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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 109-113

Stressful life events on coping mechanism among Women with dissociative disorder


1 Department of Psychiatric Social Work, AVBIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India
2 Department of Psychiatric Social Work, Institute of Psychiatry-COE, Kolkata, West Bengal, India
3 Department of Psychiatriy, Institute of Psychiatry-COE, Kolkata, West Bengal, India

Date of Submission26-Jul-2021
Date of Decision30-Oct-2021
Date of Acceptance01-Nov-2021
Date of Web Publication12-Jan-2022

Correspondence Address:
Dr. Upendra Singh
Department of Psychiatric Social Work, AVBIMH and Dr. Ram Manohar Lohia Hospital, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_29_21

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  Abstract 


Background: Dissociative disorder in adults is caused by traumatic life events. Various cultural backgrounds specify the multiple types of stressful or undesirable life events. Dissociative phenomena have a pervasive relationship with traumatic stress derived from any negative life event. The inability to cope with the stressors disrupted their behaviors or daily functioning beside that any traumatic life events considered a triggering factor of their mental illness. The interrelation between these two variables; coping mechanism and life event determine the treatment outcome, relapse rate, and prognosis of the dissociative disorder.
Aim: The aim of this study is to compare the coping strategies and stressful life events between person with dissociative disorder and normal control group.
Materials and Methods: Seventy respondents (35 of dissociative disorders and 35 of general population) were reviewed, and the two groups were compared with respect to their sociodemographic profile, life events, and coping mechanisms.
Results: Respondents with dissociative disorders have experienced a higher number of stressful life events with dysfunctional coping mechanism.
Conclusion: Stressful life events lead to develop dysfunctional coping pattern in the persons with dissociative disorder.

Keywords: Coping, dissociative disorder, stress, stressful life events


How to cite this article:
Bhowmick I, Sil IB, Singh U, Saha PK. Stressful life events on coping mechanism among Women with dissociative disorder. Telangana J Psychiatry 2021;7:109-13

How to cite this URL:
Bhowmick I, Sil IB, Singh U, Saha PK. Stressful life events on coping mechanism among Women with dissociative disorder. Telangana J Psychiatry [serial online] 2021 [cited 2022 Jan 17];7:109-13. Available from: http://www.:tjpipstsb.org/text.asp?2021/7/2/109/335639




  Introduction Top


A large number of people due to stress are mentally disturbed in the contemporary world. The disturbance may be sudden or gradual, transient of chronic, and the signs and symptoms of the disorder are often caused by psychological trauma. The inability to cope with the stressors disrupted their behaviors or daily functioning beside that any traumatic life events considered as a triggering factor of their mental illness. Any kind of experiences that people have, whether good or bad can have a deep and long-lasting effect on them, and everyone has their own way of dealing with those. Dissociative disorder is often caused by traumatic events such as: Major accidents, severe emotional upset (such as the death of a loved one), psychological stress (such as a divorce), difficult relationships, physical or sexual abuse, it can be hard to find the cause of someone's dissociative disorder. For some people, conversion starts shortly after a specific event. For some others, conversion may not start until years later or that may start suddenly for no apparent reason. Always, this is not possible and it can be very tough to talk about traumatic or difficult events.

Any discrete experiences that disrupt individual's usual activities can be defined as life event and it causes a significant change and readjustment. There are many examples of life events; those include marriage, divorce, illness or injury, and changing or losing a job. Some of the literatures on stress, life events have been traditionally considered as one type of stressor, along with chronic strains (ongoing stressful circumstances, especially distress such as living with disability or poverty). Since the pioneering work of Holmes and Rahe, in 1967, an enormous body of the literature has developed and specified on the topic of life events and illness.[1] Stressful life events are identifiable and those discrete changes in life pattern bring the disruption in daily life and changes in usual behavior and threaten the personal well-being. These range from tragic events, such as the death of one's spouse or being fired from a job, to more monotonous but still problematic events, such as shifting to a new home. Any negative, uncontrollable, and ambiguous events are stressful than positive, controllable, and unambiguous events in someone's life.

The psychological coping mechanisms those are commonly termed as coping strategies or coping skills. Coping the term normally refers to adaptive like constructive coping strategies. The positive kind of coping strategies is found to be very useful as those may decrease stress. In difference, the other coping strategies are coined as maladaptive patter, as those may increase the level of distress among persons. The effectiveness of the coping pattern depends on the type of stress a person have, one individual, and the conditions or circumstances. The responses of coping are partially restricted by personality (like habitual traits), but also to a degree by the socialenvironment or atmosphere, particularly the nature of the distressful circumstances.

