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Dissociation following traumatic medical treatment procedures in childhood: A longitudinal follow-up

Published online by Cambridge University Press:  10 February 2006

TROND H. DISETH
Affiliation:
Rikshospitalet University Hospital, Oslo

Abstract

Chronic illnesses often involve repeated hospitalization and invasive treatment procedures that can have a traumatic impact on child development. To explore possible consequences of treatment procedures, three groups of patients with congenital anomalies were examined longitudinally. At first admission, adolescents (ages 10–20, mean 15) with anorectal anomalies (n = 14), adolescents with Hirschsprung disease (n = 14), and hospitalized controls (n = 14) were assessed for treatment procedures, somatic function, mental health, and dissociative experiences. The assessment included the Adolescent Dissociative Experiences Scale (A-DES). At 10-year follow-up, the patients completed the Dissociative Experiences Scale (DES) and the Somatoform Dissociative Questionnaire (SDQ-20). Anal dilatation, an invasive medical treatment procedure performed daily by the parents the first 4 years, was correlated with the frequency and severity of persisting dissociative symptomatology. The procedure was the only significant predictor of A-DES and SDQ-20 scores, and one of two significant predictors of DES scores. This “experiment of nature” permitted a specific and unique opportunity to examine the impact of early traumatic exposure on child development in the absence of parental malevolence, and on later dissociative outcome in adolescence and adulthood. The findings might be valuable theoretically to our understanding of the development of psychopathology, and may lend itself for comparison with data on sexually abused children.

