Chapter 4: Results and Analysis

In this chapter the results obtained during the analysis are presented . A general overview of the

sample its characteristics and other statistical analysis results would be discussed here.

4.1 SOCIO DEMOGRAPHIC CHARACTERISTICS OF THE SAMPLE

In this section, basic characteristics of the sample of individuals with Dissociative Disorders are

described.

As seen in Table 1, the total sample size consists of 30 individuals with DD. This sample was

made up of 26 females and 4 males.

The age criteria for selection of individuals in the sample stated that individuals should be

between the ages of 18 and 40.

The results illustrated below highlights the various sociodemographic variables and their trends

associated with them.

Table 4.1 Gender distribution in the sample:

Gender Frequency Percentage

Male 4 13

Female 26 86

Total 30 100
 Graph 4.1 Representation of gender percentages

MALE FEMALE

19%

81%

Here, the results indicate that out of a sample size of 30, 81% , were females accounting for more

than half of the sample size and 19% were males.

This indicates a disparity in the epidemiology which further will be discussed in the next chapter.

Table 4.2 Frequency and Percentages Of Marital Status within The Sample

Marital status Frequency Percentage

Married 18 60

Unmarried 12 40

Total 30 100
 Graph 4.2 Representation of Percentages Of Marital Status

Married Unmarried

40%
60%

In the category of marital status, 18 among the sample size of 30 were married accounting for

60% of the sample, remaining 12 people were unmarried accounting for 40% of the sample.

Table 4.3: Education Levels of the Sample

Percent
Level Frequency

23.33
Illiterate 7
Primary school 10 33.33
High school 5 16.66
Higher secondary school 6 20
Graduation 2 6.66
Total 30 100.0
 Graph Representation of Education Levels of the sample

ILLETERATE PRIMARY SCHOOL

HIGH SCHOOL HIGHER SECONDARY SCHOOL
Graduation

7%
23%
20%

17%
33%

As illustrated in the above table and figure, among the 30 sample size, seven were illeteerate

accounting for 23.33%. ten had passed primary school, 33.33% of the sample, 5 had passed high

school, 16.66%. six people had completed higher secondary school accounting for 20%. Of the

sample. A further two people had completed their graduation accunting for 6.66% of the sample

size .
Table 4.4 Employment Characteristics of the Sample

Occupation Frequency Percentage

Housewife 20 66.66

Student
5 16.66

Self employed 1 3.33

Unemployed 2 6.66

Laborer 2 6.66

Total 30 100.0

Graph 4.4 Employment Characteristics of the sample

7%
7%
3%

Housewife Student SelfEmployed Unemployed Labourer

17%

67%
In terms of employment, out of the 30 sample size, twenty of them were housewives accounting

for 66.66% of the sample. Five were students comprising 16.66%, one was self employed,

3.33%. among them two were unemployed representing 6.66% of the population. Two worked

as daily wage labourer, 6.6 % of the sample.

Table 4.5 Domile Distribution and the sample

Domicile Frequency Percentage (%)

Urban 5 16.66%

Semi-Urban 10 33.33%

Rural 15 50%

Total 30 100.0

Graph 4.5 Representation Domicile Distribution of the sample

Urban Semi-Urban Rural

17%

50%

33%
In the distribution of domicile, five were from urban comprising 16.66% of the population

sample, ten were from semi-urban indicative of 33.33% of sample and fifteen were frrm rural

area comprising 50% of the total sample size.

Table 4.6 Religious Charcteristics of the sample

Religion Frequency Percentage

Hindu 12 40

Muslim 18 60

Others 0 0

Total 30 100.00

Graph 4.6 Representation of Religious Charcteristics of the sample

Hindu Muslim

40%

60%
As can be seen from the respective tables and figures 4.6, majority of the sample
size belonged to mulim religion, eighteen people, 60% and Hindu religion people
comprised 40% of the respective sample.

Table 4.7 Socio Economic Status of the Sample

Economic strata Frequency Perecentage

Middle 8 26.66%

Lower 22 73.33%

Total 30 100.0

Graph 4.7 Representation of the Socio Economic Status of the Sample

Middle Lower

26%

74%
As can be seen from the above illustrated figure and table 4.7, majority of the sample belonged

to low socioeconomic division and remaining 26 % belonged to middle socioeconomic division.

