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UIUC PSYC 336 - document

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Temperament, Character, and Dissociation AmongDetoxified Male Inpatients With Alcohol DependencymCuneyt EvrenBakirkoy State Hospital for Psychiatric and NeurologicalDiseases, IstanbulmVedat SarIstanbul UniversitymErcan DalbudakBakirkoy State Hospital for Psychiatric and Neur ologicalDiseases, IstanbulThe aim of this study was to determine possible relationships ofpathological dissociation with temperament, character, and concur-rent psychopathological features in a consecutive series of malealcohol-dependent patients. Fifty-eight patients with pathologicaldissociation were compared with 118 nondissociative patientsclassified by dissociative taxon membership. Beside higher scoreson anxiety, depression, and alcoholism scales, a larger proportion ofdissociative group reported childhood abuse, suicide attempts, andself-mutilation than did the nondissociative group. They also hadhigher scores of novelty seeking and harm avoidance, but lowerscores of persistence, self-directedness, and cooperativeness. Traitanxiety, depression, and severity of alcoholism predicted dissociativeexperiences; however, none of the temperament or charactermeasures did. Rather than being a derivative of temperament orcharacter features, dissociative experiences of male alcohol-depen-dent patients are associated with overall concurrent psychopathology.& 2008 Wiley Periodicals, Inc. J Clin Psychol 64:717–727, 2008.Keywords: alcohol abuse; anxiety; character; depression; dissocia-tion; temperamentCorrespondence concerning this article should be addressed to: Cuneyt Evren, Icadiye Cad. Mentes Sok,Selcuk Apt. 1/17 Kuzguncuk, 34674 Uskudar, Istanbul, Turkey; e-mail: [email protected] OF CLINICAL PSYCHOLOGY, Vol. 64(6), 717--727 (2008) & 2008 Wiley Periodicals, Inc.Published online in Wiley InterScience (www.interscience.wiley.com). DO I: 10.1002/jclp.20485IntroductionDissociative 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), postt raumatic stress disorder (Brie re, Scott, & Weathers,2005), acute stress disorder (Spiegel, Classen, & Cardena, 2000), eating disorders(Farrington, Waller, Neiderman, Sutton, Chopping, & Lask, 2002), pathologicalgambling (Grant & Kim, 2003), kleptomania (Grant, 2004), and even schizophrenia(Ross & Keyes, 2004). A somatoform type of dissociation is proposed to be theunderlying mechanism of medically unexplained symptoms; i.e., conversionsymptoms (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 significantsubgroup of patients wi th alcohol and/or drug use have comorbid dissociativedisorders influencing treatment outcome (Karadag , Sar, Tamar-Gurol, Evren,Karagoz, & Erkiran, 2005). Namely, alcohol-dependent inpatien ts with adissociative disorder have somatization disorder, borderline personality disorder,and lifetime major depression more frequently than those without a dissociativedisorder (Evren, Sar, Karadag, Tamar-Gurol, & Karagoz, 2007).Subjects with dissociative disorders report childhood traumas frequentlyboth in clinical settings (Tutkun, Sar, Yargic, Ozpula t, Yanik, & Kiziltan, 1998)and in the general population (Sar, Akyuz, & Dogan, 2007). They constitutethe group with the highest rates of childhood trauma among all psychiatricpopulations. Dissociative disorders are increasingly considered as a chronic complexposttraumatic psychopathology closely related to childhood abuse and/orneglect (Putnam, 1997). There are also reports that alcohol-dependent patients haveelevated rates of childhood adversities (Evren, Kural, & Cakmak, 2006). Althoughpreliminary studies are not supportive of a hypothesis for dissociative disordersbased 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 originallydesigned to explore genetic and environmental factors underlying normal andabnormal personality dimensions (Cloninger, 1987). The four temperamentdimensions measured in Cloninger’s personality model (novelty seeking, harmavoidance, reward dependency, persistence) are assumed to be highly heritableand to be underlined by specific neurotransmission systems (Cloninger, 1987;Gourion, Pelissolo, & Lepine, 2003). The three character dimensions (self-directedness, self-transcendence, cooperativeness) are considered to be morereadily influenced by environmental factors. Therefore, they are less stable overtime (Basiaux et al., 2001). To prevent potential interference with the resultsof the study, we also assessed concurrent depression, anxiety, and overallseverity of alcohol dependency and entered them in multivariate statisticalevaluation.The origin of dissociative experiences among alcohol-dependent patients isunknown. An environmental fact or such as childhood trauma has been consideredas 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 (Langel and, Draijer, &718 Journal of Clinical Psychology, June 2008Journal of Clinical Psychology DOI: 10.1002/jclpvan den Brink, 2002). The aim of this study was to inquire into possible relationshipsof genetic (temperament), environmental (character), and situational (concurrentpsychopathology) factors with pathological dissociation among male pa tients withalcohol dependency.MethodParticipants and ProceduresThe study was conducted in Bakirkoy State Hospital for Psychiatric andNeurological Diseases, Alcohol and Drug Rese arch, Treatment and Training Center(AMATEM) in Istanbul between December 2005 and July 2006. AMATEM is a100-bed center that specializes in inpatient treatment of substance use disorders;referrals are made to AMATEM from all over the country. The hospital’s EthicalCommittee approved the study. Patients’ written informed consent was obtainedafter the study protocol was thoroughly explained. Interviews with the study groupwere conducted after a detoxification period. That was 4–6 weeks after the last day ofalcohol


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