Evaluation of Stressful Life Events in Patients with Dissociative Disorder Using the Holmes & Rahe Stress Scale: A Cross-Sectional Study

Introduction

Dissociative (conversion) disorder is characterised as an unconscious protection strategy that entails the separation of specific mental or behavioural processes from the individual's overall psychic functioning.¹ Dissociative disorders represent a disruption in the integrated functions of memory, identity, perception, and consciousness, often precipitated by overwhelming psychosocial stressors.² These conditions can significantly impair functioning and quality of life. Patients with Dissociative Identity Disorder (DID) may experience symptoms related to mood, anxiety, personality, eating, functional somatic, and substance use disorders, in addition to psychosis, among others.³

 The Holmes and Rahe Stress Scale (SRRS), developed in 1967, offers a standardized method to quantify life stress based on major life events. Prior research has linked high stress scores with mental health disturbances, yet data specific to dissociative disorders in Indian populations are limited.⁴

Recent international studies suggest a link between high cumulative stress and dissociative symptoms. Simon D et al. (2006)⁵ reported that increased stressful life events predicted dissociation in a community sample. Kim et al. (2020)⁶ found similar associations in patients with functional neurological symptoms.

Knowledge Gap

While studies have assessed the clinical and socio-demographic profile of dissociative disorders in India, few have utilized standardized tools to quantify stress levels. Moreover, the age- and gender-specific distribution of stress in dissociative patients remains unexplored using the Holmes & Rahe Stress Scale. This study bridges this gap by systematically evaluating stress levels and their association with symptom presentation in an Indian clinical sample.

Aim: To evaluate stressful life event in patients with dissociative disorder using the Holmes & Rahe Stress Scale.

Methods

A Cross-sectional hospital-based study on 164 patients by simple random sampling
at the Department of Psychiatry, Mahatma Gandhi Medical College and Hospital, Jaipur (Nov 2023–Dec 2024) patients of 18–45 years, either gender, Diagnosed with dissociative disorder (ICD-10) by two psychiatrists were included. Patients with Medical / neurological illness or Refusal to participate were excluded.

Tool Used:

Holmes & Rahe Stress Scale to evaluate stressful life events Semi-structured socio-demographic & clinical proforma

Questionnaire (SRRQ) -

1.     social readjustment measures the intensity and length of time necessary to accommodate to a life event, regardless of the desirability of this event.

2.     You are asked to rate a series of life events as to their relative degrees of necessary readjustment. In scoring, use all of your experience in arriving at your answer. This means personal experience where it applies as well as what you have learned to be the case for others. Some persons accommodate to change more readily than others; ease or difficulty to only certain events. Therefore, strive to give your opinion of the average degree of readjustment necessary for each event rather than the extreme.

 Scoring of the scale-

150 pts - or less means a relatively low amount of life change and a low susceptibility to stress-induce health problems.  150 to 300 pts - implies about a 50% chance of a major stress-induced health problem in the next 2 years.  300 pts or more - raises the odds to about 80%, according to the Holmes-Rahe prediction model

 Statistical Analysis:

SPSS v25.0 used. Descriptive statistics for frequencies and percentages; chi-square test for categorical comparison (p < 0.05 significant)

 

Results

In present study maximum subjects fall in moderate category of Holmes &Rahe scoring. 48.8% (N=80) have moderate Holmes &Rahe score, 24.4% (N=40) have low stress Holmes &Rahe score, and 26.8% (N=44) have at high stress Holmes &Rahe score.

Table 1: Age-wise Distribution of Holmes & Rahe Stress Levels

Age Group (years)	Low Stress (≤150)	Moderate Stress (151–299)	High Stress (≥300)	Total (n=164)
18–25	25 (30.1%)	40 (48.2%)	18 (21.7%)	83 (50.6%)
26–35	10 (22.2%)	25 (55.6%)	10 (22.2%)	45 (27.4%)
36–45	5 (13.9%)	15 (41.7%)	16 (44.4%)	36 (22.0%)
Total	40 (24.4%)	80 (48.8%)	44 (26.8%)	164 (100%)

Above table shows that the Holmes &Rahe scores of patients were comparable in different age group. Out of 83 subjects in age group of 18-25 years, 25 subjects falls in slight category of Holmes &Rahe scoring, 40 subjects falls in moderate category of Holmes &Rahe scoring, and 18 subjects falls in at risk category of Holmes &Rahe scoring. Out of 45 subjects in age group of 25-35 years, 10 subjects falls in slight category of Holmes &Rahe scoring, 25 subjects falls in moderate category of Holmes &Rahe scoring, and 10 subjects falls in at risk category of Holmes &Rahe scoring. Out of 36 subjects in age group of 36-45 years, 5 subjects falls in slight category of Holmes &Rahe scoring, 15 subjects falls in moderate category of Holmes &Rahe scoring, and 16 subjects falls in at risk category of Holmes &Rahe scoring.

Table 2: Gender-wise Distribution of Holmes & Rahe Stress Levels

Gender	Low Stress (≤150)	Moderate Stress (151–299)	High Stress (≥300)	Total (n=164)
Male	15 (36.6%)	20 (48.8%)	6 (14.6%)	41 (25%)
Female	25 (20.3%)	60 (48.8%)	38 (30.9%)	123 (75%)
Total	40 (24.4%)	80 (48.8%)	44 (26.8%)	164 (100%)

 

Above table shows that the Holmes &Rahe scores of patients were comparable in males and females. Out of 123 female subjects 25 female subjects fall in slight category of Holmes &Rahe scoring, 60 female subjects fall in moderate category of Holmes &Rahe scoring, and 38 female subjects falls in at risk category of Holmes &Rahe scoring. Out of 41 male subjects 15 male subjects fall in slight category of Holmes &Rahe scoring, 20 male subjects fall in moderate category of Holmes &Rahe scoring, and 6 male subjects falls in at risk category of Holmes &Rahe scoring.

Discussion