Macfie, J. (2001)
Center for Developmental Science, University of North Carolina, 100 East Franklin Street, Chapel Hill, NC 27599-8115.
The development of dissociation in maltreated preschool-aged children.
Development and Psychopathology, 13, 233-254 (2001)

ABSTRACT Dissociation reflects disruptions in the integration of memories, perception, and identity into a coherent sense of self, and may develop following child maltreatment. The preschool years were identified as an important period for the development of dissociation. However, prior research has not examined the development of dissociation during this time. In order to address this gap, evidence of dissociation in 45 maltreated children, assessed for sexual abuse, physical abuse, and neglect, was compared with dissociation in 33 nonmaltreated children. Rather than depend on adult observer reports of behavior, the study sought to gain an understanding of dissociation from the child's own point of view. Because self-reports have limitations with such young children, a measure of dissociation evidenced in children's narrative story-stem completions was utilized. Maltreated children, especially physically abused children and sexually abused children, demonstrated more dissociation than did nonmaltreated children. Moreover, during the preschool period maltreated and nonmaltreated children followed different trajectories such that dissociation increased for maltreated children but did not do so for nonmaltreated children. Findings suggest that although the self is normatively integrated during the preschool period, it becomes increasingly fragmented for some maltreated children. Results are discussed in terms of cascading effects of maltreatment throughout development, and the importance of developmentally sensitive interventions.

Mangel, F.S. et.al. (2000)
An examination of bias in volunteer subject selection: findings from an in-depth child abuse study
Journal of Traumatic Stress = ISSN 0894-9867: Vol. 13 (2000), no. 1 (jan), pag. 77-88.

ABSTRACT Remarkably few reported studies tested the assumption that a research sample can be constructed which is representative of the population of interest. In order to investigate potential volunteer bias in abuse research, we utilized a database assembled for an NIMH funded study investigating the relationship among adolescent physical abuse, suicidal behavior, and psychopathology. Extensive information was available concerning the nonparticipant pool from which this sample was assembled, allowing for a comprehensive assessment of possible sample bias. The volunteer sample of 99 abused families who agreed to participate in our study was compared on a large number of variables with a random sample of 99 abused families who declined to participate. Comparisons of the two groups did not support the hypothesis that the non-participating families represented a more dysfunctional population. The two groups were far more similar to, than disparate from, each other.

Markowitsch HJ (2003)
Physiological Psychology, University of Bielefeld, D-33501, Bielefeld, Germany
Psychogenic amnesia
NeuroImage Volume 20, Supplement 1 , November 2003, Pages S132-S138

ABSTRACT Time- and content-based memory systems are briefly described so that their importance for a refined analysis of memory disturbances becomes evident. These memory systems are then related to their brain instantiation, emphasizing that there are limbic circuits for encoding different forms of memories, largely cortical networks for memory storage, and a combined temporofrontal network acting to trigger information retrieval. The terms functional amnesias and psychogenic amnesias are discussed and their symptomatology is compared to that of organic amnesias. The term "mnestic block syndrome" is introduced and defined as a syndrome of its own. Experimental data, obtained especially with functional imaging methods, are presented to elucidate changes in neural activation during functional amnesic states. It is concluded that functional amnesic states, confined to a patient's biography, can be triggered by environmentally induced stress and trauma, leading to lasting inability to retrieve autobiographical events. Such an impairment may be identified at the brain level using functional imaging techniques.

Markowitsch HJ Kessler J, Weber-Luxenburger G, Van der Ven C, Albers M, Heiss WD. (2000)
Neuroimaging and behavioral correlates of recovery from mnestic block syndrome and other cognitive deteriorations.
Neuropsychiatry Neuropsychol Behav Neurol 2000 Jan;13(1):60-6

