Owning the Past, Claiming the Present: Perspectives on the Treatment of Dissociative Patients

Middleton, Warwick

doi:10.1080/j.1440-1665.2004.02148.x

Cited by 10 publications

(4 citation statements)

References 15 publications

(16 reference statements)

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“…More careful assessment of the meaning and nature of intimacy in severely dissociative and chronic trauma disorders is warranted. Therapy for severe and chronically traumatized individuals has increasingly emphasized the importance of addressing shame and dissociation for recovery (e.g., Boon et al, 2011;Chu, 2011;Middleton, 2005). Acknowledging the limitations, this study suggests that such an emphasis may have an impact on how the person perceives one-self and feels in relationships.…”

Section: Discussionmentioning

confidence: 95%

“…Among the numerous and complex variables associated with relationship self-concept are people's psychological tendencies in intimate relationships (Middleton, 2005(Middleton, , 2012. For example, whether intimate relationships preoccupy their thinking, whether they feel anxiety in, or depressed about, their intimate relationships, or whether they fear intimate connexion (Snell et al, 1996).…”

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confidence: 99%

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Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups

Dorahy

Middleton

Seager

et al. 2015

Journal of Affective Disorders

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a b s t r a c tBackground: Whilst a growing body of research has examined dissociation and other psychiatric symptoms in severe dissociative disorders (DDs), there has been no systematic examination of shame and sense of self in relationships in DDs. Chronic child abuse often associated with severe DDs, like dissociative identity disorder, is likely to heighten shame and relationship concerns. This study investigated complex posttraumatic stress disorder (PTSD), borderline and Schneiderian symptoms, dissociation, shame, child abuse, and various markers of self in relationships (e.g., relationship esteem, relationship depression, fear of relationships). Methods: Participants were assessed via clinical interview with psychometrically sound questionnaires. They fell into three diagnostic groups, dissociative disorder (n ¼ 39; primarily dissociative identity disorder), chronic PTSD (Chr-PTSD; n ¼13) or mixed psychiatric presentations (MP; n ¼ 21; primarily mood and anxiety disorders). All participants had a history of child abuse and/or neglect, and the groups did not differ on age and gender. Results: The DD group was higher on nearly all measured variables than the MP group, and had more severe dissociative, borderline and Schneiderian symptoms than the Chr-PTSD sample. Shame and complex PTSD symptoms fell marginally short of predicting reductions in relationship esteem, pathological dissociative symptoms predicted increased relationship depression, and complex PTSD symptoms predicted fear of relationships. Limitations: The representativeness of the samples was unknown. Conclusion: Severe psychiatric symptoms differentiate DDs from chronic PTSD, while dissociation and shame have a meaningful impact on specific markers of relationship functioning in psychiatric patients with a history of child abuse and neglect.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups

Dorahy

Middleton

Seager

et al. 2015

Journal of Affective Disorders

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“…In effect, the children were withdrawn from the contacts and experiences which might have taught them that not all families were like theirs. (p. 61, italics added) Isolated, dominated, sexually stimulated and conditioned from infancy, the unprotected recipient of unending parental projection, and bonded to their abusers, who use a combination of fear, shame, and conditioning while taking up permanent introjected residency in their psyche, it is apparent at Downloaded by [University of Nebraska, Lincoln] at 23:55 10 April 2015 presentation that it has not been possible for the victims of such extreme abuse and deprivation to attain enough selfhood (see Middleton, 2005) to achieve escape velocity from their ambivalently attached principal abusers, be they alive or dead. As concerning as it sounds, Josef Fritzl probably did not need to build an underground enclosed prison behind eight locked doors in order to sexually abuse his daughter and father children to her without anyone intervening.…”

Section: Discussionmentioning

confidence: 98%

Ongoing Incestuous Abuse During Adulthood

Middleton

2013

Journal of Trauma & Dissociation

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Individual cases of adult incestuous abuse have surfaced repeatedly in the lay and professional literature of the past 1.5 centuries without it occasioning systematic investigation, such as the reporting of a case series of individuals subjected to such extreme abuse. Yet substantial numbers of patients with dissociative identity disorder at the time of presentation report incestuous abuse continuing into the adult years, and for many the abuse is ongoing. Data relating to a series of 10 such incestuously abused women are presented. These patients were sexually abused from a very early age (typically from before age 3), with the manipulation of their sexual response a key component in conditioning an enduring sexualized attachment. Shame and fear were also used to ensure compliance and silence. The women, when able to speak of it, describe the induction by their paternal abuser of orgasm at an early age, typically around the age of 6. The women have high indices of self-harm and suicidality and are prone to placing themselves in dangerous reenactment scenarios. The average duration of incestuous abuse for this group of women was 31 years, and the average estimate of total episodes of sexual abuse was 3,320. Most women do not feel that they own their body and experience being "fused" to their father. Their mother was reported as an active participant in the sexual abuse or as having done nothing to protect their daughter despite seeing obvious evidence of incest. The fathers, despite a propensity to use or threaten violence, were generally outwardly productively employed, financially comfortable, and stably married and half had close church involvement. However, suicide and murder occurred within the 1st- or 2nd-degree relatives of these women at a high frequency. All 10 had been sexually abused by various groupings of individuals connected to their fathers.

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“…In my research I learned that the major harm in CT is to the sense of self (Middleton, 2005). This is not explained by DSM, ICD or even by the USA's Substance Abuse and Mental Health Services Administration (SAMHSA, https://www.samhsa.gov/trauma-violence), which continue to focus on the memories of major events.…”

Section: The Fable Of One Selfmentioning

confidence: 99%

A tale of two systems; Polarising beliefs in adventure therapy

Pringle

2024

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The fields of adventure therapy (AT) and complex trauma (CT) share similar belief systems however, internal divisions in each field seem insurmountable. Through a critical realist analysis, I present the clash between Neo-Liberal and humanist approaches and how they lead to a misunderstanding of the harmful effects of coercive treatment. Exploring ecological dynamics, sense of self, and the fundamental attribution error I discuss these complexities. A historical perspective reveals that AT already possesses solutions to bridge the gap between coercive practices and humanist CT informed AT. These solutions are outlined and a call to action encourages the international AT community to take a leadership role in mental health globally.

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Owning the Past, Claiming the Present: Perspectives on the Treatment of Dissociative Patients

Abstract: The construct of individual selfhood is of direct relevance in illustrating the psychological damage sustained by patients who have relied on dissociative defences to survive, and in highlighting issues and areas that are a particular focus of informed treatment.

Cited by 10 publications

References 15 publications

Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups

Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups

Ongoing Incestuous Abuse During Adulthood

A tale of two systems; Polarising beliefs in adventure therapy

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