Brain Injury, 13, 219-228.

ABSTRACT Reports the case of a 32-yr-old man with episodes of dissociative disorder, including depersonalization and multiple personality, that began abruptly after a mild traumatic brain injury. The episodes lasted only a few months, and their psychogenic or organic etiology was not determined. The case highlights the need to consider dissociative disorder among the possible (temporary) outcomes of a brain injury.

Cassandra L. Kisiel, Ph.D. and John S. Lyons, Ph.D. (2001)
Dissociation as a Mediator of Psychopathology Among Sexually Abused Children and Adolescents
Am J Psychiatry 158:1034-1039, July 2001

ABSTRACT OBJECTIVE: This study investigated the role of dissociation as a mediator of mental health outcomes in children with a history of sexual abuse.
METHOD: The study group consisted of 114 children and adolescents (ages 10–18 years) who were wards of the Illinois Department of Children and Family Services and were living in residential treatment centers. Interviews, provider ratings, and chart reviews were used to assess the relationship of childhood abuse history, dissociative responses, and psychopathology.
RESULTS: Sexual abuse history was significantly associated with dissociation, whereas a history of physical abuse was not. Both sexual abuse and dissociation were independently associated with several indicators of mental health disturbance, including risk-taking behavior (suicidality, self-mutilation, and sexual aggression). Severity of sexual abuse was not associated with dissociation or psychopathology. Analysis of covariance indicated that dissociation had an important mediating role between sexual abuse and psychiatric disturbance. These results were replicated across several assessment sources and varied perspectives.
CONCLUSIONS: The findings suggest a unique relationship between sexual abuse and dissociation. Dissociation may be a critical mediator of psychiatric symptoms and risk-taking behavior among sexually abused children. The assessment of dissociation among children may be an important aspect of treatment.

Chefetz, Richard A. (2004).  
Reassociating Psychoanalysis and dissociation: A review of Dissociation of Trauma: Theory, Phenomenology, and Technique. Contemporary Psychoanalysis.
Contemporary Psychoanalysis. Vol 40(1) Jan 2004, 123-133.

ABSTRACT Notes that few subjects have provoked such intense reactions from clinicians and laypersons as what was formerly called Multiple Personality Disorder (MPD), and now, is known as Dissociative Identity Disorder (DID). This controversial diagnosis has created ground as fertile for misunderstanding and misadventure as any group of passionate advocates might generate. This book makes an effort to quiet these climatologic upheavals. Author Ira Brenner speaks with the voice of a classically trained psychoanalyst who has had to make serious and far-reaching technical adaptations to accommodate extraordinarily complex patients. While he succeeds quite well, sometimes brilliantly, on the level of technique, his theoretical efforts seem too burdened by old theory. Despite this, the book is recommended to any psychoanalytically informed clinician interested in working with people who have internal organizations that rely heavily on dissociative processes. Brenner makes dissociation understandable to those not steeped in the language of traumatology. As such, both clinicians new to thinking about dissociative disorders and those acclimated to this patient population will find much to gain from reading Dissociation of Trauma.

Chefetz, Richard A. (2000).  
Affect dysregulation as a way of life.
Journal of the American Academy of Psychoanalysis (ISSN: 0090-3604), v. 28, no. 2, pp. 289-303 (Summer 2000).

ABSTRACT Dissociative processes destroy the meaning and belief structure of lived experience. The unconscious unlinking of narrative, affect, sensation, movement, spatial dimension, and memory makes traumatic experience sometimes unrecognizable and/or unknowable. The context of these processes is predicted by the neurobiology of midbrain structures, especially the temporally located hippocampus and amygdala and their relation to frontal and parietal structures (cerebral cortex) as well as the autonomic centers of the medulla. The shift from early nonverbal representational modes of thinking in infancy and childhood to more verbal modes may be responsible for the typical amnesia of childhood. However, these early modes of visual, auditory, olfactory, tactile, gustatory, and visceral coenesthetic experiencing continue in the background, in the "not-conscious," and form the hidden nucleus of affective experience and associated complex nonverbal narratives. Reports of persons with dissociative adaptations tend to have more nonverbal content and are often labeled regressive in the analytic situation. However, awareness of these variations in the psychological processing of experience will allow construction of a coherent narrative through which affect can be contained and explored. The elucidation of these states of "regulated dysregulation" will proceed via an initial description of some of the dissociative adaptations in logic and afect perception. This view will be broadened by an inquiry into the neurobiology of affect and its relation to dissociative processes. A clinical vignette will illustrate these processes as they appear in the consultation room.