ABSTRACT OBJECTIVE: We conducted a follow-up study on a patient with enduring psychic shock-induced cognitive impairment to study by neuropsychological and functional imaging methods the degree of his recovery process on the brain and cognitive levels. BACKGROUND: Based on the assumption that trauma and stress conditions can alter the functions of the nervous systems, we report on a patient whom we studied 2 and 12 months after he suffered "mnestic block syndrome" and additional cognitive deterioration symptoms. METHODS: We report on a patient studied 2 and 12 months after he suffered "mnestic block syndrome" and additional cognitive deterioration symptoms. Magnetic resonance imaging and fluorodeoxyglucose positron emission tomography were used for neural and detailed neuropsychological testing for cognitive deficits. RESULTS: The patient initially manifested severe intellectual decline, including severe anterograde and retrograde amnesia. His symptoms were correlated with major, although selective, reductions in his brain metabolism (2-3 SD below those of controls). Presently, he shows a normal brain metabolism and has regained parts of his memory and many of his other intellectual capabilities. Nevertheless, he still has long-term memory impairments. CONCLUSIONS: This case demonstrates a close relation between brain metabolism and cognitive performance, with major deficits of both at 2 months and major recovery of both at 12 months after a shocking event. It can serve as an example for possible stress-related deteriorations in certain brain regions, which can be partly corrected by psychotherapeutic interventions, passing time, and favorable environmental conditions.

Martinez-Taboas A, Bernal G (2000)
Caribbean Center for Postgraduate Studies, San Juan, Puerto Rico.
Dissociation, psychopathology, and abusive experiences in a nonclinical Latino university student group.
Cultur Divers Ethni Minor Psychol 2000 Feb;6(1):32-41

ABSTRACT A variety of clinical and experimental data suggest that many individuals who report abusive and traumatic experiences also report a wide array of dissociative and other psychopathological symptoms. In this study, 198 Puerto Rican undergraduate students participated in a study to examine the possible relationship between different types of traumatic experiences and the self-report of dissociative experiences, depressive symptoms, and general psychopathology. Another aspect of this study was the examination of the psychometric properties of the Dissociative Experiences Scale (DES) in a Latino sample. Results supported the hypothesis that those individuals who reported frequent and severe traumatic experiences were also the most likely to experience psychological malaise and scored higher on the DES. Of interest was the finding that the psychometric characteristics of the DES are consistent with those reported in the United States and other countries. The authors conclude that individuals with a marked history of trauma and abuse are more likely to use dissociative defenses as a coping response.

Marshall GN, ,Orlando M, Jaycox LH, Foy DW, Belzberg H. (2002)
RAND Criminal Justice Program, Santa Monica, California, USA.
Development and validation of a modified version of the Peritraumatic Dissociative Experiences Questionnaire.
Psychol Assess 2002 Jun;14(2):123-34

ABSTRACT This article reports results from 3 studies conducted to develop and validate a modified version of the self-administered form of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ; C. R. Marmar, D. S. Weiss, & T. J. Metzler, 1997). The objective was to develop an instrument suitable for use with persons from diverse ethnic and socioeconomic backgrounds. In Study 1, the original PDEQ was administered to a small sample (N = 15) recruited from among men admitted to the hospital for physical injuries stemming from exposure to community violence. Results led to modifications aimed at improving the utility of the instrument. In Study 2, the modified PDEQ was subjected to structural equation modeling and item response theory analyses to assess its psychometric properties in a larger, primarily male, sample of community violence survivors (N = 284). In Study 3, the reliability and validity of the modified instrument were further assessed in a sample of female survivors of sexual assault (N = 90). Results attest to the psychometric properties as well as the reliability and validity of the modified 8-item PDEQ.

Marshall, Randall D; Van der Kolk, Bessel A; Yehuda, Rachel. (2001)
Management and treatment of posttraumatic stress disorder.
Primary Psychiatry (ISSN: 1082-6319), v. 8, no. 8, pp. 75-81 (August 2001).

ABSTRACT Treatment of patients with PTSD can be complicated in clinical practice. The reasons why patients decide to seek professional help vary. Patients with chronic PTSD usually do not approach a physician with a clear understanding that their symptoms and complaints are a direct result of lasting effects of a traumatic event. One of the major methods to engage a patient in treatment is psychoeducation, which makes patients aware of their condition and reach the point wbere tbey want help and can be helped. There is probably no single treatment strategy that can be applied to all patients. Treatment has to be formulated based on the patients' preferences, capacities, and resources. Several psychotherapies and a number of medications have shown efficacy in the treatment of PTSD. The majority of experts recommend combination treatment for the most severely ill patients, although there is no systematic data to address tbis issue.