No upper division of strata was found in the given sample. Table 4.8 Representation of

frequency of Dissociative Diagnosis in the Sample

Final Diagnosis Frequency Percentage

(According to ICD 10)

Dissociative amnesia 0 0
Dissociative fugue 0 0
Dissociative stupor 0 0
Trance and possession disorders 5 16.66
Dissociate motor disorders 6 20
Dissociative convulsions 4 13.33
Dissociate anaesthesia and sensory loss 0 0
Mixed dissociative [conversion] 15 50

disorders
Other dissociative [conversion] 0 0
disorders
Ganser's syndrome
Multiple personality disorder

Transient dissociative [conversion] 0 0

disorders occurring in childhood and
adolescence
Dissociative [conversion] disorder, 0 0
unspecified
Figure 4.8 Percentage of Dissociative Disorders in the sample size
Trance and possession disorders
Dissociate motor disorders
Dissociative convulsions
Mixed dissociative [conversion] disorders

17%

50%
20%

13%
from the above table 4.8, we can see that the type of dissociative disorder is diagnosed in th

given sample. Trance and possession consisted of five patients comprising 16.66% of the samp

e, six patients were diagnosed with dissociative motore disorders, comprising 20% of the sampl

, four patients were from dissociative convulsions category indicative of 15.55% of the sam

le, fifteen patients we

4.2 To explore the different pathways to care before the patients reach the mental health

setup among the persons with D D

Dissociative Disorder and their First point of contact

Here, dissociative disorder patient has been described with their first point of contact person

when they for help seeking.

Table 4.9 Type of Healers

Type of Healers Frequency Percentage

Faith Healer 18 60

Medical Specialist (Physician, 5 16.66

gastroentologist, gynecologist)

neurologist 5 16.66

Psychiatrist 2 6.66

Total 30 100.0
 Figure 4.9 Type of Healer
Faith Healer
Medical Specialist (Physician, gastroentologist,gynecologist)
neurologist
Psychiatrist

7%

17%

60%
17%

Here, the table 4.9 and the resulatant figure 4.9 illustrates the dissociative disorder and their first

point of contact.. eighteen patients went first to faith healer comprising 60 % of the sample size,

five people went to medical specialists which included physician, gastroentologit and

gynecologist, they comprised 16.66 % of the sample. Five people went to neurologist indicative

of 16.66 % of the sample and only two people went to a psychiatrist whch comprised 6.66 % of

the toatal sample size of 30.

Table 10 Duration Taken to seek help:

Time (Days) Frequency Percentage

7 1 3.33

30 1 3.33

60 7 23.33

180 9 30

365 6 20

730 1 3.33

1095 3 10

1460 2 6.66

Total 30 100.0
Figure 10 Duration Taken to seek help (days)
7 30 60 180 365 730 1095 1460

7%3% 3%
10%
3% 23%

20%

30%
Distance From final outcome of referral path

Distance (Kms) Frequency Percentage

5 5 16.66%

10 8 26.66%

20 3 10%

30 2 6.66%

40 1 3.33%

50 1 3.33%

60 1 3.33%

80 2 6.66%

90 4 13.33%

100 1 3.33%

120 2 6.66%

Total 30 100.0
Distance From final outcome of referral path
5 10 20 30 40 50
60 80 90 100 120

7%
3% 17%

13%

7%
3% 27%
3%
3%
7% 10%

WHO INITIATED HELP SEEKING:

Initiators of Help Frequen Percent

seeking behaviour cy age

Self 2 6.66%
Spouse 6 20%
Parents 16 53.33%
Neighbour/Friend/ 6 20%

Relative
Total 30 100.0
Initiators of Help seeking behaviour
Self Spouse
Parents Neighbour/Friend/Relative

7%
20%
20%

53%
Response to combined Psychiatric and Psychological Treatment at Ihbas

RANGE OF FREQUENC PERCENTAGE

IMPROVEMEN Y

T
Not satisfied with 3 10%

treatment
Mild 20 66.66%

Improvement
Moderate 5 16.66%

Improvement
Recovery 2 6.66%
TOTAL 30 100.0

Response to combined Psychiatric and Psychological Treatment at Ihbas

Not satisfied with treatment Mild Improvement
Moderate Improvement Recovery

7% 10%
17%

67%
The level of dissociative symptoms in individual patients:

Mean Of Dissociative Scores Frequency

10-15 1

16-20 2

21-25 1

26-30 6

31-35 13

36-40 1

41-50 1
 14

12

10

Column2
6

0
0-15 16-20 21-25 26-30 31-35 36-40 41-50

High levels of dissociation are indicated by scores of 30 or more, scores under 30 indicate low
levels.

