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The formulation of precise guidelines for the treatment of dissociative disorders is hampered by the lack of an agreed definition of dissociation. On the contrary, there is unanimous agreement among experts that the term dissociation improperly groups together a vast and heterogeneous group of psychopathological manifestations sustained by different pathogenetic processes that spread throughout psychiatric clinical pictures, complicating their treatment. In view of this limitation, the review reports the guidelines for the treatment of certain dissociative manifestations of the Blue Knot Foundation (2020) of the Australian government’s Department of Health and the guidelines for the treatment of Dissociative Identity Disorder (DDI), the most severe dissociative disorder, drawn up by the International Society for the Study of Trauma and Dissociation – ISSTD. [ABSTRACT FROM AUTHOR]

Traumatic experiences, both episodic and ongoing over time, especially during development, can generate specific clinical pictures such as Post-Traumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD) and Complex Post-Traumatic Stress Disorder (CPTSD), but also constitute a psychopathological dimension that spreads across all clinical pictures worsening their prognosis and treatment outcomes. The guidelines presented in this review were developed for the treatment of specific diagnostic categories. Specifically for PTSD by the American Psychiatric Association (APA; 2017), the British National Institute for Health and Care Excellence (NICE; 2018), the Department of Veterans Affairs (VA) and Department of Defense (DoD) of the United States of America (VA/DoD; 2017). Regarding ASD, indications for the management of patients with this disorder can be found in the 2004 APA guidelines. The UK Psychological Trauma Society (2017), the International Society for Traumatic Stress Studies (ISTSS; 2019), and NICE (2018) provide guidelines for cPTSD. [ABSTRACT FROM AUTHOR]

In this work we present the theories related to the impact of the traumas on the mechanisms of dissociation, disregulation and dependence; thus we use them to analyze the life history and the scores obtained by two inmate subjects to some psychological tools. In a first moment we describe how the combination of personal and environmental characteristics and the traumatic experiences lived during infancy and adolescence can cause the pathological use of dissociative mechanisms, and can thus favor the onset of a deficit in the abilities of mentalization and autonomous regulation of affects and impulses in the subject. We therefore shortly narrate the life histories of two inmates, Mr. G and Mrs. A, both presenting problems of substance dependence and traumatic experiences. In a first moment we expose the principal events of their history, with a particular attention to those that lead to their detention, therefore we introduce and discuss the scores they obtained to a battery of psychological tools that investigate the level of psychopathy (through the PCL-R), the dissociative experiences (through the DES-II), the characteristics of state and trait anger (through the STAXI-2), the presence of traumatic experiences (through the TEC) and various characteristics of personality (through the MMPI-2). We then analyze their history in the light of the data underlined by the tests scores, as well as of the theories exposed in the first part of the work. We consider therefore the possible developmental trajectories deriving from the different experiences of life in a normal subject and in a subject with pathological dissociation, and we finally introduce our theory according to which the subject that present a dependence, considered as a result of an affective disregulation, suffer from the impossibility to autonomously regulate the impulses, with particular attention to anger, and don't have therefore other choice that to put them in action or hypercontrol them through an obsessive type of rumination mechanism. We then conclude putting in evidence that this point of view can provide a new interpretation for some antisocial and dependence behaviors, as well as useful cues to direct possible therapies both in prison that of preventive type. [ABSTRACT FROM AUTHOR]

The presence of states dissociative, especially in patients which suffer of affective disease has received always poor attention in the literature of the last decades (Mula et al. 2008). The significant studies who put in correlation the dissociative states, meant in the sense of the " divided self " with the affective syndromes are still rarer. The dissociation and the schizoid personality are considered according to the hypothesis of Winnicott (1965) and Laing (1959). We consider the affective disease, referring to the description of the "maniac world" of Binswanger (1933). We describe a clinical case of a young 33 years old woman, in which the dissociative state in the schizoid personality appears as acute maniac state. We do not take as a reference the diagnostic categories of DSM-IV-TR (Andreoli et al. 2002), and make reference to the criticism developed by many psychoanalists and psychiatrists to psychodynamic orientation (Wilson 1993) (Akhtar 1987). However have also observed the affective state gravity and the schizoid personality through tools psychodiagnostic, wide use what: Brief Psychiatric Rating stairs (BPRS), Clinical Global Impression (CGI), Minnesota Multiphasic Personality Inventory (MMPI-2) and Rorschach. In conclusion working at history and at the observation of the patient one formulated the hypothesis the mania represents the expression of a schizoid dissociative state. [ABSTRACT FROM AUTHOR]

The Authors show the fundamental principles in the treatment of the Dissociative Disorders, in the perspective of the Cognitive-Evolutionary Psychotherapy. They describe the so called "Staged Therapy", characterized by a starting phase toward the stabilization of the patient and the symptomatology's reductions; by a central phase of processing of the relational and complex traumas often grounding the dissociative states; and then by an integration and a "post-traumatic growing". The Authors examine the different strategies and techniques, most frequently used, from the therapeutical body work till self-help groups, from psychopharmacology till hypnosis. A significant part of the article show the importance of the EMDR approach in the treatment of dissociative states. [ABSTRACT FROM AUTHOR]

Dissociation is a term indicating Dissociative Disorders DSM category, a cluster of symptoms and trauma based psychopathological processes hampering the integration of mental functions. Dissociative processes cause dissociative symptoms that could dominate some disorders like Dissociative Disorders but also spread to other disorders worsening the prognosis. The wide diffusion of dissociative symptomatology in many disorders, clinical observations and supporting experimental data about the effects of childhood adversities, suggest the presence of a dimensional psychopathology associated with developmental trauma worsening therapies outcome and that requires specific skills for an appropriate treatment. [ABSTRACT FROM AUTHOR]

Comparative study of a dissociative experience of the bodily scheme lived in a group relaxing session (R.A.T.) comparable to certain somatic pains found in a schizophrenic situation. Such psychopathological experiences, usually considered by doctors as in themselves averse and without meaning, can be transferred from the emotive level to the rational level using the "Ontoanalytic" method and in this way be a valid contribution to the psicological formation of the doctors in as much as a more syntonic, human and staisfying doctor-patient relationship ensues, as Balint indicated.

The hypnotic process starts when the ties between subject and object (perceptions) are sufficiently slackened. The psychodynamics of hypnosis in the hypnotized are reviewed, highlighting the mental machinery set in motion from the start of the process to its conclusion.