Disintegrated Experience: The Dissociative Disorders Revisited.

It has been claimed that the progress of psychiatry has lagged behind that of other medical disciplines over the last few decades. This may suggest the need for innovative thinking and research in psychiatry, which should consider neglected areas as topics of interest in light of the potential progress which might be made in this regard. This review is concerned with one such field of psychiatry: dissociation and dissociative disorders. Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity. While dissociative identity disorder (DID) is the most pervasive condition of all dissociative disorders, partial representations of this spectrum may be diagnosed as dissociative amnesia (with or without fugue), depersonalization disorder, and other specified dissociative disorders such as subthreshold DID, dissociative trance disorder, acute dissociative disorders, and identity disturbances due to exposure to oppression. In addition to constituting disorders in their own right, dissociation may accompany almost every psychiatric disorder and operate as a confounding factor in general psychiatry, including neurobiological and psycho-pharmacological research. While an anti-dissociative drug does not yet exist, appropriate psychotherapy leads to considerable improvement for many patients with dissociative disorders.

Current Directions in Psychological Science, 2012

Conventional wisdom holds that dissociation is a coping mechanism triggered by exposure to intense stressors. Drawing on recent research from multiple laboratories, we challenge this prevailing posttraumatic model of dissociation and dissociative disorders. Proponents of this model hold that dissociation and dissociative disorders are associated with (a) intense objective stressors (e.g., childhood trauma), (b) serious cognitive deficits that impede processing of emotionally laden information, and (c) an avoidant information-processing style characterized by a tendency to forget painful memories. We review findings that contradict these widely accepted assumptions and argue that a sociocognitive model better accounts for the extant data. We further propose a perspective on dissociation based on a recently established link between a labile sleep-wake cycle and memory errors, cognitive failures, problems in attentional control, and difficulties in distinguishing fantasy from reality. We conclude that this perspective may help to reconcile the posttraumatic and sociocognitive models of dissociation and dissociative disorders.

Journal of Trauma & Dissociation, 2011

Journal of Abnormal Psychology, 1994

Although dissociative disorders are relatively rare, dissociative experiences are rather common in everyday life. Dissociative tendencies appear to be modestly related to other dimensions of personality, such as hypnotizability, absorption, fantasy proneness, and some facets of openness to experience. These dispositional variables may constitute diatheses, or risk factors, for dissociative psychopathology, but more complex models relating personality to psychopathology may be more appropriate. The dissociative disorders raise fundamental questions about the nature of self and identity and the role of consciousness and autobiographical memory in the continuity of personality. The dissociative disorders consist of a group of syndromes whose common core is an alteration in consciousness affecting memory and identity (for recent reviews,

Journal of Trauma & Dissociation, 2011

Handbook of Interpersonal Violence and Abuse Across the Lifespan, 2021

Dissociation is the label for a complex set of symptoms related to trauma, but likely to have other nontraumatic causes. DSM-5 diagnoses with a dominant symptom of trauma include the dissociative disorders and the dissociative subtype of posttraumatic stress disorder (PTSD-D). This chapter reviews the key definitions and models of dissociation, the symptoms that are typically included under the broader rubric of dissociation, measures of the dissociative symptom and the dissociative disorders, challenges in the diagnosis of the dissociation-related diagnoses, and methods of treatment that have thus far received empirical support.

Tijdschrift voor psychiatrie, 2006

Intuitively we are convinced that there must be a causal relationship between traumatic experiences and dissociation. However, although the theory is both elegant and attractive, the existence of a direct causal link between trauma and dissociation is open to question. Available studies on this theme have methodological shortcomings. To obtain more insight into the frequency with which psychiatric patients have undergone traumatic experiences and to find out more about the relationship between theses experiences and dissociative phenomena. Over a period of two years new outpatients attending psychiatric clinics completed questionnaires about their past life and mental health; in these questionnaires they gave information about traumatic experiences, dissociative phenomena, psychological symptoms and psychological functioning. Only 38 of the 351 patients who completed the questionnaire stated that they had never had any traumatic experiences. A relatively large number of patients men...

