Factors related to dissociation among patients with gastrointestinal complaints.
OBJECTIVE
Several recent reports have suggested that the process of dissociation is independently associated with several distressing conditions such as psychiatric diagnoses, somatization, current psychological distress, and past sexual and physical victimization. These studies, however, have not taken into account possible shared variance between these variables. Is dissociation uniquely related to each of these outcomes or do they, as a group, have common underlying factors that account for the relationship with dissociation?


METHODS
As part of a larger study of gastroenterology clinic patients with irritable bowel syndrome and patients with inflammatory bowel disease (n = 103), we used stepwise multiple regression to select the factors most associated with dissociation, while controlling for the effects of other variables. Variable domains included demographics, psychiatric diagnoses, personality factors, functional disability, and trauma history. These domains as well as individual variables within these domains were systematically evaluated for their unique contribution to the prediction of dissociation as measured by the Dissociative Experiences Scale (DES).


RESULTS
The best multivariable model for estimating dissociation magnitude included severe child sexual abuse, perceived physical disability, and lifetime dysthymia, alcoholism, and generalized anxiety disorder. These factors accounted for 37% of the variance in DES score and increased the correct classification of patients as either low-, middle-, or high-level dissociators.


CONCLUSIONS
Dissociation among this convenience sample of IBS and IBD patients is a long-term coping pattern that is associated primarily with past sexual trauma, chronic emotional distress, alcoholism, and physical disability. Prospective studies are needed to test whether these findings also occur in other more generalizable samples.
Engel
C C
CC
Tripler Army Medical Center, Honolulu, Hawaii, USA.
Walker
E A
EA
Katon
W J
WJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002649:Child Abuse / Q000523:psychology; D002650:Child Abuse, Sexual / Q000523:psychology; D003109:Colonic Diseases, Functional / Q000175:diagnosis / Q000523:psychology*; D004213:Dissociative Disorders / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000523:psychology*; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D010555:Personality Inventory; D011902:Rape / Q000523:psychology; D012307:Risk Factors; D012803:Sick Role; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology*