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Trauma-Focused Cognitive Behaviour Therapy in an Adolescent with Mixed-Dissociative Disorder: A Case Study. Case Rep Psychiatry 2023; 2023:1356682. [PMID: 36824479 PMCID: PMC9943594 DOI: 10.1155/2023/1356682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 02/16/2023] Open
Abstract
Dissociation is a psychopathological condition with a range of alterations or changes in the normally integrated mental functions such as identity, consciousness, or memory and can manifest in various types such as depersonalization, trance states, derealisation, dissociative amnesia, and dissociative identity disorder (Waller et al., 1996). From an etiological perspective, past experience of trauma plays a major role as a precipitating factor in dissociation, wherein dissociation is conceptualized as a reaction to trauma as a way to distance oneself from the traumatic situation and events related to it (Lanius et al., 2015). Initially understood as a coping mechanism, the persistent manifestation of dissociation hinders the overall psychological functioning and interferes with the daily activities of the individual. Therefore, the focus of the various treatment modalities of dissociative disorders is mostly focused on enhancing the coping skills of the patient. The current case study demonstrates the manifestation of dissociation in a 16 years old adolescent with a history of trauma. Furthermore, it documents the efficacy of Trauma-Focused Cognitive Statistical Manual of Mental (Cohen et al., 2017).
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Huntjens RJC, Janssen GPJ, Merckelbach H, Lynn SJ. The link between dissociative tendencies and hyperassociativity. J Behav Ther Exp Psychiatry 2021; 73:101665. [PMID: 34091386 DOI: 10.1016/j.jbtep.2021.101665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/22/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Anecdotal and research evidence suggests that individuals with dissociative symptoms exhibit hyperassociativity, which might explain several key features of their condition. The aim of our study was to investigate the link between dissociative tendencies and hyperassociativity among college students. METHODS The study (n = 118) entailed various measures of hyperassociativity, measures of dissociative tendencies, depressive experiences, unusual sleep experiences, cognitive failures, and alexithymia. RESULTS We found a positive association between dissociative experiences (i.e., depersonalization) and hyperassociativity specific for associative fluency and associative flexibility tasks (including neutral and valenced material), but not for a remote association task. We also found tentative evidence for cognitive failures and alexithymia explaining the link between hyperassociativity and daytime dissociation and nighttime unusual sleep experiences. LIMITATIONS Limitations include the use of hyperassociation tasks limited to verbal associations vs. imagistic associations, the lack of a measure of trauma history, and a sample limited to college students. CONCLUSION Our study reports a link between depersonalization and hyperassociativity on tasks that allow for free associations across different semantic domains, potentially explained by alexithymia and cognitive failures. This finding may, with replication, open the pathway to applied intervention studies.
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Affiliation(s)
- R J C Huntjens
- Department of Experimental Psychotherapy and Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands.
| | - G P J Janssen
- Department of Experimental Psychotherapy and Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands
| | - H Merckelbach
- Forensic Psychology Section, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - S J Lynn
- Department of Psychology, Binghamton University, 4400 Vestal Pkwy. West, Binghamton, NY, 13902, USA.
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Piedfort-Marin O, Rignol G, Tarquinio C. Le trouble dissociatif de l’identité : les mythes à l’épreuve des recherches scientifiques. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2021.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kate MA, Hopwood T, Jamieson G. The prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies. J Trauma Dissociation 2020; 21:16-61. [PMID: 31461395 DOI: 10.1080/15299732.2019.1647915] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This meta-analysis of 31,905 college students includes 12 studies diagnosing Dissociative Disorders (DD) and 92 studies measuring dissociation with the Dissociative Experiences Scale (DES). Prevalence rates were used to separately test the plausibility of the Trauma Model (TM) and the Fantasy Model (FM) of dissociation. Results show 11.4% of students sampled meet criteria for DD, which is consistent with the prevalence of experiencing multiple (types of) trauma during childhood (12%), but is not consistent with the very low prevalence expected from the role of fantasy-proneness proposed in the FM. DES scores varied significantly across the 16 countries and were not higher in North America, but in countries that were comparatively unsafe. The least well-known DD was the most common, which is inconsistent with the FM which holds that the diagnosed person is enacting a familiar social role. There was no evidence that DES scores had decreased over recent decades, which does not support FM assertions that DD were a fad of the 1990s. Three of the five hypotheses tested provided clear support for the TM and a fourth hypothesis provided partial support for the TM. None of the five hypotheses tested supported the FM. The finding that DD were slightly more common in college populations than the general population did not support predictions of either model. The theoretical perspective of the authors moderated DES scores, although this is unlikely due to experimenter bias as studies led by FM theorists had significantly higher DES scores than those led by TM theorists.
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Affiliation(s)
- Mary-Anne Kate
- Department of Psychology, University of New England, Armidale, Australia
| | - Tanya Hopwood
- Department of Psychology, University of New England, Armidale, Australia
| | - Graham Jamieson
- Department of Psychology, University of New England, Armidale, Australia
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Abstract
In recent years, many adolescents in Nepal have been affected by episodes of mass psychogenic illness, which seem to involve dissociative symptoms. To identify the potential contributors to dissociation, the present study examined correlates of dissociative experiences among adolescents in Nepal. In a cross-sectional survey, 314 adolescents were assessed with the Adolescent Dissociative Experiences Scale and measures of childhood trauma exposure, as well as cognitive and personality traits found to be associated with dissociation in studies on other populations. Path analysis confirmed that childhood trauma, cognitive and personality traits, and current distress each predicted dissociative experiences and behaviors. However, an integrated path model found that the effect of childhood trauma on dissociation was mediated either by posttraumatic stress symptoms or by cognitive failures. Future studies should develop and test multifactorial models of dissociation and multiple pathways.
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Lynn SJ, Maxwell R, Merckelbach H, Lilienfeld SO, Kloet DVHVD, Miskovic V. Dissociation and its disorders: Competing models, future directions, and a way forward. Clin Psychol Rev 2019; 73:101755. [DOI: 10.1016/j.cpr.2019.101755] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/20/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
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7
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Mahoney CT, Benight CC. The Temporal Relationship Between Coping Self-Efficacy and Dissociation in Undergraduate Students. J Trauma Dissociation 2019; 20:471-487. [PMID: 30924408 DOI: 10.1080/15299732.2019.1597805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Dissociation is a lack of information integration resulting from a process that ranges on a continuum from normative experiences (e.g., daydreaming) to a pervasive traumatic response involving alterations and/or fragmentation in mental processes such as memory, emotion, and perception. Perceived coping self-efficacy (CSE) is a cognitive appraisal ability utilized to regulate internal and external stressors that arise from traumatic events, and is crucial for effective adaptation after extreme stress or trauma. Thus, CSE may be a critical component in decreasing dissociative experiences following a traumatic event. In the present study, 136 undergraduate students (M age = 22.36 years, SD = 6.27; 81% female, 69.1% Caucasian, 77.2% attended some college) completed self-report measures of trauma, dissociation, and coping self-efficacy. All measures were completed by the same participants at two different time points (Time 1 and Time 2) two months apart; all participants reported a history of exposure to at least one Criterion A traumatic event (according to the DSM-5) at Time 1. We hypothesized that CSE for posttraumatic coping demands at Time 2 would mediate the relationship between dissociation at Time 1 and dissociation at Time 2, and subsequently found evidence of significant mediation, 95% CI [.02, .18]. These findings suggest that initial levels of persistent dissociation negatively predict CSE, which in turn directly and negatively influence persistent dissociation at a later time point. This highlights how CSE may serve as a protective factor against persistent dissociation.
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Affiliation(s)
- Colin T Mahoney
- a Department of Psychology , Idaho State University , Pocatello , ID , USA
| | - Charles C Benight
- b Department of Psychology , University of Colorado at Colorado Springs , Colorado Springs , CO , USA
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8
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Trauma-Related Dissociation Is No Fantasy: Addressing the Errors of Omission and Commission in Merckelbach and Patihis (2018). PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9336-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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9
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Puxty DJ, Ramaekers JG, de la Torre R, Farré M, Pizarro N, Pujadas M, Kuypers KPC. MDMA-Induced Dissociative State not Mediated by the 5-HT 2A Receptor. Front Pharmacol 2017; 8:455. [PMID: 28744219 PMCID: PMC5504523 DOI: 10.3389/fphar.2017.00455] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/23/2017] [Indexed: 11/13/2022] Open
Abstract
Previous research has shown that a single dose of MDMA induce a dissociative state, by elevating feelings of depersonalization and derealization. Typically, it is assumed that action on the 5-HT2A receptor is the mechanism underlying these psychedelic experiences. In addition, other studies have shown associations between dissociative states and biological parameters (heart rate, cortisol), which are elevated by MDMA. In order to investigate the role of the 5-HT2 receptor in the MDMA-induced dissociative state and the association with biological parameters, a placebo-controlled within-subject study was conducted including a single oral dose of MDMA (75 mg), combined with placebo or a single oral dose of the 5-HT2 receptor blocker ketanserin (40 mg). Twenty healthy recreational MDMA users filled out a dissociative states scale (CADSS) 90 min after treatments, which was preceded and followed by assessment of a number of biological parameters (cortisol levels, heart rate, MDMA blood concentrations). Findings showed that MDMA induced a dissociative state but this effect was not counteracted by pre-treatment with ketanserin. Heart rate was the only biological parameter that correlated with the MDMA-induced dissociative state, but an absence of correlation between these measures when participants were pretreated with ketanserin suggests an absence of directional effects of heart rate on dissociative state. It is suggested that the 5-HT2 receptor does not mediate the dissociative effects caused by a single dose of MDMA. Further research is needed to determine the exact neurobiology underlying this effect and whether these effects contribute to the therapeutic potential of MDMA.
