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Duygu Düzenleme Güçlükleri ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?

Yıl 2023, Cilt: 10 Sayı: 4, 365 - 371, 28.12.2023
https://doi.org/10.34087/cbusbed.1355003

Öz

Giriş ve Amaç: Panik bozukluğu hastalarında kaygılı bağlanma örüntüsü yoğunlaştıkça duyguların düzenlenmesinde yaşanan zorluklar ve dissosiyatif belirtilerin şiddeti hastalık yükünü artırmaktadır. Bu çalışmanın amacı panik bozukluğu hastalarında duygu düzenleme, bağlanma örüntüleri ve dissosiyatif belirtiler arasındaki ilişkiyi aydınlatmaktır.
Gereç ve Yöntemler: Çalışmamıza psikiyatri polikliniğinde panik bozukluğu tanısıyla takip edilen, yaşları 18 – 65 arasında değişen 85 hasta dahil edildi. Araştırmaya dahil edilen hastalara DSM-V Eksen Bozukluklarına Yönelik Yapılandırılmış Klinik Görüşme (SCID - I), sosyodemografik veri formu, Panik Bozukluğu Şiddet Ölçeği (PDSS), Duygu Düzenleme Güçlükleri Ölçeği (DERS), Dissosiyatif Deneyimler Ölçeği (DES), Yakın İlişki Deneyimleri Ölçeği (ECR – RS) uygulandı.
Bulgular: Panik bozukluğunun şiddeti ile dissosiyatif belirtilerin şiddeti arasında anlamlı bir ilişki bulundu (p=0,030). DERS toplam puanları ile DES puanları arasında istatistiksel olarak anlamlı korelasyon bulundu (p=0,005). DES puanı ile DERS alt ölçekleri arasındaki ilişkinin değerlendirilmesinde DERS dürtüsellik (p<0,001), DERS netlik (p=0,006), DERS amaç (p<0,001) alt ölçekleri ile DES puanı arasında anlamlı bir ilişki bulunmuştur. ECR – RS kaygı alt ölçeği ile DERS toplam puanı arasında pozitif ve istatistiksel olarak anlamlı bir ilişki bulunmuştur (p<0,001). ECR – RS kaçınma alt ölçeği ile DERS netlik alt ölçeği arasında anlamlı bir korelasyon bulunurken (p=0,011), diğer alt ölçekler ve DERS toplam puanı ile anlamlı bir korelasyon bulunmadı.
Sonuç: Panik bozukluğu hastalarının dissosiyatif deneyimleri, duygularını düzenleyememelerinden kaynaklanan telafi edici bir mekanizma olabilir. Bu bulgular ışığında dissosiyatif belirtiler yaşayan panik bozukluğu hastalarında bilişsel davranışçı terapinin uygulanması duygu düzenleme bozukluğunun yeniden şekillendirilmesi açısından faydalı olacaktır.

Etik Beyan

Ethical approval: Ethics committee approval was received for this study from Ege University Clinical Research Ethics Committee (Approval Date: September, 22, 2014; Approval Number: 14-9/25).

