg and Steven Jay Lynn Ohio University Thirty-three female college students who scored in the upper 15% on the Dissociative Experiences Scale (DES) were compared with 33 female students who scored below the mean on the DES on measures of psychopathology (Symptom Checklist-90), college adjustment (Student Adaptation to College Questionnaire), and child and adolescent maltreatment. Compared with controls, highDES subjects reported more psychopathology, poorer college adjustment, and a greater extent of psychological, physical, and sexual maltreatment. On the basis of the Dissociative Disorders Interview Schedule, 2 high-DES subjects but none of the control subjects met criteria for a dissociative disorder (i.e., multiple personality and psychogenic amnesia). Despite the sensitivity of the DES, 8 subjects who scored in the upper 2% of the population on the DES failed to meet criteria for a dissociative disorder.
Evans, 1988; Putnam, 1989; D. Spiegel, 1986; Terr, 1991). For instance, D. Spiegel (1986) noted that "dissociation is a defense often mobilized against the pain and helplessness engendered by traumatic experiences" (p. 123). Serving to block painful events from awareness, dissociation is adaptive in the sense that it allows persons to go about their lives as if nothing traumatic had happened. Because the majority of dissociation studies have been retrospective in nature, it has not been definitively shown that trauma causes dissociative pathology (Putnam, 1989). However, the trauma-dissociation connection is supported by an impressive body of research. The National Institute of Mental Health (NIMH) found that 97% of a sample of 100 multiple personality disorder (MPD) cases reported experiencing significant trauma in childhood (Putnam, Guroff, Silberman, Barban, & Post, 1986). Eighty-three percent of MPD patients reported being sexually abused, 75% reported being repeatedly physically abused, and 68% reported being both sexually and physically abused. Other research findings corroborate these statistics (Bliss, 1984; Coons & Milstein, 1986; Ross, Miller et al, 1990; Ross, Norton, & Wozney, 1989). Coons and Milstein's (1986) research is particularly noteworthy because in the majority of cases, abuse was verified by at least one family member or by emergency room reports. Investigators have found that dissociative pathology is associated with a variety of traumatic events and trauma-related disorders, such as combat exposure (Brende, 1986), witnessing a violent death during childhood (Putnam et al., 1986), rape in adolescence or adulthood (Coons & Milstein, 1986), and posttraumatic stress disorder (Eth & Pynoos, 1985; Figley, 1985; D. Spiegel et al., 1988). In short, when exposed to trauma, persons may use adaptive dissociative capacities to escape (on the intrapsychic plane) or to defend against situations that threaten to overwhelm ordinary coping abilities (Beahrs, 1990; Braun & Sachs, 1985; Kluft, 1984). Although dissociation-based defensive maneuvers may be successful in the short run, profound dissociation has long-term personal costs (Putnam, 1989).
Since the term dissociation was introduced by Pierre Janet around the turn of the century, many investigators have attempted to elaborate this elusive construct. Janet proposed that split-off parts of the personality exist and are capable of independent functioning (Putnam, 1989). Interest in dissociation has waxed and waned since Janet's early theorizing, but recent years have witnessed a swell of interest in the construct of dissociation and dissociative disorders. The Diagnostic and Statistical Manual of 'MentalDisorders (rev. 3rd ed.; DSM-IH-R; American Psychiatric Association, 1987) noted that the essential feature of dissociative disorders is "a disturbance or alteration in the normally integrated functions of identity, memory, or consciousness" (p. 269). Dissociative mechanisms have also been implicated in a variety of psychiatric disorders, including posttraumatic stress disorder (Brende, 1986; D. Spiegel, 1984,1989; D. Spiegel, Hunt, & Dondershine, 1988), obsessive-compulsive disorder (Ross & Anderson, 1988), and eating disorders (Molteni, 1990; S. Sanders, 1986; Torem, 1986; Vanderlinden & Vandereycken, 1988). In attempting to understand the genesis of dissociative disorders, investigators have converged on traumatic events as important antecedents of dissociative symptomatology. For Janet, dissociation was "the crucial psychological process with which the organism reacts to overwhelming trauma" (van der Kolk & van der Hart, 1989, p. 1523). True to Janet, contemporary theorists have hypothesized that dissociation is a normal defensive process used to cope with traumatic experiences (Beahrs, 1990; This research was conducted in partial fulfillment of the requirements of a master of science degree by David A. Sandberg at Ohio University. The research was supervised by Steven J. Lynn. We thank Bruce W Carlson and John P. Garske for their valuable contribution to this research. We also thank Kimberly A. Hanson, Steven A. Kvaal, Harry J. Sivec, and Cheryl K. Yatsko for their help in interviewing subjects. Correspondence concerning this article should be addressed to Steven Jay Lynn, Department of Psychology, Ohio University, Athens, Ohio 45701. 717
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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DAVID A. SANDBERG AND STEVEN JAY LYNN