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Affiliation(s)
- Drew J Puxty
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - Rafael de la Torre
- Integrative Pharmacology and Neurosciences Systems Research Group, Institut Hospital del Mar d'Investigacions MèdiquesBarcelona, Spain.,Spanish Biomedical Research Centre in Physiopathology of Obesity and NutritionSantiago de Compostela, Spain.,Facultat de Ciencies de la Salut i de la Vida, Universitat Pompeu FabraBarcelona, Spain
| | - Magí Farré
- Integrative Pharmacology and Neurosciences Systems Research Group, Institut Hospital del Mar d'Investigacions MèdiquesBarcelona, Spain.,Department of Pharmacology, Therapeutic and Toxicology, Universitat Autonoma de BarcelonaBarcelona, Spain.,Hospital Universitari Germans Trias i Pujol, Clinical PharmacologyBadalona, Spain
| | - Neus Pizarro
- Integrative Pharmacology and Neurosciences Systems Research Group, Institut Hospital del Mar d'Investigacions MèdiquesBarcelona, Spain.,Department of Pharmacology, Therapeutic and Toxicology, Universitat Autonoma de BarcelonaBarcelona, Spain
| | - Mitona Pujadas
- Integrative Pharmacology and Neurosciences Systems Research Group, Institut Hospital del Mar d'Investigacions MèdiquesBarcelona, Spain.,Spanish Biomedical Research Centre in Physiopathology of Obesity and NutritionSantiago de Compostela, Spain
| | - Kim P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands
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Weibel D, Martarelli CS, Häberli D, Mast FW. The Fantasy Questionnaire: A Measure to Assess Creative and Imaginative Fantasy. J Pers Assess 2017; 100:431-443. [PMID: 28613951 DOI: 10.1080/00223891.2017.1331913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article reports the construction and validation of a comprehensive self-report measure of fantasy. Unlike previous measures of fantasy, which focus on psychopathology, we conceive fantasy as a trait with positive connotation. Principal component analysis (N = 318) and confirmatory factor analyses (N = 345) were conducted using 2 sociodemographically diverse samples. The results provided support for a 2-factor conceptualization of the construct, with the dimensions imaginative fantasy and creative fantasy. Imaginative fantasy refers to vivid imagination and absorption in these images and daydreams. Creative fantasy refers to the activity of using fantasy to create new ideas. The trait measure showed good internal consistency, test-retest reliability, discriminant and convergent construct validity, as well as incremental validity. Moreover, in 3 behavioral studies, we put fantasy scores in relationship with behavioral data to provide further proof of validity. A comprehensive measure of fantasy can contribute to our understanding of individual differences in inner experiences, creative processes, and problem solving.
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Affiliation(s)
- David Weibel
- a Department of Psychology , University of Bern , Switzerland
| | | | - Diego Häberli
- a Department of Psychology , University of Bern , Switzerland
| | - Fred W Mast
- a Department of Psychology , University of Bern , Switzerland
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11
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Merckelbach H, Boskovic I, Pesy D, Dalsklev M, Lynn SJ. Symptom overreporting and dissociative experiences: A qualitative review. Conscious Cogn 2017; 49:132-144. [PMID: 28187372 DOI: 10.1016/j.concog.2017.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 10/05/2016] [Accepted: 01/23/2017] [Indexed: 02/07/2023]
Abstract
We discuss a phenomenon that has received little attention to date in research on dissociative phenomena, namely that self-reports of these phenomena overlap with the tendency to overendorse eccentric items. We review the literature documenting the dissociation-overreporting link and then briefly discuss various interpretations of this link: (1) overreporting is an artifact of measuring dissociative symptoms; (2) dissociative psychopathology engenders overreporting of eccentric symptoms through fantasy proneness or impairments in internal monitoring; (3) an overreporting response style as is evident in malingerers, for example, promotes reports of dissociative symptoms. These three interpretations are not mutually exclusive. Also, the dissociation-overreporting link may have different origins among different samples. Because overreporting may introduce noise in datasets, we need more research specifically aimed at disentangling the dissociation-overreporting link. We suggest various avenues to accomplish this goal.
