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Somatoforme dissociatie: Bijna vergeten, maar meetbaar aanwezig

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Samenvatting

Volgens de 19de-eeuwse Franse psychiatrie heeft dissociatie betrekking op psychologische aspecten van ervaringen, reacties en functies zoals amnesie en identiteitsfragmentering, alsook op lichamelijke of somatoforme aspecten, zoals anesthesie en motorische stoornissen. Bij de hernieuwde interesse voor dissociatie en dissociatieve stoornissen bestaat er te weinig belangstelling voor somatoforme dissociatie. Zoals we toelichten aan de hand van een casus, zijn er klinische aanwijzingen dat dissociatieve stoornissen samenhangen met de somatoforme dissociatieve symptomen die 19de-eeuwse patiënten met hysterie kenmerkten. Daarna beschrijven we de ontwikkeling van een zelf-rapportage-vragenlijst die de ernst van somatoforme dissociatie meet. Zowel het oorspronkelijke onderzoek als het herhalingsonderzoek wees uit dat deze Somatoform Dissociation Questionnaire (SDQ-20) over uitstekende psychometrische eigenschappen beschikt. De items bleken in sterke mate schaalbaar te zijn op een unidimensionele latente schaal. De betrouwbaarheid van de schaal was hoog. Hoge correlaties met de DIS-Q, die psychologische manifestaties van dissociatie meet, ondersteunen de convergente validiteit van de SDQ-20. Hogere scores van patiënten met een dissociatieve identiteitsstoornis vergeleken met patiënten met een dissociatieve stoornis nao of depersonalisatiestoornis wijzen op criterium-gerelateerde validiteit. De SDQ-20 items betreffen negatieve en positieve dissociatieve verschijnselen, die in de 19de-eeuwse Franse psychiatrie bekend waren als de essentiële kenmerken van hysterie.

Abstract

According to 19th-century French psychiatry, dissociation pertains to both psychological and somatoform components of experience, reactions, and functions. The renewed interest for dissociation and dissociative disorders has witnessed insufficient attention for somatoform dissociation. Using a case of dissociative identity disorder, we first provide clinical evidence suggesting that complex dissociative disorders may involve the somatoform dissociative symptoms which were characteristic of hysteria. Next, we describe the development of a self-report questionnaire measuring the severity of somatoform dissociation. The original study, as well as the replication study, revealed that the psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20) are excellent. The 20 items are strongly scalable on a unidimensional latent scale and the reliability was high. High intercorrelations with the Dissociation Questionnaire, which measures psychological dissociation support the convergent validity of the SDQ-20. Higher scores of patients with dissociative identity disorder compared to patients with dissociative disorder nos or depersonalization disorder support the criterion-related validity. The items of the SDQ-20 pertain to negative and positive dissociative symptoms which in the 19th-century were known as the major symptoms of hysteria.

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    Ellert Nijenhuis

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  1. Ellert Nijenhuis
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  2. Philip Spinhoven
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  3. Richard van Dyck
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  4. Onno van der Hart
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drs. e.r.s. nijenhuis is als psycholoog-psychotherapeut werkzaam bij de Polikliniek Psychiatrie van APZ Drenthe te Assen, en als wetenschappelijk onderzoeker bij de Vakgroep Psychiatrie, Vrije Universiteit Amsterdam en het Cats-Polm Instituut te Bilthoven, een non-profit onderzoeksinstituut dat zich richt op de bestudering van chronische traumatisering. dr. ph. spinhoven, klinisch psycholoog-psychotherapeut, is hoogleraar klinische psychologie aan de Rijksuniversiteit Leiden. dr. r. van dyck is hoogleraar psychiatrie aan de Vrije Universiteit Amsterdam. dr. o. van der hart, psycholoog-psychotherapeut, is bijzonder hoogleraar in de vakgroep Klinische Psychologie en Gezondheidspsychologie, Universiteit van Utrecht en hoofd onderzoek bij het Cats-Polm Instituut. dr. j. vanderlinden, psycholoog, is werkzaam bij de gedragtherapeutische dienst van het Universitair Centrum St. Jozef te Kortenberg, België.

Dit onderzoek werd gesubsidieerd door de Stichting Dienstbetoon Gezondheidszorg, Soesterberg, nummer 11.92

Dit artikel is een bewerking van: E.R.S. Nijenhuis en O. van der Hart (1998a) , Somatoform dissociation: A Janetian perspective. In J.M. Goodwin en R. Attias (red.), Splintered reflections: Images of the body in trauma. New York: Basic Books. In druk; The development and psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20), The Journal of Nervous and Mental Disease, 1996, 184, 688-694, en Psychometric characteristics of the Somatoform Dissociation Questionnaire: A replication study, Psychotherapy and Psychosomatics, 1998, 67, 17-23. Beide artikelen zijn van de auteurs van dit artikel. Op aanvraag worden de artikelen toegestuurd.

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Nijenhuis, E., Spinhoven, P., van Dyck, R. et al. Somatoforme dissociatie: Bijna vergeten, maar meetbaar aanwezig. DITH 18, 43–58 (1998). https://doi.org/10.1007/BF03060192

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