Many times, negative life events impact on an individual's life and that increased perceived stress of the person. That person also faces difficulties to cope with the situation. Stressful life events and psychosocial stressors tend to develop the symptoms of dissociative disorder as both are correlated with the development of conversion disorder. People, especially female population significantly is in higher number of stressors of troubles with in-laws or family, especially in the Indian context.

Aims and objectives

The aim of the present study is to assess and compare the coping strategies and the life events among women with dissociative disorder and normal control.


  Materials and Methods Top


A cross-sectional, observational study design was used in the study. Two groups were selected. Group A (Person with dissociative disorder) Person came to outpatient department of institute of psychiatry, Kolkata, also those persons who are receiving treatment from the same Institute, were selected. Group B (normal control) – Those persons who are permanent residents of Barasat, Block-1, Kolkata. A total of 70 participants were obtained throw purposive sampling technique. Ethical consideration was obtained from the Institutional Ethics Committee. Participants given written inform consent, age range 21–50 years, diagnosed dissociative disorder according to International Classification of Diseases-10 disease control rate,[2] duration of illness more than year included and having any comorbidity of other psychiatric disorder, severe physical illness were excluded from the study. For Group B participants, age range 21–55 years and living in urban of Kolkata were include and having a history of psychiatric disorders, General Health Questionnaire-12 (GHQ-12)[3] score 3 or more excluded from the study. Tools used in study, semistructured sociodemographic datasheet, Brief Cope Scale,[4] and Presumptive Stressful Life Event Scale.[5] Semistructured sociodemographic datasheet used by the researcher for assess various sociodemographic information such as age, family type, and education. Brief Cope Scale was used, it is a 28-item scale propounded by Charles Carver. It is a self-report and 4-point Likert scale containing 14 subcategory questions is present to measure the various domains of Brief Cope Scale. Presumptive Stressful Life Event Scale used in this study includes a wide range of life events, total 51 in number covering domains of family, social life, work, financial matters, marital and sexual life, heath, bereavement, education, legal issues, and finally courtship. The scale is classified into: (a) Desirable events, undesirable events, and ambiguous events and (b) personal and impersonal events.

Statistical analysis

The descriptive statistics, mean, standard deviation, and percentage were used in this study. Inferential statistics such as the Chi-square for the discrete variables and t-test for the continuous variables were also used. Pearson r correlation used to assess the association between the groups.


  Results Top


[Table 1] shows that the distribution of sociodemographic characteristics of the participants. The study found that no significant deference among both the groups on education, occupation, marital status, type of family, and socioeconomic status on the Chi-squire test. The mean age of Group A (30 ± 8.76 years) and Group B (32.66 ± 6.67 years) not statistically significant found between the groups.
Table 1: Sociodemographic characteristics of the participants

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[Table 2] shows that difference between both the groups presumptive stressful life events scale (PSLES). PSLES domains desirable and undesirable events found highly significant (P < 0.001) level among the Group A and Group B [Figure 1].
Table 2: Differentiation among Group A and Group B on Presumptive Stressful Life Event Scale

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Figure 1: Domains of PSLES

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[Table 3] shows the result among the Group A and Group B on finding of Brief Cope Scale and found that highly significant on each domain of Brief Cope Scale; Emotional, Problems, and Dysfunction at (P < 0.001) level.
Table 3: Representation of coping among Group A and Group B participants

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[Table 4] shows the association between Life Event Scale and Brief Cope Scale. The results were associated negatively significant at (P < 0.001) level; problem, dysfunction and total brief cope with Total Life Event Scale. Desirable life event domain associated significantly at (P < 0.001) level with emotional and problems coping, also negatively associated with dysfunction coping at (P < 0.001) level.
Table 4: Association between coping and life events

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  Discussion Top


The current study was conducted among two groups' first dissociative disorder and normal control group to find the difference and association between coping strategies numbers of life events in both the groups. The sample for the study was selected using the inclusion criteria and was screened out using the exclusion criteria. Written informed consent was obtained from both the groups (Group A and Group B). The scales used in the study were Brief Cope Scale, Presumptive Stressful Life Event Scale to measure perceived stress level, coping strategies, and various life events, respectively. GHQ-12 is used as a screening tool for normal control (Group B).

This particular study has been selected by the researcher because first of all, dissociative disorder has some adverse effects in individual's life. The bio, psycho, social adverse incidents may affect and rupture individual's daily life. Previously, a study conducted by Chaturvedi[6] with 893 clients had been diagnosed with dissociative disorder, whereas 591 (66%) were from outpatients and 302 (34%) were from inpatients. The proportion of clients diagnosed with dissociative disorders ranged between 1.5 and 15.0 per 1000 for outpatients and between 1.5 and 11.6 per 1000 for inpatients. The majority of clients were diagnosed with dissociative motor disorder was 43.3% outpatients, 37.7% inpatients, followed by dissociative convulsions was 23% outpatients, and 27.8% inpatients. Female prevalence was seen.