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Affiliation(s)
- H Merckelbach
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands.
| | - I Boskovic
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - D Pesy
- Department of Neurology, Franziskus Hospital, Mönchengladbach, Germany
| | - M Dalsklev
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - S J Lynn
- Binghamton University - State University of New York, Binghamton, NY, USA
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12
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Lemons P, Lynn SJ. Self-reports of trauma and dissociation: An examination of context effects. Conscious Cogn 2016; 44:8-19. [DOI: 10.1016/j.concog.2016.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/23/2016] [Accepted: 06/13/2016] [Indexed: 11/28/2022]
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13
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Night-time experiences and daytime dissociation: a path analysis modeling study. Psychiatry Res 2014; 216:236-41. [PMID: 24560022 DOI: 10.1016/j.psychres.2013.12.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 08/03/2013] [Accepted: 12/29/2013] [Indexed: 11/22/2022]
Abstract
Dissociative symptoms may be the by-products of a labile sleep-wake cycle (Koffel and Watson, 2009a). This may help to explain why dissociation overlaps with fantasy proneness and cognitive failures. Using path analysis, we tested to what extent data gathered in a nonclinical, predominantly female sample (N=139) supported two conceptual models. The first model assumes that unusual sleep experiences increase fantasy proneness and cognitive failures, which in turn encourage trait dissociation and reports of trauma. The second model assumes that trauma leads to dissociative experiences both directly and through its influence on sleep. In this cross-sectional design, the data were reasonably well described by both models. Importantly, in both models, unusual sleep experiences serve as antecedents of trait dissociation. Our analysis underlines the importance of unusual sleep experiences and may inspire treatment intervention focusing on sleep normalization.
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Kluemper NS, Dalenberg C. Is the dissociative adult suggestible? A test of the trauma and fantasy models of dissociation. J Trauma Dissociation 2014; 15:457-76. [PMID: 24678953 DOI: 10.1080/15299732.2014.880772] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Psychologists have long assumed a connection between traumatic experience and psychological dissociation. This hypothesis is referred to as the trauma model of dissociation. In the past decade, a series of papers have been published that question this traditional causal link, proposing an alternative fantasy model of dissociation. In the present research, the relationship among dissociation, suggestibility, and fantasy proneness was examined. Suggestibility was measured through the Gudjonsson Scale of Interrogative Suggestibility (GSS) as well as an autobiographically based version of this measure based on the events of September 11, 2001. Consistent with prior research and with the trauma model, dissociation correlated positively with trauma severity (r = .32, p < .01) and fantasy proneness (r = .60, p < .01). Inconsistent with the fantasy model, dissociation did not correlate with the neutral form of the GSS and correlated negatively (r = -.24, p < .05) with the trauma-focused form of this suggestibility measure. Although some participants did become quite emotional during the procedure, the risk/benefit ratio was perceived by almost all participants to be positive, with more reactive individuals evaluating the procedure more positively. The results consistently support the trauma model of dissociation and fail to support the fantasy model of dissociation.
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Affiliation(s)
- Nicole S Kluemper
- a Trauma Research Institute , Alliant International University , San Diego , California , USA
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15
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Larøi F, Billieux J, Defeldre AC, Ceschi G, Van der Linden M. Factorial structure and psychometric properties of the French adaptation of the Dissociative Experiences Scale (DES) in non-clinical participants. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY-REVUE EUROPEENNE DE PSYCHOLOGIE APPLIQUEE 2013. [DOI: 10.1016/j.erap.2013.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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van der Kloet D, Merckelbach H, Giesbrecht T, Lynn SJ. Fragmented Sleep, Fragmented Mind. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2012; 7:159-75. [DOI: 10.1177/1745691612437597] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In psychopathology, dissociation typically refers to a disturbance in the normal integration of thoughts, feelings, and experiences into consciousness and memory. In this article, we review the literature on how sleep disturbances relate to dissociative symptoms and memory failure. We contend that this body of research offers a fresh perspective on dissociation. Specifically, we argue that dissociative symptoms are associated with a labile sleep–wake cycle, in which dreamlike mentation invades the waking state, produces memory failures, and fuels dissociative experiences. The research domain of sleep and dissociation can accommodate the dominant idea in the clinical literature that trauma is the distal cause of dissociation, and it holds substantial promise to inspire new treatments for dissociative symptoms (e.g., interventions that focus on normalization of the sleep-wake cycle). We conclude with worthwhile paths for further investigations and suggest that the sleep–dissociation approach may help reconcile competing interpretations of dissociative symptoms.
