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Background: Treatment research for dissociative identity disorder (DID) and closely related severe dissociative disorders (DD) is rare, and has been made more difficult by the lack of a reliable, valid measure for assessing treatment progress in these populations. Objective: This paper presents psychometric data for therapist and patient report measures developed to evaluate therapeutic progress and outcomes for individuals with DID and other DD: the Progress in Treatment Questionnaire - Therapist (PITQ-t; a therapist report measure) and the Progress in Treatment Questionnaire - Patient (PITQ-p; a patient self-report measure). Method: We examined the data of 177 patient-therapist pairs (total N = 354) participating in the TOP DD Network Study, an online psychoeducation programme aimed at helping patients with DD establish safety, regulate emotions, and manage dissociative and posttraumatic symptoms. Results: The PITQ-t and PITQ-p demonstrated good internal consistency and evidence of moderate convergent validity in relation to established measures of emotional dysregulation, dissociation, posttraumatic stress disorder, and psychological quality of life, which are characteristic difficulties for DD patients. The measures also demonstrated significant relationships in the hypothesized directions with positive emotions, social relations, and self-harm and dangerous behaviours. The patient-completed PITQ-p, which may be used as an ongoing assessment measure to guide treatment planning, demonstrated evidence of stronger relationships with established symptom measures than the PITQ-t. Conclusions: The PITQ-t and PITQ-p merit use, additional research, and refinement in relation to the assessment of therapeutic progress with patients with DD.

Planteamiento: La investigación del tratamiento para el trastorno de identidad disociativo (TID) y los trastornos disociativos (TD) graves que están estrechamente relacionados es poco frecuente y se ha dificultado por la falta de una medida fiable y válida para evaluar el progreso del tratamiento en estas poblaciones. Objetivo: Este artículo presenta los datos psicométricos de las medidas de informes de terapeutas y pacientes desarrolladas para evaluar el progreso terapéutico y los resultados en personas con TID y otros TD: El Cuestionario del progreso del tratamiento - terapeuta (PITQ-t, siglas en inglés de Progress in Treatment Questionnaire - Therapist; una medición mediante informe del terapeuta) y el Cuestionario del progreso del tratamiento - paciente (PITQ-p, siglas en inglés de Progress in Treatment Questionnaire - Patient; una medición mediante autoinforme del paciente). Método: Se examinaron los datos de 177 pares de pacientes-terapeutas (N total = 354) que participaron en el TOP DD Network Study, un programa de psicoeducación online destinado a ayudar a los pacientes con TD a establecer seguridad, regular emociones y manejar síntomas disociativos y postraumáticos. Resultados: El PITQ-t y PITQ-p demostraron buena consistencia interna y evidencia de una validez convergente moderada en relación a las medidas establecidas de desregulación emocional, disociación, trastorno por estrés postraumático y calidad de vida psicológica - dificultades características en pacientes con TD. Las medidas también demostraron relaciones significativas en el sentido establecido por la hipótesis en cuanto a emociones positivas, relaciones sociales, y conductas autolesivas y peligrosas. El PITQ-p completado por el paciente, que puede usarse como una medida de evaluación continua para guiar la planificación del tratamiento, evidenció relaciones más fuertes con las medidas establecidas de los síntomas que el PITQ-t. Conclusiones: El PITQ-t y PITQ-p justifican su uso, investigación adicional y refinamiento en relación con la evaluación del progreso terapéutico con pacientes con TD.

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OBJECTIVE: Nonexperimental survey and field research support the notion that alcohol use may be associated with deliberate self-harm (DSH) across the spectrum of lethality, from nonsuicidal self-injury (NSSI) through suicide. Nonexperimental studies, however, provide limited information about potential causal relationships between alcohol consumption and DSH. Two previous experiments showed that a relatively high-dose of alcohol increases the likelihood of engaging in DSH in men, with DSH defined by the self-administration of a "painful" shock (the self-aggression paradigm [SAP]; Berman & Walley, 2003; McCloskey & Berman, 2003). In this study, we examined whether (a) lower doses of alcohol also elicit DSH, (b) this effect occurs for women as well as men, and (c) individual differences in past nonsuicidal self-injury (NSSI) moderate alcohol's effects on DSH. METHOD: Nonalcohol dependent men and women (N = 210) were assigned either to .00%, .05%, .075%, or .100% blood alcohol concentration (BAC) drink conditions and completed a self-rating scale of NSSI (the Deliberate Self-Harm Inventory [DSHI]; Gratz, 2001). As in previous SAP studies, DSH was operationalized by shock setting behavior during a competitive reaction time (RT) game. RESULTS: Overall, a greater proportion of participants in the .075% and .100% (but not .050%) alcohol conditions self-selected a "painful" shock to administer compared to participants in the placebo condition. NSSI predicted self-administration of painful shocks, but did not moderate the alcohol effect. CONCLUSIONS: Results provide experimental evidence to support the notion that interventions for self-harm should include processes to monitor and limit alcohol intake. (PsycINFO Database Record

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OBJECTIVE: Serotonergic (5-HT) functioning has been shown to be inversely associated with intentional self-injurious behaviors. The purpose of this study was to examine the association between three related self-report measures of intentional self-injurious behaviors (suicidal thoughts/behavior, history of nonsuicidal self-injury, history of severe self-harm when angry) and a putative electrophysiological index of 5-HT activity, the loudness dependence of auditory evoked potential (LDAEP). METHOD: Auditory evoked potentials were recorded from 41 men (mean age = 20.69, standard deviation [SD] = 2.98) during the administration of various tone loudness stimuli, followed by completion of the self-report measures. RESULTS: The component slope was associated with all measures of self-injurious behavior in the expected direction. CONCLUSION: The LDAEP has the potential to be used as a noninvasive index of intentional self-harm disposition. Additional studies are needed using other populations, including women and treatment-seeking individuals, to determine if the LDAEP more broadly discriminates risk of self-injuring.

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Psychopathy has long been associated with aggressive behavior; however, the neurochemical underpinnings of this relationship are poorly understood. Serotonin (5-HT) neurotransmitter system abnormalities have been associated with provoked aggression in general. In addition, 5-HT dysregulation has been linked to empathy, a trait that is lacking in individuals who score high on primary psychopathy. The purpose of this study was to determine if 5-HT modulates the relationship between psychopathic traits and aggression. Participants (N = 47) completed a self-report measure of psychopathy and were then administered either 40 mg paroxetine (acutely augmenting 5-HT) or placebo. Aggression was assessed during a competitive reaction-time game in which electric shocks were exchanged with an increasingly provocative fictitious opponent. Results indicated that primary psychopathy (but not secondary psychopathy) was related to aggressive responding to provocation. Moreover, 5-HT augmentation attenuated this effect, supporting the notion that aggressive responding associated with primary psychopathic traits may be due in part to 5-HT dysregulation.

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