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Danböck SK, Mertens YL, Kulla P, Seitz KI, Schalinski I. How-To Study Dissociative Symptoms in a Broad Range of Mental Disorders: A Methodological Primer. J Trauma Dissociation 2025; 26:415-451. [PMID: 40191964 DOI: 10.1080/15299732.2025.2481474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 03/11/2025] [Indexed: 04/09/2025]
Abstract
Dissociative symptoms constitute a transdiagnostic phenomenon not only characterizing dissociative disorders but also occurring across a broad range of other mental disorders such as posttraumatic stress disorder or borderline personality disorder. In the latter disorders, dissociative symptoms such as depersonalization, derealization, or gaps in awareness significantly burden patients' wellbeing and functioning. Many efforts have been undertaken to better understand these debilitating symptoms. However, empirical findings have not yet converged in many areas (e.g., considering neurobiological correlates or effects of dissociative psychopathology on treatment outcome), which might partially be due to the heterogeneity and limitations of employed methodology. Here, we critically review the current state-of-the-art methodology in dissociation research, comparing methods to assess dissociative symptoms, provoke dissociative symptoms in the laboratory, select the participant sample, and consider critical sample characteristics. Discussing the informative value and limits of various standard and novel methodological approaches, we aim to provide information and nuanced guidance for future research. By these means, we aim to raise and harmonize standards in dissociation research and enable researchers of all career stages to enter, navigate, and make a significant and lasting contribution to research on dissociative symptoms in a broad range of mental disorders, ultimately contributing to a better understanding of dissociative psychopathology.
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Affiliation(s)
- Sarah K Danböck
- Department of Psychology, University of Mannheim, Mannheim, Germany
| | - Yoki L Mertens
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
| | - Patricia Kulla
- Department of Human Sciences, Universität der Bundeswehr München, Neubiberg, Germany
| | - Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim/Heidelberg/Ulm, Germany
| | - Inga Schalinski
- Department of Human Sciences, Universität der Bundeswehr München, Neubiberg, Germany
- Non-Governmental Organization Vivo International e.V, Konstanz, Germany
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Michal M, Wiltink J, Tibubos AN, Wild PS, Münzel T, Lackner K, Pfeiffer N, König J, Gieswinkel A, Beutel M, Kerahrodi JG. Impact of depersonalization on the course of depression: longitudinal observations from the gutenberg health study. BMC Psychiatry 2024; 24:196. [PMID: 38459472 PMCID: PMC10924423 DOI: 10.1186/s12888-024-05658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Symptoms of depersonalization (DP) and derealization (DR) are a risk factor for more severe impairment, non-response to various treatments, and a chronic course. In this study, we investigated the effects of DP/DR symptoms in patients with clinically significant depressive symptoms on clinical characteristics and various outcomes in a representative population-based sample with a 5-year follow-up. METHODS The middle-aged sample comprised n = 10,422 persons at baseline, of whom n = 9,301 were free from depressive and DP/DR symptoms. N = 522 persons had clinically significant depression (PHQ-9 ≥ 10) and co-occurring DP/DR symptoms, and n = 599 persons had clinically significant depression (PHQ-9 ≥ 10) without DP/DR symptoms. RESULTS There were substantial health disparities between persons with and without depression. These disparities concerned a wide range of life domains, including lower quality of the recalled early life experiences with the parents, current socioeconomic status, social integration (partnership, loneliness), current social and interpersonal stressors (family, work), functional bodily complaints (e.g., tinnitus, migraine, chest pain), unhealthy lifestyle, and the prevalence of already developed physical diseases. These disparities persisted to the 5-year follow-up and were exceptionally severe for depressed persons with co-occurring DP/DR symptoms. Among the depressed persons, the co-occurrence of DP/DR symptoms more than doubled the risk for recurrence or persistence of depression. Only 6.9% of depressed persons with DP/DR symptoms achieved remission at the 5-year follow-up (PHQ-9 < 5). Depression with and without co-occurring DP/DR worsened self-rated physical health significantly. The impact of depression with co-occurring DP/DR on the worsening of the self-rated physical health status was stronger than those of age and major medical diseases (e.g., heart failure). However, only depression without DP/DR was associated with mortality in a hazard regression analysis adjusted for age, sex, and lifestyle. CONCLUSIONS The results demonstrated that DP/DR symptoms represent an important and easily assessable prognostic factor for the course of depression and health outcomes. Given the low remission rates for depression in general and depression with DP/DR in particular, efforts should be made to identify and better support this group, which is disadvantaged in many aspects of life.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Partner site Rhine-Main, Mainz, Germany.
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Partner site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Partner site Rhine-Main, Mainz, Germany
| | - Karl Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Jochem König
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander Gieswinkel
- Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jasmin Ghaemi Kerahrodi
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Roco-Videla Á, Flores SV, Olguín-Barraza M, Maureira-Carsalade N. [Cronbach's alpha and its confidence interval]. NUTR HOSP 2024; 41:270-271. [PMID: 38047422 DOI: 10.20960/nh.04961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Introduction
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Affiliation(s)
| | | | - Mariela Olguín-Barraza
- Facultad de Ciencias de Salud. Programa de Magister en Ciencias Químico-Biológicas. Universidad Bernardo O'Higgins
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Roco-Videla Á, Aguilera-Eguía RA, Olguín-Barraza M. [Is it possible to calculate Cronbach's alpha with only two items?]. NUTR HOSP 2023; 40:1308-1309. [PMID: 37929846 DOI: 10.20960/nh.04880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Introduction
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Affiliation(s)
- Ángel Roco-Videla
- Facultad de Medicina. Universidad Católica de la Santísima Concepción
| | | | - Mariela Olguín-Barraza
- Facultad de Ciencias de Salud. Programa de Magister en Ciencias Químico-Biológicas. Universidad Bernardo O'Higgins
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Yang J, Millman LSM, David AS, Hunter ECM. The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review. J Trauma Dissociation 2023; 24:8-41. [PMID: 35699456 DOI: 10.1080/15299732.2022.2079796] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Depersonalization-Derealization disorder (DDD) is a psychiatric condition characterized by persistent feelings of detachment from one's self and of unreality about the outside world. This review aims to examine the prevalence of DDD amongst different populations. A systematic review protocol was developed before literature searching. Original articles were drawn from three electronic databases and included only studies where prevalence rates of DDD were assessed by standardized diagnostic tools. A narrative synthesis was conducted. Twenty-three papers were identified and categorized into three groups of participants: general population, mixed in/outpatient samples, and patients with specific disorders. The prevalence rates ranged from 0% to 1.9% amongst the general population, 5-20% in outpatients and 17.5-41.9% in inpatients. In studies of patients with specific disorders, prevalence rates varied: 1.8-5.9% (substance abuse), 3.3-20.2% (anxiety), 3.7-20.4% (other dissociative disorders), 16.3% (schizophrenia), 17% (borderline personality disorder), ~50% (depression). The highest rates were found in people who experienced interpersonal abuse (25-53.8%). The prevalence rate of DDD is around 1% in the general population, consistent with previous findings. DDD is more prevalent amongst adolescents and young adults as well as in patients with mental disorders. There is also a possible relationship between interpersonal abuse and DDD, which merits further research.