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Engle J, O'Donohue W. Pathways to False Allegations of Sexual Assault. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2012. [DOI: 10.1080/15228932.2012.650071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Do Motivations for Malingering Matter? Symptoms of Malingered PTSD as a Function of Motivation and Trauma Type. PSYCHOLOGICAL INJURY & LAW 2011. [DOI: 10.1007/s12207-011-9102-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lang CM, Sharma-Patel K. The relation between childhood maltreatment and self-injury: a review of the literature on conceptualization and intervention. TRAUMA, VIOLENCE & ABUSE 2011; 12:23-37. [PMID: 21288933 DOI: 10.1177/1524838010386975] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The following article reviews literature pertaining to the association between child maltreatment and self-injury and the ways it varies according to maltreatment type. Research supporting various mediators of the relations between different maltreatment types and self-injury is summarized. Informing mediator models, dominant theories of functionality, particularly affect regulation theories, are summarized and granted empirical support. Following from explanations of its functionality, three developmental pathways (regulatory, representational/interpersonal, and reactive/neurobiological) leading from child maltreatment to self-injury are presented within an organizational model of psychopathology. Understanding the deviations in these pathways that perpetuate self-injury helps to inform intervention approaches that forge pathways perpetuating resilience instead. Three psychosocial treatments (i.e., Dialectical Behavior Therapy [DBT], Trauma-Focused Cognitive-Behavioral Therapy [TF-CBT], and Acceptance and Commitment Therapy [ACT]) were chosen for review, based upon their accumulating evidence bases, as well as upon the relevance of their core components in correcting or compensating for trauma-related developmental deviations.
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Affiliation(s)
- Colleen M Lang
- Montefiore Medical Center, Albert Einstein College of Medicine, School Health Program, Bronx, NY 10461, USA.
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20
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Psychoform and somatoform dissociation, traumatic experiences, and fantasy proneness in somatoform disorders. PERSONALITY AND INDIVIDUAL DIFFERENCES 2010. [DOI: 10.1016/j.paid.2009.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Cima M, Smeets T, Jelicic M. Self-reported trauma, cortisol levels, and aggression in psychopathic and non-psychopathic prison inmates. Biol Psychol 2008; 78:75-86. [DOI: 10.1016/j.biopsycho.2007.12.011] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 11/30/2007] [Accepted: 12/21/2007] [Indexed: 12/24/2022]
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22
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Why dissociation and schizotypy overlap: the joint influence of fantasy proneness, cognitive failures, and childhood trauma. J Nerv Ment Dis 2007; 195:812-8. [PMID: 18043521 DOI: 10.1097/nmd.0b013e3181568137] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A number of studies have noted that dissociative symptoms (e.g., feelings of derealization, depersonalization, memory complaints, absorption) overlap with the tendency to report psychotic-like experiences (i.e., schizotypy). The question arises as to what may account for the shared variance between dissociation and schizotypy. The present study investigated whether fantasy proneness, cognitive failures, and childhood trauma may jointly explain the dissociation-schizotypy link. To this end, we administered the Dissociative Experiences Scale, the Schizotypal Personality Scale, the Creative Experiences Questionnaire, the Cognitive Failures Questionnaire, and the Childhood Trauma Questionnaire to a sample of undergraduates (N = 185). Fantasy proneness, cognitive failures, and childhood trauma together explained substantial part (58%) of the dissociation-schizotypy link. The present study succeeded in explaining a considerate part of the shared variance between dissociation and schizotypy.
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23
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de Ruiter MB, Veltman DJ, Phaf RH, van Dyck R. Negative words enhance recognition in nonclinical high dissociators: An fMRI study. Neuroimage 2007; 37:323-34. [PMID: 17572110 DOI: 10.1016/j.neuroimage.2007.04.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 04/10/2007] [Accepted: 04/11/2007] [Indexed: 10/23/2022] Open
Abstract
Memory encoding and retrieval were studied in a nonclinical sample of participants that differed in the amount of reported dissociative experiences (trait dissociation). Behavioral as well as functional imaging (fMRI) indices were used as convergent measures of memory functioning. In a deep vs. shallow encoding paradigm, the influence of dissociative style on elaborative and avoidant encoding was studied, respectively. Furthermore, affectively neutral and negative words were presented, to test whether the effects of dissociative tendencies on memory functioning depended on the affective valence of the stimulus material. Results showed that (a) deep encoding of negative vs. neutral stimuli was associated with higher levels of semantic elaboration in high than in low dissociators, as indicated by increased levels of activity in hippocampus and prefrontal cortex during encoding and higher memory performance during recognition, (b) high dissociators were generally characterized by higher levels of conscious recollection as indicated by increased activity of the hippocampus and posterior parietal areas during recognition, (c) nonclinical high dissociators were not characterized by an avoidant encoding style. These results support the notion that trait dissociation in healthy individuals is associated with high levels of elaborative encoding, resulting in high levels of conscious recollection. These abilities, in addition, seem to depend on the salience of the presented stimulus material.