Type
Research Article
Copyright
© 2006 Cambridge University Press

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References

Aasland, A., & Diseth, T. H. (1999). Can the Harter self-perception profile for adolescents (SPPA) be used as an indicator of psychosocial outcome in adolescents with chronic physical disorder? European Child and Adolescent Psychiatry, 8, 7885.Google Scholar
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.
Achenbach, T. M., & Edelbrock, C. S. (1987). Manual for the Youth Self-Report and Profile. Burlington, VT: University of Vermont, Department of Psychiatry.
Ainsworth, M. D. S. (1962). The effects of maternal deprivation: A review of findings and controversy in the context of research strategy. In Deprivation of maternal care: A reassessment of its effects. Geneva: World Health Organization.
Altman, D. G. (1991). Practical statistics for medical research. London: Chapman & Hall.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Armstrong, J. G., Putnam, F. W., Carlson, E. B., Libero, D. Z., & Smith, S. R. (1997). Development and validation of a measure of adolescent dissociation: The Adolescent Dissociative Experience Scale. The Journal of Nervous and Mental Disease, 185, 491497.Google Scholar
Belsky, J., & Cassidy, J. (1994). Attachment: Theory and evidence. In M. Rutter & D. F. Hay (Eds.), Development through life. A handbook for clinicians. Oxford: Blackwell Scientific.
Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. The Journal of Nervous and Mental Disease, 174, 727735.Google Scholar
Bowlby, J. (1951). Maternal care and mental health (Monograph series, No. 2). Geneva: World Health Organization.
Bowlby, J. (1969). Attachment. London: Hogarth Press.
Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment (2nd ed.). New York: Basic Books.
Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. London: Routledge.
Brazelton, B., & Als, H. (1979). Four early stages in the development of mother–infant interaction. The Psychoanalytic Study of the Child, 34, 349369.Google Scholar
Brunner, R., Parzer, P., Schuld, V., & Resch, F. (2000). Dissociative symptomatology and traumatogenic factors in adolescent psychiatric patients. The Journal of Nervous and Mental Disease, 188, 7177.Google Scholar
Carlson, E. A. (1998). A prospective longitudinal study of disorganized/disoriented attachment. Child Development, 69, 11071128.Google Scholar
Carlson, E. B., & Putnam, F. W. (1993). An update on the dissociative experience scale. Dissociation, 6, 1627.Google Scholar
Carlson, E. B., Putnam, F. W., Ross, C. A., Torem, M., Coons, P., & Loewenstein, R. J. (1993). Validity of the dissociative experience scale: A multicenter study. The American Journal of Psychiatry, 150, 10301036.Google Scholar
Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1989). Disorganized/disoriented attachment relationships in maltreated infants. Developmental Psychology, 25, 525531.Google Scholar
Chu, J. A., Frey, L. M., Ganzel, B. L., & Matthews, J. A. (1999). Memories of childhood abuse: Dissociation, amnesia, and corroboration. The American Journal of Psychiatry, 156, 749755.Google Scholar
Cicchetti, D. (2003). Experiments of nature: Contribution to developmental theory [Editorial]. Development and Psychopathology, 15, 833835.Google Scholar
Cicchetti, D., & Cohen, D. J. (1995). Developmental psychopathology. New York: Wiley–Interscience.
Cicchetti, D., & Toth, S. (1995). Child maltreatment and attachment organization: Implication for intervention. In S. Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social, developmental, and clinical perspectives (pp. 279308). London: Analytical Press.
Diseth, T. H., Bjørnland, K., Nøvik, T. S., & Emblem, R. (1997). Bowel function, mental health and psychosocial function in adolescents with Hirschsprung's disease. Archives of Disease in Childhood, 76, 100106.Google Scholar
Diseth, T. H., Egeland, T., & Emblem, R. (1998). Effects of anal invasive treatment and incontinence on mental health and psychosocial functioning of adolescents with Hirschsprung's disease and low anorectal anomalies. Journal of Pediatric Surgery, 33, 468475.Google Scholar
Diseth, T. H., & Emblem, R. (1996). Somatic function, mental health and psychosocial adjustment of adolescents with anorectal anomalies. Journal of Pediatric Surgery, 31, 638643.Google Scholar
Diseth, T. H., Emblem, R., & Vandvik, I. H. (1995). Adolescents with anorectal malformations and their families: Examples of hidden psychosocial trauma. Family Systems Medicine, 13, 215231.Google Scholar
Douglas, J. W. B. (1975). Early hospital admission and later disturbances of behavior and learning. Developmental Medicine and Child Neurology, 17, 456480.Google Scholar
