Journal Logo

Article: Observational Study

Dissociative Symptoms and Mother's Marital Status in Young Adult Population

Bob, Petr; Selesova, Petra; Raboch, Jiri; Kukla, Lubomir

Editor(s): King., Patricia

Author Information
doi: 10.1097/MD.0000000000000408
  • Open

Abstract

INTRODUCTION

Recent empirical data indicate that relationships between parental divorce and children's emotional and behavioral problems are predominantly associated with psychological factors and there is a relationship between fatherlessness and children's emotional and behavioral problems. 1,2 According to these findings on influence of fatherlessness, there is growing evidence that a level of father's absence in divorced families and in unmarried women who live with their child without father's person significantly influences mental health of the growing child. 2–4 The influence of parental separation on child's mental health depends on age of the child when the separation happened. Other factors influencing child's mental health related to parental separation represent parental relationships after divorce and quality of contacts that children may have with a parent living out of the family. In this context, there is evidence that divorce and destructive couple conflict represent major risk factors for many forms of dysfunction and psychopathological manifestations in children. 5 In addition, there is evidence that children from single parent or blended families have increased vulnerability to traumatic and other stressful life events. 6–8

Although numerous findings show that conflicting attachment and disrupted family structure play a significant role in child psychopathology, there is no evidence indicating a relationship between disrupted family structure and dissociative symptoms that frequently occur as a response to traumatic or stressful experiences. Together these findings on stress influences related to conflicting attachment suggest a hypothesis that mother's marital status indicating father's absence in a family is related to dissociative psychopathology and other stress-related manifestations. With the aim to test the hypothesis, we have assessed whether mother's marital status will be related to dissociative symptoms, symptoms of traumatic stress, anxiety and depression, in a sample of young adults participating in the European longitudinal study (European Longitudinal Study of Parenthood and Childhood [ELSPAC]) studying parental and environmental influences on children development.

MATERIALS AND METHODS

Participants

Within the framework of European Longitudinal Study of Parenthood and Childhood (ELSPAC) data of 364 Czech young adults who within period of 2 months responded to invitation for participation in the study were collected. All participants included in the study were 19 years’ old, born in 1992 in the interval of 6 months with a high school education (mean age 18.5 years, age range within 1 year, more than 18 less than 19; 151 men and 213 women). All participants lived in the city of Brno, with similar social and economical status. The ELSPAC study started in 1992 in few European countries and its organization centers were in the United Kingdom and Czech Republic. The participants included in the study were selected randomly from the population based on voluntary agreement provided by parents awaiting newborn children.

To find potential mental health risks related to stress influences associated with mother's marital status, we have assessed dissociative symptoms, symptoms of traumatic stress, depression, and anxiety. All the participants gave written informed consent and the research based on collaboration of ELSPAC and Center for Neuropsychiatric Research of Traumatic Stress was approved by Charles University (First Faculty of Medicine) ethical committee.

Psychometric Measures

Symptoms of dissociation were assessed using the Dissociative Experiences Scale (DES). 9,10 The DES is a self-reported scale with 28 items, asking respondents to indicate their response on 100-mm scale to what extent they experience typical dissociative phenomena in daily life (Cronbach's alpha 0.92, test–retest reliability after week 0.91). Normative score of the scale defines increased probability for manifestations of dissociative disorders for total scores >30. Dissociative phenomena for example include feelings of depersonalization, derealization, psychogenic amnesia, and others. DES as well as other psychometric measures used in this study were translated into Czech language from the English original and then back-translated into English. The resulting documents were compared with the originals by a native English speaker and all the tests have good psychometric properties and equivalent quality to test occurrence of the symptoms as their English originals.

Somatoform dissociative symptoms were measured using 20-items self-reported Somatoform Dissociation Questionnaire (SDQ-20). 11,12 Normative score of the scale defines significant occurrence of somatoform dissociative symptoms for scores >30. Somatoform dissociative symptoms represent alterations in sensations of pain (analgesia, kinesthetic anesthesia), alterations of perception, loss of motor control, gastrointestinal symptoms, etc. Subjects indicate the degree of their experience on 5-point Likert scale (Cronbach's alpha 0.91, test–retest reliability after week 0.90).

