Labott, S. M. , & Wallach, H. R.

ABSTRACT This study examined whether DID can be successfully malingered on objective and projective psychological tests. 50 undergraduate women were assigned to either a Malingering or a Control condition. Each then completed the Rorschach Inkblot Test and the Dissociative Experiences Scale II (DES II). Analysis indicated that subjects asked to simulate DID were significantly more likely to endorse dissociative experiences on the DES II in the range common to patients with diagnosed DID than subjects asked to answer all materials honestly. However, there were no significant between group differences on the Rorschach. Results suggest that the assessment of DID requires a multifaceted approach with both objective and projective assessment tools. Additional research is needed to assess these issues in clinical populations.

Ladwig KH , Marten-Mittag B, Deisenhofer I, Hofmann B, Schapperer J, Weyerbrock S, Erazo N, Schmitt C.

ABSTRACT The psychophysiological startle response pattern associated with peritraumatic dissociation (DISS) was studied in 103 survivors of a life-threatening cardiac event (mean age 61.0 years, SD 13.95). Mean time period since the cardiac event was 37 (79 IQD) months. All patients underwent a psychodiagnostic evaluation (including the Peritraumatic Dissociative Experiences Questionnaire) and a psychophysiological startle experience which comprised the delivery of 15 acoustic startle trials. Magnitude and habituation to trials were measured by means of electromyogram (EMG) and skin conductance responses (SCR). Thirty-two (31%) subjects were indexed as patients with a clinically significant level of DISS symptoms. High-level DISS was associated with a higher magnitude of SCR (ANOVA for repeated measures p = 0.017) and EMG (p = 0.055) and an impaired habituation (SCR slope p = 0.064; EMG slope p = 0.005) in comparison to subjects with no or low DISS. In a subgroup analysis, high-level DISS patients with severe post-traumatic stress disorder (PTSD; n = 11) in comparison to high-level DISS patients without subsequent PTSD (n = 19) exhibited higher EMG amplitudes during all trials (repeated measures analysis of variance F = 5.511, p = 0.026). The results demonstrate exaggerated startle responses in SCR and EMG measures - an abnormal defensive response to high-intensity stimuli which indicates a steady state of increased arousal. DISS patients without PTSD exhibited balanced autonomic responses to the startle trials. DISS may, therefore, unfold malignant properties only in combination with persistent physiological hyperarousability.

ABSTRACT OBJECTIVE: This article reviews the English-language literature on child sexual abuse in sub-Saharan Africa (SSA). The focus is on the sexual abuse of children in the home/community, as opposed to the commercial sexual exploitation of children.
METHODS: English language, peer-reviewed papers cited in the Social Sciences Citation Index (SSCI) are examined. Reports from international and local NGOs and UN agencies are also examined.
RESULTS: Few published studies on the sexual abuse of children have been conducted in the region, with the exception of South Africa. Samples are predominantly clinical or University based. A number of studies report that approximately 5% of the sample reported penetrative sexual abuse during their childhood. No national survey of the general population has been conducted. The most frequent explanations for the sexual abuse of children in SSA include rapid social change, AIDS/HIV avoidance strategies, and the patriarchal nature of society. Child sexual abuse is most frequently perpetrated by family members, relatives, neighbors or others known to the child.
CONCLUSIONS: There is nothing to support the widely held view that child sexual abuse is very rare in SSA-prevalence levels are comparable with studies reported from other regions. The high prevalence levels of AIDS/HIV in the region expose sexually abused children to high risks of infection. It is estimated that, approximately.6-1.8% of all children in high HIV-incidence countries in Southern Africa will experience penetrative sexual abuse by an AIDS/HIV infected perpetrator before 18 years of age.

Behavioural and Cognitive Psychotherapy (ISSN: 1352-4658), v.28,no 2,pp175-192 (April 2000).