Central to this adaptive concept of dissociation is the notion that dissociative experiences range on a continuum (Bernstein & Putnam, 1986; Braun, 1989; Hilgard, 1977; Nemiah, 1980; Price, 1987; Putnam, 1989; B. Sanders & Giolas, 1991; H. Spiegel, 1963; Taylor & Martin, 1944) from common everyday dissociations, such as daydreaming, to incapacitating dissociations related to severe psychopathology, such as MPD. Support for the existence of a dissociative continuum derives from studies with the Dissociative Experiences Scale (DBS; Bernstein & Putnam, 1986; Putnam, 1989), the most thoroughly validated index of dissociative experiences. With a possible range of scores from 0 to 100, the median DES score for a group of MPD patients was 57.06, whereas scores for schizophrenics, phobics, and normal adults were 20.63, 6.04, and 4.38, respectively (Bernstein & Putnam, 1986). If dissociative experiences range on a continuum from normal everyday experiences to severe pathology, then it can be argued that less debilitating or extensive dissociative experiences may be associated with less severe or longstanding abuse (e.g., being hit with a belt on occasion as a form of punishment or a single occurrence of sexual fondling in childhood). Although workers in the field (Ross, Anderson, Heber, & Norton, 1990; B. Sanders & Giolas, 1991; B. Sanders, McRoberts, & Tollefson, 1989) have attempted to ascertain whether the relation between dissociation and child maltreatment is evident with respect to less severe or debilitating forms of dissociative experiences, a definitive answer to this question has not been forthcoming. Only a handful of studies (Briere & Runtz, 1988a, 1988b; Norton, Ross, & Novotny, 1990; Ross, Joshi, & Currie, 1990, 1991; Ross, Ryan, Anderson, Ross, & Hardy, 1989; B. Sanders et al., 1989) have examined less severe, more mundane forms of dissociation to provide normative information about dissociative experiences and their correlates in the general population and nonclinical samples. With respect to college samples, B. Sanders et al. (1989) and Briere and Runtz (1988a) have reported a relation between dissociation scores and retrospective self-reports of physical and psychological maltreatment in childhood. Similarly, Briere and Runtz (1988b) documented a relation between college sample dissociation scores and childhood sexual abuse variables. Because dissociation was not the focus of Briere and Runtz's (1988a, 1988b) research, they did not use a well-validated measure of dissociation. Furthermore, the single study (B. Sanders et al., 1989) that used the DES to examine the relation between dissociation and childhood abuse in a college population did not examine the relation between dissociation and sexual abuse independent of physical abuse. With the exception of B. Sanders et al.'s research, the particular focus has not been on subjects with high dissociation scores in the college population. Our research was designed to elaborate the construct of dissociation in the college student population. One aim of the our research was to address the question of whether college students selected for high scores on a well-validated measure of dissociation (DES) would report more instances of childhood and adolescent psychological and physical maltreatment, including sexual victimization, than a comparison sample of subjects who scored in the low-to-mid range of the scale. There also is a need to secure data relevant to the question of whether dissociation is related to symptomatology and malad-
justment in nonclinical samples. Only one study (Norton et al., 1990) examined the relation between psychopathology and dissociation in a college population. However, this research did not determine whether subjects who scored high on the DES were at particular risk for psychopathology. Therefore, a second aim of our research was to address the question of whether persons who scored at the extreme (upper 15%) of the distribution of dissociative experiences, as measured by the DES, would report being less well adjusted to college and would report greater symptomatology than would persons who scored in the low-to-mid range of the distribution of dissociative experiences. A final aim of our research was to examine the DES's utility in screening college students for dissociative disorders. Ross, Joshi, and Currie (1990) noted that an important question is, "When are dissociative experiences pathological?" (p. 1552). They further noted that the DES alone cannot provide a definitive answer to this question and that what is required is a diagnostic interview, such as the Dissociative Disorders Interview Schedule (DDIS; Ross, Heber, et al., 1989). Because data on the prevalence of dissociative disorders in the college population is lacking, subjects in the high and moderate-low ranges of the DES were administered a structured dissociation interview based on the DDIS. It was hypothesized that differences would be found in the number of subjects assigned a dissociative disorder diagnosis and that a greater number of subjects who scored high on the DES would receive the dissociative disorder diagnosis. Method Subjects Six hundred fifty male and female undergraduate students were administered the DES (Bernstein & Putnam, 1986) over the course of two academic quarters (DES score, M = 12.10, SD =8.81, for the total sample). On the basis of DES scores, 110 women who scored in the upper 15% (high-DES group; score > 20; DES score, M = 33.21, SD = 9.98, 96th percentile of the population) or below the sample mean (control group; score < 12; DES score, M = 5.95, SD = 2.69, 31st percentile of the population) were contacted by telephone and invited to participate in this study in exchange for extra course credit or for $5.00. Of these subjects, 66 were willing to participate (high-DES,« = 33, and control, n = 33). The mean DES scores of those who volunteered versus those who refused to participate were not significantly different, highDES, t(62) = -1.19, ns, and control, t(62) = 0.61, ns. Given financial and time constraints, only female subjects were contacted to participate in the research. Because we were particularly interested in examining the relation between dissociation and several forms of maltreatment, including sexual victimization, and because female college students are almost twice as likely as male college students to report sexual victimization (Finkelhor, 1979; Koss & Oros, 1982; Salter, 1988), we focused our efforts toward women.
