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The Dissociative Experiences Scale (DES) is the most widely used self-report measure of dissociation but lacks a validity scale. Abu-Rus et al. (2020) created the DES-V by embedding atypical and inconsistency items in the DES, ultimately concluding that atypicality demonstrated the greatest ability to differentiate honest respondents from feigners. Among their study limitations, Abu-Rus et al. noted the homogeneous nature of their clinical group (i.e., largely comprising individuals with PTSD) and the potential need to refine the existing atypicality items for a more heterogenous dissociation population. The current study aimed to refine the DES-V by enlisting dissociation experts to improve the believability of the atypical items (while simultaneously ensuring they did not betoken any actual dissociative symptomology) and by supplementing the online sample with a clinical sample that included a broad range of dissociative disorders. Data cleaning comprised eight different techniques, to better ensure the validity of the online sample. Honest and Feigning groups completed the assessments through Amazon’s Mechanical Turk; the clinical dissociative disorder group completed hard copy versions. The atypicality scale discriminated the three groups well, with the Feigning group scoring significantly higher than both of the honest groups (online and clinical). The mean atypicality scores of the two honest groups did not differ significantly. In addition, the scale incremented over the original DES-V in a logistic regression predicting honest and feigning participants. These robust results suggest that the revised DES-V could provide researchers with a valuable tool for validating online samples with greater precision – an increasingly vital need in light of the growing reliance on online samples. [ABSTRACT FROM AUTHOR]

The article focuses on the exposure of incest's widespread prevalence, challenging long-held misconceptions about its rarity and social stratification. Topics include the historical secrecy surrounding incest, the role of second-wave feminism in uncovering its frequency across all social classes, and the involvement of family members in criminal sexual exploitation and trafficking.

The first purpose of this study was to determine the course of dissociation among patients with borderline personality disorder (BPD) and personality-disordered comparison subjects (OPD) over 24 years of prospective follow-up. The second purpose was to determine clinically meaningful predictors of dissociation among patients with BPD. The Dissociative Experiences Scale (DES) was administered to 290 patients with BPD and 72 personality-disordered comparison subjects at baseline, and then once every two years over 24 years of prospective follow-up. Baseline predictors were assessed with the Revised Childhood Experiences Questionnaire (CEQ-R), the SCID-I, and the Shipley Institute of Living Scale. Time-varying predictors were assessed at baseline and every subsequent two years by means of the Abuse History Interview (AHI). Patients with BPD had higher baseline dissociation scores than personality-disordered comparison subjects. Whilst dissociation decreased significantly over time for both patient groups, the BPD group showed a steeper decline. Severity of childhood sexual abuse, adult history of rape, adult history of partner violence, and IQ were multivariate predictors of dissociation among patients with BPD. Taken together, the present findings suggest that a combination of interpersonal trauma exposure and cognitive abilities may contribute to the severity of dissociation in adult patients with BPD. [ABSTRACT FROM AUTHOR]

Higher lifetime trauma exposure and increased peritraumatic dissociation (PD) are well-known predictors of Post-Traumatic Stress Disorder (PTSD) symptoms following new trauma (prospective PTSD symptoms). The interplay between those factors, however, is not well established. In this study, we aimed to assess whether PD mediates the influence of lifetime trauma exposure on prospective PTSD symptoms. A total of 387 adults visiting five emergency departments who had experienced a traumatic event within 72 hours completed baseline assessments on lifetime trauma exposure count and PD. PTSD symptoms were assessed 1 month later. Structural equation modeling was used to examine the mediation effect of PD in the relationship between lifetime trauma exposure count and 1-month PTSD symptoms. We found that PD mediated the association between lifetime trauma exposure count and 1-month PTSD symptoms, even after accounting for some confounders. However, the mediation was partial, accounting for 17.9% of the lifetime trauma exposure count's total effect. While this finding is significant, it also suggests that additional mechanisms beyond PD play a role in explaining the influence of higher lifetime trauma exposure on prospective PTSD symptoms. These findings provide valuable insights into the complex dynamics of PTSD development and call for further research to explore complementary factors and preventive strategies. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that indirect verbal exposure to traumatic events can be sufficient to cause intrusions and other posttraumatic stress symptoms. In this study, we used a verbal trauma report to experimentally induce intrusions and a tactile task to manipulate the putative processes underlying intrusion development. Our findings indicate that the verbal report indeed induced intrusive recall. Moreover, the verbal report induced negative mood, state anxiety, and state dissociation, with mood and state dissociation predicting intrusion development. Additionally, the tactile task interfered with intrusion formation as indicated by the primary diary measure, but not the retrospective self-report. However, these results await further replication as this and previous trials suffered from limited statistical power. The findings support the reports by trauma therapists who experience secondary traumatization. They also challenge the assumption that all intrusions develop bottom-up from low-level sensory input via sensory representations. Future studies should explore differential processes for intrusion development based on their modality. [ABSTRACT FROM AUTHOR]

There is little published research on dissociative experiences among transgender people, and none from an in-depth qualitative perspective. In-depth, open-ended interviews (N = 7, 6 trans women, 1 trans man) were conducted to explore how dissociation is experienced (particularly among trans women) and its possible relation to negative emotions. There were several similarities across the dissociative experiences described by participants: six felt themselves disconnected from their body as a whole (in contrast to feeling disconnected to a specific body part), and from the world around them and/or themselves. Four acted out different personalities, and five felt emotionally numb when they were dissociating. Six participants described that their dissociation lessened after they started hormone therapy. Respondents tended to distinguish between dysphoric and dissociative experiences: dysphoric phenomena were more clearly distressful while dissociative ones were more emotionally numb. [ABSTRACT FROM AUTHOR]

Prolonged incest, where children are sexually abused by familial perpetrators into adulthood, has been documented in clinical and criminological scholarship, however it is often overlooked in research, policy and practice approaches to familial sexual abuse. This article draws on interviews with ten Australian therapists about their clinical work with clients subject to incestuous abuse continuing into adulthood. It outlines their descriptions of these cases, the nature of the reported abuse and factors that facilitated prolonged and ongoing incest, including at the time of therapy. The therapists and their clients were female. The clients were highly dissociative and experienced significant psychiatric and medical comorbidity, and extensive socio-economic disadvantage. Reported abuse was sadistic, ongoing, often involved multiple perpetrators, and sometimes had links to organized abuse. Therapists' conceptualizations of the factors related to the abuse included: enmeshed and disorganized attachment to the perpetrator; symptoms of severe dissociation; having absent, abusive or non-protective mothers; and social isolation which limited help-seeking. The study concludes that attachment, trauma and dissociation-informed therapy is essential, while further research is needed to further explore effective interventions and responses to this clinical cohort. [ABSTRACT FROM AUTHOR]

Background: There is evidence to suggest trauma significantly predicts risk for psychosis. Dissociation might be a key causal variable, mediating the relationship between trauma and hallucination-proneness in clinical samples. Objective: To investigate the associations between dissociation, trauma, and hallucination-proneness in the general population sample. Methods: The study design was correlational and cross-sectional, using a convenience sample (N = 227). Pearson's correlation coefficients were conducted to investigate the relationship between measures of hallucination-proneness and dissociative experiences, and subjective trauma and interpretations of voices. A mediation analysis was conducted to investigate whether dissociative experiences mediate the relationship between trauma and hallucination proneness. Results: There was a significant association between trauma and hallucinations, the severity of subjective trauma exposure was associated with increased hallucination-proneness. There was a significant correlation between hallucination-proneness and dissociative experiences. Dissociative experiences significantly mediated the relationship between subjective trauma and hallucination-proneness. Subjective trauma positively correlated with all measures of the interpretations of voices inventory. Discussion: Previous findings from clinical samples were replicated in this general population sample, providing support to traumagenic and continuum models of psychosis, which may have implications for clinical practice. [ABSTRACT FROM AUTHOR]

This article examines continuing misunderstanding about memory function especially for trauma, across three UK samples (N = 717). Delayed allegations of child sexual and physical abuse are prevalent in Western legal systems and often rely upon uncorroborated memory testimony to prove guilt. U.K. legal professionals and jurors typically assess the reliability of such memory recall via common sense, yet decades of scientific research show common sense beliefs often conflict with science. Recent international surveys show controversial notions of repression and accurate memory recovery remain strongly endorsed. In historical cases, these notions may lead to wrongful convictions. The current study surveyed the U.K. public, lawyers, and mental health professionals' beliefs about repression, dissociative amnesia and false memories. Study findings give unique data on judges' and barristers' beliefs. Overall, the study findings reinforce international scientists' concerns of a science – knowledge-gap. Repression was strongly endorsed by lay, legal and clinical participants (> 78%) as was dissociative amnesia (> 87%). Moreover, suboptimal professional legal education and juror guidance may increase misunderstanding. Correcting beliefs about memory function, and extending the contribution of memory science in the courtroom remains an important quest for cognitive scientists. [ABSTRACT FROM AUTHOR]

Betrayal trauma theory suggests betrayal from a trusted person affects how an event is remembered and processed. Few studies have looked at differences in psychological symptoms due to the severity and timing of betrayal trauma (BT). This study examined whether psychological symptoms, specifically, sleep disturbance, dissociation, and anxiety, differ depending on the severity and timing of BT. Participants (N = 270; 67.8% female) with at least one trauma completed online questionnaires measuring BT severity (low-medium, high), timing (childhood trauma, adulthood trauma), and frequency of psychological symptoms. A two-way between-subjects multivariate analysis of variance (MANOVA) was conducted. BT was prevalent in the sample, with 202 participants (74.8%) reporting a history of high BT. The MANOVA revealed a significant interaction between BT severity and BT timing on all outcome variables [p =.007, η2p =.05]. Childhood BT participants with low-medium BT history had significantly greater sleep disturbance [p =.008, η2p =.03], than participants with adulthood BT participants with low-medium BT history. Furthermore, adulthood BT participants with a history of high BT had significantly more dissociation [p =.003, η2p =.01] and anxiety [p <.001, η2p =.04] symptoms than childhood BT participants with a history of high BT. The research provides a novel insight into how different psychological symptoms manifest according to BT severity and timing, and the possibility of "rotating betrayal blindness" in which trauma awareness shifts in varying contexts. [ABSTRACT FROM AUTHOR]

Research on male survivors of childhood sexual abuse is notably deficient when it comes to addressing their sexual concerns, such as experiences of sexual distress, negative thoughts, and feelings related to their sexuality. Dissociation, a known consequence of childhood sexual abuse, could be associated with higher sexual concerns through identity cohesion. Precisely, dissociation can potentially be related to lower identity cohesion (e.g., not knowing what you want or need). In return, lower identity cohesion may be related to higher sexual concerns by impeding the capacity to know and accept oneself, which tends to promote a positive and healthy sexuality. This study aimed to examine the role of identity cohesion in the link between dissociation and sexual concerns in 105 men consulting for their history of childhood sexual abuse. Men completed questionnaires assessing dissociation, sexual concerns, and identity cohesion at admission in a community setting. Results of a path analysis revealed an indirect association between dissociation and higher sexual concerns through lower identity cohesion. The model explained 27.6% of the variance in sexual concerns. This study highlights the relevance of interventions targeting dissociative symptoms to improve identity cohesion and sexual health in male survivors of childhood sexual abuse. [ABSTRACT FROM AUTHOR]

The Detachment and Compartmentalization Inventory (DCI) is a valid and reliable self-report instrument that assesses these two distinct forms of dissociative symptoms. However, there is limited research on the cross-cultural validation of the DCI. Therefore, this study aimed to develop an Italian translation of the DCI and examine its internal structure and psychometric properties (including internal consistency, convergent validity, and test-retest reliability) within an Italian-speaking community sample. The sample consisted of 1276 adults (887 females; mean age: 29.57 ± 10.96 years), who completed the DCI and other self-report measures evaluating dissociative experiences and childhood trauma. Confirmatory factor analyses supported the original two-factor model (χ2169 = 1312.80, RMSEA = 0.073, 95%CI 0.069–0.077; CFI = 0.94; TLI = 0.94; SRMR = 0.04). Additionally, the DCI exhibited good internal consistency, test-retest reliability, and convergent validity with another measure of dissociation. The study also confirmed the association between DCI scores and the severity of childhood trauma. Finally, a Receiver Operating Characteristic (ROC) curve analysis demonstrated that the DCI effectively distinguishes individuals who screened positively for dissociative disorders. Overall, these findings indicate that the Italian translation of the DCI possesses satisfactory psychometric properties, suggesting its utility as a screening tool for assessing detachment and compartmentalization experiences. [ABSTRACT FROM AUTHOR]

Identifying and contrasting different patterns of intimate partner violence (IPV) (e.g. situational couple violence, coercive controlling violence) is useful for understanding IPV and its connections with health. Applying this approach to dissociation may be fruitful, given theoretical perspectives that predict a specific connection between coercive controlling violence and dissociative symptoms. To address this, community women with divorce histories (N = 188) completed measures to identify patterns of IPV victimization in prior relationships (no direct violence, situational couple violence, coercive controlling violence), and to quantify recent dissociative symptoms and number of depressed days, for comparison. Contrary to predictions, the predicted odds of recent dissociative symptoms did not differ between women who experienced situational couple violence versus coercive controlling violence. However, the latter group had greater odds of recent dissociative symptoms, but not depressed days, compared to women with no histories of direct violence. Further, a continuous measure of coercive control was uniquely associated with increased odds of dissociative symptoms. This study provides preliminary empirical support for a connection between coercive controlling violence and dissociative symptoms, compared to women without histories of direct violence. This deserves further attention given the strong theoretical rationale for this link, and the importance of dissociation for mental health. [ABSTRACT FROM AUTHOR]

Dissociation is a multifaceted phenomenon that occurs in various mental disorders, including borderline personality disorder (BPD), but also in non-clinical populations. Severity of childhood trauma (abuse, neglect) plays an important role in the development of dissociation and BPD. However, the complex interplay of different dissociative symptoms, BPD features, and self-reported childhood trauma experiences is not yet fully understood. Graph-theoretical network analysis can help to better understand such multivariate interrelations. Objective: This study aimed to investigate associations between self-reported dissociation, BPD features, and childhood trauma experiences using a graph-theoretical approach. Data was collected online via international mental health platforms and research sites. N = 921 individuals (77.4% female) were included; 40% reported pathological levels of dissociation. Variables were assessed with established psychometric scales (Dissociative Experiences Scale; Personality Assessment Inventory Borderline Features Scale; Childhood Trauma Questionnaire) and analyzed within a partial correlation network. Positive bivariate correlations between all variables were found. When accounting for their mutual influence on each other, dissociation was predominantly connected to BPD features with effect sizes between rp =.028 and rp =.126, while still showing a slight unique relationship with physical neglect (rp =.044). Findings suggest close associations between dissociative experiences and BPD features. While childhood trauma plays an important role in the development of dissociation and BPD, its recall may not fully explain their current co-occurrence. Prospective studies are needed to shed more light on causal pathways to better understand which factors contribute to dissociation and its link to BPD (features). [ABSTRACT FROM AUTHOR]

Child maltreatment and removal from home have been increasingly examined among marginalized groups but less so among multiracial youth. The present study examined 99 multiracial youth aged 11–17 (M = 14.18, SD = 1.79) years. Classification and regression tree analysis was conducted on demographic (age, gender, family religion, self-identified religious, English first language), type of maltreatment, and psychological (depression, dissociation, anger, post-traumatic cognitions) variables for three post-traumatic symptom clusters. Pathways of low and high risk were identified for reexperiencing symptoms, avoidance, and hyperarousal. The findings have implications for tailoring assessment and intervention processes for this highly vulnerable population. [ABSTRACT FROM AUTHOR]

Childhood trauma and post-traumatic stress disorder (PTSD) are risk factors for emotional distress from trauma-related research participation. The role of dissociation, however, has not been investigated. This study examined the mediation effect of dissociation and PTSD on the relationship between childhood trauma and distress in trauma studies. Pooled data of the Childhood Trauma Questionnaire, Impact of Events Scale-Revised, Dissociative Experiences Scale-Taxon, and Trauma Antecedents Questionnaire from 231 psychiatric patients (73% diagnosed with psychotic illnesses) at a psychiatric clinic in South Korea were analysed. We performed multiple mediation effect analysis to verify a structural model for distress in trauma-related questionnaires. Thirteen percent of participants reported distress after the survey. In the structural equation, the symptoms of PTSD did not show a significant relationship (p =.064). When the two parameters were included in the model, it was found that the direct effect of childhood trauma on distress was not significant (p =.43), but dissociation showed a direct effect on distress (p <.001). Childhood trauma affects distress through the sequential mediating effect of PTSD symptoms and dissociation. Dissociation should be considered as a significant contributor to distress from trauma research participation along with childhood trauma and PTSD. [ABSTRACT FROM AUTHOR]

Depersonalisation-derealization disorder (DPD) is a dissociative disorder that impairs cognitive function and occupational performance. Emerging evidence indicate the levels of tumour necrosis factor-α and interleukin associated with the dissociative symptoms. In this study, we aimed to explore the role of the immune system in the pathology of DPD. We screened the protein expression in serum samples of 30 DPD patients and 32 healthy controls. Using a mass spectrometry-based proteomic approach, we identified differential proteins that were verified in another group of 25 DPD patients and 30 healthy controls using immune assays. Finally, we performed a correlation analysis between the expression of differential proteins and clinical symptoms of patients with DPD. We identified several dysregulated proteins in patients with DPD compared to HCs, including decreased levels of C-reactive protein (CRP), complement C1q subcomponent subunit B, apolipoprotein A-IV, and increased levels of alpha-1-antichymotrypsin (SERPINA3). Moreover, the expression of CRP was positively correlated with visuospatial memory and the ability to inhibit cognitive interference of DPD. The expression of SERPINA3 was positively correlated with the ability to inhibit cognitive interference and negatively correlated with the perceptual alterations of DPD. The dysregulation of the immune system may be the underlying biological mechanism in DPD. And the expressions of CRP and SERPINA3 can be the potential predictors for the cognitive performance of DPD. [ABSTRACT FROM AUTHOR]

Severe dissociative states involving the experience of being in parts, typically associated with diagnosis such as dissociative identity disorder and other specified dissociative disorders, continue to be a controversial and rarely studied area of research. However, because persons with severe dissociative states are at risk of being harmed instead of helped within psychiatric care, their experiences of living with such states warrant further examination, while innovative ways to include them in research remain necessary. Against that background, this study aimed to illuminate the meanings of living with severe dissociative states involving the experience of being in parts. This is a phenomenological hermeneutic study with data collected from three social media sources, one personal blog and two Instagram accounts, in February and March 2023. The results were illuminated in light of four themes; Striving to remain in the world, Balancing exposure and trust, Balancing belonging and loneliness and Owning oneselves. The interpretation of the themes suggests that living with severe dissociative states means being a human under inhuman conditions, striving for coherence and meaning in a world that is often unsupportive. This calls for a trauma-informed care to better support recovery for persons with severe dissociative states. [ABSTRACT FROM AUTHOR]

Some researchers express caution about investigating potentially challenging topics in research, including trauma, non-suicidal self-injury (NSSI), and dissociation. While there have been studies that demonstrate people typically find participating in trauma- and NSSI-related research as more positive than negative, there have been no studies investigating how highly dissociative people react to trauma-, NSSI-, and dissociation-related research. Participants (n = 229) who self-reported dissociative symptoms and/or dissociative diagnoses completed an online survey about trauma, dissociation, and NSSI, followed by a quantitative questionnaire about their reactions to participation. Participants who endorsed unexpected emotional reactions were asked to explain their reactions and offer suggestions for improvement in a free-text qualitative question. Participants indicated the benefits of participating in the study outweighed the costs. Dissociation predicted emotional reactions but not other types of reactions (e.g. perceived drawbacks, personal benefits, global evaluation, and participation). However, when controlling for trauma history and NSSI, only trauma history predicted emotional reactions. Using codebook thematic analysis with the qualitative data, the following themes were developed to describe participants' unexpected emotional reactions and suggestions for improvement: (1) Trauma-Related Reactions (69.91%), (2) Neutral-Positive Feedback About the Study (39.82%), (3) Insight (24.78%), (4) Logistical Research Design Considerations (23.01%), and (5) Incongruence between Research Design and Lived Experience (11.50%). Research about trauma, dissociation, and NSSI was evaluated as more positive than negative and seemed to pose minimal risk to participants. It is important for researchers to not avoid studying these challenging topics yet strive to make their study design a safer and more validating experience for participants. [ABSTRACT FROM AUTHOR]

