Discriminating among diagnostic categories using the Dissociative Disorders Interview Schedule

The Dissociative Disorders Interview Schedule was administered to 1,308 subjects in eight diagnostic categories, including 296 with dissociative identity disorder. The study tested three hypotheses: (1) the Mahalanobis distance between dissociative identity disorder and each of seven other diagnostic categories would be large, (2) the closest diagnostic category to dissociative identity disorder would be dissociative disorder not otherwise specified, and (3) nondissociative diagnostic categories would be closer to each other than any one to dissociative identity disorder. All three hypotheses were confirmed by these data. The findings support the conclusion that dissociative identity disorder is a discrete category or taxon.     

Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety

Many patients with chronic pain also exhibit elevated levels of health anxiety. This study examined the effect of health anxiety on the use of safety-seeking behaviors (SSBs) in pain-provoking situations. Participants were 20 chronic back pain patients with high health anxiety (Group H), 20 with low health anxiety (Group L) and 20 pain-free controls (Group C). Two physical tasks were video recorded, and compared both for overt pain behavior (identified by blind observers following a standardized procedure) and for the occurrence of SSB (identified by showing the participants video playback and asking them to specify motivation for all actions/behaviors displayed during the tasks). While there were no differences in the display of overt pain behaviors, Group H deployed a greater number of SSBs than Groups L and C. This finding held true for both tasks and remained significant when concurrent pain and mood ratings were statistically controlled for. SSB was correlated with catastrophizing thoughts but not pain intensity; pain intensity was correlated with overt pain behavior but not catastrophizing. Taken together, these findings suggest that SSB is distinct from overt pain behavior and may be a defining characteristic of chronic pain patients reporting high levels of health anxiety.     

THE INTERPLAY OF THE TWO HEMISPHERES OF THE BRAIN IN PSYCHOANALYSIS

Several authors have written intriguingly about the right and left hemispheres of the brain. Each hemisphere perceives the world differently, impacting that which it looks upon and reinforcing our particular world view. Notably, the left hemisphere, has always been assumed to be the dominant hemisphere, but only because it has language and is so adept at formulating arguments. The detached mode of the left hemisphere, while useful and necessary to get distance, is no more real than the engaged, imaginative approach of the right hemisphere. Having written about self-sufficiency as a defense against feeling alone and helpless, I now consider these rational, problem solving, answer generating, and planning activities as products of the left hemisphere. The approach that I am suggesting is of calling our patients’ attention to how their left hemisphere overpowers the new, more uncertain voice of the right hemisphere just after it speaks in a session.