Dissociation Measures Dissociative Experiences Scale. The DES is a 28-item, self-administered questionnaire that measures the extent of dissociative experiences and symptomatology in both normal and clinical populations. Respondents are asked to make slashes on 100-mm lines to indicate how frequently (in percentage of time) they experience the feelings or behavior described by each of the items. The mean of all item scores
719
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
DISSOCIATION ranges from 0 to 100 and constitutes the DES score (Bernstein & Putnam, 1986). The DES has high test-retest reliability (Pearson r = .84) and good criterion-referenced and construct validity (Bernstein & Putnam, 1986; Ensink & van Otterloo, 1989; Frischholz et al., 1990; Ross, Norton, & Anderson, 1988). Dissociation interview. This 15- to 20-min structured interview consisted of sections of the DDIS (Ross, Heber et al., 1989) pertinent to making a diagnosis of a dissociative disorder on the basis of DSM-III criteria (American Psychiatric Association, 1980). The DDIS focuses primarily on the dissociative disorders. It has an overall interrater reliability (kappa) of .68 and a specificity of 100% and a sensitivity of 90% for the diagnosis of MPD (Ross, Heber et al, 1989). The sections of the DDIS used to create the dissociation interview for this study were: Psychiatric History, Features Associated With Multiple Personality Disorder, Psychogenic Amnesia, Psychogenic Fugue, Depersonalization Disorder, Multiple Personality Disorder (NIMH research criteria, which consists of DSM-III criteria plus two further criteria), and Atypical Dissociative Disorder. Subjects' responses to each question are coded as yes, no, or unsure. Criteria for diagnoses of psychogenic amnesia, psychogenic fugue, depersonalization disorder, and multiple personality disorder correspond to the DSM-III.
Measures of Psychopathology and Adjustment Symptom Checklist (SCL-90; Derogatis, 1983; Derogatis, Lipman, & Covi, 1973). The SCL-90 is a 90-item, self-report clinical rating scale designed to measure current psychiatric symptomatology. The scale comprises 9 subscales: Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism. The SCL-90 also provides three global indices of psychopathology, including a Global Severity Index that combines information about the number and intensity of symptoms experienced. Each of the items are rated on a 5-point scale of distress that ranges from not at all (0) to extremely (4). The SCL-90 has high degrees of test-retest reliability and internal consistency and good concurrent, discriminative, and construct validity (Derogatis, 1983; Derogatis et al, 1973). College adjustment. The Student Adaptation to College Questionnaire (SACQ; Baker & Siryk, 1989) is a 67-item measure designed to assess how well students adapt to the demands of their college experience. Students are asked to rank their level of adjustment for each of the items on a 9-point scale that ranges from applies very closely tome(\)\o doesn't apply to me at all (9). The four subscales include Academic Adjustment, Social Adjustment, Personal-Emotional Adjustment, and Institutional Attachment. Consideration of all items yields a full scale score. The SACQ has good internal consistency, reliability, and criterion-related validity (Baker & Siryk, 1989). Cronbach's alpha values range from .77 for the Personal-Emotional Adjustment subscale to .95 for the full scale score (Baker & Siryk, 1989).
Maltreatment and Victimization Measures Psychological and physical maltreatment scales. These scales were adapted from Briere and Runtz's (1988a) Family Experiences Questionnaire. The psychological maltreatment scale consists of 7 items about experiences that reflect psychological maltreatment, whereas the 5-item physical maltreatment scale items reflect actual physical behaviors. For both scales, subjects report the frequency of occurrence for each of the items separately for both maternal and paternal behaviors. The response format of both scales allows subjects to indicate frequency on a 7-point scale that ranges from never (0) to more than 20 times a year (6). The scales have acceptable internal consistency (for physical maltreatment, a = .75, and for psychological maltreatment,
a = .87) and are sensitive to symptomatology in college students (Briere & Runtz, 1988a). Childhood sexual victimization questionnaire. Questions intended to measure the degree of sexual victimization during childhood before the age of 15 were adapted from Finkelhor (1979). First, subjects respond to a series of increasingly involved yes-no questions about sexual experiences. Second, follow-up questions are presented in order to gather more specific information about subjects' most severe sexual victimization experience. For the purpose of this study, childhood sexual victimization was defined as any sexual contact (fondling to intercourse) experienced before the age of 15 and initiated by an individual 5 or more years the subject's senior. Adolescent sexual experiences questionnaire. Questions intended to assess whether subjects were sexually victimized in adolescence were adapted from the Sexual Experiences Survey (Koss & Oros, 1982). A series of yes-no questions were ordered in approximate ascending order on the basis of severity of victimization. For this study, sexual victimization was defined as any unwanted sexual contact (fondling to intercourse) after age 15.