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Affiliation(s)
- Michiel B de Ruiter
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
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24
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Giesbrecht T, Geraerts E, Merckelbach H. Dissociation, memory commission errors, and heightened autonomic reactivity. Psychiatry Res 2007; 150:277-85. [PMID: 17324470 DOI: 10.1016/j.psychres.2006.04.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Revised: 10/07/2005] [Accepted: 04/21/2006] [Indexed: 11/29/2022]
Abstract
If dissociative symptoms are manifestations of a psychological defense mechanism, one would expect people who have such symptoms to react with lower levels of physiological arousal and with memory omissions to emotionally provocative material. The current study tested this assumption in a sample of undergraduates. Sixty-two undergraduate students viewed a highly emotional video fragment. Pearson's product-moment correlations were calculated between dissociation (as indexed by the Dissociative Experiences Scale, DES) and all dependent measures. High dissociators exhibited elevated skin conductance responses (SCRs) to the fragment. Memory for the video fragment was then tested. While omission errors were unrelated to dissociation, high dissociators exhibited a tendency to produce commission errors. This could not be explained by a reduced working memory capacity. However, fantasy proneness was found related to high dissociators' commission errors. Thus, it seems that a pattern of heightened emotional reactivity and commission errors is typical for people with elevated dissociation scores. This pattern is difficult to reconcile with the defensive function ascribed to dissociation.
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Affiliation(s)
- Timo Giesbrecht
- Department of Experimental Psychology, University of Maastricht, PO Box 616, 6200 MD, The Netherlands.
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25
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Giesbrecht T, Smeets T, Merckelbach H, Jelicic M. Depersonalization experiences in undergraduates are related to heightened stress cortisol responses. J Nerv Ment Dis 2007; 195:282-7. [PMID: 17435477 DOI: 10.1097/01.nmd.0000253822.60618.60] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The relationship between dissociative tendencies, as measured with the Dissociative Experiences Scale and its amnesia, absorption/imaginative involvement, and depersonalization/derealization subscales, and HPA axis functioning was studied in 2 samples of undergraduate students (N = 58 and 67). Acute stress was induced by means of the Trier Social Stress Test. Subjective and physiological stress (i.e., cortisol) responses were measured. Individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited more pronounced cortisol responses, while individuals high on the absorption subscale showed attenuated responses. Interestingly, subjective stress experiences, as indicated by the Tension-Anxiety subscale of the Profile of Mood States, were positively related to trait dissociation. The present findings illustrate how various types of dissociation (i.e., depersonalization/derealization, absorption) are differentially related to cortisol stress responses.
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Affiliation(s)
- Timo Giesbrecht
- Department of Experimental Psychology, Maastricht University, The Netherlands.
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26
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Dreaming to reduce fantasy? – Fantasy proneness, dissociation, and subjective sleep experiences. PERSONALITY AND INDIVIDUAL DIFFERENCES 2006. [DOI: 10.1016/j.paid.2006.02.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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27
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Rassin E, van Rootselaar AF. From dissociation to trauma? Individual differences in dissociation as predictor of 'trauma' perception. J Behav Ther Exp Psychiatry 2006; 37:127-39. [PMID: 16563309 DOI: 10.1016/j.jbtep.2005.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2003] [Revised: 01/04/2005] [Accepted: 01/27/2005] [Indexed: 11/15/2022]
Abstract
In clinical literature, dissociative complaints are generally considered to be the result of traumatic experiences. However, it has been argued that dissociative complaints, in turn, may indulge over-reporting of traumatic experiences. Hence, correlations between dissociation and self-reported trauma may not only reflect the causal path from trauma to dissociation, but possibly also an increased trauma-item endorsement due to dissociation. To test the idea that dissociation fosters a positive response bias on trauma self-reports, participants completed a dissociation scale, and subsequently rated the perceived trauma of ambiguous stimuli. Results indicated that some dissociative complaints indeed predicted increased scores on the trauma ratings, while other manifestations of dissociation were negatively correlated with perceived trauma ratings. Hence, there is reason to argue that people differ in their readiness to perceive a situation as traumatic. However, the association between self-reported dissociation and the perception of 'trauma' is not quite clear-cut.
