Dissociative Depression Among Women with Fibromyalgia or Rheumatoid Arthritis

Abstract

The aim of this study was to inquire about the possible relations of childhood trauma, anger, and dissociation to depression among women with fibromyalgia or rheumatoid arthritis. Fifty female patients diagnosed as having fibromyalgia (n = 30) or rheumatoid arthritis (n = 20) participated in the study. The Childhood Trauma Questionnaire, Somatoform Dissociation Questionnaire (SDQ), Dissociation Questionnaire (DIS-Q), Beck Depression Inventory (BDI), Spielberger State-Trait Anger Expression Inventory, and Dissociative Disorders Interview Schedule were administered to all participants. Women with a lifetime diagnosis of depressive disorder had higher scores for somatoform and psychoform dissociation than the nondepressive patients. However, childhood trauma scores did not differ between the 2 groups. In regression analysis, current severity of depression (BDI) was predicted by psychoform dissociation (DIS-Q) and lower education, and lifetime diagnosis of major depression was predicted by somatoform dissociation (SDQ). Whereas childhood emotional neglect predicted somatoform dissociation, psychoform dissociation was predicted by childhood sexual abuse. Mental processing of anger seems to be 1 of the dimensions of psychodynamics in trauma-related depressive conditions. In the context of the perceived threat of loss of control due to expressed anger and mental disintegration, somatoform dissociation seems to contribute to overmodulation of emotions in dissociative depression. Among patients suffering from physical illness with possible psychosomatic dimensions, assessment of somatoform dissociation in addition to psychoform dissociation may be helpful to understand diverse psychopathological trajectories emerging in the aftermath of childhood adversities. The recently proposed category of “dissociative depression” (Sar, 2011) seems to be a promising concept for future research on psychosomatic aspects of traumatic stress.

KEYWORDS:

• depression
• dissociation
• trauma
• PTSD
• borderline personality

ACKNOWLEDGMENTS

This study was conducted in the Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey. An earlier version of this article was presented at the 13th Conference of the European Society for Traumatic Stress Studies in Bologna, Italy, in 2013.

FUNDING

This project was supported by a grant of the Istanbul University Scientific Research Fund.