Dissociative Symptoms in the Diagnosis of Acute Stress Disorder

  • David Spiegel
  • Cheryl Koopman
  • Etzel Cardeña
  • Catherine Classen

Abstract

The proposal for a new diagnostic entity requires very careful consideration of the benefits and risks that such a decision entails. On the one hand, if a condition that is prevalent in a substantial percentage of the population goes undiagnosed or misdiagnosed, the affected individuals will lack proper diagnosis and treatment of their condition. In turn, the lack of recognition of the diagnostic entity might prevent the proper research designed to understand the condition, its treatment, and its clinical and social ramifications. On the other hand, carelessly introducing new diagnostic entities brings the risk of pathologizing what may be innocuous or even appropriate reactions to the misfortunes of life. Further, even if the symptomatology of the diagnosis can be considered “pathological,” it is still incumbent upon the advocates of the diagnosis to show that their proposal will not simply add to the profusion of diagnoses, but rather that the disorder cannot be reasonably accommodated by the existing nosology.

Keywords

Anxiety Symptom Traumatic Event Posttraumatic Stress Posttraumatic Stress Disorder Posttraumatic Stress Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  3. Bernstein, E. M., & Putnam, E W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–734.PubMedCrossRefGoogle Scholar
  4. Branscomb, L. (1991). Dissociation in combat-related post-traumatic stress disorder. Dissociation, 4 (1), 13–20.Google Scholar
  5. Bremner, J. D., Southwick, S., Brett, E., Fontana, A., Rosenheck, R., & Charney, D. S. (1992). Dissociation and posttraumatic stress disorder in Vietnam combat veterans. American Journal of Psychiatry, 149 (3), 328–332.PubMedGoogle Scholar
  6. Gardena, E., & Spiegel, D. (1993). Dissociative reactions to the Bay Area earthquake. American Journal of Psychiatry, 150, 474–478.Google Scholar
  7. Gardena, E., Classen, C., & Spiegel, D. (1991). Stanford Acute Stress Reaction Questionnaire. Stanford, CA: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine.Google Scholar
  8. Gardena, E., Lewis-Fernandez, R., Bear, D., Pakianathan, I., & Spiegel, D. (1995). Dissociative disorders. In DSM-IV sourcebook (pp. 973–1005 ). Washington, DC: American Psychiatric Press.Google Scholar
  9. Carlson, E., & Rosser-Hogan, R. (1991). Trauma experiences, post-traumatic stress, dissociation, and depression in Cambodian refugees. American Journal of Psychiatry, 148 (11), 1548–1551.PubMedGoogle Scholar
  10. Carlson, E. B., & Rosser-Hogan, R. (1994). Cross-cultural response to trauma: A study of traumatic experiences and posttraumatic symptoms in Cambodian refugees. Journal of Traumatic Stress, 7 (1), 43–58.PubMedCrossRefGoogle Scholar
  11. Classen, C., Koopman, C., & Spiegel, D. (1993). Trauma and dissociation. Bulletin of the Menninger Clinic, 57 (2), 178–194.PubMedGoogle Scholar
  12. Freinkel, A., Koopman, C., & Spiegel, D. (1994). Dissociative symptoms in media execution witnesses. American Journal of Psychiatry, 15 (9), 1335–1339.Google Scholar
  13. Gold, J. W, & Cardera, E. (1993). Sexual abuse and combat-related trauma: Psychometric and phenomenological resemblance. Unpublished manuscript.Google Scholar
  14. Horowitz, M. J., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective distress. Psychosomatic Medicine, 41, 209–218.PubMedGoogle Scholar
  15. Horowitz, M. J., Field, N. P., & Classen, C. C. (1993). Stress response syndromes and their treatment. In L. Goldberger & S. Bresnitz (Eds.), Handbook of stress: Theoretical and clinical aspects ( 2nd ed., pp. 757–773 ). New York: Free Press.Google Scholar
  16. Keane, T M., Wolfe, J., & Taylor, K. L. (1987). Post-traumatic stress disorder: Evidence for diagnostic validity and methods of psychological assessment. Journal of Clinical Psychology, 43 (1), 32–43.PubMedCrossRefGoogle Scholar
  17. Keane, T M., Caddell, J. M., & Taylor, K. L. (1988). Mississippi Scale for Combat-Related Post-traumatic Stress Disorder: Three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 56 (1), 85–90.PubMedCrossRefGoogle Scholar
  18. Koopman, C., Classen, C., & Spiegel, D. (in press). Dissociative responses in the immediate aftermath of the Oaldand/Berkeley firestorm. Journal of Traumatic Stress Google Scholar
