UIUC PSYC 336 - document (12 pages)

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University of Illinois at Urbana, Champaign
Course:
Psyc 336 - Topics in Clin/Comm Psych
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Temperament Character and Dissociation Among Detoxified Male Inpatients With Alcohol Dependency m Cuneyt Evren Bakirkoy State Hospital for Psychiatric and Neurological Diseases Istanbul m Vedat Sar Istanbul University m Ercan Dalbudak Bakirkoy State Hospital for Psychiatric and Neurological Diseases Istanbul The aim of this study was to determine possible relationships of pathological dissociation with temperament character and concurrent psychopathological features in a consecutive series of male alcohol dependent patients Fifty eight patients with pathological dissociation were compared with 118 nondissociative patients classified by dissociative taxon membership Beside higher scores on anxiety depression and alcoholism scales a larger proportion of dissociative group reported childhood abuse suicide attempts and self mutilation than did the nondissociative group They also had higher scores of novelty seeking and harm avoidance but lower scores of persistence self directedness and cooperativeness Trait anxiety depression and severity of alcoholism predicted dissociative experiences however none of the temperament or character measures did Rather than being a derivative of temperament or character features dissociative experiences of male alcohol dependent patients are associated with overall concurrent psychopathology 2008 Wiley Periodicals Inc J Clin Psychol 64 717 727 2008 Keywords alcohol abuse anxiety character depression dissociation temperament Correspondence concerning this article should be addressed to Cuneyt Evren Icadiye Cad Mentes Sok Selcuk Apt 1 17 Kuzguncuk 34674 Uskudar Istanbul Turkey e mail cuneytevren yahoo com JOURNAL OF CLINICAL PSYCHOLOGY Vol 64 6 717 727 2008 2008 Wiley Periodicals Inc Published online in Wiley InterScience www interscience wiley com DOI 10 1002 jclp 20485 718 Journal of Clinical Psychology June 2008 Introduction Dissociative symptoms and disorders may accompany several psychiatric disorders Sar Ross 2006 including borderline personality disorder Sar et al 2003 Sar Akyuz Kugu Ozturk Ertem Vehid 2006 obsessive compulsive disorder Lochner et al 2004 posttraumatic stress disorder Briere Scott Weathers 2005 acute stress disorder Spiegel Classen Cardena 2000 eating disorders Farrington Waller Neiderman Sutton Chopping Lask 2002 pathological gambling Grant Kim 2003 kleptomania Grant 2004 and even schizophrenia Ross Keyes 2004 A somatoform type of dissociation is proposed to be the underlying mechanism of medically unexplained symptoms i e conversion symptoms e g pseudoseizures psychogenic pain and somatization disorder Nijenhuis Spinhoven Van Dyck Van der Hart Vanderlinden 1996 Sar Akyuz Kundakci Kiziltan Dogan 2004 There are also reports that a signi cant subgroup of patients with alcohol and or drug use have comorbid dissociative disorders in uencing treatment outcome Karadag Sar Tamar Gurol Evren Karagoz Erkiran 2005 Namely alcohol dependent inpatients with a dissociative disorder have somatization disorder borderline personality disorder and lifetime major depression more frequently than those without a dissociative disorder Evren Sar Karadag Tamar Gurol Karagoz 2007 Subjects with dissociative disorders report childhood traumas frequently both in clinical settings Tutkun Sar Yargic Ozpulat Yanik Kiziltan 1998 and in the general population Sar Akyuz Dogan 2007 They constitute the group with the highest rates of childhood trauma among all psychiatric populations Dissociative disorders are increasingly considered as a chronic complex posttraumatic psychopathology closely related to childhood abuse and or neglect Putnam 1997 There are also reports that alcohol dependent patients have elevated rates of childhood adversities Evren Kural Cakmak 2006 Although preliminary studies are not supportive of a hypothesis for dissociative disorders based on genetics Grabe Spitzer Juergen Freyberger 1999 Lochner et al 2004 there are reports supporting genetic determinants of alcohol dependency Enoch Goldman 2001 In the present study we administered a measure to all patients originally designed to explore genetic and environmental factors underlying normal and abnormal personality dimensions Cloninger 1987 The four temperament dimensions measured in Cloninger s personality model novelty seeking harm avoidance reward dependency persistence are assumed to be highly heritable and to be underlined by speci c neurotransmission systems Cloninger 1987 Gourion Pelissolo Lepine 2003 The three character dimensions selfdirectedness self transcendence cooperativeness are considered to be more readily in uenced by environmental factors Therefore they are less stable over time Basiaux et al 2001 To prevent potential interference with the results of the study we also assessed concurrent depression anxiety and overall severity of alcohol dependency and entered them in multivariate statistical evaluation The origin of dissociative experiences among alcohol dependent patients is unknown An environmental factor such as childhood trauma has been considered as relevant to this phenomenon Schaefer et al 2007 On the other hand dissociation itself is considered a possible factor leading to substance dependency or in turn it may be a chemical result of ongoing substance use Langeland Draijer Journal of Clinical Psychology DOI 10 1002 jclp Detoxi ed Male Inpatients With Alcohol Dependency 719 van den Brink 2002 The aim of this study was to inquire into possible relationships of genetic temperament environmental character and situational concurrent psychopathology factors with pathological dissociation among male patients with alcohol dependency Method Participants and Procedures The study was conducted in Bakirkoy State Hospital for Psychiatric and Neurological Diseases Alcohol and Drug Research Treatment and Training Center AMATEM in Istanbul between December 2005 and July 2006 AMATEM is a 100 bed center that specializes in inpatient treatment of substance use disorders referrals are made to AMATEM from all over the country The hospital s Ethical Committee approved the study Patients written informed consent was obtained after the study protocol was thoroughly explained Interviews with the study group were conducted after a detoxi cation period That was 4 6 weeks after the last day of alcohol use Two hundred consecutively admitted alcohol dependent inpatients without a history of any other substance abuse were considered for participation in the study All participants t the


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