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Affiliation(s)
- Jinyan Yang
- Division of Psychiatry, University College London, London, UK
| | | | - Anthony S David
- Division of Psychiatry, University College London, London, UK
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Becker J, Kreis A, Schorch T, Mayer A, Tsiouris A, Beutel ME, Zwerenz R. Adherence and effectiveness of an emotion-based psychodynamic online self-help during and after inpatient and day-care psychotherapy: Results of a naturalistic study. Front Psychiatry 2023; 14:1027118. [PMID: 36741111 PMCID: PMC9894873 DOI: 10.3389/fpsyt.2023.1027118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Internet-based mental health interventions are considered effective in providing low-threshold support for people with mental health disorders. However, there is a lack of research investigating the transferability of such online programs into routine care settings. Low treatment adherence and problems with technical implementation often limit a successful transfer into clinical routines. This naturalistic study aims to identify influencing factors on program adherence in patients who participated in an online intervention during inpatient or day-clinic psychotherapeutic treatment. METHODS AND FINDINGS In a naturalistic study, we investigated the transferability of the transdiagnostic psychodynamic online self-help program KEN-Online, which includes eight consecutive units. Between May 2017 and October 2018, patients who received inpatient or day-clinic psychotherapeutic treatment at the Department of Psychosomatic Medicine and Psychotherapy in the University Medical Center Mainz have been offered to use KEN-Online. Of the n = 749 patients who were admitted to the clinic, n = 239 patients (32%) registered for participation in KEN-Online. While 46.9% of the participants did not complete any unit (inactive participants), 53.1% completed at least the first unit (active participants). Age, number of diagnoses, and symptom severity were associated with (in)active participation. Adherence decreased over time resulting in only 17 participants (7.6%) who completed all units. None of the sociodemographic and medical characteristics proved to be significant predictors of adherence. Analyses of effectiveness showed a significant reduction of anxiety and depression in active participants in the course of participation, with higher improvements in participants that completed more than half of the units. CONCLUSION Adherence to the online self-help program KEN-Online was lower in the naturalistic setting than in a previous clinical trial, but was still associated with greater program effectiveness. Adherence-promoting measures are crucial to increase the effectiveness of such interventions in clinical settings.
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Affiliation(s)
- Jan Becker
- Institute of Teachers' Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Adina Kreis
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Theresa Schorch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Anna Mayer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Angeliki Tsiouris
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Bischof A, Brandt D, Schlossarek S, Vens M, Rozgonjuk D, Wernicke J, Kannen C, Wölfling K, Dreier M, Salbach H, Basenach L, Mößle T, Olbrich D, König I, Borgwardt S, Montag C, Rumpf HJ. Study protocol for a randomised controlled trial of an e-health stepped care approach for the treatment of internet use disorders versus a placebo condition: the SCAPIT study. BMJ Open 2022; 12:e061453. [PMID: 36323482 PMCID: PMC9639078 DOI: 10.1136/bmjopen-2022-061453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Excessive internet use can lead to problems for some individuals. The WHO has introduced Gaming Disorder in the International Classification of Diseases-11 (ICD-11). Previous research has shown that other internet applications can cause serious mental health problems as well. It is important to provide measures of prevention, early intervention and therapy for internet use disorders (IUDs). METHODS AND ANALYSIS The study 'Stepped Care Approach for Problematic Internet use Treatment' is a randomised, two-arm, parallel-group, observer-blind trial. The aim of the study is to investigate if a stepped care approach is effective to reduce symptom severity for IUD. The sample is primarily recruited online with a focus on employees in companies with support of health insurances. After screening, the stepped care approach depends on the success of the previous step-that is, the successful reduction of criteria-and comprise: (1) app-intervention with questionnaires and feedback, (2) two telephone counsellings (duration: 50 min) based on motivational interviewing, (3) online therapy over 17 weeks (15 weekly group sessions, eight individual sessions) based on cognitive-behavioural therapy. A follow-up is conducted after 6 months. A total of 860 participants will be randomised. Hierarchical testing procedure is used to test the coprimary endpoints number of Diagnostic and Statistical Manual of Mental Disorders, fifth edition and ICD-11 criteria. Primary analysis will be performed with a sequential logit model. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committees of the Universities of Lübeck (file number: 21-068), Mainz (file number: 2021-15907) and Berlin (file number: 015.2021). Results will be reported in accordance to the CONSORT statement. If the approach is superior to the control condition, it may serve as part of treatment for IUD. TRIAL REGISTRATION NUMBER DRKS00025994.