ABSTRACT The present study examines the effectiveness of an online standardized treatment of posttraumatic stress and pathological grief administered through the Internet. 20 students who had experienced traumatic life events and showed the symptoms of posttraumatic stress participated in the study. They received credit course points for inclusion in the research. Treatment consisted of 10 writing sessions (45 minutes each) during a period of 5 weeks. Participants were assessed at pretreatment, posttreatment, and after six weeks (follow-up). The participants improved strongly from pre- to post-treatment on posttraumatic stress and pathological grief symptoms and in psychological functioning. These improvements were sustained during the follow-up period. Moreover, 19 of the 20 participants were clinically recovered after treatment. The changes in posttraumatic stress symptomatology were compared post hoc to changes in control and experimental groups from trials on similarly protocolled but face-to-face treatment of posttraumatic stress.

Lange, A., de Beurs, E., Dolan, C., Lachnit, T., Sjollema, S., & Hanewald, G. (1999).   
Long-term effects of childhood sexual abuse: Objective and subjective characteristics of the abuse and psychopathology in later life.
Journal of Nervous & Mental Disease, 187, 150-158.

ABSTRACT Investigates the association between objective and subjective characteristics of childhood sexual abuse and psychopathology in later life. Ss were 404 Dutch females (aged 16-84 yrs) who had been sexually abused in their childhood or adolescence. The characteristics and severity of the sexual abuse were assessed with the Questionnaire Unwanted Sexual Experiences in the Past(A. Lange et al, 1996)). General psychopathology was measured with the Dutch version of the Symptom Checklist-90-revised and the degree of dissociation was measured with the Dissociation Questionnaire. Stepwise multiple regression analyses showed a moderate association between psychopathology and objective characteristics of the abuse, such as number of different types of abusive events and the duration of the abuse. Variables reflecting coping style, such as the degree of self-blame, and circumstantial factors, such as the emotional atmosphere in the family of origin and the reactions after disclosure, were more strongly associated with later psychopathology. Whether or not the abuse was incestuous did not explain additional variance in later psychopathology.

Langeland, W., vandenBrink, W., Draijer, N., Hartgers, C. (2002).   
"European Addiction Research", Free University Amsterdam, Department of Psychiatry, the Netherlands
Sensitivity of the Addiction Severity Index physical and sexual assault items: Preliminary findings on gender differences
Compr Psychiatry 2002 May-Jun;43(3):195-203

ABSTRACT There is consistent empirical evidence for a trauma-dissociation relation in general population samples and in psychiatric patients. However, contradictory findings have been reported on this relation among substance abusers. The present study attempts to resolve these inconsistencies by testing a series of hypotheses related to problems regarding the measurement of childhood abuse, the measurement of psychological dissociation, and the potential existence of substance abuse as a form of chemical dissociation. Alcoholic patients (N = 155) were administered the Dissociative Experiences Scale (DES), the Structured Trauma Interview (STI), the European Addiction Severity Index (EuropASI), and the Posttraumatic Stress Disorder (PTSD) section of the Composite International Diagnostic Interview (CIDI). The DES showed good psychometric properties. Substantial rates of traumatization and PTSD were observed, as well as a significant trauma-PTSD relation. However, the mean DES score was low (11.4) and dissociation was not related to trauma (childhood or lifetime) or to PTSD. Years of lifetime regular medicine use, however, was significantly correlated with the severity of dissociative symptoms and PTSD, particularly in males. Overall, these findings suggest that absence of a trauma-dissociation relation in alcoholics may not be due to measurement problems of childhood abuse and/or dissociation. Rather, a trauma-dissociation link may not exist, particularly in male alcoholics, because these individuals may abuse substances to achieve dissociative-like states. Additional research is needed to further evaluate the utility of the DES in alcoholic samples and to examine the notion of chemical dissociation.

Lanius, Ruth A.; Peter C. Williamson, Kristine Boksman, Maria Densmore, Madhulika Gupta, Richard W. J. Neufeld, Joseph S. Gati and Ravi S. Menon (2002).   
Brain Activation During Script-Driven Imagery Induced Dissociative Responses in PTSD: A Functional MRI Investigation
Biol Psychiatry 2002 Aug 15;52(4):305