Social Desirability Measure The Marlowe-Crowne Social Desirability Scale (MCSDS; Crowne & Marlowe, 1960) is a 33-item measure designed to assess the degree to which subjects respond in culturally sanctioned ways.
Procedure The subjects were contacted by telephone and were invited to participate in research that was conducted as part of a master's thesis project. They were offered either extra course credit or $5.00 for their participation in the project. The average time from the initial DES testing to this contact was 9 weeks. At the first session, informed consent was obtained, and the subjects were assured of confidentiality. The subjects received a large manila envelope that contained the SCL-90, the SACQ, the four maltreatment and victimization measures, and the MCSDS. Each envelope had a 4-digit identification number written in the upper right corner to ensure anonymity. After subjects filled out the questionnaires, they inserted their envelopes into a box placed at the front of the room. In the second session, the dissociation interview was administered. The interviews were conducted by David A. Sandberg and four clinical psychology graduate students who had been trained by Sandberg. The interviewers were naive with respect to subjects' DES scores. The interviewer assured each subject that he or she was unaware of how the subject responded to the initial questionnaires. The interviewer also explained that the interview would be audiorecorded and that in order to protect confidentiality he or she would not address the subject by name. Subject identification numbers were placed on each cassette tape. At the conclusion of the experiment, subjects were debriefed. The interviewer addressed each subject's concerns and presented a debriefing form that was reviewed orally. To protect subjects' welfare (in that we had hypothesized that some subjects would meet diagnostic criteria for a mental disorder), the form included a list of campus and community mental health agencies for further contact or information. The interviewer also encouraged the subject to contact the project director or the interviewer (contact information presented in writing) if she had any questions or concerns in the future.
Results Preliminary Analyses A preliminary analysis revealed no significant differences between high-DBS and control subject groups on the MCSDS,
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DAVID A. SANDBERG AND STEVEN JAY LYNN
f(64) = -1.45, ns (high-DES, M= 15.03, SD = 3.98, and control, M = 16.55, SD = 4.49). Analyses of variance (ANOVAs) performed for all continuous variables failed to secure significant differences between subjects who were paid and subjects who received academic credit; log-linear analyses performed for all discrete variables also failed to yield significant differences. The data were therefore collapsed across these variables.
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Major Findings Maltreatment. A Hotelling's T2 was performed for the four continuous maltreatment measures (mother and father psychological and physical maltreatment). The multivariate analysis was found to be significant, F(4,60) = 3.30, p < .05. Univariate analyses revealed that all four types of maltreatment were significantly related to DES scores. The means and standard deviations are given in Table 1. Sexual victimization. Separate chi-square tests were computed for child and adolescent sexual victimization. Neither analysis achieved significance, x 2 0, N = 66) = 1.06, ns, for child victimization (n = 3 high-DES subjects, and n = \ control subject) and x20, N = 66) = 0.55, ns, for adolescent victimization (n = 15 high-DES subjects, and n = 18 control subjects). An additional chi-square test was performed for adolescent sexual victimization (intercourse or penetration) with threatened or actual physical force. Because approximately 32% of the total sample reported some type of adolescent sexual victimization, we thought that a more stringent criterion for victimization might be differentially related to DES scores. Although frequencies were in the expected direction (8 high-DES subjects and 3 control subjects reported such victimization), a chisquare analysis was not found to be significant, x 2 0> N= 66) = 2.73, ns. Discriminant function analysis. To determine the best linear combination of maltreatment variables in predicting DES group membership, we performed a stepwise discriminant function analysis. Predictor variables included mother and father psychological and physical maltreatment, child sexual victimization, adolescent sexual victimization, and adolescent sexual victimization with threatened or actual physical force. Univariate analyses revealed that mother and father psychological and physical maltreatment and adolescent sexual victimization
Table 1 Maltreatment Scores for High-DES and Control Groups Control (n = 32)
High-DES (n = 33) Maltreatment Psychological Mother Father Physical Mother Father
M
SD
M
SD
(1,63)
15.67 17.03
10.17 13.08
9.30 8.00
8.68 7.25
6.91* 11.75**
3.06 3.27
3.92 4.76
1.36 1.38
1.88 1.84
4.64* 4.44*
Note. DES = Dissociative Experiences Scale. Multivariate F (4, 60) = 3.30, p < .05. *p
Journal of Abnormal Psychology 1992, Vol. 101, No. 4, 717-723
Dissociative Experiences, Psychopathology and Adjustment, and Child and Adolescent Maltreatment in Female College Students
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
David A. Sandberg and Steven Jay Lynn Ohio University Thirty-three female college students who scored in the upper 15% on the Dissociative Experiences Scale (DES) were compared with 33 female students who scored below the mean on the DES on measures of psychopathology (Symptom Checklist-90), college adjustment (Student Adaptation to College Questionnaire), and child and adolescent maltreatment. Compared with controls, highDES subjects reported more psychopathology, poorer college adjustment, and a greater extent of psychological, physical, and sexual maltreatment. On the basis of the Dissociative Disorders Interview Schedule, 2 high-DES subjects but none of the control subjects met criteria for a dissociative disorder (i.e., multiple personality and psychogenic amnesia). Despite the sensitivity of the DES, 8 subjects who scored in the upper 2% of the population on the DES failed to meet criteria for a dissociative disorder.