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Affiliation(s)
- Anja Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lubeck, Germany
| | - Dominique Brandt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lubeck, Germany
| | - Samantha Schlossarek
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lubeck, Germany
| | - Maren Vens
- Institute of Medical Biometry and Statistics, University of Lübeck, Lubeck, Germany
| | - Dmitri Rozgonjuk
- Department of Molecular Psychology, University of Ulm, Ulm, Germany
| | | | | | - Klaus Wölfling
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael Dreier
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Harriet Salbach
- Department of Education and Psychology, Free University of Berlin, Berlin, Germany
- start: psychotherapy and coaching, Berlin, Germany
| | - Lara Basenach
- Department of Education and Psychology, Free University of Berlin, Berlin, Germany
- start: psychotherapy and coaching, Berlin, Germany
| | - Thomas Mößle
- Media Protect e.V, Emmendingen, Germany
- State Police College of Baden-Württemberg, Villingen-Schwenningen, Germany
| | - Denise Olbrich
- Center for Clinical Studies, University of Lübeck, Lubeck, Germany
| | - Inke König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lubeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Christian Montag
- Department of Molecular Psychology, University of Ulm, Ulm, Germany
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lubeck, Germany
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French NJ, Eberle JW, Teachman BA. Anxiety sensitivity, distress intolerance, and negative interpretation bias strengthen the relationship between trait anxiety and depersonalization. ANXIETY, STRESS, AND COPING 2022; 35:395-408. [PMID: 34524043 PMCID: PMC8920942 DOI: 10.1080/10615806.2021.1977797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND OBJECTIVES Depersonalization is common in anxiety disorders, but little is known about factors that influence co-occurring anxiety and depersonalization. DESIGN We investigated trait moderators of the relationships between state and trait anxiety and depersonalization to better understand their co-occurrence and to identify potential points of intervention. METHODS Adults recruited on Amazon Mechanical Turk (N = 303) completed two computer tasks designed to increase variability in state anxiety and depersonalization as well as several self-report questionnaires. RESULTS As hypothesized, anxiety positively predicted depersonalization at both a state level and trait level. Moreover, as hypothesized, the trait anxiety-trait depersonalization relationship was strengthened by greater anxiety sensitivity; distress intolerance; and negative interpretation bias for anxiety sensations, and for depersonalization sensations. None of these hypothesized trait moderators significantly strengthened the state anxiety-state depersonalization relationship. CONCLUSIONS These findings suggest that, on a trait level, anxiety and depersonalization more frequently co-occur when people catastrophically misinterpret their symptoms or have lower emotional distress tolerance.
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Affiliation(s)
- Noah J French
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy W Eberle
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Bethany A Teachman
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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Kim A, Wang S, McCunn L, Bramono NT. Occupant trust in indoor air quality in a large office building after an emergent wildfire. JOURNAL OF FACILITIES MANAGEMENT 2022. [DOI: 10.1108/jfm-11-2021-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to establish a reliable scale measuring occupants’ levels of environmental trust in their work settings’ indoor air quality and explore the relationship between occupants’ levels of environmental trust and their perceived control over the air quality in their workspace.
Design/methodology/approach
The authors conducted occupant surveys concerning indoor air quality in an office building, and collected corresponding indoor air quality measurements. Descriptive statistics and correlation analysis results are reported to reveal occupants’ levels of environmental trust and perceived control.
Findings
Results reveal that psychological perceptions of indoor air quality can be quite neutral, even shortly after an extreme wildfire event resulting in very poor air quality in an urban area. Occupants’ sense of trust that their office building could protect them from harmful air outside, and their belief that the building could protect them from seasonal smoky conditions, each correlated positively with employees’ sense of control over the indoor air quality in their personal workspace.
Originality/value
This case study adds to an interdisciplinary understanding for facility managers and organizational leaders concerning a way to measure occupants’ sense of control over the indoor air quality in their building, as well as their environmental trust in terms of how protected they feel from harmful air quality conditions.
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Virtual reality induces symptoms of depersonalization and derealization: A longitudinal randomised control trial. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107233] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Schmalbach B, Zenger M, Nanette Tibubos A, Borkenhagen A, Strauss B, Brähler E. The Narcissistic Personality Inventory 8: Validation of a Brief Measure of Narcissistic Personality. Int J Psychol Res (Medellin) 2020; 13:68-77. [PMID: 33329879 PMCID: PMC7735512 DOI: 10.21500/20112084.4855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The present study was conducted with the aim of constructing and validating a short form of the Narcissistic Personality Inventory (NPI). The NPI is the most widely-applied measure for the assessment of narcissistic personality traits and, therefore, it is of great relevance for many research questions in personality and social psychology. To develop the short scale, we first found the optimal eight-item solution among all valid combinations of the NPI-15 items in an exploratory subsample (n = 1, 165) of our complete representative sample of the German general population. We then validated this model in a confirmatory subsample (n = 1, 126). Additionally, we examined its invariance across age groups and sex, as well as its reliability, as well as construct and predictive validity -comparing it to the NPI-15. Our results indicate that the NPI-8 is a valid and reliable measure of narcissistic personality with minimal losses compared to the 15-item version. Particularly where brevity and an economical assessment are desired, the NPI-8 should be considered.
