Factor structure and correlates of the dissociative experiences scale in a large offender sample

The authors examined the psychometric properties, factor structure, and construct validity of the Dissociative Experiences Scale (DES) in a large offender sample (N = 1,515). Although the DES is widely used with community and clinical samples, minimal work has examined offender samples. Participants were administered self-report and interview measures, and a subsample was followed longitudinally to determine criminal and violent recidivism. The DES exhibited good psychometric properties, but an identified three-factor structure was of questionable replicability. Moreover, the DES factors displayed no evidence of differential correlates. DES total scores were correlated with trauma-related variables even after controlling for negative affectivity. Total scores were related to measures of antisocial behavior and aggression but did not predict recidivism. These findings support the reliability and construct validity of the DES in offenders but raise questions regarding the clinical utility of the DES factor scores above and beyond that of the total score.     

MAPI code types in an inpatient crisis-unit sample

Limited data is available concerning the use of the Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982) and high-point code combinations of its personality style scales. Our study reports on the frequency of high-point codes in an inpatient crisis-unit sample. Data analyses comparing personality style codes using MAPI expressed concerns scale elevations and Rorschach data are reported. Results comparing the personality style codes and expressed concerns scales were consistent with the findings of Millon et al. (1982). Analyses comparing Rorschach and MAPI data revealed only the presence or absence of vista responses as having any appreciable relationship to MAPI codes or personality scales.     

Symptom overreporting and dissociative experiences: A qualitative review

We discuss a phenomenon that has received little attention to date in research on dissociative phenomena, namely that self-reports of these phenomena overlap with the tendency to overendorse eccentric items. We review the literature documenting the dissociation-overreporting link and then briefly discuss various interpretations of this link: (1) overreporting is an artifact of measuring dissociative symptoms; (2) dissociative psychopathology engenders overreporting of eccentric symptoms through fantasy proneness or impairments in internal monitoring; (3) an overreporting response style as is evident in malingerers, for example, promotes reports of dissociative symptoms. These three interpretations are not mutually exclusive. Also, the dissociation-overreporting link may have different origins among different samples. Because overreporting may introduce noise in datasets, we need more research specifically aimed at disentangling the dissociation-overreporting link. We suggest various avenues to accomplish this goal.     

Confirmatory factor analysis of single- and multiple-factor competing models of the dissociative experiences scale in a nonclinical sample

Previous research on the Dissociative Experiences Scale (DES) has demonstrated that (a) dissociation is quantifiable in both clinical and nonclinical samples and (b) a three-factor structure (amnesia, depersonalization, and absorption) is tenable for clinical samples. The factor structurefor nonclinical samples is less clear, with one- and multiple-factor solutions proposed. To clarify the DESfactor structure in nonclinical samples, confirmatory factor analyses were conducted on (a) one-, two-, three-, and four-factorfirst-order models and (b) two bifactor (hierarchical) models of DES scoresfor two samples of nonclinical university students. Results of delta(chi2) and goodness-of-fit indices support the three-factor (first-order) model as bestfitting of the datafor these samples. The utility of this DES model for screening both dissociative pathology and elevated normal dissociative behavior in clinical and nonclinical populations is discussed.     

MMPI-A structural summary variables: prevalence and correlates in an adolescent inpatient psychiatric sample

This study examined the prevalence and correlates of Archer and Krishnamurthy's MMPI-A Structural Summary (SS) dimensions in a sample of 632 adolescent psychiatric inpatients through a series of correlational analyses. These analyses examined the relationship between factor dimensions and categorically defined dimension elevations and external criterion measures that included chart review data, therapist ratings, chart diagnoses, and cognitive test performance. The SS dimensions provided additional interpretive yield for some within-normal-limits profiles. An examination of the pattern of correlations revealed small to moderate relationships between all SS variables and external criterion measures.     

Adolescent depression and externalizing problems: testing two models of comorbidity in an inpatient sample

Differentiating between additive (quantitative) and interactive (qualitative) effects of comorbidity has important treatment implications. This study illustrates the heuristic superiority of a multifactorial approach over simple group comparisons in testing quantitative versus qualitative models of comorbidity. Analysis of variance was used to compare 266 adolescent inpatients identified as depressed, externalizing, both, or neither on self-report measures of personality, school problems, and substance abuse. The results support quantitative rather than qualitative models of comorbidity. Depressed status related most strongly to group differences in interpersonal and self-critical concerns. Externalizing status related most strongly to group differences in school problems and drug use. Main effects for the two statuses together explained especially elevated levels of reactance and alcohol abuse among the comorbid adolescents.     