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Affiliation(s)
- Eric Rassin
- Faculty of Social Sciences, Psychology Institute, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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28
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Giesbrecht T, Jongen EMM, Smulders FTY, Merckelbach H. Dissociation, resting EEG, and subjective sleep experiences in undergraduates. J Nerv Ment Dis 2006; 194:362-8. [PMID: 16699386 DOI: 10.1097/01.nmd.0000217821.18908.bf] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this study, we explored whether individual differences in dissociation are related to certain resting electroencephalographic (EEG) parameters. Baseline EEG with eyes open and closed was recorded in an undergraduate sample (N = 67). Cortical power in the alpha range was inversely related to dissociative symptoms as measured by the Dissociative Experiences Scale, while both delta and theta power where positively related to dissociation. However, sleep experiences, as indexed with the Iowa Sleep Experiences Survey, were unrelated to resting EEG characteristics. We propose that suppression in the alpha band and raised levels of theta activity, which are typical for high dissociators, might help to explain why dissociative symptoms are accompanied by attentional and memory deficits.
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Affiliation(s)
- Timo Giesbrecht
- Department of Experimental Psychology, Maastricht University, Maastricht, The Netherlands
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29
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Wessel I, Wetzels S, Jelicic M, Merckelbach H. Dissociation and memory suppression: A comparison of high and low dissociative individuals’ performance on the Think–No Think task. PERSONALITY AND INDIVIDUAL DIFFERENCES 2005. [DOI: 10.1016/j.paid.2005.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Geraerts E, Smeets E, Jelicic M, van Heerden J, Merckelbach H. Fantasy proneness, but not self-reported trauma is related to DRM performance of women reporting recovered memories of childhood sexual abuse. Conscious Cogn 2005; 14:602-12. [PMID: 16091273 DOI: 10.1016/j.concog.2005.01.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Revised: 01/26/2005] [Accepted: 01/27/2005] [Indexed: 11/22/2022]
Abstract
Extending a strategy previously used by , we administered a neutral and a trauma-related version of the Deese-Roediger-McDermott paradigm to a sample of women reporting recovered (n=23) or repressed memories (n=16) of childhood sexual abuse (CSA), women reporting having always remembered their abuse (n=55), and women reporting no history of abuse (n=20). We found that individuals reporting recovered memories of CSA are more prone than other participants to falsely recalling and recognizing neutral words that were never presented. Moreover, our study is the first to show that this finding even held when trauma-related material was involved. Correlational analyses revealed that fantasy proneness, but not self-reported traumatic experiences and dissociative symptoms were related to false recall and false recognition.
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Affiliation(s)
- Elke Geraerts
- Department of Neurocognition, University of Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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31
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Merckelbach H, à Campo J, Hardy S, Giesbrecht T. Dissociation and fantasy proneness in psychiatric patients: a preliminary study. Compr Psychiatry 2005; 46:181-5. [PMID: 16021587 DOI: 10.1016/j.comppsych.2004.08.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Nonclinical studies found that dissociative experiences are intimately linked to a trait known as fantasy proneness. We examined the links among dissociative symptoms, fantasy proneness, and impulsivity in psychiatric outpatients. Our sample consisted of 22 patients with schizophrenia, 20 patients with a diagnosis of borderline personality disorder, and 19 patients with a major depressive disorder. For the whole sample, levels of dissociation were found to be related to fantasy proneness and impulsivity. There were group differences in dissociative symptoms, with patients with borderline personality disorder reporting more such symptoms than patients with either schizophrenia or major depressive disorder. The overlap between dissociation and fantasy proneness may have important ramifications for studies addressing comorbid phenomena of dissociative symptoms.
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Affiliation(s)
- Harald Merckelbach
- Department of Experimental Psychology, University of Maastricht, The Netherlands.
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32
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Giesbrecht T, Merckelbach H. �ber die kausale Beziehung zwischen Dissoziation und Trauma. DER NERVENARZT 2005; 76:20-7. [PMID: 15127142 DOI: 10.1007/s00115-004-1704-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article discusses the accepted view that trauma causes dissociation. We critically evaluate studies that explored this relationship and discuss their shortcomings. In addition, individual differences related to dissociative experiences are discussed. In doing so, we focus on their potential to create pseudo-correlations between dissociative symptoms and self-reports of childhood trauma. After concluding that the causal link between trauma and dissociation is far from self-evident or empirically substantiated, we suggest some avenues for further research.
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Affiliation(s)
- T Giesbrecht
- Psychologische Fakultät, Universität Maastricht, Maastricht, Niederlande.
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de Ruiter MB, Phaf RH, Elzinga BM, van Dyck R. Dissociative style and individual differences in verbal working memory span. Conscious Cogn 2004; 13:821-8. [PMID: 15522633 DOI: 10.1016/j.concog.2004.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2003] [Indexed: 11/25/2022]
Abstract
Dissociative style is mostly studied as a risk factor for dissociative pathology, but it may also reflect a fundamental characteristic of healthy information processing. Due to the close link between attention and working memory and the previous finding of enhanced attentional abilities with a high dissociative style, a positive relationship was also expected between dissociative style and verbal working memory span. In a sample of 119 psychology students, it was found that the verbal span of the high-dissociative group was about half a word larger than of the medium and low-dissociative groups. It is suggested that dissociative style may be one of only very few individual differences that is directly relevant to consciousness research.
