The impact of race on the dissociative experiences scale

Person. in&id. Din Vol. 17. No. 1, pp. 139-142, 1994

Pergamon

0191~8869(94)EOOlO-0

Elsevier Science Ltd. Printed in Great Britain.

The Impact of Race on the Dissociative Experiences Scale GARY

E. DUNN,’ ANTHONYM. PAOLO,’ JOSEPHJ.

RYAN,’

CYNTHIA E. DUNN~

and

JAY VAN FLEET’

‘Dwight D. Eisenhower Department of Veterans Affairs Medical Center, Leavenworth, KS 66048 and 2University of Kansas, Lawrence. KS 66045, U.S.A. (Received 24 September 1993)

Summary-Scores on the Dissociative Experiences Scale were compared between a group of 48 white and 48 black veterans being treated for alcohol or polysubstance abuse in a V.A. Medical Center. Groups were matched for age, education, number of previous treatments, IQ, marital status, employment status, history of childhood abuse, and psychological discomfort. Blacks achieved significantly higher scores than whites. Hypotheses were discussed to explain these findings from psycho-diagnostic and cross-cultural perspectives.

During the past decade there has been increased interest in the study of dissociative phenomena. Recent studies have attempted to quantify dissociative symptoms in a variety of clinical and non-clinical settings (Bremner, Southwick, Brett, Fontana, Rosenhack & Chamey, 1992; Chu & Dill, 1990; Ross, Anderson, Fleisher & Norton, 1991: Walker, Katon, Neraas, Jemelka & Massoth, 1992). The most commonly used instrument for this purpose is the Dissociative Experiences Scale (DES) (Bernstein & Putnam, 1986). Several investigations have reported on the relationship between selected clinical and demographic variables and the DES. Ross, Joshi and Cm-tie (1990a) found that DES scores were independent of employment status, income level, and gender, but were negatively correlated with age. Norton, Ross and Novotny (1990) reported a positive relationship between DES scores and intense anxiety, high levels of anger, assorted bodily complaints, and irrational thinking. A variety of psychiatric diagnoses, including multiple personality disorder, have been associated with high DES scores (Bernstein & Putnam, 1986; Ross, Norton & Anderson, 1988). More recently, the variables of psychological discomfort, level of intelligence, and race were found to influence DES results (Dunn, Paolo, Ryan & Van Fleet, in press). As expected, scores increased as level of psychological discomfort increased, however, test scores also increased as level of IQ decreased. Moreover, blacks scored higher on the DES than whites. Since only one investigation has repotted racial differences on this instrument, and only a small sample of minority Ss were included in the original normative sample (Bernstein & Putnam, 1986), further evaluation of the relationship between race and DES performance is warranted. If racial differences are found, this could have serious implications for proper interpretation of the scale. The present study represents an initial attempt to investigate the relationship between race and DES scores while simultaneously controlling for the effects of historical variables (i.e. number of previous treatments for substance abuse), demographic characteristics (i.e. education), overall level of psychological discomfort, and general intelligence.

METHOD

Ss were 96 males being treated on an inpatient substance abuse unit in a midwestem Department of Veteran Affairs Medical Center. All had received a diagnosis of alcohol or polysubstance abuse. None of the Ss had concurrent psychiatric disorders. Forty-eight of the Ss were white and 48 were black. For the entire sample means for age, education, and IQ were 43.65 (SD = 10.98), 11.68 (SD = 1.70). and 88.47 (SD = 11.43), respectively.

Instruments The DES (Bernstein & Putnam, 1986) is a brief self-report measure which consists of 28 items. Respondents indicate the percentage of time they experience particular feelings, thoughts, or behaviors by marking a 100 mm line. The items cover disturbances in identity, memory, cognition, and feelings of depersonalization. The total score can range from 0 to 100. Individuals who achieve a score of 20 or more are considered in need of further assessment to rule out a dissociative disorder (Steinberg, Rounsaville & Cichetti, 1991). Scores of 30 or more suggest an increased probability of a multiple personality disorder or PTSD (Ross, 1989). and scores over 40 are generally thought to characterize patients with a diagnosis of multiple personality disorder (Ross, Miller, Reagor, Bjomson, Fraser & Anderson, 1990b). The DES has adequate reliability and validity (Bernstein & Putnam, 1986; Steinberg et al., 1991). Two additional measures were collected to assess overall.level of psychological discomfort and general intelligence. The F scale (Meehl & Hathaway, 1946), taken from the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen & Kaemmer, 1989), was used as a measure of the first variable. The IQ score from the Shipley-Hartford Institute of Living Scale (Zachary, 1986) constituted a measure of the latter construct. 139

NOTES AND SHORTER COMMUNICATIONS

140 Table I. Comparison

of blacks and whites on demographic Black (N = 48)

and clinical

variables White total (N = 166)

White (N-48)

Variable

Mean

SD

Mean

SD

Mean

SD

Age

43.48 II.85 I .52 88.13 59.65 17.75

IO.84 I .88 I .29 11.61 17.95 13.91

43.81 I I .50 I .79 88.81 58.42 12.27

I I .24 I .49 I .35 I I .35 17.62 9.84

48.28 II.96 3.26 94.77 59.58 II.79

I I .96 I .98 4.17 II.41 16.46 9.86

Education Number of treatmenrs

IQ Scale (r-scores)