The items of are clustered in four subscales representing the main features of dissociation

including, amnesia, which is a form of memory loss (e.g. not knowing how you got somewhere);

depersonalization/derealization, feeling detached from ones self and mental processes or sense

of unreality of the self (e.g. feeling that you are standing next to yourself); absorption, being

preoccupied by something to the point that one is distracted from what is going on around

oneself.
Mean Depersonalization Amnestic Absorption

Scores / Dissociatio &

Derealization n Imaginative

Involvemen

t
0-10 15 12 2
10-20 5 5 20

20-30 4 1 25

Chart Title
30
25
20
15
10
5
0 0-10
10-20
Axis Title
20-30

Axis Title
 To study the nature and difficulties in emotional regulation among the persons with
DD.

The scores of the DERS was assessed and their respective average was calculated. Accordingly

the following the table is illustrated-

Mean Of DERS Scores Frequency

40-50 2

51-60 1

61-70 1

71-80 23

81-90 3
 Frequency
25

20

15 Frequency

10

0
40-50 51-60 61-70 71-80 81-90
The raw scores of the Difficulties in Emotional Regulation Scale (DERS) was assessed on a

continuum of six specific factors related to emotion Dysregulation as illustrated below:

The raw scores of both the sentences are tallied and their required percentages obtained. The

percentages reveal various dimensions of their emotional difficulties which allows the

researcher to qualitatively analysie it and arrive at a conclusion.

Scores Goals Impulse Aware Strategies Clarity Nonacceptance

0-10 2 2 18 5 13 3

10-20 5 6 9 7 6 16

20-30 15 7 2 16 8 10

30-40 8 15 1 2 2 1
 20
18
16
14
12
10
0-10
Axis Title 8 10 -20
6 20-30
4 30-40
2
0

Axis Title

Through the bar diagram it can be seen that the individuals are undergoing a emotional upheaval

moment which they are unable to handle.

They are unclear about their feelings and they experience their emotions as out of control. They

get upset easily.

Qualitative Analysis:

To study patients personal experiences and perception about cause of their illness among the
persons with DD, detailed analysis of five patients were done to get an in-depth idea about their
experience and their perception of their illness.
Interpretative Phenomenological Analysis (IPA) of the five semi-structured interviews was done

which resulted in the emergence of master themes and superordinate themes. T he findings convey

the researchers interpretation of the participants interpretation of their experience (Smith et al.,

2009).

The results section is organized by five themes identified in the analysis process. The focus of

phenomenology is on the common elements of a phenomenon, rather than on the individual; in

keeping with this aspect of the chosen methodology for the study, when presenting excerpts from the

interview transcripts, the researcher does not include participant names or pseudonyms.

Exploration of these master themes and their constituent superordinate themes will form the

basis of this chapter, with each theme illustrated by verbatim extracts from the interviews.

Patients undergoing treatment for dissociation have poor perception of themselves. During

detailed qualitative interviews, it could be entailed that various schema rule their lives along with

their illness. They have a history of trauma along with lowered self esteem.

In presenting the verbatim extracts some minor changes have been made to improve m

readability. Minor hesitations, word repetitions and utterances such as erm have mostly been

removed. Missing material is indicated by dotted lines within brackets (...), and where material

has been added (e.g. to explain what a participant is referring to) it is presented within square

brackets. Dotted lines at the beginning or end of an extract indicate that the person was talking

prior to or after the extract. All identifying information has been removed or changed, and the

alias names used in the Method chapter have been maintained to protect the anonymity of

participants.

The various themes which have been unearthed in the interview schedule can be summarized and

illustrated as:
Table Representing the master themes and superordinate themes

Master themes Superordinate Themes

Attributing illness to parental figures

Holding conflicting explanatory Models of Attributing illness to spouse
Increased Emotional expression by
Illness
family members.

Dependency
Presence of inherent personality traits
Emotional neuroticism

Presence of current trauma / strained Conflictual relationship with significant

relationship other

4. Holding conflicting explanatory models of illness

This master theme aims to capture the idea that the patients hold various people responsible for

their dissociation. Each person emerges as the superior or the authority figure in the attachment

bond. Attribution of illness is caused by anger towards self and others.

4.3.1 Attributing illness to parental figures

This superordinate theme addresses the patients submerged anger against their own parents.