Draijer, N., & Langeland, W. (1999). Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. The American Journal of Psychiatry, 156, 379385.Google Scholar
Drotar, D., & Bush, M. (1985). Mental health issues and services. In N. Hobbs & J. M. Perrin (Eds.), Issues in the care of children with chronic illness. San Francisco, CA: Jossey–Bass.
Erikson, E. H. (1963). Childhood and society. New York: W.W. Norton & Company.
Erikson, E. H. (1968). Identity youth and crisis. New York: W.W. Norton & Company.
Glaser, D. (2000). Child abuse and neglect and the brain. Journal of Child Psychology and Psychiatry, 41, 97116.Google Scholar
Glaser, D., & Prior, V. (1997). Is the term child protection applicable to emotional abuse? Child Abuse Review, 6, 315329.Google Scholar
Grabe, H. J., Spitzer, C., & Freyberger, H. J. (1999). Relationship of dissociation to temperament and character in men and women. The American Journal of Psychiatry, 156, 18111813.Google Scholar
Gunnar, M., Brodersen, L., Nachmias, M., Buss, K., & Rigatuso, J. (1996). Stress reactivity and attachment security. Developmental Psychobiology, 29, 191204.Google Scholar
Hodges, K., McKnew, D., Cytryn, L., Stern, L., & Kline, J. (1982). The Child Assessment Schedule (CAS) diagnostic interview: A report on reliability and validity. Journal of the American Academy of Child Psychiatry, 21, 468473.Google Scholar
Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Events Scale: A measure of subjective distress. Psychosomatic Medicine, 41, 207218.Google Scholar
Joseph, S. (2000). Psychometric evaluation of the Impact of Events Scale: A review. Journal of Traumatic Stress, 13, 101113.Google Scholar
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113, 164180.Google Scholar
Kisiel, C. L., & Lyons, J. S. (2001). Dissociation as a mediator of psychopathology among sexually abused children and adolescents. The American Journal of Psychiatry, 158, 10341039.Google Scholar
Kleinbaum, D., Kupper, L., & Muller, K. (1988). Applied regression analysis and other multivariable methods (2nd ed.). Boston: PWS-KENT Publishing Company.
Koomen, H. M. Y., & Hoeksma, J. B. (1993). Early hospitalization and disturbances of infant behavior and the mother–infant relationship. Journal of Child Psychology and Psychiatry, 34, 917934.Google Scholar
Lange, A., de Beurs, E., Dolan, C., Lachnit, T., Sjollema, S., & Hanewald, G. (1999). Long-term effects of childhood sexual abuse: Objective and subjective characteristics of the abuse and psychopathology in later life. The Journal of Nervous and Mental Disease, 187, 150158.Google Scholar
Liotti, G. (1992). Disorganized/disoriented attachment in the etiology of the dissociative disorders. Dissociation, 5, 196204.Google Scholar
Liotti, G. (1999). Disorganization of attachment as a model of understanding dissociative psychopathology. In J. Solomon & C. George (Eds.), Attachment disorganization (pp. 291317). New York: Guilford Press.
Lyons-Ruth, K., Bronfman, E., & Parson, E. (1999). Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. Monographs of the Society for Research in Child Development, 64, 6796.Google Scholar
Lyons-Ruth, K., Repacholi, B., McLeod, S., & Silva, E. (1991). Disorganized attachment behavior in infancy: Short-term stability, maternal and infant correlates, and risk-related subtypes. Development and Psychopathology, 3, 377396.Google Scholar
Macfie, J., Cicchetti, D., & Toth, S. L. (2001). Dissociation in maltreated versus nonmaltreated preschool-aged children. Child Abuse and Neglect, 25, 12531267.Google Scholar
Maclean, K. (2003). The impact of institutionalization on child development. Development and Psychopathology, 15, 853884.Google Scholar
Mahler, M. S., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant. Symbiosis and individuation. London: Hutchinson.
Main, M. (1995). Recent studies in attachment: Overview, with selected implications for clinical work. In S. Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social, developmental, and clinical perspectives (pp. 407474). Hillsdale, NJ: Analytic Press.
Main, M., & Hesse, E. (1990). Parents' unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M. T. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161182). Chicago: University of Chicago Press.
Manly, J. T., Kim, J. E., Rogosch, F. A., & Cicchetti, D. (2001). Dimensions of child maltreatment and children's adjustment: Contributions of developmental timing and subtype. Development and Psychopathology, 13, 759782.Google Scholar
McCullagh, P., & Nelder, J. A. (1989). Models for continuous data with constant variance. In P. McCullagh & J. A. Nelder (Eds.), Generalized linear models (2nd ed., pp. 4897). London: Chapman & Hall.