Across all subtypes of dissociative disorder except dissociative fugue. The ratio of females was higher than males in this study. Moreover, the cultural background also varies in Eastern countries. One study found that the mean age of the cases was 21.23 years. Cases of dissociative motor disorders had significantly higher age (26.4 years) as compared to dissociative conversion (18.8 years) and dissociative stupor of 20.6 years (38.5%).[7] The mean age of the Group A 30 years and Group B 32 years also present working participants in our study.

This study focused on specifically three variables, those are coping strategies and life events. These three variables are interrelated. Persons with dissociative disorder have a relationship with these variables. Hence, the interrelationship between coping strategies and life events determine the treatment outcome, frequency, and prognosis of the dissociative disorder. In case of general population, the variables are used to determine the difference between the two groups. Beside that a comparison between these variable focused by the researcher. Therefore, it is very important to study the difference in coping mechanism and life events with persons having dissociative disorder and normal control group.

The present study was selected only female participants. The literature suggested that dissociative disorder was more common in females from 10 to 30 years of age group and that the initial diagnosis remained unchanged in the majority of the clients. Most of the clients were educated though the total level of education was not very high.[8] In the present study, result was found that there was no statistically significant deference between Group A and Group B in terms of education, occupation, family type, and marital status. That means person with dissociative disorder and normal control group did not differ significantly in respect of sociodemographic variables. Only domicile is significantly differ because normal control group was selected urban area only.

Table 2 shows that in the present study it was found that there was a statistically significant difference between Group A and Group B in terms of their number of life events. The difference was found to be highly significant at (P < 0.001) level in total score of Life Event Scale. Desirable and undesirable events domain also pointed out at the level of (P < 0.001). That means persons with dissociative disorder experienced more undesirable events than Group B. A study conducted by Kulhara and Chopra[9] suggested same results, that dissociative disorder clients had higher number of life events.

Similar study conducted by[7] that was case − control study of 39 cases of dissociative disorders and compared them with 39 another controls using a self-designed questionnaire and Gurmeet Singh's PSLES.[5] The cases had more stressful life events in the past 1 year as well as whole life when compared to controls and the level of significance found at (P < 0.001)level. Family conflict was seen to be the noted precipitating stress. Dissociative disorder mainly affected young people. Dissociative motor disorder was a distinct subtype with a higher age of onset.

Table 3 shows that in the present study it was found that there was a statistically significant difference (P < 0.001) level between Group A and Group B in terms of coping strategies in two domains. This means that persons with dissociative disorder and normal control group differ significantly with respect to problem focused and dysfunctional coping strategies.


  Conclusion Top


Persons with dissociative disorder and normal control group do not differ in respect to emotion focused coping strategies. Persons with dissociative disorder and normal control group significantly differ in respect to problem focused coping strategies and dysfunctional focused coping strategies. Persons with dissociative disorder and normal control group differ in respect to their life events. Majority of persons in Group A have lower rates of desirable events, whereas the majority of participants Group B have higher rate of desirable events. Majority of persons with dissociative disorder have the higher rates of undesirable events, whereas the majority of persons normal control group experienced the lower rate of undesirable events.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Holmes TH, Rahe RH. Schedule of recent experience. Marriage 1967;10:50.  Back to cited text no. 1
    
2.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization; 1993.  Back to cited text no. 2
    
3.
Gureje O, Obikoya B. The GHQ-12 as a screening tool in a primary care setting. Soc Psychiatry Psychiatr Epidemiol 1990;25:276-80.  Back to cited text no. 3
    
4.
Carver CS. You want to measure coping but your protocol's too long: Consider the brief COPE. Int J Behav Med 1997;4:92-100.  Back to cited text no. 4
    
5.
Singh G, Kaur D, Kaur H. Presumptive stressful life events scale (psles) – A new stressful life events scale for use in India. Indian J Psychiatry 1984;26:107-14.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Chaturvedi SK, Desai G, Shaligram D. Dissociative disorders in a psychiatric institute in India – A selected review and patterns over a decade. Int J Soc Psychiatry 2010;56:533-9.  Back to cited text no. 6
    
7.
Thapa R. Dissociative disorders: A study of clinico-demographic profile and associated stressors. J Psychiatr Assoc Nepal 2014;3:25-30.  Back to cited text no. 7
    
8.
Datta A, Bhagabati D, Bera NK, Kalita N. A study of socio-demographic variables of patients admitted with dissociative symptoms in a tertiary care hospital. East J Psychiatry 2016;18:2-5.  Back to cited text no. 8
    
9.
Kulhara P, Chopra R. Social support, social dysfunction and stressful life events in neurotic patients. Indian J Psychiatry 1996;38:23-9.  Back to cited text no. 9
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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