ABSTRACT BACKGROUND: The goal of this study was to examine the neuronal circuitry underlying dissociative responses to traumatic script-driven imagery in sexual-abuse-related posttraumatic stress disorder (PTSD). Pilot studies in our laboratory have shown that PTSD patients had very different responses to traumatic script-driven imagery. Approximately 70% of patients relived their traumatic experience and showed an increase in heart rate while recalling the traumatic memory. The other 30% of patients had a dissociative response with no concomitant increase in heart rate. This article focuses on the latter group.METHODS: The neuronal circuitry underlying dissociative responses in PTSD was studied using the traumatic script-driven symptom provocation paradigm adapted to functional magnetic resonance imaging (fMRI) at a 4 Tesla field strength in 7 subjects with sexual-abuse-related PTSD and 10 control subjects.RESULTS: Compared with control subjects, PTSD patients in a dissociative state showed more activation in the superior and middle temporal gyri (BA 38), the inferior frontal gyrus (BA 47), the occipital lobe (BA 19), the parietal lobe (BA 7), the medial frontal gyrus (BA 10), the medial cortex (BA 9), and the anterior cingulate gyrus (BA 24 and 32).CONCLUSIONS: These findings suggest that prefrontal and limbic structures underlie dissociative responses in PTSD. Differences observed clinically, psychophysiologically, and neurobiologically between patients who respond to traumatic script-driven imagery with dissociative versus nondissociative responses may suggest different neuronal mechanisms underlying these two distinct reactions.

Lanius, Ruth A; Williamson, Peter C; Densmore, Maria; Boksman, Kristine; Gupta, Madhulika A; Neufeld, R W; Gati, Joseph S; Menon, Ravi S. (2001).   
Neural correlates of traumatic memories in posttraumatic stress disorder: a functional MRI investigation.
American Journal of Psychiatry (ISSN: 0002-953X), v. 158, no. 11, pp. 1920-1922 (Nov. 2001).

ABSTRACT OBJECTIVE: The neuronal circuitry underlying PTSD was studied in traumatized subjects with and without PTSD. METHOD: Traumatized subjects with (N = 9) and without (N = 9) PTSD were studied by using the script-driven symptom provocation paradigm adapted to functional magnetic resonance imaging at a 4-T field strength. RESULTS: PTSD subjects showed significantly less activation of the thalamus, the anterior cingulate gyrus (Brodmann's area 32), and the medial frontal gyrus (Brodmann's area 10/11) than did the comparison subjects. CONCLUSIONS: The findings suggest anterior cingulate, frontal, and thalamic involvement in the neuronal circuitry underlying PTSD.

ABSTRACT Grief and dissociation after traumatic exposures are among the most important predictors of posttraumatic stress disorder (PTSD). This article introduces the Traumatic Dissociation and Grief Scale (TDGS), a 23-item measure easily administered. The TDGS, the Child PTSD-Reaction Index (CPTSD-RI), and a questionnaire concerning risk factors related to the event (losses, injury, and witnessing death and injuries) were administered to school-aged children who had been directly exposed to the 1999 earthquakes in Turkey and to a nonexposed control group. Factor analysis of the TDGS yielded four factors: perceptual distortions, body-self distortions, irritability, and guilt and anhedonia. A moderate positive correlation was noted between the TDGS and the CPTSD-RI. Different sets of risk factors were associated with the different scale factors. The results suggest that the assessment of psychopathology in children following a disaster requires the complementary evaluation of symptoms of posttrauma, dissociation, and grief.

ABSTRACT The authors present a new theory of the neurobiological mechanisms mediating the memory processes involved in posttraumatic stress disorder (PTSD). The current fear-conditioning model accounts for learning that underlies certain central features of PTSD, but it fails to account for peritraumatic memory disturbances, episodic memory phenomena that also are characteristic of the disorder. A more comprehensive model of PTSD, consistent with the clinical phenomenology of the disorder, is proposed on the basis of observations from human memory experiments. It is argued that the amygdala is the locus of consolidation of the core of the traumatic experience and that amygdalar inhibition of hippocampal function at high levels of emotional arousal mediates diminution of conscious memory for peritraumatic events. The model is amenable to specific experimental manipulations that should yield information pertinent to further development of theory and, ultimately, to more rational clinical intervention.