Marshall Randall D, Franklin R. Schneier, Shu-Hsing Lin, H. Blair Simpson, Donna Vermes, Michael Liebowitz (2000)
Childhood Trauma and Dissociative Symptoms in Panic Disorder
Am J Psychiatry 2000. 157:451-453

ABSTRACT : Childhood trauma has been associated with increased risk for both panic disorder and dissociative symptoms in adulthood. The authors hypothesized that among individuals with a primary diagnosis of panic disorder, those experiencing depersonalization/derealization during panic attacks would be more likely to have a history of childhood trauma. METHOD: Rates of traumatic events were compared between panic disorder patients with (N=34) and without (N=40) prominent depersonalization/derealization during panic attacks. Symptom severity in the two groups was also examined. RESULTS: Contrary to the authors’ hypothesis, no evidence was found that depersonalization/derealization during panic attacks was associated with childhood trauma. Minimal differences in severity of illness were found between patients with dissociative symptoms and those without such symptoms. CONCLUSIONS: This finding is consistent with a multifactorial model of dissociation. Factors other than childhood trauma and general psychopathology may underlie vulnerability to dissociative symptoms in panic disorder

Mathew, R.J., Wilson, W.H., Chiu, N.Y., Turkington, T.G., Degrado, T.R., & Coleman, R.E. (1999)   
Regional cerebral blood flow and depersonalization after tetrahydrocannabinol administration
Acta Psychiatrica Scandinavica, 100, 67-75.

ABSTRACT Examined the relationship between depersonalization induced by tetrahydrocannabinol (THC), and regional brain activation. Cerebral blood flow (CBF) was measured by means of positron emission tomography (PET) in 59 normal right-handed volunteers (mean age 31.8 yrs) before and following intravenous infusions of THC. After THC, CBF showed a global increase which was more marked in the right hemisphere, frontal lobes, and anterior cingulate. Regression analyses showed positive correlations between the right frontal and anterior cingulate and depersonalization. 

Linda M. McLean, Ph.D., and Ruth Gallop, Ph.D. (2003)   
Implications of Childhood Sexual Abuse for Adult Borderline Personality Disorder and Complex Posttraumatic Stress Disorder
Am J Psychiatry 160:369-371, February 2003

ABSTRACT OBJECTIVE: This study examined whether women with a history of early-onset sexual abuse or those with late-onset sexual abuse were more likely to meet diagnostic criteria for both borderline personality disorder and complex posttraumatic stress disorder (PTSD). METHOD: The Revised Diagnostic Interview for Borderlines and the Trauma Assessment Package were administered to 65 women from three outpatient clinics in a metropolitan area. Thirty-eight subjects met criteria for early-onset abuse, while 27 subjects met criteria for late-onset abuse. RESULTS: The diagnoses of both borderline personality disorder and complex PTSD were significantly higher in women reporting early-onset abuse than in those with late-onset abuse. The trauma variables sexual abuse and paternal incest were significant predictors of both diagnoses. CONCLUSIONS: In contrast to those with comorbid diagnoses, some women with a history of childhood sexual abuse may be extricated from the diagnosis of borderline personality disorder and subsumed under that of complex PTSD.

McNally, Richard J. (2004)   
The Science and Folklore of Traumatic Amnesia
Clinical Psychology: Science and Practice V11 N1, 2004.

ABSTRACT Some clinical theorists believe that certain experiences are so overwhelmingly traumatic that many victims dissociate their memory for the experience (Gleaves, Smith, Butler, & Spiegel, this issue). Unfortunately, clinicians who endorse this hypothesis often exhibit confusion about the very studies they cite in support of it. For example, they often misinterpret everyday forgetfulness that develops after a trauma with an inability to remember the trauma itself; they confuse organic amnesia with traumatic amnesia; they confuse psychogenic amnesia (massive non-organic retrograde amnesia coupled with loss of personal identity) with (alleged) inability to remember a traumatic event; and they confuse not thinking about something (e.g., sexual abuse) for a long period of time with an inability to remember it (i.e., amnesia). The purpose of this commentary is to dispel some of this confusion.

McNally, Richard J. (2001)   
The cognitive psychology of repressed and recovered memories of childhood sexual abuse: clinical implications.
Psychiatric Annals (ISSN: 0048-5713), v. 31, no. 8, pp. 509-514 (August 2001).