For investigation of childhood traumas, the Trauma Symptom Checklist (TSC-40) 13 was used. The TSC-40 is a self-reported 40-item questionnaire rated on a 4-point Likert scale. TSC-40 evaluates symptomatology in adults associated with childhood or adult traumatic experiences and measures aspects of posttraumatic stress and other symptom clusters found in some traumatized individuals (Cronbach's alpha 0.91, test–retest reliability after week 0.88). Normative score of the scale assumes likely occurrence of traumatic events for scores >70. 13

For the assessment of depressive symptoms, the Beck Depression Inventory (BDI-II) 14 was used. The BDI-II represents 21-items questionnaire for assessing depression (Cronbach's alpha 0.89, test–retest reliability after week 0.85). Subjects indicate degree of their experience of depressive symptoms on a 4-point Likert scale. Normative score of the scale defines significant level of depression for scores >30. 14

Levels of anxiety symptoms were assessed using the Zung's Self-Rating Anxiety Scale (SAS) (Cronbach's alpha 0.89, test–retest reliability after week 0.85). 15 The SAS is a 20-item self-reporting questionnaire focused on the most common general anxiety symptoms. Each question is scored on 4-point Likert scale from 1 to 4. Normative score of the scale defines significant level of anxiety for scores >30. 15

Statistical Methods

Statistical evaluations of psychometric measures included means, standard deviations, Kruskal–Wallis analysis of variance (ANOVA), Mann–Whitney test for independent samples, and power analysis. All the methods of statistical evaluation were performed using the software package Statistica, version 6.

RESULTS

The group of participants (N = 364) was divided into 3 subgroups according to the mother's marital status. The first Fatherless subgroup contained 60 participants and included 20 men whose mother was divorced (N = 16) or unmarried (N = 4), and 40 women whose mother was divorced (N = 36) or unmarried (N = 4). The second subgroup contained 273 participants whose mother was married and included 114 men and 159 women. The third group contained 31 participants whose mother was re-married and included 17 men and 14 women.

In the statistical analysis, all differences between these 3 subgroups using Kruskal–Wallis ANOVA for the whole group including women and men (Table 1) and separately for the men's group (Table 1) and for the women's group (Table 1) were found statistically significant for dissociative symptoms (DES at P < 0.0002, z > 4.23 and SDQ-20 at P < 0.002, z > 3.69), symptoms of traumatic stress (TSC-40 at P < 0.004, z > 3.57), depression (BDI-II at P < 0.005, z > 3.47), and anxiety (SAS at P < 0.005, z > 3.51).

Table 1
Table 1:
Psychometric Scores (Mean, Standard Error, Confidence Interval) for the Groups According to the Mother's Marital Status

The statistical analysis shows significant clinical values of psychological dissociative symptoms measured by DES (Table 1). All differences in DES scores between the subgroups using Kruskal–Wallis ANOVA were found statistically significant in men (P < 0.002, z > 0.76) and women (P < 0.0003, z > 4.17).

Because Kruskal–Wallis ANOVA has not well established and standardized methods of power analysis, we have estimated standardized effect sizes for the mean values characterizing differences of dissociative symptoms measured by DES between the subgroups of men and women (Table 1) that were found statistically significant with medium or high effect sizes, that is, effect size for DES means in men between Fatherless and Married subgroups is 0.75, P < 0.01; between Fatherless and Re-married subgroup is 0.74, P < 0.01; whereas the effect size between Married and Re-married subgroup was not statistically significant (population SD = 8.71). The effect size for DES Means in women between Remarried and Married subgroup is 0.45, P < 0.01; between Remarried and Fatherless subgroup is 0.43, P < 0.01; whereas the effect size between Married and Fatherless subgroup is not significant.

The results also indicate that psychological dissociative symptoms measured by DES are significantly correlated to symptoms of somatoform dissociation (SDQ-20) (Spearman r = 0.55, P < 0.01), traumatic stress (TSC-40) (Spearman r = 0.52, P < 0.01), depression (BDI-II) (Spearman r = 0.39, P < 0.01), and anxiety (SAS) (Spearman r = 0.40, P < 0.01).