Leavitt F (2000)
Surviving Roots of Trauma: Prevalence of Silent Signs of Sex Abuse in Patients Who Recover Memories of Childhood Sex Abuse as Adults
Journal of Personality Assessment Volume: 74 Number: 2 Page: 311

ABSTRACT Recent research suggests that victimization imagery is chronically accessible in sex-abused populations, which is helpful in distinguishing them from nonabused populations. Eight categories of victimization imagery were selectively activated by Rorschach stimuli. These 8 sex-abuse signs were replicated in a new sample of 36 patients with continuous memory of sex abuse. Classification accuracy was 83%. By contrast, these signs were present in only 4% (5 of 115) of the protocols of nonabused patients. Taken together, the 2 studies confirm reasonably high sensitivity of the 8 signs for sex-abused populations and high specificity for nonabused populations. The 8 signs were also differentially salient for patients who recovered memory of childhood sexual trauma as adults. The Rorschach protocols of 59 of 114 patients with delayed recall of sexual abuse possessed signs of sex abuse. There was no linkage between therapy and recovered-memory cases with and without sex-abuse signs. Emergence of trauma memories was not uniquely traceable to treatment. Memories arose outside of the context of therapy in over 56% of the cases. Implications for the false-memory debate are discussed.

Leavitt F (2000)
Department of Psychology, Rush Medical College, Chicago, IL, USA.
Texture response patterns associated with sexual trauma of childhood and adult onset: developmental and recovered memory implications.  
Child Abuse Negl 2000 Feb;24(2):251-7

ABSTRACT OBJECTIVE: Reduce texture sensitivity on the Rorschach is proposed as a sequela of early sexual abuse that is unlikely to be contaminated by situational variables. If this conceptualization has merit, texture attributes offer a roadmap for studying vying claims in the recovered memory debate. To explore this possibility, we examined the extent to which intense preoccupation with sexual trauma of childhood and of adult onset was related to reduced texture productivity. METHOD: Texture productivity was measured in 4 groups comprised of 108 patients using the Rorschach. Twenty-seven patients with recovered memory were compared with 27 patients with continuous memory of childhood sexual trauma, 27 post trauma stress patients with sexual trauma of adult onset, and 27 non-abused patients. RESULTS: The study replicated previous findings of reduced texture productivity among patients who always remembered sexual trauma of childhood-onset. The same texture deficiency pattern was observed among patients who recovered memory of childhood sexual abuse. This pattern was not observed in Post Traumatic Stress Disorder (PTSD) patients intensely preoccupied with sexual trauma of adult onset despite the fact that they mimicked the recovered memory group in respect to enduring preoccupation with distressing thoughts of sexual abuse. CONCLUSION: The findings indicate that intrusive memories of sexual trauma do not shape patients' response to textural cues on the Rorschach. Variations in texture productivity are primarily moderated by age of trauma onset. Dismissal of claims of recovered memories on the basis of intense sexual preoccupation is not warranted.

Leavitt F, Labott SM (1998)
Department of Psychology and Social Sciences, Rush Medical College, Chicago, Illinois 60612, USA.
Revision of the Word Association Test for assessing associations of patients reporting satanic ritual abuse in childhood.
J Clin Psychol 1998 Nov;54(7):933-43

ABSTRACT A growing number of psychiatric patients report satanic ritual abuse, prompting research into this controversial area. In the current study, the Word Association Test (WAT) was modified to assess experience with satanic abuse. Pilot work resulted in norms for two domains: normative and satanic. Female psychiatric patients were compared on their associations in two studies. Based on a sexual history, they were grouped into those reporting sexual abuse, those reporting satanic ritual abuse (SRA), and those without a history of sexual abuse (controls). In both studies, SRA patients gave significantly more total associations, significantly fewer normative associations, and significantly more satanic associations than did the other two groups. These results suggest that an experience base is shared by individuals reporting SRA that is not found in individuals who do not report satanic abuse (even if they do report sexual abuse). The implications of these findings are discussed from the perspective of arguments advanced by advocates and critics of SRA.

