Are there two qualitatively distinct forms of dissociation? A review and some clinical implications

Holmes, Emily A.; Brown, Richard J.; Mansell, Warren; Fearon, Pasco; Hunter, Elaine; Frasquilho, F; Oakley, David A.

doi:10.1016/j.cpr.2004.08.006

Cited by 485 publications

(462 citation statements)

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“…Gershuny & Thayer, 1999;Holmes et al, 2005), this concept remains loosely and inconsistently defined. According to van der Kolk and Fisler (1995), " Dissociation refers to a compartmentalization of experience: elements of the experience are not integrated into a unitary whole, but are stored in memory as isolated fragments and stored as sensory perceptions, affective states or as behavioral reenactments" (p. 506).…”

mentioning

confidence: 99%

Dissociation and pain perception: An experimental investigation

Horowitz

Telch

2007

Journal of Traumatic Stress

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Dissociative symptoms and abnormalities in pain perception have been associated with a range of disorders. The authors tested whether experimentally induced increases in state dissociation would cause an analgesic response. Participants (N = 120) were randomized to a dissociation induction condition via audiophotic stimulation or a credible control condition and were compared on pre‐ and postchanges in subjective pain and immersion time in response to a standard cold pressor test. Unexpectedly, the dissociation induction led to small, but significant increases in subjective pain and did not lead to greater immersion time. An exploratory analysis revealed that increases in absorption and derealization significantly predicted increased subjective pain and increased immersion time, respectively.

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confidence: 99%

Dissociation and pain perception: An experimental investigation

Horowitz

Telch

2007

Journal of Traumatic Stress

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“…The question of what can be defined as dissociation is a topic of ongoing debate even among experts (Dell, 2011; Holmes et al, 2005; Nijenhuis & van der Hart, 2011). Dissociative symptoms are very prevalent in patients with common mental disorders, e.g.…”

Section: Introductionmentioning

confidence: 99%

The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder

Schäflein

Sattel

Schmidt

et al. 2018

European Journal of Psychotraumatology

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Background: Patients suffering from dissociative disorders (DD) are characterized by an avoidance of aversive stimuli. Clinical experience has shown that DD patients typically avoid the confrontation with their own faces in a mirror (CFM). Objective: To investigate potential CFM-associated self-reported and psychophysiological stress reactions of DD patients, which most likely inform on the still unknown pathophysiology of dysfunctional self-perception in DD. Method: Eighteen DD patients and 18 healthy controls (HCs) underwent CFM. They were assessed for CFM-induced subjective self-reported stress, acute dissociative symptoms and sympathetic and parasympathetic drive using impedance cardiography. Results: DD patients experienced more subjective stress and acute dissociation than HCs upon CFM. Their psychological stress response did not activate the sympathetic and parasympathetic nervous system. Conclusions: In DD patients, CFM constitutes serious self-reported stress and is associated with a blunted autonomic reactivity. Therapeutic approaches promoting self-perception and self-compassion, in particular by using CFM, might serve as goal-oriented diagnostic and therapeutic tools in DD.

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“…However, several authors have noted that confusion remains as to how dissociation should be defined and which symptoms and experiences should be included as dissociative (Brown, 2006; Dell, 2009; Holmes et al, 2005). Empirical data clearly suggest that dissociative experiences do not form a unitary dimension, but are better understood as multidimensional phenomena (Briere, Weathers, & Runtz, 2005; Bryant, 2007; Dell, 2006b; Holmes et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…Empirical data clearly suggest that dissociative experiences do not form a unitary dimension, but are better understood as multidimensional phenomena (Briere, Weathers, & Runtz, 2005; Bryant, 2007; Dell, 2006b; Holmes et al, 2005). It is, for instance, common to differentiate between compartmentalization, involving an inability to access or control normal mental processes, and detachment, such as depersonalization, derealization and numbing.…”

Section: Introductionmentioning

confidence: 99%

“…First, because experiences of NWC distress are conceptualized as being within the typical and normal state of humans, they should be more common and frequently endorsed than experiences of TRASC. Secondly, because experiences of TRASC are hypothesized to be more compartmentalized as dissociative experiences, they are hypothesized to less intercorrelated (Brown, 2006; Holmes et al, 2005) across the four dimensions than in the form of NWC distress, especially when measured over time (i.e. dimensions of NWC should correlate more strongly than dimensions of TRASC).…”

Section: Introductionmentioning

confidence: 99%

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Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

Bækkelund

Frewen

Lanius

et al. 2018

European Journal of Psychotraumatology

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Background: The four-dimensional (‘4-D’) model has been proposed as a theoretical framework to understand and delineate trauma-related dissociative experiences, categorizing symptoms into trauma-related altered states of consciousness (TRASC) and normal waking consciousness (NWC), which occur along four dimensions: time, thought, body and emotion.Objective: The main aim of the present study was to evaluate the validity of this model in patients with post-traumatic stress disorder (PTSD), with and without comorbid dissociative disorders.Method: The predictions of the 4-D model were tested in 142 patients with PTSD, with (N = 46) and without (N = 96) comorbid dissociative disorders.Results: As predicted by the 4-D model, experiences of TRASC were less frequent and more specifically related to other measures of dissociation, dissociative disorder comorbidity and a history of childhood sexual abuse compared to experiences of NWC. The predicted lower intercorrelation of TRASC was not supported.Conclusion: The 4-D model represents a promising framework for understanding dissociation across trauma-related disorders.

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Are there two qualitatively distinct forms of dissociation? A review and some clinical implications

Cited by 485 publications

References 100 publications

Dissociation and pain perception: An experimental investigation

Dissociation and pain perception: An experimental investigation

The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

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