ABSTRACT Few controversies in psychiatry have been as bitter as the one concerning repressed and recovered memories of childhood sexual abuse. Whereas some scholars doubt that traumatic amnesia occurs at all, others believe it happens often. Strikingly, this debate has been wholly unencumbered by data on cognitive functioning in the very people at the heart of the controversy: individuals who report having repressed and recovered memories of childhood sexual abuse. To fill this empirical gap, our research team has conducted a series of studies on four groups of women recruited from the community via newspaper announcements: (1) those who believe they were sexually abused as children, but who have no memory for these events ("repressed" memory group); (2) those who report having recalled long-forgotten episodes of childhood sexual abuse ("recovered" memory group); (3) those who report never having forgotten their childhood sexual abuse ("continuous" memory group); and (4) those who report never having been sexually abused ("control" group). The twofold purpose of this article is to summarize our findings and to elucidate their implications for clinical practice. [Text, p. 509]

McNally, Richard J; Clancy, Susan A; Schacter, Daniel L. (2001)   
Directed forgetting of trauma cues in adults reporting repressed or recovered memories of childhood sexual abuse.
Journal of Abnormal Psychology. Vol 110(1) Feb 2001, 151-156

ABSTRACT An item-cuing directed forgetting task was used to investigate whether women reporting repressed (n = 13) or recovered (n = 13) memories of childhood sexual abuse (CSA) exhibit an avoidant encoding style (and resultant impaired memory) for trauma cues relative to women reporting no CSA experience (n = 15). All participants viewed intermixed trauma (e.g., molested), positive (e.g., confident), and categorized neutral (e.g., mailbox) words on a computer screen and were instructed either to remember or to forget each word. The results provided no support for the hypothesis that people reporting either repressed or recovered memories of CSA are especially adept at forgetting words related to trauma. These groups recalled words they were instructed to remember more often than words they were instructed to forget regardless of whether they were trauma related.

McNally, Richard J. and Susan A. Clancy, and Daniel L. Schacter (2000)   
Cognitive Processing of Trauma Cues in Adults Reporting Repressed, Recovered, or Continuous Memories of Childhood Sexual Abuse
Journal of Abnormal Psychology, 2000, Vol. 109, No. 3, 355–359,

ABSTRACT Psychologically traumatized people exhibit delayed color naming of trauma words in the emotional Stroop task. Four groups of participants were asked to color name positive words, neutral words, and trauma words; these groups included 15 women who believed that they harbored repressed memories of childhood sexual abuse (CSA), 13 women who reported recovered memories of CSA, 15 women who had never forgotten their CSA, and 12 women who had never been abused. Repressed-memory participants exhibited patterns of interference indistinguishable from those of the nonabused control group participants. Irrespective of group membership, the severity of self-reported posttraumatic stress disorder symptoms was the only significant predictor of trauma-related interference, r(48) = .30, p

Meares R (1999).
Dept. of Psychological Medicine, University of Sydney, Westmead Hospital, Australia.  
The contribution of Hughlings Jackson to an understanding of dissociation.
Am J Psychiatry 1999 Dec;156(12):1850-5

ABSTRACT The author provides a preliminary framework for a systematic and dynamic understanding of dissociation through a consideration of the theories of Hughlings Jackson. Jackson's ideas are briefly reviewed. He saw the proper scientific investigation of mental illness as an experimental investigation of mind. Accordingly, his argument begins with this fundamental concept. His views of the brain-mind relationship and of mind, or self, resemble modern conceptions. He viewed the self as double and focused on those disruptions of the self system which he called the "dreamy state." This state involves an "uncoupling" of normal consciousness, resulting in the loss of the most recently developed forms of memory and of the stream of consciousness. Dissociation is seen here as analogous to the dreamy state. Jacksonian theory predicts the main features of dissociation, i.e., constriction of consciousness, a particular form of amnesia, disaggregation of perceptual phenomena, depersonalization, derealization, and hallucinosis. It leads to the view that dissociation can be seen, in essence, as an uncoupling of consciousness.

