Reddy Lohit Somashekar, Patil N M, Nayak Raghavendra B, Chate Sameeran S, Ansari Saba
Department of Psychiatry, SDM College of Medical Sciences and Hospital, Dharwad, India.
Department of Psychiatry, Jawaharlal Nehru Medical College, Belgaum, India.
Indian J Psychol Med. 2018 Jan-Feb;40(1):41-46. doi: 10.4103/IJPSYM.IJPSYM_237_17.
Patients present with dissociative disorders as a decompensation to underlying stressful situation. It is clinically important to evaluate the presence, type, and temporal relation of the stressors resulting in dissociation. Further knowing the sociodemographic and psychological profile of the dissociative patient helps in better management.
The study included 55 dissociative patients aged between 5 to 45 years. Psychiatric diagnosis was made using ICD-10 DCR. Psychosocial stressors and stressful life events were assessed using presumptive stressful life events scale/life events scale for Indian children and clinical interview. Personality and temperament traits were assessed using medico psychological questionnaire and temperament measurement schedule, respectively. Intelligence quotient (IQ) was assessed using standard progressive matrices and colored progressive matrices. Statistical analysis was done using Epi Info 7 software.
All patients had significant psychosocial stressors preceding dissociation. Precipitating factor with temporal association was observed in only 83.64%. Family disharmony (41.82%) followed by education-related problems (29.09%) was the most common psychosocial stressors. 61.82% of the dissociative patients had psychiatric comorbidity. Mean IQ of study sample was 92.47. Dissociative children had high emotionality and energy levels but low sociability, rhythmicity, and distractibility. 50% of the adults were neurotic and had emotionally unstable personality.
Dissociative disorders are commonly seen in females, adolescents, and in those from lower socioeconomic status and rural areas. They are always preceded by psychosocial stressors. Most of them have comorbid psychiatric disorders such as depression and anxiety. Neuroticism and emotionally unstable personality traits are common in adult patients while temperamental traits such as low sociability, low rhythmicity, low distractibility, high emotionality, and high energy levels are common in children.
患者出现分离性障碍是对潜在应激状况的一种失代偿表现。评估导致分离的应激源的存在、类型及时间关系在临床上具有重要意义。进一步了解分离性障碍患者的社会人口学和心理特征有助于更好地进行管理。
该研究纳入了55名年龄在5至45岁之间的分离性障碍患者。采用国际疾病分类第10版精神与行为障碍分类（ICD - 10 DCR）进行精神科诊断。使用印度儿童推定应激性生活事件量表/生活事件量表以及临床访谈来评估心理社会应激源和应激性生活事件。分别使用医学心理问卷和气质测量量表评估人格和气质特征。使用标准渐进矩阵和彩色渐进矩阵评估智商（IQ）。使用Epi Info 7软件进行统计分析。
所有患者在出现分离之前均有显著的心理社会应激源。仅83.64%的患者观察到有时间关联的促发因素。家庭不和（41.82%）其次是与教育相关的问题（29.09%）是最常见的心理社会应激源。61.82%的分离性障碍患者有精神科共病。研究样本的平均智商为92.47。分离性障碍儿童情绪性和能量水平较高，但社交性、节律性和注意力分散性较低。50%的成年人有神经质倾向且人格情绪不稳定。
分离性障碍常见于女性、青少年以及社会经济地位较低和农村地区的人群。它们总是先于心理社会应激源出现。其中大多数伴有抑郁和焦虑等共病精神障碍。神经质和情绪不稳定的人格特质在成年患者中常见，而社交性低、节律性低、注意力分散性低、情绪性高和能量水平高的气质特质在儿童中常见。