Among the five patients interviewed, three of them had appeared to be in conflict with their

parental figures. They appear to have unhealthy attachment with their parents. Attachment styles

indicate avoidant attachment or disorganized attachment. Over involvment by parents increasing

interference in the patients life lead to development of anxiety and stress.

Mujhe aapne mummy pe bahut gussa aaata hain, wo mujhe kuch privacy nahi deti hain mere life

main. Mujhe har chhoti chhoti cheez ke liye unko puchna padhta hain. Main bahut tang aagayi

hoon in baatoon se aur frustrate ho gayi hooo. Ms C, 24 yrs

.mujhe hamesha mere parent ne had ze zyada pyaar kiya hain, bahut kiya hain. Toh abhi wo

log mujhe mana nahi kar sakte hain. Main unki luati ladki hoon,jitna bhi zidd karungi, meri baat

toh ek din who maan hi jayenge. Unki nahi maanne ki wajaise aaja main biamr huwi hoon. Wo

log mujhe nahi respect hain , naahi mere friends ko respect karte hain. Ms N, 23 yrs.

4.2.1 Attributing illness to spouse

Among the five patients interviewed, three were married. They did not have a healthy

relationship with their spouses. Their supposed or real rejections by them gave their sense of self

a fragility; they experienced a lack of certainty regarding themselves and that their experience of

themselves was negative. Patients also described high levels of wanting perfectionism and self-

criticism to which their self seemed vulnerable. They attribute their illness to behavior meted

out to them by their halves.

Mere pati mujhe respect nahi karte, naahi mujhe pyaar karte hai. Ye hamari relationship ka koi

astitva hi nahi hai. Mera bas kaam hain baacho ko dekhna aur ghar sambhalna, mere pati mujhe
use and throw ki tarah istemaal karte hain. Main dukhi hoon apne iss haal se, ki unhone mera ye

kya haal bana rakha hain. Wo mujhe apni barabar samsjhte hi nahi hain Mrs S,36 yrs

.Main apne shaadi se khush nahi hoon, ye shaadi zabardasti huwi thi jo meri girlfriend thi

wo mujhe chhod ke chali gayi thi, parents ke dabab me maine ye shaadi kiya tha. She does not

understand me. Uski attitude ki wajah se aaj me iss haal mein hoon. Mr R. 31 yrs.

4.2.2 Increased Emotional expression by family members

This superordinate theme revolves around the heightened expression of emotion by the

family members of the patients leading to development and worsening of symptom

presentation. Expressed emotion is the critical, hostile, and emotionally over-involved

attitude that relatives have toward a family member with a disorder. According to the

accounts of the patients, the family members, especially the siblings and in-laws tend to

be very verbally very hostile and critical towards them.

mere mother-in-law wo mujhse kabhie khush hi nahi hai, roz tana marti hi rehti hain,

kabhie kuch toh kabhie kuch. Wo mujhe pehle pehle shaadi ke dino mein bahut criticize

karte they, ab bhi karte hai, mera iss ghar mein koi wajood hi nahi hain mere father-in-

law hamesha kuch na kuch bolte he rehte ahin, tumhe khana banana nahi aata, ye nahi

wo nahi.hame ladki acchi nahi mili.Mrs D,37 yrs.

4.3 Presence of inherent personality traits

This master theme explores the presence of personality traits inherent in the individuals which

make them vulnerable or predispose them to the development of dissociation early on.
4.3.1 Dependency Vs Rejection

This superordinate theme explores through the accounts of the people interviewed, the need to be

dependent on someone, mostly someone in authority or superior. When this need is not met, then

the person becomes dissatisfied with self and self criticisms increases leading to lowered self

esteem. They experience a lack of certainty regarding themselves and their experience of

themselves as negative. Participants also described high levels of perfectionism and self loathing

to which their self seemed vulnerable.

Feeling rejected by her spouse, Mrs S stated,

I dont know who I am anymore,not worthy of anyone I have no identity in my family, I have

no one. I cant make anyone happy

Mr R, recounts, I dislike everything about myself and also described the experience of being

himself as,Horrible and disappointing. . Sometimes I worry that I have no real identity

I have been treated most badly by my own dear ones. Everyone hates me. I hate myself why does

no like me.

