Switch Function and Pathological Dissociation in Acute Psychiatric Inpatients
April
Switch Function and Pathological Dissociation in Acute Psychiatric Inpatients
Chui-De Chiu 0 1
Mei-Chih Meg Tseng 1
Yi-Ling Chien 1
Shih-Cheng Liao 1
Chih- Min Liu 1
Yei-Yu Yeh 1
Hai-Gwo Hwu 1
0 Department of Psychology, The Chinese University of Hong Kong , Hong Kong SAR , The People's Republic of China, 2 Department of Psychology, National Taiwan University , Taipei, Taiwan , 3 Department of Psychiatry, National Taiwan University , Taipei, Taiwan , 4 Department of Psychiatry, Far Eastern Memorial Hospital , New Taipei City, Taiwan , 5 Department of Psychiatry, National Taiwan University Hospital , Taipei , Taiwan
1 Editor: Valsamma Eapen, University of New South Wales , AUSTRALIA
Swift switching, along with atypical ability on updating and inhibition, has been found in nonclinical dissociators. However, whether swift switching is a cognitive endophenotype that intertwines with traumatisation and pathological dissociation remains unknown. Unspecified acute psychiatric patients were recruited to verify a hypothesis that pathological dissociation is associated with swift switching and traumatisation may explain this relationship. Behavioural measures of intellectual function and three executive functions including updating, switching and inhibition were administered, together with standardised scales to evaluate pathological dissociation and traumatisation. Our results showed superior control ability on switching and updating in inpatients who displayed more symptoms of pathological dissociation. When all three executive functions were entered as predictors, in addition to intellectual quotient and demographic variables to regress upon pathological dissociation, switching rather than updating remained the significant predictor. Importantly, the relationship between pathological dissociation and switching became non-significant when the effect of childhood trauma were controlled. The results support a trauma-related switching hypothesis which postulates swift switching as a cognitive endophenotype of pathological dissociation; traumatisation in childhood may explain the importance of swift switching.
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OPEN ACCESS
Data Availability Statement: Data are from the
study of dissociative disorders and dissociation in
acute psychiatric inpatient in Taiwan. Due to the
confidentiality criteria which we adopted to apply for
the IRB at the National Taiwan University Hospital
and were listed on the informed consent, the
individual data, even without identifying variables,
cannot be uploaded for public access. Therefore, for
interested readers with an adequate research
purpose, the data can be shared upon request.
Please contact Chui-De Chiu at Department of
Psychology, The Chinese University of Hong Kong for
the data.
Introduction
Dissociation refers to a disruption in the normal integration of consciousness, memory,
identity, emotion, perception, body representation, motor control and behaviour (DSM-5, p. 291).
Dissociation is the cardinal feature of dissociative disorders and a prevalent comorbidity of
several mental disorders including psychotic and mood disorders [
1,2
]. To investigate the etiology
of dissociation, non-clinical and clinical studies have been conducted for two decades. A set of
factors linked to dissociation has been identified, despite the ongoing debate on the
pathogenesis of dissociation [
3–6
]. These factors include biological predisposition [
7,8
], interpersonal
adversity [
9–11
] and neuro-cognitive abnormalities.
Funding: The preparation of this manuscript is
supported by a grant from National Science Council
(NSC 101-2420-H-002-021-DR) and a start-up grant
from The Chinese University of Hong Kong to CDC,
and a grant from National Science Council to YYY
(NSC 102-2420-H-002-009-MY2). The funders had
no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.
Executive control, which is responsible for the manipulation of mental representations and
the coordination of mental operations [
12
], may underlie dissociation [
13
]. The main effect of
dissociation on attention and working memory tasks supports this hypothesis. Studies testing
patients with dissociative identity disorder (DID) showed superior disengagement abilities in
updating information in working memory and ineffective inhibition about suppressing unwanted
mental representations [
14–16
]. Similar findings were observed in non-clinical dissociative
individuals. Non-clinical dissociators showed superior abilities in dividing attention ([
17–19
]; but
also see [
20,21
] for failures to replicate the finding) and updating information in working
memory [22]. Non-clinical dissociators showed ineffective inhibition about suppressing target-related
competitors [
23,24
], task-irrelevant distractors [25] and unwanted mental representations ([
26
];
but also see [
20,21,27–30
] for the absence of a dissociation effect on the standard directed
forgetti (...truncated)