Search

Supplemental Material for The Impact of Relationship Context on Dissociation-Induced Shame Using Vignette Scenarios by Martin J. Dorahy , Kate McKeogh and Kumar in Psychological Reports.

Dissociative experiences are thought to occur acutely (e.g., during or immediately following trauma) or chronically and are considered to reduce the subjective distress accompanying stressful events. Growing evidence is consistent with a model that distinguishes between two qualitatively different types of phenomena—“compartmentalization” and “detachment.” Compartmentalization involves a deficit in the ability to deliberately control processes or actions that would normally be amendable to such control (e.g., amnesia and dissociative identities). Detachment refers to an experienced state of disconnection from the self or the environment (e.g., depersonalization, derealization, and numbing). In the present contribution, we discuss both detachment and compartmentalization phenomena. In addition, we discuss both dissociation as an acute response to trauma and persistent dissociation in the form of the most severe and chronic of the dissociative disorders, dissociative identity disorder (DID). We attend to the burgeoning empirical literature on memory processing and dissociation given the central role of these cognitive operations in the development and maintenance of the dissociative disorders, and more broadly, posttraumatic symptomatology. We end with a more general appeal for more transdiagnostic studies of dissociative phenomena, both in the areas of detachment and compartmentalization, emphasizing that dissociative disorders are not a category of mysterious diagnoses that need to be understood outside of well-known cognitive operations. Keywords: dissociation; dissociative identity disorder (DID); trauma; detachment; compartmentalization; dissociative amnesia

Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societala and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry., NA

The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma. Refereed/Peer-reviewed