For example, an often refractory, multifaceted sleep disorder has been described in severely dissociative, complex trauma patients.
DD patients represent a large underserved population whose lack of recognition leads to substantial human and societal costs. Males with DD may particularly go unrecognized. The powerful relationship of dissociation, DD, and suicidal and self-destructive behavior needs to be part of efforts to lower suicide risk in general and clinical populations. Most DD research, like the recent treatment outcome studies, has been bootstrapped by dedicated researchers with minimal external funding. The fantasy is that DD patients do not exist.
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Failure to properly diagnose and treat DD has a very high human cost. This is the real iatrogenesis. National Center for Biotechnology Information , U. Journal List Dialogues Clin Neurosci v. Dialogues Clin Neurosci. Richard J. Author information Copyright and License information Disclaimer. All rights reserved. Abstract Controversy about dissociation and the dissociative disorders DD has existed since the beginning of modern psychiatry and psychology. Keywords: amnesia , controversy , dissociation , dissociative disorder , dissociative identity disorder , dissociative theoretical model , trauma.
The Trauma Model TM The Trauma Model posits that dissociation is a psychobiological state or trait that functions as a protective response to traumatic or overwhelming experiences. What does the historical record tell us? Wartime trauma and dissociation Until the latter part of the 20 th century, except during wartime, there was decreased professional attention to dissociation, with the dissociative conditions seen as rare and exotic. Modern interest in dissociation and dissociative disorders Modern study of dissociation results from several factors.
What are the data on dissociation and dissociative disorders? Scientific study of dissociation Beginning in the s, researchers on dissociation and DD developed a number of reliable and valid symptom self-report inventories, structured and semi-structured diagnostic interviews, and self-report diagnostic inventories to assess state and trait dissociation and DD in children, adolescents, and adults See ref 2 for a full review.
Adapted from Loewenstein et al 2. Open in a separate window. Studies of DD in clinical populations In clinical populations, international epidemiological studies in North America, Europe, the Middle East, and Asia show that DD are readily found in adolescent, adult inpatient, residential, outpatient, substance abuse, and emergency department populations Table II.
Genetic studies Genetic studies of dissociation suggest that there is a complex interplay between genetic factors and type, timing, and chronicity of trauma.
Dissociative Identity Disorder Childhood trauma DID is conceptualized as a childhood onset posttraumatic developmental disorder. Clinical presentation Symptom patterns of DID patients differ from portrayals in the media and many psychiatric and psychology textbooks. Treatment outcome studies of DID Treatment outcome studies of the phasic trauma treatment model of DID, 67 including recent international, prospective, longitudinal studies, have found that DID improves with appropriate treatment and that costs to the health system for DID treatment can decrease substantially as well.
Acknowledgments The author reports no conflicts of interest. American Psychiatric Association. Loewenstein RJ. Dissociative Disorders. Vol 1. Ellenberger HF. The Discovery of the Unconscious. Dalenberg CJ.
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Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychol Bull. Waller NG. Types of dissociation and dissociative types: A taxonometric analysis of dissociative experiences. Psychol Methods. Lyssenko L. Dissociation in psychiatric disorders: A meta-analysis of studies using the Dissociative Experiences Scale. Am J Psychiatry. Brand BL.
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Treatment of Dissociative Identity Disorder. In: Gabbard GO, ed. Gabbard's Treatments of Psychiatric Disorders. A longitudinal naturalistic study of patients with dissociative disorders treated by community clinicians. Psychol Trauma. Paris J. The rise and fall of dissociative identity disorder. J Nerv Ment Dis. Dispelling myths about dissociative identity disorder treatment: an empirically based approach.
Pragmatic approaches to stage oriented treatment for early life trauma related complex posttraumatic stress and dissociative disorders. McHugh PR. Lilienfeld SO. Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past. Giesbrecht T. Cognitive processes in dissociation: an analysis of core theoretical assumptions. Bogousslavsky J.
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Hysteria: The Rise of an Enigma. Vol Basel, Switzerland: Karger. Psychiatric misadventures. The American Scholar. A Reader's guide to Pierre Janet on dissociation: a neglected intellectual heritage.
Brenneis CB. Multiple personality: Fantasy proneness, demand characteristics, and indirect communication.
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Psychoanal Psychol. Hustvedt A. New York, NY: Norton. Walusinski O. The girls of La Salpetriere. In: Bogousslavsky J, ed. Kuch K. Carlson EB. Trauma experiences, posttraumatic stress, dissociation, and depression in Cambodian refugees. Van Ommeren M. Psychiatric disorders in tortured Bhutanese refugees in Nepal. Arch Gen Psychiatry. Kira IA. The mental health effects of torture trauma and its severity: a replication and extension. Kempe CH.
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