Meares R (1999).
Dept. of Psychological Medicine, University of Sydney, Westmead Hospital, Australia.  
The "adualistic" representation of trauma: on malignant internalization.   
Am J Psychother 1999 Summer;53(3):392-402

ABSTRACT This paper suggests that traumatic memories are represented in a way that is qualitatively different from nontraumatic memories. The argument depends upon a concept of self, derived from Hughlings Jackson and William James, which is double, involving not only mental life but reflection upon it. Trauma is seen as causing an uncoupling, or dedoubling, of consciousness. The traumatic diminishment of the subject-object distinction in psychic life has several main effects. First, there is a change in the form of consciousness to a state which is focussed on the present and on immediate stimuli. Secondly, the memory system in which the traumatic events are recorded is nonepisodic, lacking the reflective component. In this way, it is unconscious. Thirdly, the traumatized-traumatizer dyad is represented not as two persons in relation but more nearly as a fused monad. This representation is not integrated into the system of self as the stream of consciousness but remains relatively sequestered. This sequestration is "unstable," determining rapidly oscillating, and opposite, forms of relatedness, termed "reversals." Finally, in an "uncoupled" state, the interpretation of the "meaning" of the traumatic event is impaired. Its construction is determined by affect.

Melchert, T.P. (1999).  
Relations among childhood memory, a history of abuse, dissociation, and repression.
Journal of Interpersonal Violence, 14, 1172-1192.

ABSTRACT Investigated questions regarding the relationships between a history of child abuse, recovered abuse memories, childhood memory in general, repression, and dissociation. Of 560 college student Ss (mean age 19.14 yrs) who completed a series of questionnaires, one quarter reported a history of child abuse, and 18% of these reported that they had a period when they lacked memories of their abuse. These Ss endorsed a variety of descriptions of their recovered memories, many of which do not suggest a lack of conscious access to the memories. General quality of childhood memory was found to be unrelated to a history of abuse, and most Ss, regardless of their abuse history, reported recovering memories from their childhood in general. Repressive personality traits were found to be unrelated to recovering abuse memories, but dissociative traits were found to be weakly associated with recovering abuse memories.

Merckelbach H, Muris P (2001)
Department of Experimental Psychology, Maastricht University, The Netherlands.
The causal link between self-reported trauma and dissociation: A critical review.   
Behaviour Research & Therapy. 2001 Mar Vol 39(3) 245-254

ABSTRACT Summarizes evidence that cast doubts on the commonly voiced view that the connection between self-reported trauma and dissociation is a simple and robust one. It is argued that: (1) the correlations between self-reported traumatic experiences and dissociative symptoms reported in the literature are, at best, modest; (2) other factors may act as a 3rd variable in the relationship between trauma and dissociation; and (3) high scores on the Dissociative Experiences Scale are accompanied by fantasy proneness, heightened suggestibility, and susceptibility to pseudomemories. The authors maintain that these correlates of dissociation may promote a positive response bias to retrospective self-report instruments of traumatic experiences. Thus, the possibility that dissociation encourages self-reported traumatic experiences rather than vice versa merits investigation. It is concluded that while attractive, simple models in which trauma directly causes dissociation are unlikely to be true.

ABSTRACT Previous research has noted a robust correlation between dissociation and schizophrenia-like symptoms. One way to interpret the relationship between dissociation and schizotypy is to assume that it is an artifact of fantasy proneness. In the present study, 152 undergraduates completed measures of dissociation, schizotypy, and fantasy proneness. Dissociative tendencies were found to be related to the full range of schizotypal features. Regression analysis showed that schizotypy still contributed to the prediction of dissociative tendencies when variance related to fantasy proneness was extracted. These results indicate that the close connection between dissociation and schizotypy cannot be interpreted in terms of an artifact produced by fantasy proneness. Thus, the overlap between dissociation and schizotypy warrants systematic study

Merrill LL, Thomsen CJ, Gold SR, Milner JS (2001)
Childhood abuse and premilitary sexual assault in male Navy recruits.   
J Consult Clin Psychol 2001 Apr; 69(2):252-61 .

