Dissociative

Symptoms Physical

Studies

in people whether

have

reported

with

psychiatric

dissociative

with

histories

inpatients

cused

on

A. Chu,

rates

of childhood

illness.

symptoms

ofabuse.

This are

self-report

childhood

history

abuse.

symptom

of

adults,

and

score

Eighty-three

scores of

24%

patients

Subjects

with

above

the

had

scores

with

female

psychiatric

percent

had

median

score

Sixtyand/or

dissociative

at or above

of

normal

the

median

stress

symptoms

fo-

dissociative

in general. physical

of childhood

higher levels of dissociative did not. (Am J Psychiatry 1990;

that

trauma,

posttraumatic

a history

examined

instruments

disorder.

abuse than

reported those

who

147:887-892)

R

esearch statistics have revealed an astonishing incidence of trauma, including childhood physical and sexual abuse, in the histories of both psychiatric patients (1-9) and the general population (10-12). The deleterious effects of childhood abusive expeniences on growth and development have been welt documented and are associated with a variety of later psychiatnic difficulties, including depression, anxiety, affect dysregulation, identity disturbance, social isolation, self-destructive behavior, alcohol and drug abuse, eating disorders, and various physiological changes (920). Although many different psychiatric symptoms have been associated with childhood abuse, several authors

Presented Psychiatric

in part at the 142nd annual meeting of the Association, San Francisco, May 6-1 1, 1989. 1989; revisions received Oct. 25 and Nov. 28,

June 27, cepted Dec.

21, 1989.

From

McLean

of Psychiatry, quests to Dr. 02178. The authors

Harvard Medical School, Chu, McLean Hospital,

R.N.,

Brain,

Patricia

thank

Salvatrice

Mary

Hospital Boston. I 15 Mill

Bellina,

Margaret

R.N.,

Camaredese,

men, Gibbs, Marie

J

Psychiatry

1 47: 7, July

1990

to Childhood

Abuse

L. Dill,

Ed.D.

have linked abuse experiences specifically with the development of dissociative disorders (19, 21-23). For example, Putnam et at. (23) found that 97% of 100 patients with multiple personality disorder had histonies of childhood abuse. Dissociative defenses in generat seem to be used in the presence of a psychological need to escape overwhelming experiences such as trauma and abuse. Painful events can be made less intense through dissociative alterations in perceptions (depersonalization and deneatization), can be “forgotten” (psychogenic amnesia), on can even be completely disowned as “someone else’s” experience (multiple personalities). As Freud (24) noted in his discussions of the repetition compulsion, repressed and dissociated experiences do not remain dormant; instead, they are reexpenienced in the form of dreams and nightmares, flashbacks, and the flooding of feelings and sensations related to the original experiences. Thus, many patients who have used dissociation to cope with traumatic experiences have a constellation of symptoms that indude reexpeniencing phenomena as well as dissociative defenses. In this study, both are defined as dissociative symptoms. We tested the hypothesis that dissociative symptoms are markedly more prevalent in adult female inpatients who were abused as children than in patients who were not abused. We studied 98 female inpatients to 1) replicate previous reports on the high prevalence of abuse histories in inpatients (5-7, 9), 2) estimate the prevalence of dissociative symptoms, and 3) examine whether dissociative symptoms occur more often in patients with histories of abuse than in patients without histories of abuse.

American

Received 1989;

ac-

METHOD

and the Department Address reprint reSt., Belmont, MA Elizabeth

R.N.,

Benham,

Anne

Cra-

R.N., Meredith Curley, R.N., Federico D’Amore, Nancy RN., Elizabeth Hatch, R.N., Donna Holohan, RN., Ann McCarthy, R.N., Jane Millikan, Carol Niziolek, R.N., Helen O’Reilly, Sandra Peterson, R.N., and Melissa Weintraub for their assistance. Copyright © 1990 American Psychiatric Association.

Am

Sexual

and Diana

abuse

to patients

Ninety-eight

completed

study

M.D.,

specific

symptoms, and psychiatric symptoms three percent of the subjects reported

sexual

and

James

high

in Relation

The target study group for this survey included female inpatients 1 8-60 years old who were consecutivety admitted to alt units of a psychiatric teaching hospital, excluding admissions to the chemical dependency unit. Of 188 patients admitted, 32 were discharged before they could be asked to participate. The remaining 156 were asked to participate in a survey of “current symptoms and past life experiences, including possible experiences of abuse.” One hundred three

887

DISSOCIATIVE

SYMPTOMS

AND CHILDHOOD

ABUSE

(66%) agreed to participate, 18 (12%) were judged not competent to participate, and 35 (22%) refused to participate. When reasons were offered for refusing, several patients indicated that they would find reviewing their pasts uncomfortable, which is suggestive of abuse. Of the 103 participants, data for five were incomplete and were therefore dropped from the anatysis, leaving 98 subjects. The subjects’ mean±SD age was 34±10.5 years. Nearly alt (N=93) were white. Fifty-one had never married, 25 were married, and 22 were separated, divonced, or widowed. They had a mean of 14.7±2.1 years of education. Forty-four were employed. Subjects who agreed to participate did not differ significantly from those who refused in age (t=O.76, df 136, n.s.) on number of previous hospitalizations (t 0.30, df= 108, n.s.). Also, subjects who participated did not differ diagnostically from those who refused, except that a greater proportion of those who refused had schizophrenia or schizoaffective disorder (continuity-corrected 221.2S, dfl, p