J Clin Psychol 1998 Oct;54(6):803-10

ABSTRACT The purpose of the present study was to replicate Rorschach signs of Multiple Personality Disorder (MPD) using DSM-IV criteria of Dissociative Identity Disorder (DID). Women admitted to either an inpatient dissociative disorder's unit (n = 27) or a general psychiatric unit (n = 72) were given the Rorschach, which was scored for the Labott, Barach, and Wagner Rorschach markers of MPD. Results indicated that Rorschach signs of the three different systems were significantly better than chance at classifying patients as DID or as non-DID. The Labott system, which performed the best, was able to accurately classify 92% of the sample. These results argue for the validity of the DID diagnosis. The Rorschach signs operate independent of external bias, yet correspond to the diagnoses obtained through psychiatric evaluation in an inpatient setting. The fact that two relatively rare sets of signs (DID and Rorschach) converge in the same small sector of the psychiatric population represents evidence of linkage that is clinically meaningful and not explainable on the basis of artificial creation.

ABSTRACT Considerable progress has been made over the past 20 years in relating specific circuits of the brain to emotional functions. Much of this work has involved studies of Pavlovian or classical fear conditioning, a behavioral procedure that is used to couple meaningless environmental stimuli to emotional (defense) response networks. 2. The major conclusion from studies of fear conditioning is that the amygdala plays critical role in linking external stimuli to defense responses. 3. Before describing research on the role of the amygdala in fear conditioning, though, it will be helpful to briefly examine the historical events that preceded modern research on conditioned fear.

ABSTRACT In recent years, there has been an explosion of interest in the neural basis of emotion. Much of this enthusiasm has been triggered by studies of the amygdala and its contribution to fear. This work has shown that the amygdala detects and organizes responses to natural dangers (like predators) and learns about novel threats and the stimuli that predict their occurrence. The latter process has been studied extensively using a procedure called classical fear conditioning. This article surveys the progress that has been made in understanding the neural basis of fear and its implications for anxiety disorders, as well as the gaps in our knowledge.

ABSTRACT In this study, the Rorschach scoring system for splitting developed by Lerner, Sugarman, and Gaughran (1981) was applied to the Holtzman Inkblot Technique (HIT). Normal individuals (n = 30), patients with neurotic disorders (n = 30), patients with borderline personality disorder (n = 30), patients with acute schizophrenia (n = 25), and patients with chronic schizophrenia (n = 25) were studied with respect to their use of splitting. Sufficient interrater reliability was demonstrated for the scoring of splitting in the HIT. Significant differences between borderline patients, acute schizophrenic patients, and chronic schizophrenic patients, on the one hand, and patients with neurotic disorders, on the other hand, were demonstrated. Furthermore, it was shown that the indicators of splitting were associated with measures of identity diffusion, primitive defense mechanisms, and other measures of psychopathology. The Lerner indicator of splitting proved to be multidimensional. Different forms of splitting seem to be characteristic of borderline patients and schizophrenic patients. The application of the Lerner criteria of primitive defenses to the HIT appears to be promising

ABSTRACT OBJECTIVE: This study examined the relationships of dissociation and childhood trauma with ataque de nervios. METHOD: Forty Puerto Rican psychiatric outpatients were evaluated for frequency of ataque de nervios, dissociative symptoms, exposure to trauma, and mood and anxiety psychopathology. Blind conditions were maintained across assessments. Data for 29 female patients were analyzed. RESULTS: Among these 29 patients, clinician-rated dissociative symptoms increased with frequency of ataque de nervios. Dissociative Experiences Scale scores and diagnoses of panic disorder and dissociative disorders were also associated with ataque frequency, before corrections were made for multiple comparisons. The rate of childhood trauma was uniformly high among the patients and showed no relationship to dissociative symptoms and disorder or number of ataques. CONCLUSIONS: Frequent ataques de nervios may, in part, be a marker for psychiatric disorders characterized by dissociative symptoms. Childhood trauma per se did not account for ataque status in this group of female outpatients.