Evans, 1988; Putnam, 1989; D. Spiegel, 1986; Terr, 1991). For instance, D. Spiegel (1986) noted that "dissociation is a defense often mobilized against the pain and helplessness engendered by traumatic experiences" (p. 123). Serving to block painful events from awareness, dissociation is adaptive in the sense that it allows persons to go about their lives as if nothing traumatic had happened. Because the majority of dissociation studies have been retrospective in nature, it has not been definitively shown that trauma causes dissociative pathology (Putnam, 1989). However, the trauma-dissociation connection is supported by an impressive body of research. The National Institute of Mental Health (NIMH) found that 97% of a sample of 100 multiple personality disorder (MPD) cases reported experiencing significant trauma in childhood (Putnam, Guroff, Silberman, Barban, & Post, 1986). Eighty-three percent of MPD patients reported being sexually abused, 75% reported being repeatedly physically abused, and 68% reported being both sexually and physically abused. Other research findings corroborate these statistics (Bliss, 1984; Coons & Milstein, 1986; Ross, Miller et al, 1990; Ross, Norton, & Wozney, 1989). Coons and Milstein's (1986) research is particularly noteworthy because in the majority of cases, abuse was verified by at least one family member or by emergency room reports. Investigators have found that dissociative pathology is associated with a variety of traumatic events and trauma-related disorders, such as combat exposure (Brende, 1986), witnessing a violent death during childhood (Putnam et al., 1986), rape in adolescence or adulthood (Coons & Milstein, 1986), and posttraumatic stress disorder (Eth & Pynoos, 1985; Figley, 1985; D. Spiegel et al., 1988). In short, when exposed to trauma, persons may use adaptive dissociative capacities to escape (on the intrapsychic plane) or to defend against situations that threaten to overwhelm ordinary coping abilities (Beahrs, 1990; Braun & Sachs, 1985; Kluft, 1984). Although dissociation-based defensive maneuvers may be successful in the short run, profound dissociation has long-term personal costs (Putnam, 1989).
Since the term dissociation was introduced by Pierre Janet around the turn of the century, many investigators have attempted to elaborate this elusive construct. Janet proposed that split-off parts of the personality exist and are capable of independent functioning (Putnam, 1989). Interest in dissociation has waxed and waned since Janet's early theorizing, but recent years have witnessed a swell of interest in the construct of dissociation and dissociative disorders. The Diagnostic and Statistical Manual of 'MentalDisorders (rev. 3rd ed.; DSM-IH-R; American Psychiatric Association, 1987) noted that the essential feature of dissociative disorders is "a disturbance or alteration in the normally integrated functions of identity, memory, or consciousness" (p. 269). Dissociative mechanisms have also been implicated in a variety of psychiatric disorders, including posttraumatic stress disorder (Brende, 1986; D. Spiegel, 1984,1989; D. Spiegel, Hunt, & Dondershine, 1988), obsessive-compulsive disorder (Ross & Anderson, 1988), and eating disorders (Molteni, 1990; S. Sanders, 1986; Torem, 1986; Vanderlinden & Vandereycken, 1988). In attempting to understand the genesis of dissociative disorders, investigators have converged on traumatic events as important antecedents of dissociative symptomatology. For Janet, dissociation was "the crucial psychological process with which the organism reacts to overwhelming trauma" (van der Kolk & van der Hart, 1989, p. 1523). True to Janet, contemporary theorists have hypothesized that dissociation is a normal defensive process used to cope with traumatic experiences (Beahrs, 1990; This research was conducted in partial fulfillment of the requirements of a master of science degree by David A. Sandberg at Ohio University. The research was supervised by Steven J. Lynn. We thank Bruce W Carlson and John P. Garske for their valuable contribution to this research. We also thank Kimberly A. Hanson, Steven A. Kvaal, Harry J. Sivec, and Cheryl K. Yatsko for their help in interviewing subjects. Correspondence concerning this article should be addressed to Steven Jay Lynn, Department of Psychology, Ohio University, Athens, Ohio 45701. 717
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
718
DAVID A. SANDBERG AND STEVEN JAY LYNN
Central to this adaptive concept of dissociation is the notion that dissociative experiences range on a continuum (Bernstein & Putnam, 1986; Braun, 1989; Hilgard, 1977; Nemiah, 1980; Price, 1987; Putnam, 1989; B. Sanders & Giolas, 1991; H. Spiegel, 1963; Taylor & Martin, 1944) from common everyday dissociations, such as daydreaming, to incapacitating dissociations related to severe psychopathology, such as MPD. Support for the existence of a dissociative continuum derives from studies with the Dissociative Experiences Scale (DBS; Bernstein & Putnam, 1986; Putnam, 1989), the most thoroughly validated index of dissociative experiences. With a possible range of scores from 0 to 100, the median DES score for a group of MPD patients was 57.06, whereas scores for schizophrenics, phobics, and normal adults were 20.63, 6.04, and 4.38, respectively (Bernstein & Putnam, 1986). If dissociative experiences range on a continuum from normal everyday experiences to severe pathology, then it can be argued that less debilitating