Kaynakça

  • 1. Rudaz, M, Craske, MG, Becker, ES, Ledermann, T, Margraf, J, Health anxiety and fear of fear in panic disorder and agoraphobia vs. social phobia: A prospective longitudinal study, Depress Anxiety, 2010, 27, 404–11.
  • 2. Loewenstein, RJ, Frewen, P, Lewis-Fernandez, R, Dissociative Disorders, In: Sadock, BJ, Sadock, VA, Ruiz, P, eds, Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (50th Anniversary Edition), 10th ed, Philedelphia: Wolters Kluwer, 2017, 1866-93.
  • 3. Dorahy, MJ, McCusker, CG, Loewenstein, RJ, Colbert, K, Mulholland, C, Cognitive inhibition and interference in dissociative identity disorder: The effects of anxiety on specific executive functions, Behav Res Ther, 2006, 44, 749-764.
  • 4. Ray, S, Ray, R, Singh, N, Paul, I, Dissociative experiences and health anxiety in panic disorder, Indian journal of psychiatry, 2021, 63(1), 70–73.
  • 5. Nolte, T, Guiney, J, Fonagy, P, Mayes, LC, Luyten, P, Interpersonal stress regulation and the development of anxiety disorders: an attachment-based developmental framework, Front Behav Neurosci, 2011, 5, 55.
  • 6. Shear, MK, Brown, TA, Barlow, DH et al, Multicenter collaborative panic disorder severity scale, Am J Psychiatry, 1997, 154, 1571-1575.
  • 7. Monkul, ES, Tural, U, Onur, E et al, Panic disorder severity scale: reliability and validity of the Turkish version, Depress Anxiety, 2004, 20, 8-16.
  • 8. Bernstein, EM, Putnam, FW, Development, reliability and validity of a dissociation scale, J Nerv Ment Disord, 1986, 47, 285-293.
  • 9. Şar, V, Kundakçı, T, Kızıltan, E, et al, Dissociative Validity and reliability of the Experiences Scale (DES-II), 33. National Psychiatry Congress, Full Text Book of Proceedings, 1997, 55-64.
  • 10. Gratz KL, Roemer L, Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale, J Psychopathol Behav Assess, 2004, 26, 41-54.
  • 11. Rugancı, RN, Gençöz T, Psychometric properties of a Turkish version of the Difficulties in Emotion Regulation Scale, J Clin Psychol, 2010, 66, 442-455.
  • 12. Fraley, RC, Waller, NG, Brennan, KA, An item response theory analysis of self-report measures of adult attachment, J Pers Soc Psychol, 2000, 78, 350.
  • 13. Selçuk, E, Günaydın, G, Sümer, N, et al, A new measurement for adult attachment dimensions: Psychometric evaluation of the Experiences in Close Relationships Inventory-II in a Turkish sample, Turkish Psychology Writings, 2005, 8, 1-11
  • 14. Mendoza, L, Navinés, R, Crippa, JA, Fagundo, AB, Gutierrez, F, Nardi, AE et al, Depersonalization and personality in panic disorder, Compr Psychiatry, 2011, 52, 413–419.
  • 15. Tull, MT, Roemer, L, Emotion Regulation Difficulties Associated with the Experience of Uncued Panic Attacks: Evidence of Experiential Avoidance, Emotional Nonacceptance and Decreased Emotional Clarity, Behav Ther, 2007, 38(4), 378-391.
  • 16. Lynch, TR, Robins, CJ, Morse, JQ, Krause, ED, A Mediational Model Relating Affect Intensity Emotion Inhibitionand Psychological Distress, Behav Ther, 2001, 32(3), 519-536.
  • 17. Bouton, ME, Mineka, S, Barlow, DH, A modern learning theory perspective on the etiology of panic disorder, Psychol Rev, 2001, 108(1), 4-32.
  • 18. Myhr, G, Sookman, D, Pinard, G, Attachment security and parental bonding in adults with obsessive-compulsive disorder: a comparison with depressed out-patients and healthy controls, Acta Psychiatr Scand, 2004, 109, 447-456.
  • 19. Hoyer, J, Braeuer, D, Crawcour, S, Klumbies, E, Kirscbaum, C, Depersonalization/derealization during acute social stres in social phobia, J Anxiety Disord, 2013, 27, 178-187.
  • 20. Kulacaoglu, F, Solmaz, M, Ardic, FC, Akin, E, Kose, S, The relationship between childhood traumas, dissociation, and impulsivity in patients with borderline personality disorder comorbid with ADHD, Psychiatry and Clin Psychopharmacol, 2017, 27(4), 393-402.

Do Emotion Regulation Difficulties and Insecure Attachment Increase the Severity of Dissociative Symptoms in Panic Disorder?

Yıl 2023, Cilt: 10 Sayı: 4, 365 - 371, 28.12.2023
https://doi.org/10.34087/cbusbed.1355003

