Auckland PSI^TM  Institute                                                       

*Introductory Notes:

At the turn of the millennium, dissociation is one of the most intriguing
constructs in psychology and psychiatry. In diagnostic publications such as the
DSM-IV, dissociation has been equated with dissociative loss of memory,
depersonalization, derealization, and fragmentation of identity.
However, according to 19th century French psychiatry, World War I
psychiatry, and various contemporary clinical observations, dissociation
also pertains to a lack of synthesis and integration into consciousness,
memory, and identity of somatoform components of experience, reactions,
and functions, for example sensory and motor functions. A range of
systematic research studies has demonstrated that these clinical views
are accurate (Nijenhuis, 1999). Somatoform dissociation is highly
characteristic of dissociative disorder clients, and a core feature in
many clients with somatoform disorders. It is strongly correlated with
reported trauma among psychiatric clients and clients with chronic
pelvic pain presenting in somatic health care. The major somatoform
dissociative symptoms prominently include anesthesia/analgesia and
freezing, which have similarities with animal defensive reactions to
predatory imminence and injury (Nijenhuis, Spinhoven, Vanderlinden, Van
Dyck, & Van der Hart, 1998a).

The SDQ looks at somatoform disorders and their relation to
dissociation. As Nijenhuis notes, the SDQ is more sensitive than the
DES in picking up dissociative symptoms in the group of persons with
somatoform disorders. Take a look at the questions. You may wish to
incorporate them into your routine interview, even if you decide not to
use the SDQ formally.

These instruments are not a substitute for a thoughtful, skillful,
face-to-face interview in a safe clinical setting. When our clients
respond to the questions listed in these tools there is a moment of
personal vulnerability. The risk for the person with dissociative
adaptations to living is held in the simultaneous hope and fear that
someone will notice what has otherwise been inarticulate for them. While
some clinicians may give these instruments to clients to fill out and
return in the next session, that may
prove to be unwise. Some questions may provoke intense anxiety for some
clients. If that is the case, the resulting anxiety would best be
contained by the timely intervention of the clinician and the provision
of a holding environment. Windows of opportunity may open at an initial
contact, and then close once a patient figures out the relative risk of
a clinical setting. In other words, we urge you to make use of your
powers of observation and to make your use of these tools as part of an
overall empathic approach to your clients.

The Scoring and Interpretation of the SDQ-20 and SDQ-5

Add up the item scores, and you have the total score (min 20, max 100).
Substantial somatoform dissociation starts from about 30, clients with DDNOS have on average 44, and clients with DID on average about 56.
The SDQ-5 consists of the item 4, 8 13 ,15 18 (min 5, max 25). The cut off in the screening for DSM-IV dissociative disorders is 8. Thus I would recommend to follow clients with scores higher than 7 up with the SCID-D diagnostic interview.

Courtesy of E.R.S. Nijenhuis
 
 

The Somatoform Dissociation Questionnaire

The book to find it all and more: Nijenhuis, E.
SOMATOFORM DISSOCIATION PHENOMENA, MEASUREMENT AND THEORETICAL ISSUES
Van Gorcum    ISBN: 90 232 3527 4 (2000)
(temporarily out of print. Look for new version hopefully coming soon)

*Taken from the ISSD website member only section
Reproduced here with permission from Ellert R.S. Nijenhuis, Ph.D. 2003

Relevant References

  Nijenhuis, E.R.S. (2000). Somatoform dissociation: Major symptoms of
dissociative disorders. Journal of Trauma and Dissociation, 1(4), 7-32.

   Nijenhuis, E.R.S. (2002, in press). Somatoforme Dissoziation. In: A.
Eckhart-Henn & S.O. Hoffman (Eds.), Dissoziative Störungen des
Bewußtseins [Dissociative Disorders of Consciousness]. Stuttgart:
Schattauer-Verlag.

Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., &
Vanderlinden, J. (1996). The development and the psychometric
characteristics of the Somatoform Dissociation Questionnaire (SDQ20).
Journal of Nervous and Mental Disease, 184, 688/694.

Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., de
Graaf, A.M.J., & Knoppert, E.A.M. (1997). Dissociative pathology
discriminates between bipolar mood disorder and dissociative disorder
(letter). British Journal of Psychiatry, 170, 581.

Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., &
Vanderlinden, J. (1997). The development of the Somatoform Dissociation
Questionnaire (SDQ5) as a screening instrument for dissociative
disorders. Acta Psychiatrica Scandinavica, 96, 311/318.

Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., &
Vanderlinden, J.(1998). Degree of somatoform and psychological
dissociation in dissociative disorders is correlated with reported
trauma. Journal of Traumatic Stress, 11, 711-730.

Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., &
Vanderlinden, J. (1998). Psychometric characteristics of the Somatoform
Dissociation Questionnaire: A replication study. Psychotherapy &
Psychosomatics, 67, 17-23.

Nijenhuis, E.R.S., Spinhoven, P., Vanderlinden, J., Van Dyck, R., & Van
der Hart, O. (1998). Somatoform dissociative symptoms as related to
animal defensive reactions to predatory threat and injury. Journal of
Abnormal Psychology, 107, 63-73.

Nijenhuis, E.R.S., Vanderlinden, J., & Spinhoven, P. (1998). Animal
defensive reactions as a model for trauma-induced dissociative
reactions. Journal of Traumatic Stress, 11, 243-260.