Field reliability of comprehensive system scoring in an adolescent inpatient sample

The extent to which the Comprehensive System for the Rorschach is reliably scored has been a topic of some controversy. Although several studies have concluded it can be scored reliably in research settings, little is known about its reliability in field settings. This study evaluated the reliability of both response-level codes and protocol-level scores among 84 adolescent psychiatric inpatients in a clinical setting. Rorschachs were originally administered and scored for clinical purposes. Among response codes, 87% demonstrated acceptable reliability(> .60), and most coefficients exceeded .80. Results were similar for protocol-level scores, with only one score demonstrating less than adequate reliability. The findings are consistent with previous evidence, indicating reliable scoring is possible even in field settings.     

A comparison of two mental status examinations in an inpatient psychiatric sample

This study compares the psychometric properties and clinical use of the Mini-Mental Status Exam (MMSE) and the Modified MMSE (3MS) in patients admitted to an acute medical-psychiatric inpatient unit. Internal consistencies were .56 for the estimated MMSE and .72 for the 3MS. Regression analyses revealed that the 3MS was a significant predictor of both length of hospital stay (LOS) and the need for additional services postdischarge. Regressions were also used to evaluate the contribution of the four new items contained in the 3MS: Word Generation, Similarities, Second Recall, and Date and Place of Birth. The 3MS was a significant predictor of LOS and the need for discharge services, whereas the MMSE did not contribute to any regression model. Word Generation was found to be a significant predictor of patients' needing posthospital services. Results support prior findings of the 3MS's superiority over the (estimated) MMSE and help to demonstrate the continued importance of cognitive screening in psychiatric samples.     

Dissociation and memory fragmentation in post-traumatic stress disorder: an evaluation of the dissociative encoding hypothesis

Several prominent theories of post-traumatic stress disorder (PTSD) posit that peritraumatic dissociation results in insufficient encoding of the trauma memory and that persistent dissociation prevents memory elaboration, resulting in memory fragmentation and PTSD. In this review we summarise the empirical literature on peritraumatic and trait dissociation and trauma narrative fragmentation as measured by meta-memory and rater/objective coding. Across 16 studies to date, the association between dissociation and fragmentation was most prominent when examining peritraumatic dissociation and patient's own ratings of memory fragmentation. This relationship did not hold when examining trait dissociation or rater-coded or computer-generated measures of fragmentation. Thus initial evidence points more towards a strong self-reported association between constructs that is not supported on more objective fragmentation coding. Measurement overlap, construct ambiguity, and exclusion of potential confounds may underlie lack of a strong association between dissociation and objective-rated fragmentation.     

An evaluation of the incremental validity of the MMPI-2 Superlative (S) scale in an inpatient psychiatric sample

The MMPI-2 Superlative (S) scale was developed by Butcher and Han (1995) to assess individuals' tendencies to present themselves in an unrealistically positive light. The current study examined the performance of the L, K, and S scales in accurately distinguishing the MMPI-2 profiles of 379 psychiatric inpatients who produced one or more elevations on the basic scale profiles, from 82 psychiatric inpatients who produced no clinical range elevation on any of the eight basic clinical scales (excluding scales 5 and 0). The findings from the present study indicate that the S scale appears to be effective in the identification of defensiveness among psychiatric inpatients, with mean effect sizes in the moderate to large range. The optimal T-score cutoff for identifying defensive responders was 70 for both men and women. Further, results of hierarchical regression analyses showed that the S scale added incrementally to the prediction levels achieved by the optimal combination of the L and K scales.     

Measuring dissociation: comparison of alternative forms of the dissociative experiences scale

The dissociative experiences scale (DES), developed by Bernstein and Putnam (1986), is commonly used to measure dissociation in clinical populations. It is often used with nonclinical populations to assess how levels of dissociation covary with other psychometric measures. When it is used with nonclinical populations, problems arise because the resulting scores can show severe floor effects and often are highly skewed. To remedy these problems, we developed alternative ways of measuring self-reported dissociative experiences. A form of the DES in which people were required to rate how often they have each of 28 experiences compared with other people was superior in avoiding problems of floor effects and skewness. We discuss situations in which this alternative, which we call DES C, is preferred.     

