This study demonstrates that DDD is not characterized by elevated responsiveness to direct verbal suggestions. Exploratory analyses revealed that patients with more severe anomalous bodily experiences were also more responsive to suggestion, an effect not seen in controls. Although suggestibility did not correlate with severity of depersonalization-derealization symptoms in controls, r=-.03, there was a weak tendency for a positive association in patients, r=.25. 11) but displayed significantly lower mindfulness (g = 1.38), and imagery vividness (g = 0.63), and significantly greater anxiety (g = 1.39). Relative to controls, patients did not exhibit elevated suggestibility (g = 0.26, BF10 =. 55 DDD patients and 36 healthy controls completed a standardised behavioural measure of direct verbal suggestibility that includes a correction for compliant responding (BSS-C), and psychometric measures of depersonalization-derealization (CDS), mindfulness (FFMQ), imagery vividness (VVIQ), and anxiety (GAD-7). However, it remains unclear whether atypical responsiveness to suggestion is similarly present in depersonalization-derealization disorder (DDD). The dissociative disorders and germane conditions are reliably characterized by elevated responsiveness to direct verbal suggestions. Accordingly, one interpretation of the present results is that elevated suggestibility is specific to a high dissociation (compartmentalization) subtype that possesses a more similar symptom profile to other dissociative disorders, or a high severity subtype, that also includes more severe anxiety, given the current trend towards more severe depersonalization-derealization symptoms as well as anxiety symptoms being associated with heightened suggestibility. Recent work examining heterogeneity in DDD (Millman et al., 2021) yielded evidence for five distinct classes of DDD patients: three comprising subtypes based on severity (Low severity, Moderate severity, High severity), and two subtypes differing on detachment and compartmentalization (High depersonalization, High dissociation) symptomatology (Holmes et al., 2005 Brown, 2006). By contrast, DDD is primarily characterized by detachment from one's body, mental states, or sense of self (depersonalization) and/or from one's surroundings (derealization Hunter et al., 2014). However, it is important to note that significant portions of dissociative disorder patients do not report trauma (Lynn et al., 2019), and other factors including ruminations (Vannikov-Lugassi et al., 2020), stress and anxiety (Soffer-Dudek, 2017), and drug use (Good, 1989 Madden and Einhorn, 2018) can predict increases in dissociative symptoms. The symptom differences seen in DDD as compared to other dissociative disorders are potentially attributable to differential aetiologies: whereas trauma exposure has been considered a primary antecedent of dissociative disorders and PTSD (Wieder and Terhune, 2019), it seems to be implicated in smaller proportion of DDD cases, corresponding to ~40% (Baker et al., 2003 Michal et al., 2016 Millman et al., 2021 Simeon et al., 2003). Indeed, a recent meta-analysis demonstrated that patients with DDD score lower on the Dissociative Experiences Scale (DES Carlson and Putnam, 1993) than those diagnosed with dissociative identity disorder and other dissociative disorders as well as those with posttraumatic stress disorder (PTSD), borderline personality disorder, and functional neurological disorder, which are not classified as dissociative disorders within the DSM-5 (American Psychiatric Association, 2013). Further elucidation of these subtypes has potential implications for the etiology, mechanisms, and treatment of DDD. The five classes reliably differed on several nondissociative symptoms, comorbidities, and factors precipitating their diagnosis but did not significantly differ in other symptoms including anxiety.Ĭonclusion: These results suggest the presence of three distinct DDD subtypes in the upper severity range that are distinguished by differential expression of detachment and compartmentalization symptoms. Results: The analysis yielded evidence for five discrete subgroups: three of varying severity levels and two moderate-to-severe classes characterized by differential dissociative symptoms. Method: We applied latent profile analysis to psychometric measures of anxiety, depersonalization–derealization, and dissociation in 303 DDD patients. This study aims to determine whether symptom heterogeneity is attributable to the presence of latent subgroups. Objective: Depersonalization–derealization disorder (DDD) is characterized by diverse symptomatology overlapping with anxiety and dissociative disorders, but the sources of this variability are poorly understood.
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