ABSTRACT In a recent article in this journal, D. H. Gleaves (1996) criticized the sociocognitive model (SCM; N. P. Spanos, 1994) of dissociative identity disorder (DID) and argued in favor of a posttraumatic model (PTM) in which DID is conceptualized as a consequence of childhood abuse and other traumatic events. The present authors demonstrate that (a) many of Gleaves's arguments were predicated on misunderstandings of the SCM, (b) scrutiny of the evidence regarding the psychopathology and assessment of DID raises questions concerning the PTM's conceptual and empirical underpinnings, (c) the treatment literature suggests that iatrogenic factors play an important role in the etiology of DID, and (d) the evidence linking child abuse to DID is more problematic than implied by Gleaves. The present authors conclude that Gleaves's analysis underemphasized the cultural manifestations of multiple role enactments and that the history of DID imparts a valuable lesson to contemporary psychotherapists.

ABSTRACT BACKGROUND: The aim of this study was to extend our knowledge of associations among the constructs of alexithymia, depression, somatization and dissociation. SAMPLING AND METHODS: 924 nonclinical subjects answered questions about depression (21-item Beck Depression Inventory), somatization (13-item somatization part of Symptom Check List-90), dissociation (28-item Dissociative Experiences Scale) and alexithymia (20-item Toronto Alexithymia Scale). In addition, a 12-item General Health Questionnaire (GHQ-12) was administered to detect psychiatric distress among subjects. RESULTS: The results suggested that there was a significant clinical correlation between somatization, dissociation, depression and alexithymia (rho varied from 0.31 to 0.56). The principal component analysis revealed the presence of four components: depression, somatization, dissociation and alexithymia. The use of factor scores diminished the covariance between measures (rho varied from -0.10 to 0.01 between the factor scores). There was almost no correlation between the dissociation factor (rho = 0.06) and alexithymia factor (rho = 0.09) scores and general distress (GHQ-12). CONCLUSIONS: This study suggests that while somatization, dissociation, depression and alexithymia are distinct constructs, they correlate to a considerable extent. The use of factor analysis and factor scores should be considered to diminish covariance between the above constructs. Comparing results between factored and unfactored results may prove illuminating. As a case in point, the results suggest that the part of dissociation that coincides with other constructs (overlaps) is associated with distress, whereas the distinct part of dissociation (no shared covariance) is not associated with distress. The same applies to the alexithymia construct. Longitudinal studies are needed to show whether there is a trait such as a relatively stable dissociation component and also whether a separate state-dependent dissociation component exists that is associated with coincident distress, somatization and depression.

ABSTRACT OBJECTIVE: To test the hypothesis that serious losses in the life of the attachment figure and patients' early traumatic experiences are risk factors for the development of borderline personality disorder. METHOD: A multicentric hospital-based case-control study of 66 cases and 146 controls. RESULTS: We estimated an odds ratio of 2.5 (95% CI 1.1-5.8) for mothers' serious losses experienced within 2 years of patients' birth and an odds ratio of 5.3 (95% CI 2.1-13) for patients' early traumatic experiences. Both of them are adjusted for the confounding effect of the other as well as for that of age, size of family and type of patient (in- or out-patient), using a multiple logistic function. CONCLUSION: Mourning process in the mother within 2 years of the patient's birth and patients' early traumatic experiences are predictive factors for the development of borderline personality disorder.

ABSTRACT Handedness is considered an indirect marker for bilateral language capacity in the brain. The Edinburgh Inventory for Handedness and the Dissociative Experiences Scale (DES) were administered to 297 nonclinical volunteers. Female sex, young age, and non-right handedness accounted for 24% of the total variance on the DES, including both pathological and nonpathological dissociative experiences. This is consistent with the hypothesis that cerebral lateralization indicating handedness is a predisposing factor for dissociative episodes especially in female subjects.

ABSTRACT Visual distortions (VDSTs) are often incorrectly diagnosed and easily dismissed. The causes of VDSTs are poorly understood. The aim of this study was to investigate the link between VDSTs and dissociative experiences in a nonclinical population. 297 nonclinical 18-80-yr-olds completed the Dissociative Experience Scale (DES) and answered questions concerning visual distortions. The results suggest that VDSTs are quite common. among those Ss with self-reported VDSTs, dissociative trends, as measured with the DES, were significantly higher. Literature suggests that the link between VDSTs and dissociative phenomena may be caused by disturbances in brain lateralization. Bilateral language capacity may interfere with abilities usually associated with the nondominant hemisphere.