Mulder, R. T., Beautrais, A. L., Joyce, P. R., & Fergusson, D. M. (1998). Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample. The American Journal of Psychiatry, 155, 806811.Google Scholar
Nijenhuis, E. R., Spinhoven, P., Van Dyck, R., Van der Hart, O., & Vanderlinden, J. (1996). The development and the psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). The Journal of Nervous and Mental Disease, 184, 688694.Google Scholar
Nijenhuis, E. R., Spinhoven, P., Van Dyck, R., Van der Hart, O., & Vanderlinden, J. (1998). Psychometric characteristics of the Somatoform Dissociation Questionnaire: A replication study. Psychotherapy and Psychosomatics, 67, 1723.Google Scholar
Ogawa, J. R., Sroufe, L. A., Weinfield, N. S., Carlson, E. A., & Egeland, B. (1997). Development and the fragmented self: Longitudinal study of dissociative symptomatology in a nonclinical sample. Development and Psychopathology, 9, 855879.Google Scholar
Phillips, M., & Frederick, C. (1995). Healing the divided self: Clinical and Ericksonian hypnotherapy for post-traumatic and dissociative conditions. New York: W.W. Norton.
Putnam, F. W. (1997). Dissociation in children and adolescents. A developmental perspective (pp. 180198). New York: Guilford Press.
Pynoos, R. S. (1993). Traumatic stress and developmental psychopathology in children and adolescents. In J. Oldham, M. Riba, & A. Tasman (Eds.), American Psychiatric Press review of psychiatry (Vol. 12, pp. 205238). Washington, DC: American Psychiatric Association.
Pynoos, R. S., Steinberg, A. M., & Goenjian, A. K. (1996). Traumatic stress in childhood and adolescence. Recent developments and current controversies. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress. The effects of overwhelming experience on mind, body and society (pp. 331358). New York: Guilford Press.
Quinton, D., & Rutter, M. (1976). Early hospital admission and later disturbances of behavior: An attempted replication of Douglas' findings. Developmental Medicine and Child Neurology, 18, 447459.Google Scholar
Robertson, J., & Robertson, J. (1971). Young children in brief separation: A fresh look. The Psychoanalytic Study of the Child, 26, 264315.Google Scholar
Rutter, M. (1995). Clinical implications of attachment concepts: Retrospect and prospect. Journal of Child Psychology and Psychiatry, 36, 549571.Google Scholar
Sapolsky, R. (1996). Why stress is bad for your brain. Science, 273, 749750.Google Scholar
Shemesh, E., Keshavarz, R., Leichtling, N. K., Weinberg, E., Mousavi, A., Sadow, K., et al. (2003). Pediatric emergency department assessment of psychological trauma and posttraumatic stress. Psychiatric Services, 54, 12771281.Google Scholar
Simeon, D., Guralnik, O., Schmeidler, J., Sirof, B., & Knutelska, M. (2001). The role of childhood interpersonal trauma in depersonalization disorder. The American Journal of Psychiatry, 158, 10271033.Google Scholar
Smith, S. R., & Carlson, E. B. (1996). Reliability and validity of the Adolescent Dissociative Experience Scale. Dissociation, 9, 125129.Google Scholar
Steinberg, M., Rounsaville, B., & Cicchetti, D. (1991). Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview. The American Journal of Psychiatry, 148, 10501054.Google Scholar
Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.
Stern, D. N. (1995). The motherhood constellation: A unified view of parent–infant psychotherapy. New York: Basic Books.
Stuber, M. L., Kazak, A. E., Meeske, K., Barakat, L., Guthrie, D., Garnier, H., et al. (1997). Predictors of posttraumatic stress symptoms in childhood cancer survivors. Pediatrics, 100, 958964.Google Scholar
Stuber, M. L., Shemesh, E., & Saxe, G. N. (2003). Posttraumatic stress responses in children with life-threatening illnesses. Child and Adolescent Psychiatric Clinics of North America, 12, 195209.Google Scholar
Taylor, E. A. (1986). The overactive child. In E. A. Taylor (Ed.), Clinics in developmental medicine (Vol. 97). Oxford: Blackwell Scientific.
Terr, L. C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148, 1020.Google Scholar
van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1, 253265.Google Scholar
Vandvik, I. H., Høyeraal, H. M., & Fagertun, H. (1989). Chronic family difficulties and stressful life events in recent onset juvenile arthritis. Journal of Rheumatology, 16, 10881092.Google Scholar
Wohlfarth, T. D., Winkel, F. W., van den Brink, W., & ter Smitten, M. (2003). Screening for posttraumatic stress disorder: An evaluation of two self-report scales among crime victims. Psychological Assessment, 15, 101109.Google Scholar
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Dissociation following traumatic medical treatment procedures in childhood: A longitudinal follow-up
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