Traumatic dissociation: Theory, research, and treatment.

Abstract

Adverse and traumatic experiences in childhood have been linked to a number of symptoms, including dissociation. We provide an overview of the theoretical and scientific literature on the relationship between antecedent trauma and dissociation. Further, we discuss the effects of disrupted attachment and dissociation on emotional, cognitive, and neurobiological development. Within treatment and research settings, high dissociation and its comorbid conditions can impact retention and alter treatment outcomes, making it crucial that clinicians and researchers understand methods of assessing, treating, and studying dissociation. We review the assessment and treatment of dissociative conditions, including the dissociative subtype of posttraumatic stress disorder and the dissociative disorders. Finally, we highlight areas for future research.

Describing the indescribable: A qualitative study of dissociative experiences in psychosis

“…The result of this difficulty-perhaps exacerbated by fear, mental avoidance, and concerns about others' reactions-was that people did not feel able to talk about these events. Lack of reporting to clinicians may partially explain why dissociation is so often under-recognised [2]. We therefore recommend that clinicians proactively ask about dissociative experiences, as clients are unlikely to describe these unprompted.…”

“…It is interesting that the DES-II scores of nine participants were in the range expected for people with dissociative disorder diagnoses, and it is a limitation of the study that co-morbid dissociative disorders were not asked about or recorded. However, given the under-recognition of such difficulties [2], it is unlikely that many of the participants had a formal diagnosis of dissociation, even if they met criteria for these. Some may argue that participants may have been mis-diagnosed with a psychotic disorder, and in fact better fit the criteria for a dissociative disorder.…”

“…Dissociation is a complex phenomenon in mental health, with a large body of historical and contemporary publications outlining many (often opposing) frameworks [1]. Despite this wealth of literature, dissociative symptoms remain repeatedly under-recognized or misidentified [2]. Recognition of symptoms may be a particular challenge in dissociation due to the ongoing conceptual debate, which has negatively impacted the clarity of the construct [1,3], and because many clinicians receive inadequate training in this area [4].…”

“…Improvement of the recognition of dissociation is therefore an important goal clinically [2] as well as in psychosis research, where it would be potentially beneficial to investigate dissociation as a putative causal or maintenance mechanism. However, difficulties identifying dissociative phenomena impede these efforts.…”

Developmental and attachment-based perspectives on dissociation: beyond the effects of maltreatment

“…Dissociation refers broadly to disruptions in the normal integration of memories, thoughts, identity, affects, sensations, perceptions, behaviour, or control over bodily movements (World Health Organization, 2018 ), resulting in experiences of being ‘detached from the environment, but also from the self’ (Allen, Console, & Lewis, 1999 , p. 165). Numerous years of theory, research, and clinical advancements have informed our understanding of the caregiving experiences known to predispose individuals to dissociation, resulting in widespread recognition of the role of childhood trauma in the form of maltreatment (primarily abuse and neglect) as an aetiological factor (Bailey & Brand, 2017 ; Farina, Liotti, & Imperatori, 2019 ). The goal of the current paper is to present an integrative theoretical perspective on the development of dissociation, as it relates to caregiving experiences, but with additional emphasis on the spectrum of vulnerability that can exist over and above the experience of childhood trauma.…”