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Affiliation(s)
- Bjarne Schmalbach
- . Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. Hochschule Mainz Johannes Gutenberg University Mainz Mainz Germany
| | - Markus Zenger
- . Faculty of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany. Frankfurt University of Applied Sciences University of Applied Sciences Magdeburg-Stendal Stendal Germany.,. Integrated Research and Treatment Center AdiposityDiseases - Behavioral Medicine, Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany. University of Leipzig Medical Center Leipzig Germany
| | - Ana Nanette Tibubos
- . Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. Hochschule Mainz Johannes Gutenberg University Mainz Mainz Germany
| | - Ada Borkenhagen
- . University Hospital for Psychosomatic Medicine and Psychotherapy, University of Magdeburg, Magdeburg, Germany. University of Magdeburg Magdeburg Germany
| | - Bernhard Strauss
- . University Hospital Jena, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, University of Jena, Jena, Germany University of Jena Jena Germany
| | - Elmar Brähler
- . Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. Hochschule Mainz Johannes Gutenberg University Mainz Mainz Germany.,. Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany. University of Leipzig Leipzig Germany
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Schlax J, Wiltink J, Beutel ME, Münzel T, Pfeiffer N, Wild P, Blettner M, Ghaemi Kerahrodi J, Michal M. Symptoms of depersonalization/derealization are independent risk factors for the development or persistence of psychological distress in the general population: Results from the Gutenberg health study. J Affect Disord 2020; 273:41-47. [PMID: 32421621 DOI: 10.1016/j.jad.2020.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptoms of depersonalization (DP) and derealization (DR) have a high prevalence in patient and community samples. Previous studies suggested that DP/DR symptoms might represent a marker of disease severity and poor prognosis. However, population-based studies investigating the impact of DP/DR symptoms on the course of depression and anxiety are sparse. Therefore, we aimed to analyze whether symptoms of DP/DR are longitudinally associated with the persistence or incidence of elevated symptoms of depression/anxiety. METHODS We analyzed observational data from a sample of 13.182 participants of the Gutenberg Health Study. The outcomes were elevated symptoms of depression/anxiety at the 2.5 years follow-up as determined by the 2-item depression scale (PHQ-2), the 2-item anxiety scale (GAD-2), and the compound measure PHQ-4 respectively. The predictor was the 2-item Cambridge Depersonalization Scale (CDS-2). RESULTS 8.7% of the sample were bothered by symptoms of DP/DR at baseline. They had an increased risk for elevated symptoms of depression/anxiety at the 2.5-year follow-up beyond baseline depression/anxiety and other factors. Each point increment in the CDS-2 scale, ranging from 0-6, was associated with a 21% increase of risk for PHQ-4 ≥ 3 at the follow-up (odds ratio 1.21, 95% confidence interval 1.11-1.32). LIMITATIONS The study was mostly questionnaire-based. CONCLUSION Symptoms of DP/DR are independent risk factors for the persistence or incidence of elevated symptoms of depression/anxiety. Symptoms of DP/DR represent an easily assessable risk factor for the course of mental disorders. Treatment and prevention of mental disorders might benefit from the broader recognition of these phenomena.
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Affiliation(s)
- Jasmin Schlax
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Philipp Wild
- Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology & Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Jasmin Ghaemi Kerahrodi
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
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Tuineag M, Therman S, Lindgren M, Rouanet M, Nahon S, Bertrand L, Saury S, Renaud S, Beaulieu S, Linnaranta O. Dissociative symptoms as measured by the Cambridge Depersonalization Scale in patients with a bipolar disorder. J Affect Disord 2020; 263:187-192. [PMID: 31818776 DOI: 10.1016/j.jad.2019.11.137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/25/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Cambridge Depersonalization Scale (CDS) characterizes the quality, frequency, and duration of dissociative symptoms. While the psychometric properties of the CDS have been evaluated in primary dissociative disorder, this has been insufficiently addressed among other psychiatric patient groups such as patients with a bipolar disorder (BD). METHODS Outpatients with variable mood (n = 73) responded to a survey that assessed dissociative symptoms and other characteristics. We used factor analysis and McDonald's omega to evaluate psychometric properties of the CDS, and correlations with other characteristics. RESULTS Previously suggested multifactorial models of the CDS were not supported, but the single-dimensional model fit both dichotomized (p = 0.31, CFI = 0.99, RMSEA = 0.02, ECV 70%) and trichotomized CDS responses (p = 0.06, CFI = 0.96, RMSEA = 0.04, ECV 47%). The CDS showed high internal consistency (ω = 0.96). CDS factor scores correlated with symptom severity on the Quick Inventory for Depressive Symptoms (QIDS-SR-16) (ρ = 0.59), the Social Phobia Inventory (ρ = 0.52), the American Association of Psychiatry Severity measure for Panic Disorders (ρ = 0.46), the Childhood Trauma Questionnaire (ρ = 0.44), and the Trauma Screening Questionnaire (ρ = 0.53). Two abbreviated versions of the CDS, retaining the best 14 or 7 items were proposed. LIMITATIONS The sample size remained moderate. CONCLUSIONS The CDS is a psychometrically sound, unidimensional measure with clinical impact to detect and characterize dissociative symptoms in BD patients. Establishing the reliability and validity of the abbreviated scales for screening necessitates further study.
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Affiliation(s)
- Maria Tuineag
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Mood disorders Psychopharmacology Unit, University of Toronto, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
| | - Sebastian Therman
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Maija Lindgren
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Manon Rouanet
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sara Nahon
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Lia Bertrand
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sybille Saury
- Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Suzanne Renaud
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
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Krylov V, Demeneva A, Retyunsky K. The phenomenology of depersonalization in depressive disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:37-41. [DOI: 10.17116/jnevro202012012137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tibubos AN, Grammes J, Beutel ME, Michal M, Schmutzer G, Brähler E. Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms. J Affect Disord 2018; 227:571-579. [PMID: 29172049 DOI: 10.1016/j.jad.2017.11.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/14/2017] [Accepted: 11/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the relationships of common emotion regulation strategies (suppression and reappraisal) to self-reported fatigue and depersonalization/derealization symptoms. Specifically, we tested the moderating effect of suppression and reappraisal on the link of fatigue with depersonalization and derealization symptoms. Opposite effects were expected for both emotion regulation strategies assuming that cognitive reappraisal has an adaptive buffering effect, while suppression intensifies the association of fatigue and depersonalization/derealization experiences. METHODS In a representative study (N = 2524) we assessed emotion regulation strategies, fatigue, depersonalization/derealization, distress, and demographic variables via questionnaires. 55.5% of the participants were female, mean age was 49.4 (SD = 18.2) years with age groups represented in comparable proportions. RESULTS In line with the assumptions, moderated regression analyses revealed an interaction effect of emotion regulation strategies and fatigue. Simple slope analyses indicated a buffering effect of cognitive reappraisal on the positive relation of fatigue with depersonalization and derealization symptoms. In contrast, suppression fosters the positive correlation of fatigue and depersonalization and derealization experiences. LIMITATIONS Our study is limited to these two habitual emotion regulation strategies employing a cross sectional design. CONCLUSION Our findings provide comprehensive empirical data investigating depersonalization/derealization symptoms from the perspective of emotion regulation research. Cognitive reappraisal might help people suffering from fatigue to prevent depersonalization and derealization tendencies.