To analyze effects of sex on dissociative and other stress-related psychopathological processes, we have used the Mann–Whitney test for independent samples and found that women have significantly higher levels of depression (BDI-II), anxiety (SAS), and traumatic symptoms (TSC-40) (P < 0.00007, z > 4.0], however, not dissociative symptoms compared with men.

DISCUSSION

The results indicate that fatherless conditions in single parent families in boys and stepfather influence in families with girls are significantly associated with development of psychological dissociative symptoms that have clinically significant values. Other psychopathological manifestations related to mother's marital status did not reach clinical values, but may represent latent vulnerability that may manifest later in life because of specific influences of stressful experiences on brain development. 16–18 Key results of this study represent significantly increased dissociation in young adult men whose mothers were fatherless (unmarried or divorced) and increased dissociation in women whose mothers were re-married.

In this context of differences in dissociative symptoms between women and men, results of this study show that girls and boys respond to the same mother's marital status and to limited father's presence or absence differently. Daughters of remarried mothers have pathologically increased dissociation in comparison with sons. This result is in agreement with findings suggesting that girls had more difficulties interacting with stepfathers than sons 19–21 and some data also suggest that stepfather–daughter erotic attachment and sexual abuse is more prevalent than the abuse by biological fathers. 22–25 In addition, mother–daughter attachment due to stepfather–daughter erotic transference (or partnership) can result to competition and conflict between mother and daughter, which may seriously affect mental disintegration and dissociative symptoms.

On the contrary, boys living with unmarried or divorced (not re-married) mothers, have clinically significant dissociation. The reason for this difference might be that, in comparison with girls, boys need a specific kind of separateness from mothers to find male identity for which they need father or father's figure. 26–34 In addition, in the case of boys without fathers or step-fathers, there is an increased risk of compensatory erotic transference that significantly increases pathologically dependent attachment between mother and son. 35,36 For example, recent data indicate that more than two-thirds of African American children are born to unmarried mothers, 37 which may represent a significant factor of criminal behavior. 38,39 These data seem to support several psychoanalytical data and interpretations regarding mental disintegration associated with pathologically dependent mother-son relationships and violence. 35,36,39 Further research is warranted to explain to which extent psychodynamic factors play significant roles in these family processes associated with dissociation.