F

DES scores

Procedure From April, 1991 to August, 1992 all patients in the substance abuse treatment program completed the MMPI-2, DES, and Shipley-Hartford Institute of Living Scale as part of a routine psychological test battery. Of those, 48 black patients met the criteria of having an alcohol or polysubstance abuse diagnosis without concurrent psychiatric diagnosis. This group was selected for the present study. One-hundred and sixty-six white Ss met the same criteria. Of these, 48 were matched with the black Ss on relevant clinical and demographic variables. The matching variables were: age, education, employment status, marital status, IQ. number of previous treatments, history of childhood abuse, and psychological discomfort as measured by the F scale of the MMPI-2. A series of r-tests indicated that the groups did not differ in terms of mean age, education, IQ, number of previous treatments, or F scale t-scores. Likewise, chi-square analyses indicated group comparability in terms of marital status (married, divorced, single, widowed, separated), employment status (employed, unemployed, retired), history of childhood abuse (physical, emotional, sexual, multiple, none), and diagnoses (alcohol abuse, polysubstance abuse). Means and standard deviations for each of these variables by racial groups are presented in Table I. Means and standard deviations are also provided for the entire white sample.

RESULTS A r-test for related measures demonstrated significant DES scores differences across groups, with blacks scoring on the average more than 5 points higher than whites (t = - 2.47, df= 47, P < 0.02). The effect size associated with this difference was 0.46 suggesting moderate clinical significance (Cohen, 1988). Means and standard deviations for DES scores are presented in Table 1. Table 2 provides the number and percentages of white and black Ss across different DES score ranges. Using a suggested cut-off score of 20,41.7% of the black Ss and 18.8% of the white Ss would need further evaluation. A proportional analysis indicated a significant difference across groups (z = 2.45, P < 0.02).

DISCUSSION Preliminary findings regarding the relationship between race and the DES indicate that, on average, blacks achieve scores over five points higher than whites. This discrepancy was found to be statistically significant and cannot be attributed to differences in age, education, marital status, number of previous treatments, IQ, employment status, history of childhood abuse, or psychological discomfort as measured by the MMPI-2 F scale. Several explanations may account for these results. From a psycho-diagnostic perspective, the present study reveals that a larger percentage of black substance abusers, in comparison to white substance abusers, are in need of further screening for a dissociative disorder. Using a cut-off of 20 (Steinberg ef al., 1991). over 41% of blacks require further assessment in comparison to < 19% of whites. Furthermore, over 20% of blacks, in comparison to slightly less than 5% of whites, achieved DES scores which are generally associated with diagnoses of PTSD or multiple personality disorder (Ross, 1989; Ross et al., 1990b). These figures would seem to suggest

Table 2. Number and percent of persons within specified DES score ranges by race Range

Black

White

< 20 20-29 30-39 40

28 (58.3%) IO (20.8%) 6 (12.5%) 4 (8.3%)

39 (81.3%) 7 (14.5%) I (2.1%) I (2.1%)

NOTES AND SHORTER COMMUNICATIONS

141

that blacks are at least twice as likely to suffer from dissociative symptoms or develop serious psychiatric disorders. It should be noted, however, that elevated scores for blacks on other psychological measures, such as the 8 scale from the MMPI-2, do not necessarily suggest greater psychopathology (Graham, 1990). Thus, differences in DES performance between whites and blacks may be accounted for in an alternative manner. From a cross-cultural perspective the discrepancy in DES scores between black and white Ss may be rooted in a very different explanation. This viewpoint emphasizes the problems, and counter productivity, of making inferences about minority performance on psychological assessments based on a comparison to the majority group’s norms (Brooks, 1984; Casa, 1984). In their discussion about cultural equivalency, Lonner and Sundberg (1985) stated that one cannot be assured that a psychological construct is the same across cultures. Their example was that of intelligence, however the same rationale may apply for dissociation. The assumption of equivalency, without empirical evidence, can result in the incorrect conclusion that minority members have higher incidence rates of psychological disturbance and poorer mental health (Casa. 1984). This can further result in a failure to recognize relevant strengths and adaptive resources which exist within minority cultures. Dissociation, in certain degrees, may actually be an adaptive strategy. Pinderhughes (1973)referred to a “mild dissociation” among blacks which involves separating their true selves from their racial identity as seen by the dominant culture. Based on an analysis of black history, Sue (1981) suggested that some blacks learn to dissociate their true feelings, and develop a second identity in response to racial discrimination. This can manifest itself in two ways. First, some individuals learn to maintain a facade of being calm and composed despite inward feelings of conflict and rage. This defense mechanism is thought to protect the person from harm and exploitation. A second form of dissociation can occur as one maintains a non-assertive, passive role in an effort to deny aggressive feelings toward perceived oppressors. From this perspective, higher DES scores may actually represent an adaptive coping strategy rather than increased psychopathology. A third explanation for the racial differences found on DES scores, is that it is specific to the patient population which was used in this study. All Ss were male veterans being treated in a substance abuse unit in a V.A. Medical Center. The majority were unemployed, of low average intelligence, and had been treated for their addiction on at least one other occasion. It should also be noted that this study was of an archival nature and caution is therefore needed in generalizing these results to other populations. Despite the limitations noted above the present study represents the first attempt to specifically investigate the relationship between race and dissociative experiences as measured by the DES. Significant differences were found with blacks scoring higher than whites, and this cannot be accounted for by basic demographic or clinical variables. Future research is needed to determine whether these findings can be replicated with other clinical populations and minority groups. Of equal importance is the need to understand the cause of these findings. Hypotheses from psycho-diagnostic and cross-cultural perspectives were discussed, but a definite conclusion can not be drawn at the present time. Finally, it is imperative that separate norms be developed for the DES among blacks as well as other racial groups. Without this information, it remains impossible to determine what specific DES scores mean unless the individual is white.

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NOTES AND SHORTER COMMUNICATIONS

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