title: Assessment of dissociation in Bosnian treatment-seeking refugees in Denmark.
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.
  
  
  OBJECTIVE
  To describe the phenomenology of dissociative symptoms in Bosnian treatment-seeking refugees in Denmark.
  
  
  METHODS
  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.
authors.affiliation: Sabina Palic, M.Sc., Psychology, Danish National Centre for Psychotraumatology, University of Southern Denmark , Odense , Denmark.
authors.forename: Sabina
authors.initials: S
authors.lastname: Palic
authors.forename: Jessica
authors.initials: J
authors.lastname: Carlsson
authors.forename: Cherie
authors.initials: C
authors.lastname: Armour
authors.forename: Ask
authors.initials: A
authors.lastname: Elklit
mesh_terms: D000328:Adult; D000368:Aged; D017522:Bosnia and Herzegovina / Q000208:ethnology; D003718:Denmark / Q000208:ethnology; D004213:Dissociative Disorders / Q000175:diagnosis* / Q000208:ethnology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology; D012036:Refugees / Q000523:psychology; D016896:Treatment Outcome
keywords: Assessment; DES; Dissociation; Refugees; SIDES