Chefetz, Richard A. (2000).  
Disorder in the Therapist's View of the Self: Working with the Person with Dissociative Identity Disorder
Psychoanalytic Inquiry, 14 April 2000, vol. 20, no. 2, pp. 305-305(1)

ABSTRACT In the treatment of a person with Dissociative Identity Disorder (DID), both patient and therapist are confronted with major challenges to their routine views of having a "Self," being an "I." In this way we can understand that the treatment of DID is an exploration of distortions in the experience of experiencing. To explore this treatment we need not give up our normal frames of reference. What is needed is additional perspective on understanding the profound effect of massive traumatic experience on the Self. The broad thematic headings in this paper include the clinical context of dissociative disorders, dissociation as adaptation, fantasy proneness, autohypnotic experience, and the sadomasochistic default. Brief clinical vignettes illustrate these concepts.

Chu, J.A., Frey, L.M., Ganzel, B.L., & Matthews, J.A. (1999).  
Memories of childhood abuse: Dissociation, amnesia, and corroboration
American Journal of Psychiatry, 156, 749-755.

ABSTRACT Investigated the relationship between self-reported childhood abuse and dissociative symptoms and amnesia. The presence or absence of corroboration of recovered memories of childhood abuse was also studied. Ss were 90 female 18-60 yr old patients admitted to a unit specializing in the treatment of trauma-related disorders. Ss completed instruments that measured dissociative symptoms and elicited details concerning childhood physical abuse, sexual abuse, and witnessing abuse. Ss also underwent a structured interview that asked about amnesia for traumatic experiences, the circumstances of recovered memory, the role of suggestion in recovered memories, and independent corroboration of the memories. Ss reporting any type of childhood abuse showed higher and more elevated levels of dissociative symptoms than those in Ss not reporting abuse. Higher dissociative symptoms were correlated with early age at onset of physical and sexual abuse and more frequent sexual abuse. A substantial proportion of Ss with all types of abuse reported partial or complete amnesia for abuse memories. For physical and sexual abuse, early age at onset was correlated with greater levels of amnesia. A majority of Ss found strong corroboration of recovered memories.

Clancy, S. A., McNally, R.J. & Schachter, D. (1999).
Effects of guided imagery in women reporting recovered memories.
Journal of Traumatic Stress, 12(4), 559-570.

ABSTRACT "We tested whether having participants imagine unusual childhood events inflates their confidence that these events happened to them, and tested whether this effect is greater in women who report recovered memories of childhood sexual abuse than in women who do not. Participants were pretested on how confident they were that certain childhood events had happened to them before being asked to imagine some of these events in the laboratory. New confidence measures were readministered. Although guided imagery did not significantly inflate confidence that early childhood events had occurred in either group, the effect size for inflated confidence was more than twice as large in the control group as in the group with recovered memory. These data suggest that individuals can counteract memory distortions potentially associated with guided imagery, at least under some conditions." The authors note: "We tested the hypothesis that women who report recovered memories of sexual abuse would be especially susceptible to imagination inflation following guided imagery. Our results do not support this hypothesis. Indeed, if anything, control participants were (nonsignificantly) more susceptible to the memory-distorting effects of guided imagery techniques than were participants with recovered memories." N.B. Eleven of the 12 subjects who participated in the recovered memory condition indicated that "no one could provide corroboration."