Ultimo, 2009

This paper contrasts the roles of splitting and dissociation in multiple personality disorder. It is proposed thllt dissociation is a unique defensive process that serves to protect the patient from the overwhelming effects of severe trauma and thllt multiple personality disorder need not a:zll upon splitting as its central defensive process. Fantasies of restitution may be incorporated into the dissociative defense. Psychological, physiological, and behavioral models all are of use, making it likely thllt ultimately dissocia-tion will be understood along multiple lines of study. The dramatic shifts of manifest clinical phenomena noted in patients suffering multiple personality disorder have caused some investigators to emphasize splitting mechanisms to explain these shifting states (Pohl

Routledge eBooks, 2022

This chapter explores the most pertinent research questions to understand and advance the study of dissociation. Drawing on specific themes, recommendations for future work are outlined at the end of each section. Our chapter in the first edition of this book still contains questions empirically unanswered (e.g., genetics and neurobiology of dissociative disorders, dissociation in other psychiatric disorders). We will focus in this chapter on the most pressing questions that currently need to inform the scientific understanding of dissociation. The Broader Field Definition The widely accepted definition of dissociation has been based on a disruption in one or more psychological functions which implies fragmentation, division, or disintegration (Van der Hart, Nijenhuis, & Steele, 2006). Nevertheless, there have been attempts to expand this definition. For example, although some authors consider absorption to lie outside the domain of dissociation, others claim that it involves dissociation as a narrowing of consciousness and/ or a trance state (Schimmenti & Şar, 2019). Liotti (1992) underlined the interpersonal aspect of dissociation. While in some cases dissociation takes the form of a disorder, it also appears to be a transdiagnostic phenomenon seen in several psychiatric conditions, such as eating disorder, borderline personality disorder, and somatic symptom disorders (Lyssenko et al., 2018). Dissociative symptoms and dissociative disorders are usually related to childhood adversities (Şar & Ross, 2006). Recommended Research 1. Studies addressing domains of dissociation to improve the definition of dissociation. 2. Exploration of personality characteristics of patients with dissociative disorders according to various (e.g., dimensional) models. 3. Trans-diagnostic studies inquiring into possible relationships of dissociation with other domains of psychopathology. Assessment Steinberg's (1994) Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) is widely used in the field. A meta-analysis of the studies using this instrument revealed it has good diagnostic reliability (Mychailyszyn et al., 2021). Ross and Browning (2017) provided a revised version of the Dissociative Disorders Interview Schedule (DDIS) adapted to the DSM-5 which yielded good reliability for the self-report version of the instrument. Many self-report and screening measures of dissociation now exist, including the Dissociative Experiences Scale (DES; Bernstein &

Psychological Bulletin, 2014

argued that convincing evidence (a) supports the longstanding trauma model (TM), which posits that early trauma plays a key role in the genesis of dissociation; and (b) refutes the fantasy model (FM), which posits that fantasy proneness, suggestibility, cognitive failures, and other variables foster dissociation. We review evidence bearing on Dalenberg et al.'s 8 predictions and find them largely wanting in empirical support. We contend that the authors repeat errors committed by many previous proponents of the TM, such as attributing a central etiological role to trauma in the absence of sufficient evidence. Specifically, Dalenberg et al. leap too quickly from correlational data to causal conclusions, do not adequately consider the lack of corroboration of abuse in many studies, and underestimate the relation between dissociation and false memories. Nevertheless, we identify points of agreement between the TM and FM regarding potential moderators and mediators of dissociative symptoms (e.g., family environment, biological vulnerabilities) and the hypothesis that dissociative identity disorder is a disorder of self-understanding. We acknowledge that trauma may play a causal role in dissociation but that this role is less central and specific than Dalenberg et al. contend. Finally, although a key assumption of the TM is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma-dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorders.