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We discuss consciousness from evolutionary and developmental perspectives. The expansion of communicative abilities was a necessary step for the emergence of a new type of cooperation based on equality that probably appeared for the first time among nomadic hunter gatherers during the upper Paleolithic era. In turn, this new level of cooperation gave raise to an expanded form of consciousness. From a developmental perspective an expansion of intersubjective abilities and consciousness go together. Three basic levels of intersubjectivity are present in humans. A primary form of intersubjective communication is accompanied by a primary form of consciousness that is not easily accessible for conscious scrutiny. During the second year of human life secondary forms of intersubjectivity expand consciousness from the immediacy of one-to-one interactions, to include a shared understanding of intentions and goals with caregivers. Secondary forms of intersubjectivity give raise to the type of consciousness characterized by preverbal symbols and images--a primordial form of conceptual knowledge. A further step in intersubjective communication uses the meanings and concepts that have emerged earlier in development and transforms them into words. The leap into language allows our species to conceive past, present, and future simultaneously. The cultural transmission of knowledge and social mores depends on these abilities. This further expands the scope of consciousness and creates conditions for self reflection, a type of consciousness that is uniquely human.

In this comment to Paolo Stramba-Badiale’s description of his clinical case, I argue that the therapist’s acknowledgment of feelings of powerlessness both in self and in the patient, without surrendering to them and without untimely attempting to overcome them, is a major factor of therapeutic change in the treatment of dissociative adults who had been chronically traumatized since early childhood. Consideration of the dynamic tension between the motivational system engaged in coping with environmental threats (freezing-fight-flight-feigned death) and the care-seeking (attachment) system provides the background for the argument, together with the knowledge of the controlling interpersonal strategies that typically follow, during childhood, infant attachment trauma. [ABSTRACT FROM PUBLISHER]

This paper reviews theoretical, clinical and research studies on the apperance, in a subgroup of obsessive compulsive disorders (OCD), of symptoms related to the disruption of the usually integrated functions of consciousness, memory, identity and perception (pathological dissociation). The coexistence of dissociative and obsessive-compulsive symptoms is a relatively frequent clinical occurrence, that seems to be responsible for unsatisfactory response to the cognitive-behavorial therapy (CBT) of OCD. The aim of the review is to clarify the different types of dissociative symptoms and processes that may appear in OCD, their relation to absorption in compulsive responses, and the role played by traumatic expreriences in the association between dissociative and obsessive-compulsive symptoms. Such a clarification is a necessary premise to the implementation of modified types of CBT interventions able to yield satisfactory outcomes in cases of OCD complicated by dissociative symptoms. [ABSTRACT FROM AUTHOR]