ABSTRACT Research has yielded contradictory results on the relationship between childhood sexual abuse and later parental functioning. This study was undertaken to specify the link between childhood sexual abuse and maternal parenting, while taking into account mothers' childhood physical and emotional traumas and current depressive and dissociative symptoms. Data were collected through self-report measures completed by 93 French-speaking Canadian mothers of children aged 6 to 11 years referred to Youth Protection Services. Parental behaviors examined included involvement with the child, use of positive reinforcement, lack of monitoring and supervision of the child, inconsistency in applying discipline, and use of corporal punishment. Mothers' perception of the quality of the relationship with her child was also assessed. In addition, history of abuse and neglect, depression and dissociation were respectively measured with the Childhood Trauma Questionnaire, the Diagnostic Interview Schedule Simplified, and the Dissociative Experiences Scale. The short-form of the Marlowe-Crowne Social Desirability Scale was used to control for respondent bias aimed at minimizing their problems. Mothers' current depressive symptoms were not found to predict any of the parental dimensions measured. Results from multiple hierarchical regressions pointed to dissociative symptoms as the key predictor of parental practices and attitudes. More specifically, dissociative symptoms predicted the use of positive reinforcement, lack of monitoring and supervision of the child, inconsistency in applying discipline, and use of corporal punishment. Dissociation also mediated the association between childhood maltreatment (physical and emotional abuse and neglect) and inconsistency in applying discipline. Implications for research and practice are discussed.

Clayton, Kymbra BSc (2004).
The Interrelatedness of Dissconnection: The Relationship Between Dissociative Tendencies and Alexithymia
Journal of Trauma and Dissociation, vol. 5 issue 1; 2004, 77 - 101 DOI: 10.1300/J229v05n01_05

ABSTRACT This study explored the extent to which alexithymia can be seen as a dissociative phenomenon, examining three facets of dissociation in relationship to the five dimensions of alexithymia. The dissociative facets were: pathological psychoform dissociation (amnesia and derealization/depersonalization), non-pathological psychoform dissociation (absorption) and somatoform dissociation. The alexithymia facets were: difficulties emotionalizing, fantasizing, identifying, verbalizing and analyzing emotions. Various self-report measures were used including the latest developed measure of alexithymia, the Bermond Vorst Alexithymia Questionnaire (BVAQ). Canonical correlation results indicated that somatoform dissociation was the strongest predictor of alexithymia. For younger males, somatoform dissociation was directly related to all facets of alexithymia except for fantasizing. Males with somatoform dissociation, irrespective of age, appeared to have the highest difficulties emotionalizing and identifying emotions. Whilst somatoform and pathological psychoform dissociation were related to difficulties identifying emotions for younger females, no type of dissociation directly influenced the development of any alexithymia dimension for women.

Philip M. Coons, MD; Elizabeth S. Bow man, MD.(2001).
Ten-Year Follow-Up Study of Patients with Dissociative Identity Disorder
Journal of Trauma and Dissociation; Vol.2 nr. 1 (2001) 73-90.

ABSTRACT Little follow-up data has been published on individuals with dissociative identity disorder (DID). In this study, DID was diagnosed in 25 patients by two seasoned dissociative disorder clinician/researchers beginning in 1986. The initial evaluation include dacomprehensive medical and psychiatric evaluation and Minnesota Multi -phasic Personality Inventory (MMPI). A ten-year fol low-up evaluation included the Dissociative Experiences Scale, Civilian Mississippi PTSD Scale, Beck Inventory for Depression, Life Experiences Survey, the MMPI Hypochondriasis scale, and a dissociative disorders follow-up question naire. The patients were also asked to write a narrative about their life and treatment since intake. Twelve patients provided follow-up data. Of these twelve, six ultimately achieved full integration of their personality states, although two of them subsequently dissociated into alter personality states again. The two teen-aged patients achieved full integration within two years, while the older patients took considerably longer. Of the patients who elected to continue in treatment for their dissociative disorder and who continued to dissoccate into alter personality states, all have experienced major symptomatic improvement in both dissociative and non-dissociative symptomatology. Of the two therapy drop outs, both continue to have dissociative symptoms at follow-up. We conclude that treatment for DID following treatment guidelines pro-mulgated by the International Society for the Study of Dissociation brings about symptomatic improvement in both dissociative and non-dissociative symptoms. Ignoring symptoms of dissociation, as has been advocated by some, results in no improvement.

Coons, P.M. (1999).
Psychogenic or dissociative fugue: A clinical investigation of five cases
Psychological Reports, 84, 881-886.