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Affiliation(s)
- Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany.
| | - Jennifer Grammes
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
| | - Gabriele Schmutzer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
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Becker J, Zwerenz R, Johansson R, Frederick RJ, Andersson G, Beutel ME. Using a transdiagnostic, psychodynamic online self-help intervention to maintain inpatient psychosomatic treatment effects: Study protocol of a feasibility study. Internet Interv 2016; 5:30-35. [PMID: 30135804 PMCID: PMC6096314 DOI: 10.1016/j.invent.2016.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Online self-help interventions have proven to be effective in treating various specific mental disorders, mainly depression and anxiety. Knowledge regarding their acceptance, efficacy, and usefulness in addition to inpatient or outpatient psychotherapy is limited. Therefore, we plan to evaluate an affect-focused, transdiagnostic, psychodynamic online self-help intervention following inpatient psychotherapy for mixed diagnoses in a feasibility study to determine acceptance, satisfaction, and preliminary estimates of efficacy. METHODS The intervention is based on the book "Living Like You Mean It" by Ronald J. Frederick (2009) and the Swedish adaption by Johansson and colleagues (2013). The book was translated into German and thoroughly revised using parts of the Swedish adaption and additional tasks from their intervention. In a pilot phase, corrections concerning comprehensibility of the content and exercises were made based on patient's feedback. In the second step, we developed a website presenting the German adaption in eight units. In the third step, at least N = 66 patients from the Department of Psychosomatic Medicine and Psychotherapy will be recruited for a feasibility study. Patients are randomized into two groups. The intervention group (IG) will receive ten weeks of access to the online self-help intervention together with weekly therapeutic feedback on their progress. The wait-list control group (WLC) will receive access to the intervention for ten weeks as well, but without therapeutic feedback and with a ten-week delay. We will conduct assessments at the beginning of the intervention of the IG (T0), the end of the intervention of the IG (T1), two months later (only IG, T2), and at the end of the intervention of the WLC (T3). The primary outcome is satisfaction with the treatment as measured by the ZUF-8 at T1 and T3 respectively. Secondary outcome measures include emotional competence, depression, anxiety, and quality of life. CONCLUSION We expect insight into the usefulness and acceptance of an online self-help intervention used to maintain inpatient treatment effects. Furthermore, we await both groups to benefit from the participation in the intervention. Pre- post and between subject differences will be used as estimate effect sizes to calculate the necessary sample size for a larger efficacy trial.
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Affiliation(s)
- Jan Becker
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131 Mainz, Germany,Corresponding author.
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Robert Johansson
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden,Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, SE-171 77 Stockholm, Sweden
| | - Ronald J. Frederick
- Center for Courageous Living, 9300 Wilshire Boulevard, Suite #520, Beverly Hills, CA 90212, USA
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
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Michal M, Adler J, Wiltink J, Reiner I, Tschan R, Wölfling K, Weimert S, Tuin I, Subic-Wrana C, Beutel ME, Zwerenz R. A case series of 223 patients with depersonalization-derealization syndrome. BMC Psychiatry 2016; 16:203. [PMID: 27349226 PMCID: PMC4924239 DOI: 10.1186/s12888-016-0908-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/20/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depersonalization-derealization syndrome (DDS) is an underdiagnosed and underresearched clinical phenomenon. In Germany, its administrative prevalence is far below the threshold for orphan diseases, although according to epidemiological surveys the diagnosis should be comparable frequent as anorexia nervosa for instance. Against this background, we carried out a large comprehensive survey of a DDS series in a tertiary mental health center with a specialized depersonalization-derealization clinic. To reveal differential characteristics, we compared the DDS patients, who consulted the specialized depersonalization-derealization clinic, with a group of patients with depressive disorders without comorbid DDS from the regular outpatient clinic of the mental health center. METHODS The sample comprised 223 patients with a diagnosis of depersonalization-derealization-syndrome and 1129 patients with a depressive disorder but without a comorbid diagnosis of DDS. DDS patients were described and compared with depressive outpatients in terms of sociodemographic characteristics, treatment history, treatment wishes, clinical symptomatology, prevailing psychosocial stressors, family history of common mental disorders and history of childhood trauma. RESULTS Despite the high comorbidity of DDS patients with depressive disorders and comparable burden with symptoms of depression and anxiety, the clinical picture and course of both patient groups differed strongly. DDS patients were younger, had a significant preponderance of male sex, longer disease duration and an earlier age of onset, a higher education but were more often unemployed. They tended to show more severe functional impairment. They had higher rates of previous or current mental health care utilization. Nearly all DDS patients endorsed the wish for a symptom specific counseling and 70.7 % were interested in the internet-based treatment of their problems. DDS patients had lower levels of self-rated traumatic childhood experiences and current psychosocial stressors. However, they reported a family history of anxiety disorders more often. CONCLUSION In consideration of the selection bias of this study, this case series supports the view that the course of the DDS tends to be long-lasting. DDS patients are severely impaired, utilizing mental health care to a high degree, which nevertheless might not meet their treatment needs, as patients strongly opt for obtaining disorder specific counseling. In view of the size of the problem, more research on the disorder, its course and its optimal treatment is urgently required.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
| | - Julia Adler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Iris Reiner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Regine Tschan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Klaus Wölfling
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Sabine Weimert
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Inka Tuin
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Claudia Subic-Wrana
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Kuss DJ, Lopez-Fernandez O. Internet addiction and problematic Internet use: A systematic review of clinical research. World J Psychiatry 2016; 6:143-76. [PMID: 27014605 PMCID: PMC4804263 DOI: 10.5498/wjp.v6.i1.143] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/19/2015] [Accepted: 01/05/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science. METHODS Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions (including problematic Internet use) more generally. RESULTS The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving (1) treatment seeker characteristics; (2) psychopharmacotherapy; (3) psychological therapy; and (4) combined treatment. CONCLUSION A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.
