Dear Editor:
I was excited to read about the dissociative cases in the Leong, et al., article, “ Dissociative amnesia and DSM-IV-TR cluster C personality traits” [Psychiatry 2006 2006;3(1):51–55]. I, too, have had the experience of “picking up” dissociative spectrum disorders in Cluster C and A patients, though these events are commonly thought of as occurring more regularly with Cluster B personalities. I treated several cases of patients who were in stressful home environments or new jobs concordant with substance use disorders. A concern I have about seeing these dissociative events is the “chicken or the egg” phenomenon—what I mean by this is: Are drug and alcohol problems and environmental problems causing, merely contributing to, or secondary to the dissociative events? Clinical experience and a rich literature describe these interesting events in the addictions field. I suspect that the authors may very well find serious addiction problems in subjects with dissociative events no matter what their “primary” or other diagnosis. My colleagues and I at several different addiction treatment centers have observed dissociative events in those who have used inhalants (gasoline, glue, spray starch, and other volatile agents), alcohol, sedative-hypnotics, narcotics, and other substances, including serotonin reuptake inhibitors. Comorbidity is more often the norm, and it is important to address pre-existing, newly emerging, or other types of substance use, abuse, and dependency to include all classes of mind-altering substances.
With regards,
James J. Staudenmeier, MD, MPH
University of Hawaii and Hawaii Pacific University Uniformed Services University of the Health Sciences
David G. Brown, PsyD
Hawaii Pacific University Honolulu, Hawaii
Contributor Information
James J. Staudenmeier, University of Hawaii and Hawaii Pacific University Uniformed Services University of the Health Sciences.
David G. Brown, Hawaii Pacific University Honolulu, Hawaii.