or extensive dissociative experiences may be associated with less severe or longstanding abuse (e.g., being hit with a belt on occasion as a form of punishment or a single occurrence of sexual fondling in childhood). Although workers in the field (Ross, Anderson, Heber, & Norton, 1990; B. Sanders & Giolas, 1991; B. Sanders, McRoberts, & Tollefson, 1989) have attempted to ascertain whether the relation between dissociation and child maltreatment is evident with respect to less severe or debilitating forms of dissociative experiences, a definitive answer to this question has not been forthcoming. Only a handful of studies (Briere & Runtz, 1988a, 1988b; Norton, Ross, & Novotny, 1990; Ross, Joshi, & Currie, 1990, 1991; Ross, Ryan, Anderson, Ross, & Hardy, 1989; B. Sanders et al., 1989) have examined less severe, more mundane forms of dissociation to provide normative information about dissociative experiences and their correlates in the general population and nonclinical samples. With respect to college samples, B. Sanders et al. (1989) and Briere and Runtz (1988a) have reported a relation between dissociation scores and retrospective self-reports of physical and psychological maltreatment in childhood. Similarly, Briere and Runtz (1988b) documented a relation between college sample dissociation scores and childhood sexual abuse variables. Because dissociation was not the focus of Briere and Runtz's (1988a, 1988b) research, they did not use a well-validated measure of dissociation. Furthermore, the single study (B. Sanders et al., 1989) that used the DES to examine the relation between dissociation and childhood abuse in a college population did not examine the relation between dissociation and sexual abuse independent of physical abuse. With the exception of B. Sanders et al.'s research, the particular focus has not been on subjects with high dissociation scores in the college population. Our research was designed to elaborate the construct of dissociation in the college student population. One aim of the our research was to address the question of whether college students selected for high scores on a well-validated measure of dissociation (DES) would report more instances of childhood and adolescent psychological and physical maltreatment, including sexual victimization, than a comparison sample of subjects who scored in the low-to-mid range of the scale. There also is a need to secure data relevant to the question of whether dissociation is related to symptomatology and malad-
justment in nonclinical samples. Only one study (Norton et al., 1990) examined the relation between psychopathology and dissociation in a college population. However, this research did not determine whether subjects who scored high on the DES were at particular risk for psychopathology. Therefore, a second aim of our research was to address the question of whether persons who scored at the extreme (upper 15%) of the distribution of dissociative experiences, as measured by the DES, would report being less well adjusted to college and would report greater symptomatology than would persons who scored in the low-to-mid range of the distribution of dissociative experiences. A final aim of our research was to examine the DES's utility in screening college students for dissociative disorders. Ross, Joshi, and Currie (1990) noted that an important question is, "When are dissociative experiences pathological?" (p. 1552). They further noted that the DES alone cannot provide a definitive answer to this question and that what is required is a diagnostic interview, such as the Dissociative Disorders Interview Schedule (DDIS; Ross, Heber, et al., 1989). Because data on the prevalence of dissociative disorders in the college population is lacking, subjects in the high and moderate-low ranges of the DES were administered a structured dissociation interview based on the DDIS. It was hypothesized that differences would be found in the number of subjects assigned a dissociative disorder diagnosis and that a greater number of subjects who scored high on the DES would receive the dissociative disorder diagnosis. Method Subjects Six hundred fifty male and female undergraduate students were administered the DES (Bernstein & Putnam, 1986) over the course of two academic quarters (DES score, M = 12.10, SD =8.81, for the total sample). On the basis of DES scores, 110 women who scored in the upper 15% (high-DES group; score > 20; DES score, M = 33.21, SD = 9.98, 96th percentile of the population) or below the sample mean (control group; score < 12; DES score, M = 5.95, SD = 2.69, 31st percentile of the population) were contacted by telephone and invited to participate in this study in exchange for extra course credit or for $5.00. Of these subjects, 66 were willing to participate (high-DES,« = 33, and control, n = 33). The mean DES scores of those who volunteered versus those who refused to participate were not significantly different, highDES, t(62) = -1.19, ns, and control, t(62) = 0.61, ns. Given financial and time constraints, only female subjects were contacted to participate in the research. Because we were particularly interested in examining the relation between dissociation and several forms of maltreatment, including sexual victimization, and because female college students are almost twice as likely as male college students to report sexual victimization (Finkelhor, 1979; Koss & Oros, 1982; Salter, 1988), we focused our efforts toward women.