ABSTRACT Three samples of male U.S. Navy recruits (N = 7,850) were surveyed to determine whether a history of childhood physical abuse (CPA) or childhood sexual abuse (CSA) was predictive of premilitary rape of women and whether these relationships were mediated by alcohol problems and number of sex partners. In the 3 samples, 11.3%, 11.6%, and 9.9% of men reported committing premilitary rape. When demographic factors were controlled for, both CPA and CSA were independently and additively predictive of rape in each sample, with men who experienced both forms of abuse showing the highest risk of committing rape. Additional analyses revealed that alcohol problems and number of sex partners significantly mediated the relationship between childhood abuse (CPA and CSA) and rape perpetration.

ABSTRACT OBJECTIVE: Series of patients fulfilling diagnostic criteria for Dissociative Identity Disorder (DID), otherwise known as multiple personality disorder, have particularly been reported on in North America and increasingly in other countries. The present study investigated the trauma and past treatment histories, symptom profiles and dissociative phenomenology of 62 patients fulfilling diagnostic criteria for DID seen in Brisbane (Queensland, Australia). METHOD: From 1992, systematic assessments, including the Dissociative Experience Scale and the Dissociative Disorders Interview Schedule, were performed with a personal series of 57 patients with DID seen by one of the authors (WM) and five patients seen by the second author (JB). RESULTS: The histories of childhood trauma, the clinical profiles and dissociative indices of these patients closely approximate those described in series reported in other countries. CONCLUSIONS: Patients fulfilling diagnostic criteria for DID are regularly seen in Australian inpatient and outpatient settings. The dissociative symptomatology of the patients examined in the present study represents a significant component of a complex syndrome associated with a history of severe ongoing developmental trauma dating from early childhood.

ABSTRACT Survivors of severe, chronic childhood trauma, including those with dissociative disorders, present for therapy with a wide range of symptomatology that interferes with daily functioning. Fragmentation and PTSD disrupt the capacity for integrated and satisfying relationship development, which affects the social, professional, and intimate lives of survivors. The problem with pleasure -- that pleasurable stimuli are often not experienced as such by survivors -- is generally not addressed in the literature. This paper posits that clinical attention to the problem with pleasure may significantly enhance therapy, engendering substantial gains in resiliency that may allow some survivors to more easily overcome the circumstances of extreme neglect and abuse. This paper discusses four primary domains that are affected and that have implications for problems with pleasure: excitation and hyperarousal states, the capacity for self-soothing and the problem of numbing, skill development and skill deficit, and core belief systems and attendant script decisions. This paper posits that by understanding more fully the interconnection between these capacities and deficits, therapeutic work with survivors can be enhanced, with greater engagement of their resiliency, and hastening their recovery through the restoration of pleasure.

ABSTRACT Similarities between implicit memories and unprocessed traumatic memories have led traumatologists to equate them. Both have "physicality": They are grounded in the body rather than narrative, being retrieved in sensations, motor responses, affects, ego states, and images. Sheltered from the cognitive processes that use language to alter memories, they remain stable over time, unconscious, and dependent on specific retrieval cues that replicate part of the original event. Nevertheless, if dissociation produces unprocessed traumatic memories whereas association produces implicit memories, how can they be identical? I argue that they differ in the causal mechanisms and unconscious strategies that the self uses to process their physicality. I hypothesize that unprocessed traumatic memories change over time if the self integrates their physicality into its central goals and meanings, its core, making them less similar to implicit memories and more similar to normal event memories. I propose a new concept, "self-embodied memories" -- related to concepts developed by Elin and Glenberg -- that, like the concept of implicit memory, captures memory's physicality but also relates it to the self's processing strategies. A clinical vignette illustrates changes in a child's unprocessed traumatic memory as it became integrated with her sense of self. KEY WORDS: traumatic memory, implicit memory, embodied self memory, dissociation, unconscious, self-integration, encoding-specificity, accuracy

Croatian Medical Journal = ISSN 0353-9504: Vol. 40 (1999), no. 4 (dec), pag. 503-507.

