Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-18T19:03:52.011Z Has data issue: false hasContentIssue false

Dissociative psychosis: an atypical presentation and response to cognitive-analytic therapy

Published online by Cambridge University Press:  13 June 2014

Candida Graham
Affiliation:
University of Leicester Department of Psychiatry, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, England
Rijan Thavasotby
Affiliation:
Walsgrave Hospital, Coventry CV2 2DX, Department of Psychiatry, University of BirminghamB15 2QZ, England

Abstract

We report on a patient with a rare type of dissociative disorder, dissociative psychosis (hysterical psychosis), in whom gustatory, olfactory, visual and auditory hallucinations occurred. Auditory and visual hallucinations have been described in previous cases of dissociative psychosis, and olfactory and gustatory hallucinations have been described associated with sexual assault but this case is unusual in that hallucinations occur in all modalities in one patient, as yet not described in the literature The basis of the dissociative disorder lay in a childhood sexual trauma and therefore the traditionally advocated treatment for such a case is the psychotherapeutic abreaction of these previous traumatising events. This approach caused worsening symptomatology and the patient experienced frequent lapses into dissociative psychosis. However, focused cognitive-analytic therapy concentrating on the patient's personal conflicts at the time of presentation resulted in a resolution of symptoms and a return to health.

Type
Case Reports
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.World Health Organisation. Dissociative disorders. ICD-10 Classification of Mental and Behavioural disorders. 1992; 151–61.Google Scholar
2.Andrade, C, Srinath, S. True auditory hallucinations as a conversive symptom. Br J Psychiatry 1986; 148: 100–2.CrossRefGoogle Scholar
3.Levinson, H. Auditory hallucinations in a case of hysteria. Br J Psychiatry 1966; 112; 1926.CrossRefGoogle Scholar
4.Modai, I, Sirota, P, Cygielman, G, Wijsenbeek, H. Conversive hallucinations. J Nerv Ment Dis 1980; 168: 564–5.CrossRefGoogle ScholarPubMed
5.Siomopoulos, V. Hysterical Psychosis: psychopathological aspects. Br J Psycholo Med 1971; 44: 95100.CrossRefGoogle ScholarPubMed
6.Hollender, IH, Hirsch, SJ. Hysterical psychosis. Am J Psychiatry 1964; 120: 1066–74.CrossRefGoogle ScholarPubMed
7.Ryle, A. Cognitive-Analytic Therapy: active participation in change. London: John Wiley Press, 1990.Google Scholar
8.Wing, JK, Cooper, JE, Sartorious, N. The Present State Examination. The Measurement and Classification of Psychiatric Symptoms. Cambridge: University Press, 1974.Google Scholar
9.Berstein, EM, Putman, FW. Development, reliability and validity of a dissociative scale. J Nerv Ment Dis 1986; 12: 727–32.CrossRefGoogle Scholar
10.Steinberg, M, Rounsaville, B, Cicchetti, D. Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview. Am J Psychiatry 1991; 148: 1050–4.Google Scholar
11.Slater, E, Glithero, E. A follow-up of patients diagnosed as suffering from hysteria. J Psychosom Res 1965; 9: 913.CrossRefGoogle ScholarPubMed
12. American Psychiatric Association. Dissociative disorders. Diagnostic and statistical manual of mental disorders, third revised edition 1987; 269277.Google Scholar
13.Putman, FW. Dissociation as a response to extreme trauma. In: Klu, RP, editor. Childhood antecedents of multiple personality. Washington DC: American Psychiatric Press, 1985Google Scholar
14.Chu, JA, Dill, DL. Dissociative symptoms in relation to childhood physical and sexual abuse. Am J Psychiatry 1990; 147: 887–92.Google ScholarPubMed