ABSTRACT Regions of the brain's frontal lobe that are associated with memory retention and retrieval begin to mature during the last quarter of the first year in humans. This implies that infants younger than 8 or 9 months should have difficulty in registering an experience and retrieving it after a long delay. Here we show that 13-month-old children are unable to recall a sequence of actions performed in front of them when they were 9 months old, whereas 21- and 28-month-olds are able to retrieve representations of the same acts when these were witnessed at 17 and 24 months. Our findings indicate that long-term retention increases during the second year and support the idea that maturation of the frontal lobe at the end of the first year contributes to memory enhancement during this period.

Journal of Abnormal Psychology, 2000, Vol. 109, No. 1, 26–39,

ABSTRACT The emotional deficits associated with posttraumatic stress disorder (PTSD) are the least understood and the most understudied aspect of the syndrome. In this study, the connection was evaluated between trauma–context reactivity and subsequent emotional deficits in PTSD. Combat veterans with PTSD and well-adjusted veteran control participants were exposed to reminders of combat, after which their emotional behavior was assessed in response to a series of emotionally evocative images. Under the neutral condition, both groups exhibited emotional behavior modulated by stimulus valence. Partially consistent with the conceptual model described by B. Litz (1992), the PTSD group exhibited suppressed expressive–motor responses to positively valenced images, in comparison with the control group, only after being exposed to a trauma-related prime. Contrary to expectations, the PTSD group showed no augmentation of emotional response to negatively valenced cues after being exposed to trauma reminders. However, the PTSD group responded to all images, in both prime conditions, with higher heart rate reactivity, suggesting an automatic preparation for demand or threat in any uncertain emotional context. Possible causes and consequences of these results are discussed.

Lussier, R.G., J. Steiner, A. Grey, & C. Hansen (1997)
Prevalence of dissociative disorders in an acute care day hospital population
Psychiatric Services, 48(2), Feb 1997, 244-46.

ABSTRACT This study investigated the prevalence of dissociative disorders in a day hospital and examine their relation to traumatic experiences. Trained clinicians evaluated 70 of 229 patients consecutively admitted to an acute care day hospital. Six of the 70 patients (9%) received a definite diagnosis of a dissociative disorder. Five of the 6 patients reported a history of childhood sexual or physical abuse. The results indicate that dissociative disorders are not rare among general psychiatric patients and are associated with histories of childhood trauma. -Ross, Colin A. Epidemiology of multiple personality disorder and dissociation. Psychiatric Clinics of North America, 14(3), Sept 1991, 503-17. This study surveyed 454 adults from the general population in the city of Winnipeg, Canada and found that MPD related to childhood abuse affected about 1% of the subjects. Approximately 10% of the subjects had a DSM-III-R dissociative disorder of some kind. It is concluded that pathologic dissociation appears to be about as common as anxiety, mood, and substance abuse disorders.

Lyons-Ruth K. (2003)
Departm. of Psychiatry, Harvard Med. School, Cambridge Hospital, MA 02139, USA. Klruth@hms.harvard.edu
Dissociation and the parent-infant dialogue: a longitudinal perspective from attachment research.
J Am Psychoanal Assoc. 2003 Summer;51(3):883-911.

ABSTRACT Two longitudinal attachment studies of families at social risk have now followed their cohorts of infants to late adolescence. Several key findings have emerged related to outcomes of interest to psychoanalysts. First, data from both studies indicate that disorganized attachment behaviors in infancy are important precursors of later dissociative symptomatology. Second, this early vulnerability is related to patterns of parent-infant affective communication, particularly quieter behaviors like emotional unavailability or role reversal, and does not appear to reside in the infant alone. Finally, the results suggest that the quality of the attachment relationship may in part account for why some people exposed to later trauma develop dissociative symptoms and others do not. To paraphrase Dori Laub (1993), the mother's seeing and not knowing in infancy may be a precondition of her child's knowing and not knowing in late adolescence. It remains unclear, however, whether the early relationship is predictive due primarily to the onset of an internal defensive process in infancy or whether its predictive power resides primarily in enduring patterns of parent-child dialogue that continually reinforce the child's segregated and contradictory mental contents.