The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry

Abstract

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.

Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research

“…Conceptualizing TRASC across these four dimensions has transdiagnostic implications for trauma-spectrum disorders involving dissociation and is relevant to efforts to identify key factors related to the development and maintenance of trauma-related symptoms described both in the DSM and the International Classification of Disease. It will be crucial for future research to examine directly these symptoms along each dimension of consciousness and to identify further their neurobiological and physiological underpinnings, and to determine their role in treatment outcome (also see Sar, 2014 ). This work, guided by the 4-D model as well as numerous existing models of dissociation, has the potential to advance collectively the important and often neglected field of dissociation.…”

Parallel-Distinct Structures of Internal World and External Reality: Disavowing and Re-Claiming the Self-Identity in the Aftermath of Trauma-Generated Dissociation

“…Research shows that chronic relational traumas (e.g., childhood abuse and neglect) are as damaging to mental health and relationship outcomes as the non-relational and acute ones (Anders et al, 2012). Various types of complex clinical constellations may emerge in the aftermath of relational trauma such as complex posttraumatic stress disorder (PTSD), dissociative depression, dissociative identity disorder (DID), and “borderline” phenomena (Şar, 2011b, 2014, 2016). …”

The Trauma-Self and Its Resistances in Psychotherapy

“…Being a result of inadequate trauma processing, they tend to appear together. Any of them may be seen in other psychiatric conditions also, however, they constitute a bundle of interrelated phenomena when observed in dissociative disorders [26]. Thus, succesful therapeutic work on the trauma-self would help in overcoming of these phenomena all together and, consequently, in improving the clinical condition.…”