Dissociation Measures Dissociative Experiences Scale. The DES is a 28-item, self-administered questionnaire that measures the extent of dissociative experiences and symptomatology in both normal and clinical populations. Respondents are asked to make slashes on 100-mm lines to indicate how frequently (in percentage of time) they experience the feelings or behavior described by each of the items. The mean of all item scores
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DISSOCIATION ranges from 0 to 100 and constitutes the DES score (Bernstein & Putnam, 1986). The DES has high test-retest reliability (Pearson r = .84) and good criterion-referenced and construct validity (Bernstein & Putnam, 1986; Ensink & van Otterloo, 1989; Frischholz et al., 1990; Ross, Norton, & Anderson, 1988). Dissociation interview. This 15- to 20-min structured interview consisted of sections of the DDIS (Ross, Heber et al., 1989) pertinent to making a diagnosis of a dissociative disorder on the basis of DSM-III criteria (American Psychiatric Association, 1980). The DDIS focuses primarily on the dissociative disorders. It has an overall interrater reliability (kappa) of .68 and a specificity of 100% and a sensitivity of 90% for the diagnosis of MPD (Ross, Heber et al, 1989). The sections of the DDIS used to create the dissociation interview for this study were: Psychiatric History, Features Associated With Multiple Personality Disorder, Psychogenic Amnesia, Psychogenic Fugue, Depersonalization Disorder, Multiple Personality Disorder (NIMH research criteria, which consists of DSM-III criteria plus two further criteria), and Atypical Dissociative Disorder. Subjects' responses to each question are coded as yes, no, or unsure. Criteria for diagnoses of psychogenic amnesia, psychogenic fugue, depersonalization disorder, and multiple personality disorder correspond to the DSM-III.
Measures of Psychopathology and Adjustment Symptom Checklist (SCL-90; Derogatis, 1983; Derogatis, Lipman, & Covi, 1973). The SCL-90 is a 90-item, self-report clinical rating scale designed to measure current psychiatric symptomatology. The scale comprises 9 subscales: Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism. The SCL-90 also provides three global indices of psychopathology, including a Global Severity Index that combines information about the number and intensity of symptoms experienced. Each of the items are rated on a 5-point scale of distress that ranges from not at all (0) to extremely (4). The SCL-90 has high degrees of test-retest reliability and internal consistency and good concurrent, discriminative, and construct validity (Derogatis, 1983; Derogatis et al, 1973). College adjustment. The Student Adaptation to College Questionnaire (SACQ; Baker & Siryk, 1989) is a 67-item measure designed to assess how well students adapt to the demands of their college experience. Students are asked to rank their level of adjustment for each of the items on a 9-point scale that ranges from applies very closely tome(\)\o doesn't apply to me at all (9). The four subscales include Academic Adjustment, Social Adjustment, Personal-Emotional Adjustment, and Institutional Attachment. Consideration of all items yields a full scale score. The SACQ has good internal consistency, reliability, and criterion-related validity (Baker & Siryk, 1989). Cronbach's alpha values range from .77 for the Personal-Emotional Adjustment subscale to .95 for the full scale score (Baker & Siryk, 1989).
Maltreatment and Victimization Measures Psychological and physical maltreatment scales. These scales were adapted from Briere and Runtz's (1988a) Family Experiences Questionnaire. The psychological maltreatment scale consists of 7 items about experiences that reflect psychological maltreatment, whereas the 5-item physical maltreatment scale items reflect actual physical behaviors. For both scales, subjects report the frequency of occurrence for each of the items separately for both maternal and paternal behaviors. The response format of both scales allows subjects to indicate frequency on a 7-point scale that ranges from never (0) to more than 20 times a year (6). The scales have acceptable internal consistency (for physical maltreatment, a = .75, and for psychological maltreatment,
a = .87) and are sensitive to symptomatology in college students (Briere & Runtz, 1988a). Childhood sexual victimization questionnaire. Questions intended to measure the degree of sexual victimization during childhood before the age of 15 were adapted from Finkelhor (1979). First, subjects respond to a series of increasingly involved yes-no questions about sexual experiences. Second, follow-up questions are presented in order to gather more specific information about subjects' most severe sexual victimization experience. For the purpose of this study, childhood sexual victimization was defined as any sexual contact (fondling to intercourse) experienced before the age of 15 and initiated by an individual 5 or more years the subject's senior. Adolescent sexual experiences questionnaire. Questions intended to assess whether subjects were sexually victimized in adolescence were adapted from the Sexual Experiences Survey (Koss & Oros, 1982). A series of yes-no questions were ordered in approximate ascending order on the basis of severity of victimization. For this study, sexual victimization was defined as any unwanted sexual contact (fondling to intercourse) after age 15.