ABSTRACT Dissociative fugue (formerly psychogenic fugue) is a rare and little understood dissociative disorder. Following a review of the pertinent literature, five cases of dissociative fugue are described. These cases were systematically studied with a comprehensive history, mental status examination, physical and neurological evaluation, review of previous medical and psychiatric records, and psychological testing including MMPI, Wechsler Adult Intelligence Scale~~Revised (WAIS~~R), electroencephalogram, and Dissociative Experiences Scale. An unexpected finding was that, in some cases, associated criminal activity may allow the person with dissociative fugue to continue to function in spite of their loss of memory and original identity.

Coons, P.M. (1998).
Dissociative disorders: Rarely considered and under-diagnosed
Psychiatric Clinics of North America, 21, 637-648

ABSTRACT The dissociative disorders have often been under-diagnosed by psychiatric professionals. Reasons for this under-diagnosis are diverse and include unfamiliarity with the diagnoses, unfamiliarity with dissociative symptoms, lack of appreciation of the epidemiology of dissociative disorders, and even disbelief in certain dissociative disorders diagnoses. In order to provide the clinician with a more complete and reliable diagnostic armamentarium, this article reviews the clinical phenomenology and epidemiology of the dissociative disorders.

F. M. Corrigan, A. Davidson, H. Heard (2000).
The role of dysregulated amygdalic emotion in borderline personality disorder
Medical Hypotheses pp. 574-579 (doi:10.1054/mehy.1999.0898)

ABSTRACT Borderline personality disorder (BPD), is a condition that has a high mortality and is associated with much distress for the sufferers as well as with difficult management problems for health professionals. Taking emotional dysregulation as the core feature of BPD, the authors propose that the disorder arises from impaired modulation of subcortical inputs to consciousness. We hypothesize that the amygdaloid complex, and its connections with thalamus, cingulate cortex and insular cortex are critical in the development and maintenance of the disorder. If this is the case, peptides such as galanin, somatostatin and cholecystokinin will be the most important neurotransmitters, thus explaining the relative lack of efficacy of standard antipsychotic and antidepressant drugs

Journal of Trauma and Dissociation (ISSN: 1529-9732), v. 3, no. 2, pp. 57-80 (2002).

ABSTRACT Pesso Boyden System Psychomotor Therapy (Psychomotor) is offered as a useful approach to treating Dissociative Identity Disorder. Originally developed for group work, this therapy can be modified so that the alters can learn to play roles for one another that promote resolution of childhood injury, enhance internal communication and cooperation, and ultimately support the prospect of integration. Psychomotor is unique in that it helps in the creation of synthesizing memories that provide antidotes for early traumas; not only can childhood abuse and neglect be metabolized, but also images of needs being met can be added. Moreover, Psychomotor develops the "Pilot" or adult functioning so that there is less likelihood of regression or dependence on the therapist. A four-stage progression of treatment is outlined: development of the "Pilot", teaching the system's adults to engage in parenting the child alters, healing the wounds and the defensiveness of the "Protector/Controller", and the internalization of the image of "Ideal Parents" so that the client can continue to resolve any surfacing memories of trauma or inadequate rearing. KEY WORDS: Pesso Boyden System Psychomotor, dissociative identity disorder, DID, dissociative disorders

Am J Psychother 1997;51(4):464-496

ABSTRACT "This article provides an updated treatment model for adults who report having experienced incestuous abuse in childhood. It integrates psychodynamic, traumatic stress, developmental and feminist formulations, accords greater emphasis to object relations and self-psychology perspectives, includes more attention to dissociative reactions, and utilizes more cognitive-behavioral interventions. It is also responsive to issues raised in the recovered/false memory controversy. This holistic model is sequenced, paced, and titrated according to the patient's characterological structure, ego strength, and needs as well as the range and severity of presenting problems and life difficulties. Special consideration is given to issues pertaining to memory and the maintenance of a neutral stance by the therapist, especially in the case of recovered rather than continuous memories and/or suspicions rather than actual knowledge of abuse. Contemporary perspectives regarding some of the unique transference, countertransference, and vicarious traumatization issues with this population and their potential impact on treatment are also discussed".