ABSTRACT AIM: To present the complexity of therapist's feelings and emotions in the work with war-traumatized persons and the importance of psychological mechanisms taking place in such circumstances. METHODS: The method of psychoanalytical psychotherapy was used, adapted to the work with war-traumatized persons. The therapy sessions were held once a week and lasted for 50 minutes. The patients were given transference interpretations differing from customary transference interpretations. They were modified to provide support, aiming at overcoming of the feelings overwhelming each patient. RESULTS: The diversity of the therapist's feelings amalgamated into countertransference was one of the most important psychological mechanisms in the therapy procedures, and served as an indicator of the patient's feelings in the procedure. It was related to the processes of projective identification as a framework of the complex patient-therapist relationship CONCLUSIN: In the work with a war-traumatized patient, it is inevitable that the patient's feelings are partly shared by the therapist through projective identification. This can lead to the "burnout" syndrome and threaten the boundaries of the therapist's psychological system. The role of the therapist includes not only knowledge but also the personal experience of work on himself. Through the process of therapy and by using interpretations as the powerful tool, the therapist is capable to accept such traumatic feelings and help the patient overcome them, but also to remain within the framework of his role.

ABSTRACT Cyclical spouse abusers, whether male or female, appear to suffer from a specific type of dissociative disorder that is related to a disturbance of attachment. Similar to the classic story of Dr. Jekyll and Mr. Hyde, the disorder is sufficiently common to be designated as a dissociative disorder in its own right. The partner of the spouse abuser appears to develop a parallel dissociative process, developing chains of state- dependent memory for the different phases of the domestic abuse cycle. This dissociative process helps both partners stay in the relationship, while leaving might be the best course of action. This "dissociative dance" facilitates the formation of dissociative splits in their children, enhancing the likelihood that they will be either victims or perpetrators of domestic violence. The article explains how the dissociation theory is manifested throughout all phases of the abuse cycle, including buildup, discharge, and post-discharge. Strategies for helping battered spouses leave abusive relationships are described. 15 references. (Author abstract modified)

Modestin J, Erni T. ,

Psychiatry Res. 2004 Apr 15;126(1):77-82.

ABSTRACT A dissociative taxon has been proposed by Waller et al. (1996) to help identify individuals experiencing pathological dissociation. We studied the frequency of taxon membership and tested its validity. A total of 276 students and 204 psychiatric inpatients completed the Dissociative Experiences Scale (DES). In patients with higher DES ratings, the Dissociative Disorders Interview Schedule was administered. Taxon classification applied to 2.9% of non-patients and to 12.7% of patients. No statistically significant relationship was found between taxon membership and the clinical diagnosis of a dissociative disorder. Taxon membership indicates a higher frequency of dissociative experiences but cannot be equated with the presence of a dissociative disorder.

Modestin J , Lotscher K, Erni T.

ABSTRACT The relationship between dissociation and some of its potential correlates and antecedents was explored. Young medical students (N = 276) completed the Dissociative Experiences Scale (DES), Parental Bonding Instrument (PBI), 20-item Toronto Alexithymia Scale (TAS-20) and Munich Personality Test (MPT). The findings indicate that both personality characteristics (such as alexithymia and neuroticism) and, to a modest degree, environmental factors in terms of the lack of parental care contribute to the dissociation variance.

ABSTRACT The rationale underpinning the diagnosis of acute stress disorder is that cognitive mechanisms result in avoidant processing of aversive experiences. This study investigated acutely traumatized participants with either acute stress disorder (ASD; n=15) or no ASD (n=14) and nontraumatized comparison participants (n=16). Participants were administered intermixed presentations on a computer screen of positive, neutral, and trauma-related words that were followed by instructions to either remember or forget each word. On a subsequent recall test, ASD participants displayed poorer recall of to-be-forgotten trauma-related words than did non-ASD participants. Severity of psychopathology was negatively correlated with to-be-remembered positive words. These findings are consistent with the proposal that people who develop ASD display an aptitude for superior forgetting of aversive material.