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Adler J, Schabinger N, Michal M, Beutel ME, Gillmeister H. Is that me in the mirror? Depersonalisation modulates tactile mirroring mechanisms. Neuropsychologia 2016; 85:148-58. [PMID: 26970140 DOI: 10.1016/j.neuropsychologia.2016.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 02/19/2016] [Accepted: 03/08/2016] [Indexed: 11/17/2022]
Abstract
Our sense of self is thought to develop through sensory-motor contingencies provided, not only by observing one's own body, but also by mirroring interactions with others. This suggests that there is a strong link between mirroring mechanisms and the bodily self. The present study tested whether this link is expressed at early, implicit stages of the mirroring process or at later, more cognitive stages. We also provide, to the best of our knowledge, the first demonstration of how inter-individual differences in our sense of bodily self may affect mirroring mechanisms. We used somatosensory event-related potentials (SEPs) to investigate the temporal dynamics of mirroring highly self-related information (viewed touch on one's own face) compared to other-related information (viewed touch on a stranger's face), in individuals with low and high levels of depersonalisation, a mental condition characterised by feeling detached or estranged from one's self and body. For the low-depersonalisation group, mirroring for self-related events (P45) preceded mirroring for other-related events (N80). At later stages (P200), mirroring was stronger for other-related than self-related events. This shows that early, implicit and later, more cognitive processes play different relative roles in mirroring self- and other-related bodily events. Critically, mirroring differed in the high-depersonalisation group, specifically for self-related events. An absence of early, implicit mirroring for self-related events over P45 suggests that the associated processes may be the neural correlates of the disembodiment experienced in depersonalisation. A lack of differential mirroring for self- and other-related events over P200 may reflect compensatory mechanisms that redress deficiencies in mirroring at earlier stages, which may break down to give rise to symptoms of depersonalisation. Alternatively, or in addition, they may represent an attenuation of processes related to self-other distinction. Our study thus shows that mirroring, especially for events on one's own face, can be strongly affected by how connected the observer feels to their own bodily self.
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Affiliation(s)
- Julia Adler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg - University Mainz, Mainz, Germany.
| | - Nadine Schabinger
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg - University Mainz, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg - University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg - University Mainz, Mainz, Germany
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Frank B, Ariza L, Lamparter H, Grossmann V, Prochaska JH, Ullmann A, Kindler F, Weisser G, Walter U, Lackner KJ, Espinola-Klein C, Münzel T, Konstantinides SV, Wild PS. Rationale and design of three observational, prospective cohort studies including biobanking to evaluate and improve diagnostics, management strategies and risk stratification in venous thromboembolism: the VTEval Project. BMJ Open 2015; 5:e008157. [PMID: 26133379 PMCID: PMC4499722 DOI: 10.1136/bmjopen-2015-008157] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) with its two manifestations deep vein thrombosis (DVT) and pulmonary embolism (PE) is a major public health problem. The VTEval Project aims to investigate numerous research questions on diagnosis, clinical management, treatment and prognosis of VTE, which have remained uncertain to date. METHODS AND ANALYSIS The VTEval Project consists of three observational, prospective cohort studies on VTE comprising cohorts of individuals with a clinical suspicion of acute PE (with or without DVT), with a clinical suspicion of acute DVT (without symptomatic PE) and with an incidental diagnosis of VTE (PE or DVT). The VTEval Project expects to enrol a total of approximately 2000 individuals with subsequent active and passive follow-up investigations over a time period of 5 years per participant. Time points for active follow-up investigations are at months 3, 6, 12, 24 and 36 after diagnosis (depending on the disease cohort); passive follow-up investigations via registry offices and the cancer registry are performed 48 and 60 months after diagnosis for all participants. Primary short-term outcome is defined by overall mortality (PE-related death and all other causes of death), primary long-term outcome by symptomatic VTE (PE-related death, recurrence of non-fatal PE or DVT). The VTEval Project includes three 'all-comer' studies and involves the standardised acquisition of high-quality data, covering the systematic assessment of VTE including symptoms, risk profile, psychosocial, environmental and lifestyle factors as well as clinical and subclinical disease, and it builds up a large state-of-the-art biorepository containing various materials from serial blood samplings. ETHICS AND DISSEMINATION The VTEval Project has been approved by the local data safety commissioner and the responsible ethics committee (reference no. 837.320.12 (8421-F)). Trial results will be published in peer-reviewed journals and presented at national and international scientific meetings. TRIAL REGISTRATION NUMBER NCT02156401.
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Affiliation(s)
- Bernd Frank
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Liana Ariza
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Heidrun Lamparter
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Vera Grossmann
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Alexander Ullmann
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Florentina Kindler
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Gerhard Weisser
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Ulrich Walter
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | | | - Thomas Münzel
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site RhineMain, Mainz, Germany
| | | | - Philipp S Wild
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site RhineMain, Mainz, Germany
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Michal M, Duven E, Giralt S, Dreier M, Müller KW, Adler J, Beutel ME, Wölfling K. Prevalence and correlates of depersonalization in students aged 12-18 years in Germany. Soc Psychiatry Psychiatr Epidemiol 2015; 50:995-1003. [PMID: 25201182 DOI: 10.1007/s00127-014-0957-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 08/30/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depersonalization (DP) involves unpleasant experiences of detachment from one's sense of self or unreality in the environment. DP may occur in a broad range of conditions, among healthy persons due to sleep loss, drug induced, secondary to anxiety disorders or primary in depersonalization disorder. Although DP has an early age of onset, little is known about the prevalence and correlates of DP among adolescents. METHODS Between January and June 2011, we conducted a questionnaire-based representative survey of pupils aged 12-18 years in the federal state Rhineland-Palatinate of Germany. The final sample comprised 3,809 pupils. We analyzed the prevalence of depersonalization and its correlates regarding sociodemographic characteristics, substance abuse, global mental distress and resilience factors. RESULTS One-third of the sample showed severe global mental distress, and 11.9 % were in the range of clinically significant depersonalization. Depersonalized students were less often living with both parents (67.3 vs. 75.7 %), came more often from an disadvantaged socioeconomic background, had a very severe level of global mental distress (comparable to psychiatric inpatients), were more often smoking and abusing cannabis and they suffered from specific impairments regarding social insecurity, global self-efficacy and active coping abilities. CONCLUSIONS Experiences of depersonalization were very common among adolescents and may indicate an increased risk for poor academic achievement and mental health in the long term. Prospective studies are needed to investigate the course and clinical relevance of depersonalization for the development of the adolescents.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany,
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Müller KW, Beutel ME, Wölfling K. A contribution to the clinical characterization of Internet addiction in a sample of treatment seekers: validity of assessment, severity of psychopathology and type of co-morbidity. Compr Psychiatry 2014; 55:770-7. [PMID: 24602498 DOI: 10.1016/j.comppsych.2014.01.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 01/09/2014] [Accepted: 01/14/2014] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Internet addiction becomes a growing health problem worldwide with prevalence rates up to 3%. Still, uncertainties exist regarding its diagnostics and clinical characterization. Especially the lacking clinical evidence regarding self-report measures assessing Internet addiction has been criticized. METHODS This study aimed to characterize 290 German treatment seekers and to determine the diagnostic accuracy of a self-report scale for Internet addiction. Patients filled in self-report measures (SCL-90R, PHQ, AICA-S - Scale for the Assessment of Internet and Computer game Addiction) and underwent diagnostic interviews to assess symptoms of Internet addiction and level of functioning. RESULTS Of the predominantly male treatment seekers 71% met the clinical diagnosis of Internet addiction. These displayed higher levels of psychopathology, especially depressive and dissociative symptoms. Half of the patients met criteria for one further psychiatric disorder according to clinical interviews, especially depressive disorders. Their level of functioning was decreased in all domains. AICA-S showed good psychometric properties and satisfying diagnostic accuracy (sensitivity: 80.5%; specificity: 82.4%). DISCUSSION In this sample, Internet addiction was associated with high levels of psychosocial distress that is mainly related to depressive symptoms. Co-morbid disorders were common among those patients. First analyses on diagnostic accuracy of AICA-S (using the therapist's rating on Internet addiction as an independent external criterion) showed promising results.
