Introduction: Exploring Dissociation: Setting the Course

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.

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 &

Journal of Abnormal Psychology, 1991

Journal of Neurology & Stroke, 2019

This article examines the dynamics of dissociation, its function, and cautions in its treatment. Determining the functionality and dysfunctionality is complex. When taken within the framework of Posttraumatic Stress Disorder, throughout a life span, the complexity and its functionality emerges. Through working with patients with Dissociative Identity Disorder over three decades, there are assumptions that are frequently made by clinicians which are inaccurate and potentially harmful to the therapeutic relationship, treatment efforts, and the patients. How does our mind protect itself when some aspect of reality is too painful to cope with? Like any natural response to pain, we have psychological mechanisms which protect us from severe emotional trauma. For our mind, one of those mechanisms is dissociation. It allows us to continue to function in everyday life without experiencing what could be debilitating emotional pain.

"Controversy about dissociation and the dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence support a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/ or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and that DD are artefactual conditions produced by iatrogenesis and/or socio-cultural factors. Almost no research or clinical data support this view" (page 229, Loewenstein, R. (2018). Dissociation debates: everything you know is wrong. Dialogues in Clinical Neuroscience , 20 (3): 229-242. Available at: www.dialogues-cns.org. (Dr K Johansson Blight is not an author of this article but recommend its reading).

Psychotherapy: Theory, Research, Practice, Training, 2004

2020

5 Psychiatrist, Hospital of Psychiatry “Elisabeta Doamna”, Professor, Department of Psychiatry, “Dunarea de Jos” University of Galati, Galati, Romania Abstract: Introduction: Dissociative symptoms are present in a various number of psychiatric disorders and are viewed as a major risk factor for suicidal and self-destructive behavior. Dissociation is defined in DSM-5 as a “disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior”. Assessing dissociation within different categories of mental disorders can be used to predict symptom severity and nonresponse to psychotherapeutic treatments. The most important tool in this process is the Dissociative Experiences Scale (DES). The purpose of the current study is to extend the understanding of dissociation in Psychiatric Disorders. Material and methods: The current study used PubMed and Cochrane databases to identify relevant articl...

Psychological Perspectives

In a lively and wide-ranging roundtable discussion, five seasoned clinicians versed in the treatment of dissociative disorders discuss the importance of recognizing dissociative phenomena: why they happen, how to recognize them, how to work with dissociation and Dissociative Identity Disorder. The panel emphasizes the point that dissociative processes are not exclusive to those suffering from an extreme dissociative disorder and can germinate from other experiences such as attachment trauma, for example. The case is made that dissociation has important implications for work with all patients, as it conveys a more experientially near conceptualization for a model of the mind.

Clinical psychology review, 2005

This review aims to clarify the use of the term ‘dissociation’ in theory, research and clinical practice. Current psychiatric definitions of dissociation are contrasted with recent conceptualizations that have converged on a dichotomy between two qualitatively different phenomena: ‘detachment’ and ‘compartmentalization’. We review some evidence for this distinction within the domains of phenomenology, factor analysis of self-report scales and experimental research. Available evidence supports the distinction but more controlled evaluations are needed. We conclude with recommendations for future research and clinical practice, proposing that using this dichotomy can lead to clearer case formulation and an improved choice of treatment strategy. Examples are provided within Depersonalization Disorder, Conversion Disorder and Posttraumatic Stress Disorder (PTSD).

A common attribute of dissociation is entering an altered sense of self or sense of identity. We focus on (1) differentiating pathological, 'normal', and psychospiritual forms of dissociative experiences which configure a "dissociation spectrum" (Steele et al., 2023); (2) Trauma-related Structural Dissociation of the Personality (van der Hart, 2021a); (3) two distinct categories of dissociative phenomena-'detachment' and 'compartmentalization' (Holmes, 2005); (4) hypnotherapy in the treatment of dissociation (van der Hart, 2021b); and (5) how the psychospiritually altered sense of self can lead to a state called nondual awareness or ego dissolution (Sleight et al., 2023), often considered to be the culminating stage of psychospiritual development, a rarefied condition which may be considered the pinnacle of self-realization (Wilber, 2000).