Öz

Objective: As the anxious attachment pattern intensifies in patients with panic disorder, difficulties in regulating emotions and the severity of dissociative symptoms increase the burden of disease. The aim of this study was to elucidate the relationship between emotion regulation, attachment patterns and dissociative symptoms in patients with panic disorder.
Materials and Methods: A total of 85 individuals aged between 18 – 65 years, who were followed up in the psychiatry outpatient clinic of our institution with the diagnosis of panic disorder were enrolled in our study. Structured Clinical Interview for the DSM- V Axis Disorders (SCID - I), sociodemographic data form, Panic Disorder Severity Scale (PDSS), Difficulties in Emotion Regulation Scale (DERS), Dissociative Experiences Scale (DES), Experiences in Close Relationships – Relationship Structures Scale (ECR – RS) have been applied to patients thay have been included in this research.
Results: A significant correlation was found between the severity of panic disorder and the severity of dissociative symptoms (p=0.030). A statistically significant correlation was found between DERS total scores and DES scores (p=0.005). In the evaluation of the relationship between DES score and DERS subscales, a significant relationship was found between DERS impulsivity (p<0.001), DERS clarity (p=0.006), DERS purpose (p<0.001) subscales and DES score. A positive and statistically significant relationship was found between the ECR – RS anxiety and DERS total score (p<0.001). A significant correlation was found between the ECR – RS avoidance subscale and the DERS clarity subscale (p=0.011), but no significant correlation was found with the other subscales and the DERS total score.
Conclusion: The dissociative experiences of panic disorder patients may be a compensatory mechanism caused by the inability to regulate their emotions. In the light of these findings, the application of cognitive behavioral therapy in panic disorder patients who experience dissociative symptoms will be beneficial in terms of reshaping the disorder in emotion regulation.

Etik Beyan

Ethical approval: Ethics committee approval was received for this study from Ege University Clinical Research Ethics Committee (Approval Date: September, 22, 2014; Approval Number: 14-9/25).

Kaynakça

  • 1. Rudaz, M, Craske, MG, Becker, ES, Ledermann, T, Margraf, J, Health anxiety and fear of fear in panic disorder and agoraphobia vs. social phobia: A prospective longitudinal study, Depress Anxiety, 2010, 27, 404–11.
  • 2. Loewenstein, RJ, Frewen, P, Lewis-Fernandez, R, Dissociative Disorders, In: Sadock, BJ, Sadock, VA, Ruiz, P, eds, Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (50th Anniversary Edition), 10th ed, Philedelphia: Wolters Kluwer, 2017, 1866-93.
  • 3. Dorahy, MJ, McCusker, CG, Loewenstein, RJ, Colbert, K, Mulholland, C, Cognitive inhibition and interference in dissociative identity disorder: The effects of anxiety on specific executive functions, Behav Res Ther, 2006, 44, 749-764.
  • 4. Ray, S, Ray, R, Singh, N, Paul, I, Dissociative experiences and health anxiety in panic disorder, Indian journal of psychiatry, 2021, 63(1), 70–73.
  • 5. Nolte, T, Guiney, J, Fonagy, P, Mayes, LC, Luyten, P, Interpersonal stress regulation and the development of anxiety disorders: an attachment-based developmental framework, Front Behav Neurosci, 2011, 5, 55.
  • 6. Shear, MK, Brown, TA, Barlow, DH et al, Multicenter collaborative panic disorder severity scale, Am J Psychiatry, 1997, 154, 1571-1575.
  • 7. Monkul, ES, Tural, U, Onur, E et al, Panic disorder severity scale: reliability and validity of the Turkish version, Depress Anxiety, 2004, 20, 8-16.
  • 8. Bernstein, EM, Putnam, FW, Development, reliability and validity of a dissociation scale, J Nerv Ment Disord, 1986, 47, 285-293.
  • 9. Şar, V, Kundakçı, T, Kızıltan, E, et al, Dissociative Validity and reliability of the Experiences Scale (DES-II), 33. National Psychiatry Congress, Full Text Book of Proceedings, 1997, 55-64.
  • 10. Gratz KL, Roemer L, Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale, J Psychopathol Behav Assess, 2004, 26, 41-54.
  • 11. Rugancı, RN, Gençöz T, Psychometric properties of a Turkish version of the Difficulties in Emotion Regulation Scale, J Clin Psychol, 2010, 66, 442-455.
  • 12. Fraley, RC, Waller, NG, Brennan, KA, An item response theory analysis of self-report measures of adult attachment, J Pers Soc Psychol, 2000, 78, 350.
  • 13. Selçuk, E, Günaydın, G, Sümer, N, et al, A new measurement for adult attachment dimensions: Psychometric evaluation of the Experiences in Close Relationships Inventory-II in a Turkish sample, Turkish Psychology Writings, 2005, 8, 1-11
  • 14. Mendoza, L, Navinés, R, Crippa, JA, Fagundo, AB, Gutierrez, F, Nardi, AE et al, Depersonalization and personality in panic disorder, Compr Psychiatry, 2011, 52, 413–419.
  • 15. Tull, MT, Roemer, L, Emotion Regulation Difficulties Associated with the Experience of Uncued Panic Attacks: Evidence of Experiential Avoidance, Emotional Nonacceptance and Decreased Emotional Clarity, Behav Ther, 2007, 38(4), 378-391.
  • 16. Lynch, TR, Robins, CJ, Morse, JQ, Krause, ED, A Mediational Model Relating Affect Intensity Emotion Inhibitionand Psychological Distress, Behav Ther, 2001, 32(3), 519-536.
  • 17. Bouton, ME, Mineka, S, Barlow, DH, A modern learning theory perspective on the etiology of panic disorder, Psychol Rev, 2001, 108(1), 4-32.
  • 18. Myhr, G, Sookman, D, Pinard, G, Attachment security and parental bonding in adults with obsessive-compulsive disorder: a comparison with depressed out-patients and healthy controls, Acta Psychiatr Scand, 2004, 109, 447-456.
  • 19. Hoyer, J, Braeuer, D, Crawcour, S, Klumbies, E, Kirscbaum, C, Depersonalization/derealization during acute social stres in social phobia, J Anxiety Disord, 2013, 27, 178-187.
  • 20. Kulacaoglu, F, Solmaz, M, Ardic, FC, Akin, E, Kose, S, The relationship between childhood traumas, dissociation, and impulsivity in patients with borderline personality disorder comorbid with ADHD, Psychiatry and Clin Psychopharmacol, 2017, 27(4), 393-402.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Psikiyatri
Bölüm Araştırma Makalesi
Yazarlar