ABSTRACT OBJECTIVE: Peritraumatic dissociation has been associated with subsequent development of posttraumatic stress disorder, but supporting data have been largely retrospective. The current study was designed to assess the nature and prevalence of dissociative symptoms in healthy humans experiencing acute, uncontrollable stress during U.S. Army survival training. METHOD: In study 1, 94 subjects completed the Clinician-Administered Dissociative States Scale after exposure to the stress of survival training. In study 2, 59 subjects completed the Brief Trauma Questionnaire before acute stress and the dissociative states scale before and after acute stress. A randomly selected group of subjects in study 2 completed a health problems questionnaire after acute stress. RESULTS: In study 1, 96% of subjects reported dissociative symptoms in response to acute stress. Total scores, as well as individual item scores, on the dissociation scale were significantly lower in Special Forces soldiers compared to general infantry troops. In study 2, 42% of subjects reported dissociative symptoms before stress and 96% reported them after acute stress. Dissociative symptoms before and after stress were significantly higher in individuals who reported a perceived threat to life in the past. Forty-one percent of the variance in reported health problems was accounted for by poststress dissociation scores. Discussion: Symptoms of dissociation were prevalent in healthy subjects exposed to high stress. Stress-hardy individuals (Special Forces soldiers) experienced fewer symptoms of dissociation, compared to individuals who were less hardy. These data support the idea that the nature of response to previously experienced threatening events significantly determines the nature of psychological and somatic response to subsequent stress.

ABSTRACT Examined the validity of the Traumatic Stress Disorder scale of the Screen for Child Anxiety Related Emotional Disorders (SCARED), a recently developed self-report questionnaire measuring Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) defined anxiety disorders symptoms in children. A large sample of normal schoolchildren (N = 996) ages 7 to 19 years completed the SCARED. Children who scored high on the SCARED Traumatic Stress Disorder scale (i.e., trauma group; n = 43) and children who scored low on this scale (i.e., control group; n = 43) were then interviewed about their most aversive life event. In addition, children completed self-report questionnaires of traumatic experiences and posttraumatic stress disorder (PTSD) symptomatology. Results showed that children in the trauma group more frequently reported life events that independent judges considered to be 'potentially traumatic' than did control children. Furthermore, children in the trauma group reported having experienced more traumatic incidents and had higher scores on PTSD-related questionnaires compared with control children. Moreover, trauma group children more frequently fulfilled DSM-IV criteria for PTSD than did control children. The results of this study support the validity of the Traumatic Stress Disorder scale of the SCARED.

ABSTRACT A community sample of depressed and well mothers, recruited at 2 months postpartum and assessed through to 18 months, was followed up at 5 years. The quality of mother-child interactions was assessed, as was the children's behavioural and social adjustment, using maternal reports and observations of child behaviour during free play at school. Several aspects of child outcome were found to be associated with postnatal depression, even when taking account of current adverse circumstances (maternal depression and parental conflict). These included the child's behaviour with the mother, the presence of behavioural disturbance at home, and the content and social patterning of play at school. These associations with postnatal depression were independent of the child's gender. The child's relationship with the mother appeared to be mediated by the quality of infant attachment at 18 months. The mother's behaviour with her child was more affected by current difficulties, in particular by conflict with the child's father. Together these findings suggest that, while maternal behaviour varies with changing circumstances, exposure to maternal depression in the early postpartum months may have an enduring influence on child psychological adjustment.

J Forensic Sci 2000 May;45(3):698-701

ABSTRACT Sexual homicide by juveniles is a rare phenomenon, and information regarding the psychological and behavioral characteristics of this group is limited. No studies exist which have investigated anger experience and styles of anger expression, and the relationship between anger, sadistic personality disorder, and psychopathy, in this type of youthful offender. These areas were explored by evaluating 14 juvenile sexual homicide offenders through clinical assessment, the State-Trait Anger Expression Inventory (STAXI), the Schedule for Nonadaptive and Adaptive Personality (SNAP), the Revised Psychopathy Checklist (PCL-R), and review of correctional records. Descriptive information for the STAXI scales and internal consistency data are presented. Trait Anger was significantly higher than State Anger for the youth, but still comparable to adolescent norms. The difference between Anger-In and Anger-Out scale scores was not significant. Unexpectedly, Anger Control scale scores were significantly higher than Anger Out scale scores, clinically consistent with efforts by some of these boys to resist sadistic impulses. Those four (31%) participants who met criteria for sadistic personality had significantly higher Anger-Out scale scores than those without the disorder, and were also higher on Trait Anger to a marginally significant degree. Psychopathy was significantly negatively associated with Anger Control. This study is intended to contribute to the scant literature on juvenile sexual homicide, and lends some support to the validity and utility of sadistic personality disorder as a diagnosis in younger forensic populations. The findings did not support the contention that this form of violence is necessarily an outgrowth of excessive anger.