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Affiliation(s)
- K W Müller
- Outpatient Clinic for Behavioural Addictions, Department of Psychosomatic Medicine and Psychotherapy of the University Medical Centre of the Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
| | - M E Beutel
- Outpatient Clinic for Behavioural Addictions, Department of Psychosomatic Medicine and Psychotherapy of the University Medical Centre of the Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
| | - K Wölfling
- Outpatient Clinic for Behavioural Addictions, Department of Psychosomatic Medicine and Psychotherapy of the University Medical Centre of the Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
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Eisinga R, Grotenhuis MT, Pelzer B. The reliability of a two-item scale: Pearson, Cronbach, or Spearman-Brown? Int J Public Health 2012; 58:637-42. [PMID: 23089674 DOI: 10.1007/s00038-012-0416-3] [Citation(s) in RCA: 879] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 06/27/2012] [Accepted: 09/24/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rob Eisinga
- Radboud University Nijmegen, P.O. Box 9104, 6500 HE, Nijmegen, Netherlands.
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Beutel ME, Wiltink J, Till Y, Wild PS, Münzel T, Ojeda FM, Zeller T, Schnabel RB, Lackner K, Blettner M, Zwiener I, Michal M. Type D personality as a cardiovascular risk marker in the general population: results from the Gutenberg health study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 81:108-17. [PMID: 22262039 DOI: 10.1159/000331776] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 08/12/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Type D personality is considered as an independent risk factor for morbidity and mortality in cardiovascular patients and a vulnerability factor for distress in the general population. Because representative community studies are rare, we sought to determine the prevalence of type D personality and its relationship with demographic characteristics, different features of mental disorders, cardiovascular risk factors, health behavior, endothelial function and cardiovascular biomarkers in the general population. METHODS The prevalence of type D personality and its correlates were analyzed cross-sectionally in a population-based sample of 5,000 Mid-Europeans aged 35-74 years from the Gutenberg Health Study. RESULTS The prevalence of type D personality was 22.2% without remarkable differences in sex distribution. Type D subjects were characterized by lower socioeconomic status, lack of a partnership, increased depression, anxiety, depersonalization and health care utilization. Despite its strong association with mental disorders, type D personality emerged as psychometrically distinct. Although type D personality was independently associated with coronary heart disease (OR = 1.54, p = 0.044), no associations with traditional cardiovascular risk factors were found independently from depression or anxiety. CONCLUSIONS Although type D personality is strongly associated with depression, anxiety, impaired mental and somatic health status, and increased health care utilization, the type D construct seems to comprise dysfunctional personality patterns not covered by depression and anxiety scales. Beyond these associations, the pathways of the cardiotoxic impact of type D personality remain to be elucidated. There is a need for prospective population studies on potential links between type D personality and cardiac disease.