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Affiliation(s)
- Michiel B de Ruiter
- Psychonomics Department, Faculty of Social and Behavioral Sciences, University of Amsterdam, The Netherlands.
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Giesbrecht T, Merckelbach H, Geraerts E, Smeets E. Dissociation in undergraduate students: disruptions in executive functioning. J Nerv Ment Dis 2004; 192:567-9. [PMID: 15387160 DOI: 10.1097/01.nmd.0000135572.45899.f2] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The concept of dissociation refers to disruptions in attentional control. Attentional control is an executive function. Few studies have addressed the link between dissociation and executive functioning. Our study investigated this relationship in a sample of undergraduate students (N = 185) who completed the Dissociative Experiences Scale and the Random Number Generation Task. We found that minor disruptions in executive functioning were related to a subclass of dissociative experiences, notably dissociative amnesia and the Dissociative Experiences Scale Taxon. However, the two other subscales of the Dissociative Experiences Scale, measuring depersonalization and absorption, were unrelated to executive functioning. Our findings suggest that a failure to inhibit previous responses might contribute to the pathological memory manifestations of dissociation.
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Affiliation(s)
- Timo Giesbrecht
- Department of Experimental Psychology, Maastricht University, The Netherlands
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36
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Abstract
In current psychiatric literature, the received view is that dissociative symptoms originate from aversive childhood events. To a large extent, this view is based on cross-sectional studies that do not rule out a scenario in which dissociative tendencies contribute to self-reports of childhood trauma. In two studies, we tested one particular implication of this scenario, namely, that dissociative symptoms are related to endorsement of vague rather than specific items about childhood trauma. In study 1 (N = 43) and study 2 (N = 127), nonclinical participants completed standard measures of dissociation, childhood trauma, and fantasy proneness. We performed correlational and regression analyses on the data. Fantasy proneness and responses to broad trauma items, but not responses to factual trauma items predicted dissociation levels. This pattern of findings shows that the link between trauma and dissociation is considerably more complex than is often assumed. As well, it suggests that at least in nonclinical samples, dissociative symptoms may breed endorsement of vague trauma items.
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Affiliation(s)
- Harald Merckelbach
- Department of Experimental Psychology and Faculty of Law, University of Maastricht, The Netherlands
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37
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Candel I, Merckelbach H, Kuijpers M. Dissociative experiences are related to commissions in emotional memory. Behav Res Ther 2003; 41:719-25. [PMID: 12732378 DOI: 10.1016/s0005-7967(03)00016-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two rival hypotheses of the link between dissociative experiences and emotional memory were tested: 1) the defence mechanism hypothesis that assumes that dissociation promotes fragmentation of emotional memory; and 2) the fantasy proneness hypothesis that claims that because of its overlap with fantasy proneness, dissociation is related to commissions in emotional memory. Undergraduates scoring high (n = 19) or low (n = 19) on the Dissociative Experiences Scale (DES) listened to an aversive story. Next, a free recall task was administered. While high dissociators made more commission errors in their free recall than did low dissociators, fantasy proneness did not account for this difference.
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Affiliation(s)
- I Candel
- Department of Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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38
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Seedat S, Stein MB, Forde DR. Prevalence of dissociative experiences in a community sample: relationship to gender, ethnicity, and substance use. J Nerv Ment Dis 2003; 191:115-20. [PMID: 12586965 DOI: 10.1097/01.nmd.0000050940.16782.6b] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the relationship between gender, ethnicity, substance use, and dissociation in a community sample of adults. Telephone interviews were conducted using, among others, measures of dissociation (Dissociative Experiences Scale-Taxon [DES-T]) and alcohol use (Alcohol Use Disorders Identification Test [AUDIT]) to screen a representative sample of 1007 adults in Memphis, Tennessee. Six percent of respondents endorsed four or more lifetime dissociative symptoms, whereas approximately one third of respondents endorsed at least one symptom. Only 2% were identified as having pathological dissociation on the DES-T. DES-T scores were significantly associated with gender (male), ethnicity (African-American), and harmful alcohol use. Dissociative symptoms appear to be relatively common in the population, but only a small proportion of individuals suffer from significant levels of dissociation. Further assessment of the link between demographic factors and the severity and expression of dissociative phenomena in nonclinical samples is warranted.
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Affiliation(s)
- Soraya Seedat
- Department of Psychiatry, University of California San Diego, 8950 Villa La Jolla Drive, Suite 2243, La Jolla, California 92037, USA
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