Social Desirability Measure The Marlowe-Crowne Social Desirability Scale (MCSDS; Crowne & Marlowe, 1960) is a 33-item measure designed to assess the degree to which subjects respond in culturally sanctioned ways.
Procedure The subjects were contacted by telephone and were invited to participate in research that was conducted as part of a master's thesis project. They were offered either extra course credit or $5.00 for their participation in the project. The average time from the initial DES testing to this contact was 9 weeks. At the first session, informed consent was obtained, and the subjects were assured of confidentiality. The subjects received a large manila envelope that contained the SCL-90, the SACQ, the four maltreatment and victimization measures, and the MCSDS. Each envelope had a 4-digit identification number written in the upper right corner to ensure anonymity. After subjects filled out the questionnaires, they inserted their envelopes into a box placed at the front of the room. In the second session, the dissociation interview was administered. The interviews were conducted by David A. Sandberg and four clinical psychology graduate students who had been trained by Sandberg. The interviewers were naive with respect to subjects' DES scores. The interviewer assured each subject that he or she was unaware of how the subject responded to the initial questionnaires. The interviewer also explained that the interview would be audiorecorded and that in order to protect confidentiality he or she would not address the subject by name. Subject identification numbers were placed on each cassette tape. At the conclusion of the experiment, subjects were debriefed. The interviewer addressed each subject's concerns and presented a debriefing form that was reviewed orally. To protect subjects' welfare (in that we had hypothesized that some subjects would meet diagnostic criteria for a mental disorder), the form included a list of campus and community mental health agencies for further contact or information. The interviewer also encouraged the subject to contact the project director or the interviewer (contact information presented in writing) if she had any questions or concerns in the future.
Results Preliminary Analyses A preliminary analysis revealed no significant differences between high-DBS and control subject groups on the MCSDS,
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DAVID A. SANDBERG AND STEVEN JAY LYNN
f(64) = -1.45, ns (high-DES, M= 15.03, SD = 3.98, and control, M = 16.55, SD = 4.49). Analyses of variance (ANOVAs) performed for all continuous variables failed to secure significant differences between subjects who were paid and subjects who received academic credit; log-linear analyses performed for all discrete variables also failed to yield significant differences. The data were therefore collapsed across these variables.
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Major Findings Maltreatment. A Hotelling's T2 was performed for the four continuous maltreatment measures (mother and father psychological and physical maltreatment). The multivariate analysis was found to be significant, F(4,60) = 3.30, p < .05. Univariate analyses revealed that all four types of maltreatment were significantly related to DES scores. The means and standard deviations are given in Table 1. Sexual victimization. Separate chi-square tests were computed for child and adolescent sexual victimization. Neither analysis achieved significance, x 2 0, N = 66) = 1.06, ns, for child victimization (n = 3 high-DES subjects, and n = \ control subject) and x20, N = 66) = 0.55, ns, for adolescent victimization (n = 15 high-DES subjects, and n = 18 control subjects). An additional chi-square test was performed for adolescent sexual victimization (intercourse or penetration) with threatened or actual physical force. Because approximately 32% of the total sample reported some type of adolescent sexual victimization, we thought that a more stringent criterion for victimization might be differentially related to DES scores. Although frequencies were in the expected direction (8 high-DES subjects and 3 control subjects reported such victimization), a chisquare analysis was not found to be significant, x 2 0> N= 66) = 2.73, ns. Discriminant function analysis. To determine the best linear combination of maltreatment variables in predicting DES group membership, we performed a stepwise discriminant function analysis. Predictor variables included mother and father psychological and physical maltreatment, child sexual victimization, adolescent sexual victimization, and adolescent sexual victimization with threatened or actual physical force. Univariate analyses revealed that mother and father psychological and physical maltreatment and adolescent sexual victimization
Table 1 Maltreatment Scores for High-DES and Control Groups Control (n = 32)
High-DES (n = 33) Maltreatment Psychological Mother Father Physical Mother Father
M
SD
M
SD
(1,63)
15.67 17.03
10.17 13.08
9.30 8.00
8.68 7.25
6.91* 11.75**
3.06 3.27
3.92 4.76
1.36 1.38
1.88 1.84
4.64* 4.44*
Note. DES = Dissociative Experiences Scale. Multivariate F (4, 60) = 3.30, p < .05. *p