REFERENCES

1. Stolz HE, Barber BK, Olsen JA. Toward disentangling fathering and mothering: an assessment of relative importance. J Marriage Fam 2005; 67:1076–1092.
2. Flouri E. Fathers’ behaviors and children's psychopathology. Clin Psychol Rev 2010; 30:363–369.
3. Calzada EJ, Eyberg SM, Rich B, et al. Parenting disruptive preschoolers: experiences of mothers and fathers. J Abnorm Child Psychol 2004; 32:203–213.
4. Phares V, Lopez E, Fields S, et al. Are fathers involved in pediatric psychology research and treatment? J Pediatr Psychol 2005; 30:631–643.
5. Amato PR, Cheadle JE. Parental divorce, marital conflict and children's behavior problems: a comparison of adopted and biological children. Social Forces 2008; 86:1139–1161.
6. Coates S, Gaensbauer TJ. Event trauma in early childhood: symptoms, assessment, intervention. Child Adolesc Psychiatr Clin N Am 2009; 18:611–626.
7. Gunnar MR, Quevedo KM. Early care experiences and HPA axis regulation in child: a mechanism for later trauma vulnerability. Prog Brain Res 2008; 167:137–149.
8. de Zulueta CF. Mass violence and mental health: attachment and trauma. Int Rev Psychiatry 2007; 19:221–233.
9. Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986; 174:727–735.
10. Ptacek R, Bob P, Paclt I, et al. Psychobiology of dissociation and its clinical assessment. Neuro Endocrinol Lett 2007; 28:191–198.
11. Nijenhuis ER, Spinhoven P, Van Dyck R, et al. The development and psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). J Nerv Ment Dis 1996; 184:688–694.
12. Kukla L, Selesova P, Okrajek P, et al. Somatoform dissociation and symptoms of traumatic stress in adolescents. Act Nerv Super (Praha) 2010; 52:29–31.
13. Briere J. Stamm BH. Psychometric review of the Trauma Symptom Checklist-40 In. Measurement of Stress, Trauma, and Adaptation . Lutherville: Sidran Press, 1996.
14. Beck AT, Steer RA, Brown GK. Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.
15. Zung WW. A rating instrument for anxiety disorders. Psychosomatics 1971; 12:371–379.
16. Andersen SL, Teicher MH. Stress, sensitive periods and maturational events in adolescent depression. Trends Neurosci 2008; 31:183–191.
17. Andersen SL, Tomada A, Vincow ES, et al. Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development. J Neuropsychiatry Clin Neurosci 2008; 20:292–301.
18. Andersen SL, Teicher MH. Desperately driven and no brakes: developmental stress exposure and subsequent risk for substance abuse. Neurosci Biobehav Rev 2009; 33:516–524.
19. Vuchinich S, Hetherington EM, Vuchinich RA, et al. Parent-child interaction and gender differences in early adolescents’ adaptation to stepfamilies. Dev Psychol 1991; 27:618–626.
20. Hetherington EM, Henderson SH, Reiss D, et al. Adolescent siblings in stepfamilies: family functioning and adolescent adjustment. Monogr Soc Res Child Dev 1999; 64:208.
21. Turner HA, Finkelhor D, Ormrod R. Family structure variations in patterns and predictors of child victimization. Am J Orthopsychiatry 2007; 77:282–295.
22. Russell DEH. The prevalence and seriousness of incestuous abuse: stepfathers vs. biological fathers. Child Abuse Negl 1984; 8:15–22.
23. Sariola H, Uutela A. The prevalence and context of family violence against children in Finland. Child Abuse Negl 1992; 16:823–832.
24. Sariola H, Uutela A. The prevalence and context of incest abuse in Finland. Child Abuse Negl 1996; 20:843–850.
25. Greenberg DM, Firestone P, Nunes KL, et al. Biological fathers and stepfathers who molest their daughters: psychological, phallometric, and criminal features. Sex Abuse 2005; 17:39–46.
26. Henderson J. The role of the father in separation-individuation. Bull Menninger Clin 1982; 46:231–254.
27. Shulman S, Klein MM. Distinctive role of the father in adolescent separation-individuation. New Dir Child Dev 1993; 62:41–57.
28. Henderson J. On fathering (the nature and functions of the father role) Part II: Conceptualization of fathering. Can J Psychiatry 1980; 25:413–431.
29. Jones KA, Kramer TL, Armitage T, et al. The impact of father absence on adolescent separation-individuation. Genet Soc Gen Psychol Monogr 2003; 129:73–95.
30. Diamond MJ. The shaping of masculinity: revisioning boys turning away from their mothers to construct male gender identity. Int J Psychoanal 2004; 85:359–379.
31. Blum HP. Separation-individuation theory and attachment theory. J Am Psychoanal Assoc 2004; 52:535–553.
32. Lovas GS. Gender and patterns of emotional availability in mother-toddler and father-toddler dyads. Infant Ment Health J 2005; 26:327–353.
33. Saintonge S, Achille PA, Lachance L. The influence of big brothers on the separation-individuation of adolescents from single-parent families. Adolescence 1998; 33:343–353.
34. DuBois DL, Doolittle F, Yates BT, et al. Research methodology and youth mentoring. J Community Psychol 2006; 34:657–676.
35. Fulmer RH. ’Don’t save her’- Sigmund Freud meets Project Pat: the rescue motif in hip-hop. Int J Psychoanal 2008; 89:727–742.
36. Perelberg RJ. Murdered father; dead father: revisiting the Oedipus complex. Int J Psychoanal 2009; 90:713–732.
37. Lu MC, Jones L, Bond MJ, et al. Where is the F in MCH? Father involvement in African American families. Ethn Dis 2010; 20:49–61.
38. Pettit B, Western B. Mass imprisonment and the life course: race and class inequality in U.S. incarceration. Am Sociol Rev 2004; 69:151–169.
39. Niehaus I. Maternal incest as moral panic: envisioning futures without fathers in the South African lowveld. J South Afr Stud 2010; 36:833–849.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.