  19. Koopman, C., Classen, C., Cardera, E., & Spiegel, D. (1995). When disaster strikes, acute stress disorder may follow. Journal of Traumatic Stress, 8 (1), 29–46.PubMedCrossRefGoogle Scholar
  20. Koopman, C., Classen, C., & Spiegel, D. (1994). Predictors of posttraumatic stress symptoms among survivors of the Oakland/Berkeley, Calif. firestorm. American Journal of Psychiatry, 151 (6), 888–894.PubMedGoogle Scholar
  21. Kraemer, H. C. (1992). Evaluating medical tests: Objectives and quantitative guidelines. Newbury Park, CA: Sage.Google Scholar
  22. Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141–148.Google Scholar
  23. Marmar, C. R., Weiss, D. S., Schlenger, W. E., Fairbank, J. A., Jordan, B. K., Kulka, R. A., & Huff, R. L. (1994). Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans. American Journal of Psychiatry, 151 (6), 902–907.PubMedGoogle Scholar
  24. Marshall, J. (1991, October 19). S5 billion damage estimate may be too high. San Francisco Chronicle, p. A19.Google Scholar
  25. McFarlane, A. C. (1986). Posttraumatic morbidity of a disaster. Journal of Nervous and Mental Disease, 174, 4–14.PubMedCrossRefGoogle Scholar
  26. Mellman, T A., Randolph, C. A., Brawman-Mintzer, O., Flores, L. P., & Milanes, E J. (1992). Phenomenology and course of psychiatric disorders associated with combat-related post-traumatic stress disorder. American Journal of Psychiatry, 149, 1568–1574.PubMedGoogle Scholar
  27. Rangell, L. (1976). Discussion of the Buffalo Creek disaster: The course of psychic trauma. American Journal of Psychiatry, 133, 313–316.PubMedGoogle Scholar
  28. Schwarzwald, J., Solomon, Z., Weisenberg, M., & Mikulincer, M. (1987). Validation of the impact of event scale for psychological sequelae of combat. Journal of Consulting and Clinical Psychology, 55, 251–256.PubMedCrossRefGoogle Scholar
  29. Siegel, R. K. (1984). Hostage hallucinations: Visual imagery induced by isolation and life-threatening stress. Journal of Nervous and Mental Disease, 172 (5), 264–272.PubMedCrossRefGoogle Scholar
  30. Solomon, Z., Mikulincer, M., & Benbenistry, R. (1989). Combat stress reaction: Clinical manifestations and correlates. Military Psychology, 1, 35–47.CrossRefGoogle Scholar
  31. Spiegel, D., & Cardera, E. (1990). New uses of hypnosis in the treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 51 (10, suppl.), 39–43.PubMedGoogle Scholar
  32. Spiegel, D., & Cardera, E. (1991). Disintegrated experience: The dissociative disorders revisited. Journal of Abnormal Psychology, 100 (3), 366–378.PubMedCrossRefGoogle Scholar
  33. Spiegel, D., Hunt, T, & Dondershine, H. E. (1988). Dissociation and hypnotizability in post-traumatic stress disorder. American Journal of Psychiatry, 145, 301–305.PubMedGoogle Scholar
  34. Spiegel, D., Koopman, C., Cardera, E., & Classen, C. (1993). The development of a state measure of dissociative reactions to trauma. Final report to NIMH. Stanford, CA: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine.Google Scholar
  35. Spiegel, D., Koopman, C, & Classen, E. (1994). Acute stress disorder and dissociation. Australian Journal of Clinical and Experimental Hypnosis, 22 (1), 11–23.Google Scholar
  36. Staff. ( 1993, January). 1992 disasters cost the U.S.17 billion in emergency aid. San Francisco Chronicle, p. 4.Google Scholar
  37. Stutman, R. K., & Bliss, E. L. (1985). Posttraumatic stress disorder, hypnotizability, and imagery. American Journal of Psychiatry, 142, 741–743.PubMedGoogle Scholar
  38. Taylor, M., & Wildermuth, J. (1991, October 25). It was worst wildfire in U.S. history. San Francisco Chronicle, p. Al, A16.Google Scholar
  39. Wilkinson, C. B., (1983). Aftermath of a disaster: The collapse of the Hyatt Regency Hotel skywalks. American Journal of Psychiatry, 140, 1134–1139.PubMedGoogle Scholar
  40. World Health Organization. (1990). International classification of diseases and related health problems (10th ed.) Geneva: Author.Google Scholar
  41. Zilberg, N. J., Weiss, D. S., & Horowitz, M. (1982). Impact of Event scale: A cross-validation study. Journal of Consulting and Clinical Psychology, 50, 407–414.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • David Spiegel
    • 1
  • Cheryl Koopman
    • 1
  • Etzel Cardeña
    • 2
  • Catherine Classen
    • 1
  1. 1.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA
  2. 2.Department of PsychiatryUniformed Services University of the Health SciencesBethesdaUSA

Personalised recommendations