The Shutdown Dissociation Scale (Shut-D)

Figures & data

Table 1 Assumed survival advantage of the shutdown continuum according to Schauer and Elbert (2010) in order to inhibit non-adaptive action disposition and enable survival

Freeze	During attentive immobility (orienting response)  - blend in with its surroundings by remaining as motionless as an inanimate object  - shift the attention of predators to other moving or noisy stimuli
Flight/fight	During active defense response  - increase in heart rate, blood pressure, faster and deeper breathing  - increase in sweating (cools the body, moist palms at the same time allow for a better grip in order to flee, lowering the chances for injury)  - the release of sympathetically mediated adrenalin is initiated  - the heart and muscles with the required energy for flight or fight  - peripheral vessels constrict in order to reduce potential blood loss in the case of an injury  - shutdown of perception for nociception to inhibit recuperative behavior  - limitation of cognitive ability
Fright	During unresponsive immobility  - increase in survival chances even when physical contact has been made, because movement cues are critical, releasing stimuli for predatory behavior  - immobility helps avoiding tissue damage when threatened with sharp objects or when penetrated  - immobility signals surrender and eliminates cues for counter aggression  - shut down/numbing of anger emotion to inhibit aggression and defense  - suppressed vocal behavior
Flag/faint including flaccid immobility	During flaccid immobility  - lowering blood pressure in case of tissue damage, minimizing blood loss  - “automatic” shock-bedding – availability of oxygen and nutrients in central organs (i.e., the brain)  - decrease in heart rate while maintaining metabolism in case of intoxication or contamination  - cardio-protection (→ cortisol stops stress reaction)  - analgesia  - numbing of all emotions including fear, disgust, etc.  - shutdown of physiological arousal and memory functions

Table 2 Sample description, mean, and standard deviation of age, frequency of gender, and mean and standard deviation of shutdown dissociation

Sample	Age, M (SD)	Gender, % female	Shutdown Dissociation Score, M (SD)
Study sample 1 (n=71) HC (n=17) MD (n=10) PTSD (n=44)	32 (6.8) 30 (13.7) 35 (10.1)	100	0.94 (1.25) 4.8 (3.4) 17 (8.6)
Study sample 2 (n=77) HC (n=51) BPD (n=13) MD (n=13)	31.5 (11.2) 30.4 (10.3) 27.6 (8.7) 42.2 (14.5)	100	2.02 (3.1) 14.88 (10.7) 5.77 (4.7)
Study sample 3 (n=130) PSD (n=104) BPD/MD (n=26)	29.2 (9.1) 26.5 (6.1)	38 33.7 53.8	4.3 (4.7) 8.03 (5.8)
Study sample 4 DID (n=15)	43 (9.1)	100	19.2 (9.4)

Table 3 Item difficulties and factor loadings in an one-factor solution as well as in a rotated (Varimax) two-factor solution

		One-factor solution	Two-factor solution^a
	Items	M (SD)	1. Factor loading (43.43%)	1. Factor loading (43.43%)^a, (27.25%)^b	2. Factor loading (8.19%)^a, (24.37%)^b
1	Have you fainted?/Have you been passing out?	0.2 (0.58)	0.58	0.24	0.60
2	Have you felt dizzy and has your vision gone black?/Felt dizzy and couldn't see anymore, as though you were blind?	0.83 (1.06)	0.72	0.57	0.45
3	Have you felt as though you couldn't hear for a while, as though you were deaf? When people were talking to you, did they sound far away?	0.49 (0.96)	0.68	0.21	0.78
4	Have you had an experience of not being able to properly see things around you (e.g., blurred vision)	0.62 (1.0)	0.71	0.37	0.65
5	Have you felt as though your body or a part of your body has gone numb?	0.64 (1.08)	0.71	0.51	0.50
6	Have you felt as though you couldn't move for a while, as though you were paralyzed?	0.37 (0.81)	0.72	0.71	0.28
7	Have you felt as though your body, or a part of it was insensitive to pain (analgesia)?	0.46 (0.93)	0.64	0.33	0.58
8	Have you been in a state in which your body suddenly felt heavy and tired?	1.0 (1.32)	0.60	0.61	0.23
9	Have you experienced that your body becoming stiff for a while?	0.39 (0.85)	0.64	0.80	0.08
10	Have you felt nauseous? Have you felt as though you were about to throw up? Have you felt yourself break out in a cold sweat?	0.80 (1.10)	0.62	0.68	0.19
11	Have you had an “out-of-body” sensation? Have you felt as though you were outside of your body?	0.43 (0.90)	0.50	0.06	0.68
12	Have you had moments in which you have found yourself unable to speak?/Have you been able to speak only with great effort?/Have you had an experience in which you could only whisper for a period of time?	0.46 (0.91)	0.70	0.63	0.35
13	Have you felt suddenly weak and warm?	0.48 (0.95)	0.71	0.51	0.50

Note. ^aBefore rotation; ^brotated (Varimax) factor matrix.

