Assessment of dissociation in Bosnian treatment-seeking refugees in Denmark

Sabina Palic, Jessica Carlsson, Cherie Armour, Ask Elklit

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND:Dissociative experiences are common in traumatized individuals, and can sometimes be mistaken for psychosis. It is difficult to identify pathological dissociation in the treatment of traumatized refugees, because there is a lack of systematic clinical descriptions of dissociative phenomena in refugees. Furthermore, we are currently unaware of how dissociation measures perform in this clinical group.AIMS:To describe the phenomenology of dissociative symptoms in Bosnian treatment-seeking refugees in Denmark.METHOD:As a part of a larger study, dissociation was assessed systematically in 86 Bosnian treatment-seeking refugees using a semi-structured clinical interview (Structured Interview for Disorders of Extreme Stress-dissociation subscale; SIDES-D) and a self-report scale (Dissociative Experiences Scale; DES).RESULTS:The SIDES-D indicated twice as high prevalence of pathological dissociation as the DES. According to the DES, 30% of the refugees had pathological dissociation 15 years after their resettlement. On the SIDES-D, depersonalization and derealization experiences were the most common. Also, questions about depersonalization and derealization at times elicited reporting of visual and perceptual hallucinations, which were unrelated to traumatic re-experiencing. Questions about personality alteration elicited spontaneous reports of a phenomenon of "split" pre- and post-war identity in the refugee group. Whether this in fact is a dissociative phenomenon, characteristic of severe traumatization in adulthood, needs further examination.CONCLUSIONS:Knowledge of dissociative symptoms in traumatized refugees is important in clinical settings to prevent misclassification and to better target psychotherapeutic interventions. Much development in the measurement of dissociation in refugees is needed.
LanguageEnglish
Pages307-314
JournalNordic Journal of Psychiatry
Volume69
Issue number4
DOIs
Publication statusPublished - 2015

Fingerprint

Refugees
Denmark
Dissociative Disorders
Depersonalization
Therapeutics
Interviews
Hallucinations
Psychotic Disorders
Self Report
Personality

Keywords

  • Assessment
  • DES
  • Dissociation
  • Refugees
  • SIDES

Cite this

Palic, Sabina ; Carlsson, Jessica ; Armour, Cherie ; Elklit, Ask. / Assessment of dissociation in Bosnian treatment-seeking refugees in Denmark. In: Nordic Journal of Psychiatry. 2015 ; Vol. 69, No. 4. pp. 307-314.
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Assessment of dissociation in Bosnian treatment-seeking refugees in Denmark. / Palic, Sabina; Carlsson, Jessica; Armour, Cherie; Elklit, Ask.

In: Nordic Journal of Psychiatry, Vol. 69, No. 4, 2015, p. 307-314.

Research output: Contribution to journalArticle

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AU - Palic, Sabina

AU - Carlsson, Jessica

AU - Armour, Cherie

AU - Elklit, Ask

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N2 - BACKGROUND:Dissociative experiences are common in traumatized individuals, and can sometimes be mistaken for psychosis. It is difficult to identify pathological dissociation in the treatment of traumatized refugees, because there is a lack of systematic clinical descriptions of dissociative phenomena in refugees. Furthermore, we are currently unaware of how dissociation measures perform in this clinical group.AIMS:To describe the phenomenology of dissociative symptoms in Bosnian treatment-seeking refugees in Denmark.METHOD:As a part of a larger study, dissociation was assessed systematically in 86 Bosnian treatment-seeking refugees using a semi-structured clinical interview (Structured Interview for Disorders of Extreme Stress-dissociation subscale; SIDES-D) and a self-report scale (Dissociative Experiences Scale; DES).RESULTS:The SIDES-D indicated twice as high prevalence of pathological dissociation as the DES. According to the DES, 30% of the refugees had pathological dissociation 15 years after their resettlement. On the SIDES-D, depersonalization and derealization experiences were the most common. Also, questions about depersonalization and derealization at times elicited reporting of visual and perceptual hallucinations, which were unrelated to traumatic re-experiencing. Questions about personality alteration elicited spontaneous reports of a phenomenon of "split" pre- and post-war identity in the refugee group. Whether this in fact is a dissociative phenomenon, characteristic of severe traumatization in adulthood, needs further examination.CONCLUSIONS:Knowledge of dissociative symptoms in traumatized refugees is important in clinical settings to prevent misclassification and to better target psychotherapeutic interventions. Much development in the measurement of dissociation in refugees is needed.

AB - BACKGROUND:Dissociative experiences are common in traumatized individuals, and can sometimes be mistaken for psychosis. It is difficult to identify pathological dissociation in the treatment of traumatized refugees, because there is a lack of systematic clinical descriptions of dissociative phenomena in refugees. Furthermore, we are currently unaware of how dissociation measures perform in this clinical group.AIMS:To describe the phenomenology of dissociative symptoms in Bosnian treatment-seeking refugees in Denmark.METHOD:As a part of a larger study, dissociation was assessed systematically in 86 Bosnian treatment-seeking refugees using a semi-structured clinical interview (Structured Interview for Disorders of Extreme Stress-dissociation subscale; SIDES-D) and a self-report scale (Dissociative Experiences Scale; DES).RESULTS:The SIDES-D indicated twice as high prevalence of pathological dissociation as the DES. According to the DES, 30% of the refugees had pathological dissociation 15 years after their resettlement. On the SIDES-D, depersonalization and derealization experiences were the most common. Also, questions about depersonalization and derealization at times elicited reporting of visual and perceptual hallucinations, which were unrelated to traumatic re-experiencing. Questions about personality alteration elicited spontaneous reports of a phenomenon of "split" pre- and post-war identity in the refugee group. Whether this in fact is a dissociative phenomenon, characteristic of severe traumatization in adulthood, needs further examination.CONCLUSIONS:Knowledge of dissociative symptoms in traumatized refugees is important in clinical settings to prevent misclassification and to better target psychotherapeutic interventions. Much development in the measurement of dissociation in refugees is needed.

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