Psychiatry and Clinical Psychopharmacology

A near hanging case with dissociative disorder presenting with parasomnia

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S204-S205
Read: 632 Published: 17 February 2021

The role of traumatic events in childhood has been reported in the etiology of both dissociative disorders and sleep disorders. The association between dissociative disorders and sleep disorders such as parasomnia has been mentioned in some studies. Dissociative disorder is seen in 41.6 percent of patients, who have non-REM parasomnia. Sleepwalking is a parasomnia that is characterized by sudden arousals from deep sleep and this arousal is associated with motor activity, which may be elaborate and purposive. It has been suggested that, in some cases, sleepwalking may be understood as a motoric reenactment of a repressed traumatic experience. Here we present a patient diagnosed with a dissociative disorder presenting with parasomnia. A 37-year old female patient was presented to psychiatric emergency service with near hanging while she did not remember that suicide attempt. It was reported that patients’ complaints had begun after her sister death with hanging. She had found her sisters’ death body and twenty days later her complaints had begun. Sleepwalking-like symptoms were described as follows: she would get up and walk in her sleep, generally after 60-90 minutes of sleep, and would often leave the house in her nightclothes. She was absent minded at times, did not hear anything that was said to her. Finally, she attempted to suicide with hanging in one of the nights and she was amnestic along the whole period. Psychiatric examination showed the presence of anxiety and dissociative amnestic processes. Based on the SCID-D (Structured Clinical Interview for DSM-IV Dissociative Disorders), she was diagnosed as not other specified (NOS) dissociative disorder. Her Hamilton Depression Rating Scale was 10, Hamilton Anxiety Rating Scale was 18 and Epworth Sleepiness Scale and Sleep Index Score were 4. Video- polysomnography (V-PSG) was performed one night. During sleep, epileptic activity and motor movement disorder were not observed We would suggest that in certain traumatized patients dissociative mechanisms might come into play within the attack as part of their response to the intense arousal from slow wave sleep associated with distress and/or behaviors normally kept in check. Primitive sensorial restriction is necessary for the protection of individual’s wakeful awareness. During such episodes, the individual may be considered to be awake rather than asleep, but no more fully conscious of themselves than the daytime wakeful individual with an alleged dissociative mechanism operating to produce amnesia. In our case, the sleep pattern was coherent with dissociation while we cannot eliminate the diagnosis of parasomnia with one night V-PSG application. We need further researches to reveal the relationship between sleep and dissociative disorders.

EISSN 2475-0581