Nijenhuis, E.R.S., Van Dyck, R., Van der Hart, O., & Spinhoven, P.
(1998). Somatoform dissociation is unlikely to be a result of
indoctrination by therapists (letter). British Journal of Psychiatry,
172, 452.

Nijenhuis, E.R.S., Van Dyck, R., Spinhoven, P., Van der Hart, O.,
Chatrou, M., Vanderlinden, J., & Moene, F. (1999). Somatoform
dissociation discriminates between diagnostic categories over and above
general psychopathology. Australian and New Zealand Journal of
Psychiatry, 33, 512-520.

Nijenhuis, E.R.S., Van Engen, A., Kusters, I., & Van der Hart, O.
(2001). Peritraumatic somatoform and psychological dissociation in
relation to recall of childhood sexual abuse. Journal of Trauma and
Dissociation, 2(3), 49-68.

Nijenhuis, E.R.S., Van der Hart, O., & Kruger, K. (2002). The
psychometric characteristics of the Traumatic Experiences Questionnaire
(TEC): First findings among psychiatric outpatients. Clinical Psychology
and Psychotherapy, 9(3), 200-210.

Nijenhuis, E.R.S., Van Engen, A., Kusters, I., & Van der Hart, O.
(2001). Peritraumatic somatoform and psychological dissociation in
relation to recall of childhood sexual abuse. Journal of Trauma and
Dissociation, 2(3), 49-68.

Nijenhuis, E.R.S. & Van der Hart, O. (1999). Somatoform dissociative
phenomena: A Janetian Perspective. In J.M. Goodwin & R. Attias (Eds.),
Splintered reflections: Images of the body in trauma (pp. 89-127). New
York: Basic Books.

Nijenhuis, E.R.S., Van Dyck, R., Ter Kuile, M., Mourits, M., Spinhoven,
P., & Van der Hart, O. (1999). Evidence for associations between
somatoform dissociation, psychological dissociation and reported trauma
in chronic pelvic pain patients. In Nijenhuis, E.R.S., Somatoform
dissociation: Phenomena, measurement, and theoretical issues (pp.
146-160). Assen, The Netherlands: Van Gorcum. * To be published in June
2003 in Psychosomatic Obstetrics and Gynecology.



There has been a special issue on somatoform dissociation of the Journal
of Trauma and Dissociation with very interesting studies/papers by
several authors including Sar et al., Vander Hart et al., and Waller et
al. Later issues have included more papers on somatoform dissociation,
among other by El Hage et al. from France. Here are some of these refs:

El-Hage, W., Darves-Bornoz, J.-M., Allilaire, J.-F., & Gaillard, P.
(2002). Posttraumatic somatoform dissociation in French psychiatric
outpatients. Journal of Trauma and Dissociation, 3, 3, 59-73.

Kuyk, J., Spinhoven, P., Van Emde Boas, W., & Van Dyck, R. (1999).
Dissociation in temporal lobe epilepsy and pseudo-epileptic seizure
patients. Journal of Nervous and Mental Disease, 187, 12, 713-720.

Kuyk J, Van Dyck R and Spinhoven P (1996) The case for a dissociative
interpretation of pseudo-epileptic seizures: A review. The Journal of
Nervous and Mental Disease, 184, 468-474.

Sar V, Kundakci T, Kiziltan E, Bakim B and Bozkurt O (2000)
Differentiating dissociative disorders fron other diagnostic groups
through somatoform dissociation. Journal of Trauma and Dissociation, 1,
67-80.

Van der Hart O, Van Dijke A, Van Son M and Steele K (2000) Somatoform
dissociation in traumatized World War I combat soldiers: A neglected
clinical heritage. Journal of Trauma and Dissociation, 1 (4), 33-66.

Van Ommeren, M., Sharma, B., Sharma G. K., de Jong, J. T. V. M.,
Komproe, I., & Cardeña, E. (still in press?). The relationship between
somatic and PTSD symptoms among Bhutanese refugee torture survivors. In
T. M.McIntyre, & S. Krippner (Eds.), The impact of war trauma on
civilian populations: An international perspective. Greenwood Press/Praeger.

Waller G, Hamilton K, Elliott P, Lewendon J, Stopa L, Waters A, Kennedy
F, Lee G, Pearson D, Kennerley H, Hargreaves I, Bashford V and Chalkey J
(2000) Somatoform dissociation, psychological dissociation and specific
forms of trauma. Journal of Trauma and Dissociation, 1, 81-98.



You may also want to consult the following important chapters:

Kihlstrom JF (1994) One hundred years of hysteria. In Dissociation:
Clinical and Theoretical Perspectives, Lynn SJ and Rhue JW (eds),
Guilford, New York, pp. 365-395.

Nemiah JC (1991) Dissociation, conversion, and somatiza­ti­on. In
American Psychiatric Press Annual Review of Psychiatry, Vol. 10, Tasman
A and Goldfinger SM (eds), American Psychiatric Press, Was­hington, DC,
pp. 248-260.



 Texts on somatoform dissociation:

Janet, P. (1901). The mental state of hystericals. New York: Putnam &
Sons. Reprint: University Publications of America, Washington DC, 1977.
Original editions: L'Etat mental des hystériques: Les stigmates mentaux.
Paris: Rueff &Cie., 1893, and L'Etat mental des hystériques: Les
accidents mentaux. Paris: Rueff & Cie., 1894.

Janet P (1907) The Major Symptoms of Hysteria. Macmillan, London and New
York.

-