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Affiliation(s)
- M E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Jäger S, Müller KW, Ruckes C, Wittig T, Batra A, Musalek M, Mann K, Wölfling K, Beutel ME. Effects of a manualized short-term treatment of internet and computer game addiction (STICA): study protocol for a randomized controlled trial. Trials 2012; 13:43. [PMID: 22540330 PMCID: PMC3418190 DOI: 10.1186/1745-6215-13-43] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/27/2012] [Indexed: 12/18/2022] Open
Abstract
Background In the last few years, excessive internet use and computer gaming have increased dramatically. Salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse have been defined as diagnostic criteria for internet addiction (IA) and computer addiction (CA) in the scientific community. Despite a growing number of individuals seeking help, there are no specific treatments of established efficacy. Methods/design This clinical trial aims to determine the effect of the disorder-specific manualized short-term treatment of IA/CA (STICA). The cognitive behavioural treatment combines individual and group interventions with a total duration of 4 months. Patients will be randomly assigned to STICA treatment or to a wait list control group. Reliable and valid measures of IA/CA and co-morbid mental symptoms (for example social anxiety, depression) will be assessed prior to the beginning, in the middle, at the end, and 6 months after completion of treatment. Discussion A treatment of IA/CA will establish efficacy and is desperately needed. As this is the first trial to determine efficacy of a disorder specific treatment, a wait list control group will be implemented. Pros and cons of the design were discussed. Trial Registration ClinicalTrials (NCT01434589)
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Affiliation(s)
- Susanne Jäger
- Outpatient Clinic for Behavioural Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Michal M, Wiltink J, Till Y, Wild PS, Blettner M, Beutel ME. Distinctiveness and overlap of depersonalization with anxiety and depression in a community sample: results from the Gutenberg Heart Study. Psychiatry Res 2011; 188:264-8. [PMID: 21122925 DOI: 10.1016/j.psychres.2010.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/26/2010] [Accepted: 11/01/2010] [Indexed: 11/19/2022]
Abstract
Depersonalization disorder is considered to be a common clinical phenomenon and disorder with an enormous gap between prevalence and detection partly due to the common interpretation of depersonalization (DP) being a negligible variant of anxiety and depression. Therefore, we sought to analyze (1) the prevalence rate of DP in a large community sample (n=5000) according to a recently developed ultra brief two-item depersonalization screener; (2) the associations with depression, anxiety, physical and mental health status; and 93) whether DP contributes independently to the health status beyond anxiety and depression. The prevalence of clinically significant DP was 0.8% (n=41), and 8.5% (n=427) endorsed at least one symptom of DP. DP was independently associated with impairment of mental and physical health status as well as with a medical history of any depressive or anxiety disorder. Despite the consistent association of DP with anxiety and depression, the shared variances were small, and DP was clearly separated from symptoms of anxiety and depression in the principal component analysis. Therefore, we conclude that the implementation of depersonalization screening might be recommended.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
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Beutel ME, Brähler E, Glaesmer H, Kuss DJ, Wölfling K, Müller KW. Regular and problematic leisure-time Internet use in the community: results from a German population-based survey. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2010; 14:291-6. [PMID: 21067277 DOI: 10.1089/cyber.2010.0199] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In our study, we attempted to identify systematically the use of Internet applications in the German population in order to derive risk factors for problematic use. In a representative survey of the German population, we queried 1,401 women and 1,111 men between the ages of 14 and 94 years by specific questions and standardized questionnaires on depression, anxiety (HADS), and depersonalization (CDS-2). The majority of the German population (55%) used the Internet in their leisure time. Users were younger and had a higher socioeconomic status (education, employment, income). Leisure-time use included e-mail and information search, as well as shopping. Chatting, online communities, games and sex were domains of young, mostly male adults. Overall, 9.3% reported at least one negative consequence of Internet use, especially neglect of recreational activities and problems with family/partner, work or education, and health. Problematic use was associated with longer average daily online times, avoidance of negative emotions, preference for certain applications (gaming, gambling, online sex) and an increased rate of depersonalization. The extent of Internet use per se is not sufficient as an addiction criterion and other negative consequences; rather, specific adverse consequences need to be identified. If the Internet is used excessively to cope with negative affect states and alternative means of coping (e.g., social support, health-promoting behavior) are diminished, a vicious cycle may ensue with increasing stress and reliance on the reinforcing properties of certain online activities that may finally lead to addictive behavior.
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Affiliation(s)
- Manfred E Beutel
- Ambulanz für Spielsucht, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Mainz, Untere Zahlbacher Strasse 8, Mainz, Germany
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Michal M, Wiltink J, Till Y, Wild PS, Münzel T, Blankenberg S, Beutel ME. Type-D personality and depersonalization are associated with suicidal ideation in the German general population aged 35-74: results from the Gutenberg Heart Study. J Affect Disord 2010; 125:227-33. [PMID: 20206385 DOI: 10.1016/j.jad.2010.02.108] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 02/05/2010] [Accepted: 02/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Suicidal ideation (SID) is a major risk factor for suicide attempts. Mental disorders are among the strongest correlates of suicide, with depression and anxiety disorders playing a major role. The present study aims to investigate the contribution of under researched factors contributing to SID such as depersonalization, Type-D personality and cardiovascular risk factors. METHODS Factors associated with SID were investigated in a sample of N=5000 participants (aged 35-74 years) of the community-based survey "Gutenberg Heart Study". The factors were assessed by self-report instruments, computer-assisted interviews and medical examination. RESULTS 7.5% of the sample reported SID over the last 2 weeks. In the univariate analysis SID was significantly associated with female sex, living without a partner, low socioeconomic status, diagnosis of coronary heart disease, family history of myocardial infarction, smoking and mental distress. In the full adjusted model significant associations remained with age (in years) OR 1.02 (95%CI 1.01-1.04, p=0.002), self-reported depression OR 3.21 (95%CI 2.23-4.62, p<0.0001), panic disorder OR 1.56 (95%CI 1.03-2.36, p=0.036), depersonalization OR 2.45 (95%CI 1.78-3.38, p<0.0001), Type-D personality OR 1.98 (95%CI 1.49-2.63, p<0.0001) and impairment by mental distress OR 2.15 (95%CI 1.74-2.67, p<0.0001). LIMITATIONS Main limitations are the reliance on self-report measures of SID and of mental distress. CONCLUSIONS For the first time it has been shown that in the general population depersonalization and Type-D personality are uniquely associated with SID. These associations need further elucidation.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
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[How often is the Depersonalization-Derealization Disorder (ICD-10: F48.1) diagnosed in the outpatient health-care service?]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2010; 56:74-83. [PMID: 20229493 DOI: 10.13109/zptm.2010.56.1.74] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The study determines how often Depersonalization-Derealization Disorder (ICD-10: F48.1) is diagnosed in the general population and analyzes the associations of other diseases with F48.1. METHODS The sample consists of 1.567 million insured persons of a statutory health insurance fund in Germany. We analyzed the prevalence of F48.1 and the associations of F48.1 with other diseases according to ICD-10. RESULTS We found a 1-year prevalence of 0.007 % for the diagnosis of F48.1. After adjustment for age, sex, depression and anxiety, several somatic disease groups were found to be associated with an increased likelihood of F48.1, e.g., abnormalities of breathing (R06), cardiac arrhythmias (I47-I49), epilepsy (G40), dizziness (H81, H82, R42) and headache (G43, G44, R51). CONCLUSIONS According to epidemiological studies, the prevalence of depersonalization-derealization disorder is 1-2 %. We therefore conclude that F48.1 is severely underdiagnosed. Increased awareness for the detection of F48.1 and further health care research are urgently warranted.
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