Sleep experiences,dissociation, imaginal experiences,and schizotypy: The role of context

Watson (2001) reported moderate correlations between the Iowa Sleep Experience Survey (ISES) and self-report measures of dissociation and schizotypy. Subsequent investigations (Fassler, Knox, & Lynn, 2003; Watson, 2003) reported similar, although somewhat more modest, correlations between the ISES and measures of dissociation and schizotypy, as well as with measures of absorption and negative affect. The present study tested subjects in conditions in which the measures of sleep experiences were administered with other measures in either the same (N = 86) or a different (N = 87) test context. We determined that sleep experiences were associated with measures of dissociation, absorption, and schizotypy. We closely replicated Watson (2001) and found that the ISES correlations with other measures were not affected by the test context. We suggest that Watson’s (2001) hypothesized common domain of unusual cognitive and perceptual experiences (e.g., sleep experiences) may be underpinned by common ties to imaginative experiences.     

Therapeutic factors in interactional inpatient groups: Results from a Turkish sample

Therapeutic factors in an inpatient group from Turkey are presented. A total of 40 patients were seen over a period of 2 years and each patient was given Yalom's (1983) 60-item therapeutic factor list on discharge. The first four most valued therapeutic factor groups were Catharsis, Existential Factors, Cohesiveness and Hope. There were significant differences in the highly valued factors in different diagnostic groups. Patients with diagnoses of anxiety/somatization and borderline/identity problem preferred factors resembling those in many out-patient studies. The results are discussed in the light of relevant literature.     

The prevalence of personality disorders in a Kenyan inpatient sample

DSM-IV Axis I and II comorbidities and the pattern of Axis II diagnoses in patients admitted at Mathari (Psychiatric) Hospital, Nairobi, Kenya are unknown. To determine DSM-IV Axis I and II comorbidities and patterns of Axis II diagnoses in patients admitted at Mathari Hospital. Cross-sectional study on 148 randomly sampled patients. Twenty percent of the patients were confirmed for an Axis II diagnosis. Eighty-seven percent of the Axis II disorders were Cluster B Personality Disorders of various types. Using chi2 tests, significant associations were found between Axis I and II diagnoses and substance use/dependence (p < 0.001; 66.7%), mood disorder (p = 0.002; 46.7%) and schizophrenia (p < 0.001; 23.3%). The prevalence of personality disorders was lower than that reported in psychiatric patients in USA and Europe. The results are likely to be a true reflection of the actual epidemiological situation, but cannot be generalized to outpatient or general populations.     

Rorschach administration: a comparison of the effect of two instructions given to an inpatient sample of drug addicts

The effect of administering the Rorschach Inkblot Method under two instructional sets was compared on three classes of outcome variables: the frequency with which subjects asked questions about the test; the frequency of brief protocols (fewer than 14 responses); and 17 traditional Rorschach structural summary scores. Sixty subjects, obtained from three inpatient psychiatric clinics treating drug addicts, randomly received either the short pre‐testing instruction “What might this be?” originally developed by Herman Rorschach and recommended in the Comprehensive System, or a longer and more elaborated instruction, which for many years has been the standard instruction in Norway. Compared with the Norwegian instruction, the short instruction produced significantly more questions to the examiner about the test. For the other outcome measures no differences were observed.     

Corporal punishment experiences and attitudes in a sample of college students

This article describes an analysis of an exploratory survey administered to a sample of 123 college students. The purpose was twofold. First, the respondents' experiences with spanking in childhood are described. Second, factors that led respondents to perceive their childhood spankings as beneficial or not beneficial are examined.     

Hypersexuality in inpatient children and adolescents: recognition, differential diagnosis, and evaluation

We describe a 17-year-old girl with hypersexuality resulting from virilization, the latter a consequence of polycystic ovary syndrome, and we review the literature pertinent to hypersexuality in children and adults. Inappropriate sexual behavior (a common cause of disruption among children who are hospitalized for psychiatric disorders) may be caused either by hypersexuality or by simply ill-regulated behavior: a definition of hypersexuality is proposed that can be applied at the bedside (namely, sexual behaviors or fantasies that have abruptly increased in frequency by comparison with a previous baseline, are of sufficient excessiveness to disrupt expected or usual social, academic, or occupational functioning, or constitute a source of distress), so that this distinction can be made promptly, and we present a differential diagnosis for hypersexuality to direct its evaluation. Virilization does not seem to be a common cause of hypersexuality in children and adolescents, but it should not be overlooked when it does exist. The differential diagnosis of hypersexuality in adults, which we present for comparison, is much larger than it is in children.