4.3.2 Emotional neuroticism

This superordinate theme revolves around the concept of extreme neuroticism found in the

interview accounts of select patients. It is the tendency to experience negative emotions, such as

anger, anxiety, or depression .It is sometimes called emotional instability, or is reversed and

referred to as emotional stability. According to Eysenck's (1967) theory of personality,

neuroticism is interlinked with low tolerance for stress or aversive stimuli. Those who score high
in neuroticism are emotionally reactive and vulnerable to stress. They are more likely to interpret

ordinary situations as threatening, and minor frustrations as hopelessly difficult. Their negative

emotional reactions tend to persist for unusually long periods of time, which means they are

often in a bad mood. Neuroticism is connected to a pessimistic approach toward work,

confidence that work impedes personal relationships, and apparent anxiety linked with work.

They have problems in emotional regulation, cant think clearly, or make decisions, and cope

effectively with stress.

I lost parts of myself to the point where I didnt know who I really was, I was in pain, mujhe

pata nahi main kaha thi. Mujhe kuch nahi samsjh mein aaraha tha.main bahut pareshan hoon

apne aap se. pal pal mein rona aata hain. Aage ke liye kya karoon nahi samsjh mein aata

hain.. zindagi ne mujhe hamesha udaasi hi diya hai You have no idea what kind of life I

am dealing with, what I have to deal with everyday, yes I am angry, I am angry at my husband,

my family. They do not respect me. I am nothing in front of their eyes. They make fun of meI

work hard the entire day and there is no reward for me..I feel worthless, helpless, I want to run

away, escape from my present situation..Mrs S

Patients coupled with poor emotional processing and poor familial support are at a loss as to how

to go about and deal with the sudden changes happening in their lives. They are taken aback and

are unsure.

Ive lost it and its just, its that aspect of my own personality that I wish I could get back. I

know that whatever I do, its never going to be particularly good and I will never feel that it s

good enough..Ms N
Sometimes I get so sad, so sad, that I completely shut down.mere friends mera mazzak banate

hain, school main accha nahi kar pa rahi hoon, parents merese khush nahi hain. I am

sometime totally lost from the world..I feel unwanted by the world, the world teases me and

has never accepted me , the way it has accepted my sisters I have tried everyday to forget , but

I cant, I am hurt, I am incapable of thinking beyond this...Nobody listens to me. They have no

time for me. Ms D.

4.3 Presence of current trauma / strained relationship

This master theme revolves around the presence of implied or real trauma; this trauma

which stems from a number of factors in the lives of the patients encompasses the beginning

of this illness and serves as a very important factor in maintaining it.

4.3.1 Conflictual relationship with significant other

This superordinate theme addresses participants accounts of experiencing themselves in an

extremely negative or distressing way. This is due to the presence of conflict between the

patients and their immediate near and dear ones. They have extreme negative views of their self

together with self defeating behaviors- feelings of helplessness, worthless and hopelessness.

These couples with their fragile self esteem leads to a vicious cycle of learned helplessness.

Abusive partners, uncaring family members maintain this cycle. They experience a rejection

from the family which they generalize to the world. The effect of early traumatic experiences on

self development is immense. The varied accounts of patients elucidate their lost sense of self

and fragmentation; they also describe and compartmentalize their feelings as and having buried

or submerged aspects of their real or inner self. Having compartmentalized self in this way,
there was a sense almost of mourning captured in their descriptions of the loss of these parts of

themselves.

my mother-in-law hits me and slaps me, mere husband kuch nahi karte he has never

supported me. I feel useless. Tired of my father-in-law verbally abusing me every single day,

I have tried to kill myself but that too hasnt brought me any peace.. for how long can I tolerate

this kitne der aur? Mrs. S

Mere maths ke professor ne hamesha mujhe low intelligent bolte they main padhai mein

kabhie accha nahi kar payi pitaji marte hain mujhe, kya karun. Main toh kisi kaam ki nahi

hoon. Ms D.

Conclusion:

Thus, in their own personalized accounts we can get a sense of their own feelings dependency,

and rejection, helplessness and burdened by the clusters of their emotions. The feelings of

inadequacy heightened by their own emotional vulnerability leads to development of the clinical

and psychological presentation of the illness.

Here, the following factors come into being-
Personality
Analysis of interview samples
shows that patients traits of
hysterical personality factors. They
become excited easily and are
prone to diffuse unstable emotions.
On the other hand, 2-3 patients
showed difficulty in opening uo
during the sessions thus making
the interview schedule difficult.
They appeared closed up and not
prone to quick tbursts of
Family
Support
 Secondary
Primary
exces gain
gain
s

Environm trauma
ental
factors

Personality Traits Trauma Poor emotional

processing

Dissociative Disorders