Table 4 Item-total-correlation as well as retest reliability index on item level

	Item	Item-total correlation	Retest reliability index on item level^a
1	Fainting	0.44, p<0.001	0.73, p<0.001
2	Dizziness/transitory blindness	0.72, p<0.001	0.74, p<0.001
3	Transitory deafness, changed acoustic perception	0.62, p<0.001	0.68, p<0.001
4	Changed visual perception	0.64, p<0.001	0.76, p<0.001
5	Numbness	0.67, p<0.001	0.66, p<0.001
6	Transitory paralysis	0.56, p<0.001	0.59, p<0.001
7	Analgesia	0.55, p<0.001	0.76, p<0.001
8	Heavy and tired	0.68, p<0.001	0.66, p<0.001
9	Tension	0.56, p<0.001	0.38, p=0.007
10	Feeling of nausea	0.68, p<0.001	0.67, p<0.001
11	Out of body	0.45, p<0.001	0.82, p<0.001
12	Inability to speak	0.60, p<0.001	0.87, p<0.001
13	Weakness and hot flash	0.62, p<0.001	0.70, p<0.001

Note. ^aThe retest reliability index on item level was calculated in study sample 1.

Fig. 1 The relationship between the sum score of the first and second assessments of the shutdown dissociation score. The filled circles present members of the patient group of the study sample 1 (patients with posttraumatic stress disorder and/or major depression) and the open circles members of the healthy control group. The line indicates the regression line (model estimation from the patient sample).

Fig. 2 The relationship between the shutdown dissociation score and the shutdown dissociative strength in response to emotional evocative pictures. The filled circles present a PTSD/MD group and the open circles a non-PTSD group member. The line shows the regression line (model estimation from the patient sample). PTSD=posttraumatic stress disorder, MD=major depression.

Fig. 3 The scatterplot of the shutdown dissociation sum score and the sum score of the Dissociative Experience Scale (DES) across different diagnostic groups and healthy controls. The patients in the dissociative identity disorder group were instructed to rate the symptoms for the host personality. The dashed horizontal line presents the cut-off score of the DES sum score, and those values above 30 are indicative of a dissociative disorder or of posttraumatic stress disorder (PTSD).

Fig. 4 Boxplot of the shutdown dissociation sum score across different diagnostic groups and healthy controls. The patients in the dissociative identity disorder group were instructed to rate their symptoms for the host personality. BPD=borderline personality disorder, MD=major depression.

Table 5 Group comparisons between different diagnostic groups as well as healthy controls

Sample	Healthy control Study 2	Psychotic disorder	MD Study 1	MD Study 2	MD/BPD Study 3	BPD Study 2	PTSD	DID
Healthy Control Study 1	W=347 p=0.203	W=454 p=0.001*	W=28.5 p=0.003	W=48 p=0.006	W=44 p<0.001*	W=210 p<0.001*	W=734.5 p<0.001*	W=255 p<0.001*
Healthy Control Study 2		W=3,502 p=0.001*	W=130 p=0.013	W=200 p=0.025	W=217 p<0.001*	W=600.5 p<0.001*	W=2,152.5 p<0.001*	W=746 p<0.001*
Psychotic disorder			W=433 p=0.382	W=560 p=0.312	W=801 p=0.001	W=1,112.5 p<0.001*	W=4,110.5 p<0.001*	W=1,450 p<0.001*
MD Study 1				W=56 p=0.594	W=88.5 p=0.146	W=101.5 p=0.025	W=392.5 p<0.001*	W=137 p<0.001*
MD Study 2					W=206.5 p=0.268	W=600.5 p<0.001*	W=496.5 p<0.001*	W=173 p<0.001*
MD/BPD Study 3						W=232 p=0.062	W=911.5 p<0.001*	W=327 p<0.001*
BPD Study 2							W=333.5 p=0.371	W=125 p=0.213
PTSD								W=374 p=0.448

Note. *Significant at Bonferroni adjusted p-value (p=0.001). MD=major depression, BPD=borderline personality disorder, PTSD=posttraumatic stress disorder, DID=dissociative identity disorder.

Fig. 5 Scatterplots illustrating correlations between shutdown dissociation and (A) the number of different traumatic event types, (B) the number of different witnessed traumatic event types, (C) the severity of PTSD symptoms, and (D) the severity of depression symptoms. The slope of the regression is presented for significant associations. PTSD=posttraumatic stress disorder.

Schlumpf Y. R., Nijenhuis E. R., Chalavi S., Weder E. V., Zimmermann E., Luechinger R., etal. Dissociative part-dependent biopsychosocial reactions to backward masked angry and neutral faces: An fMRI study of dissociative identity disorder. NeuroImage: Clinical. 2013; 3: 54–64.

 PubMed Web of Science ®Google Scholar