Nur Özge Akçam 0000-0001-5221-9678

Nazan Dolapoğlu 0000-0003-1400-7580

Şebnem Pırıldar 0000-0002-0513-4601

Yayımlanma Tarihi 28 Aralık 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 10 Sayı: 4

Kaynak Göster

APA Akçam, N. Ö., Dolapoğlu, N., & Pırıldar, Ş. (2023). Duygu Düzenleme Güçlükleri ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 10(4), 365-371. https://doi.org/10.34087/cbusbed.1355003
AMA Akçam NÖ, Dolapoğlu N, Pırıldar Ş. Duygu Düzenleme Güçlükleri ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?. CBU-SBED. Aralık 2023;10(4):365-371. doi:10.34087/cbusbed.1355003
Chicago Akçam, Nur Özge, Nazan Dolapoğlu, ve Şebnem Pırıldar. “Duygu Düzenleme Güçlükleri Ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?”. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10, sy. 4 (Aralık 2023): 365-71. https://doi.org/10.34087/cbusbed.1355003.
EndNote Akçam NÖ, Dolapoğlu N, Pırıldar Ş (01 Aralık 2023) Duygu Düzenleme Güçlükleri ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 4 365–371.
IEEE N. Ö. Akçam, N. Dolapoğlu, ve Ş. Pırıldar, “Duygu Düzenleme Güçlükleri ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?”, CBU-SBED, c. 10, sy. 4, ss. 365–371, 2023, doi: 10.34087/cbusbed.1355003.
ISNAD Akçam, Nur Özge vd. “Duygu Düzenleme Güçlükleri Ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?”. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10/4 (Aralık 2023), 365-371. https://doi.org/10.34087/cbusbed.1355003.
JAMA Akçam NÖ, Dolapoğlu N, Pırıldar Ş. Duygu Düzenleme Güçlükleri ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?. CBU-SBED. 2023;10:365–371.
MLA Akçam, Nur Özge vd. “Duygu Düzenleme Güçlükleri Ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?”. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, c. 10, sy. 4, 2023, ss. 365-71, doi:10.34087/cbusbed.1355003.
Vancouver Akçam NÖ, Dolapoğlu N, Pırıldar Ş. Duygu Düzenleme Güçlükleri ve Güvensiz Bağlanma Panik Bozukluğunda Dissosiyatif Belirtilerin Şiddetini Artırır mı?. CBU-SBED. 2023;10(4):365-71.