Previous research has linked self-harm to adverse childhood experiences (i.e. abuse and neglect). Despite the extensive literature on self-harm, it remains of high importance to examine psychological predictors of repetitive self-harming behaviors in those who report childhood trauma. This study explored the role of maladaptive emotion regulation strategies, dissociation proneness, and borderline personality (BP) features. An international sample with n = 374 participants (N = 287, 77%, reporting intentional use of self-harm), was recruited online via relevant mental health platforms and research sites. Within an anonymous survey, participants completed the Self-harm Inventory, Childhood Trauma Questionnaire, Dissociative Experience Scale, Cognitive Emotion Regulation Questionnaire, and Personality Assessment Inventory-Borderline Personality Features Scale. Structural equation modeling (SEM) was used to explore direct and indirect effects. Self-harm was positively correlated to severity of childhood trauma, maladaptive emotion regulation strategies, dissociation, and BP features. In the path-analytical model, independent indirect effects of childhood trauma severity via self-blame, catastrophizing, dissociation, as well as BP features on self-harm were found. Maladaptive emotion regulation, dissociation proneness, and BP features all seem to be important intermediary agents in the close association between childhood trauma and self-harm. [ABSTRACT FROM AUTHOR]

A PTSD subtype with dissociative symptoms (D-PTSD) was included in the DSM-5 recognizing the existence of a more severe form of PTSD, associated to past trauma, high comorbidity, and complex clinical management. As research is rapidly growing and results are inconsistent, a better investigation of this subtype is of primary importance. We conducted a systematic review of studies using Latent Profile Analysis to investigate the existence of a D-PTSD subtype. Covariates of D-PTSD were included, to understand additional symptoms, risk factors and comorbidities. The search was performed on PubMed, EBSCOHost, and PTSDPubs according to 2020 PRISMA guidelines. Eligible articles assessed trauma exposure, PTSD symptoms and diagnosis, and dissociation, in adult samples. 13 of 165 articles met the inclusion criteria. All identified a dissociative subtype of PTSD, mainly characterized by higher levels of depersonalization and derealization. D-PTSD profile sometimes presented other dissociative symptoms, such as gaps in awareness and memory, other comorbid disorders, and a history of abuse. Despite some limitations, this review supports the existence of a dissociative subgroup of individuals among those with PTSD. More rigorous studies are needed to clarify these findings and their clinical implications. [ABSTRACT FROM AUTHOR]

Women involved in the criminal legal system report high rates of interpersonal violence, particularly sexual violence, and mental health problems. Although existing research has linked experiences of interpersonal violence to multiple negative mental health outcomes, few researchers have examined concurrent psychopathology as an outcome of child and adult sexual violence in system-involved women. The purpose of this study was to examine child sexual abuse (CSA) and adult sexual violence, while controlling for other forms of interpersonal violence, as predictors of current symptoms of posttraumatic stress disorder (PSTD), substance use disorder (SUD), and dissociation in women in jail in the Mountain West. Randomly selected participants (N = 146) completed clinician-administered measures of trauma histories and mental health symptoms. The majority of the women (73%) reported experiences of CSA and about half reported experiences of adult sexual violence. Over half of the women reported symptoms consistent with current probable PTSD, about 20% reported dissociation symptoms in a clinical range, and over 70% met criteria for a SUD in the past year. The proposed model was tested with path analysis. CSA significantly predicted current symptoms of PTSD while adult sexual violence exposure predicted symptoms of SUD and dissociation. These results illustrate the high rates of sexual violence exposure as well as the complexity of mental health needs associated with these exposures in system-involved women. Findings highlight the need to comprehensively assess incarcerated women's trauma exposure and psychological distress to better meet the needs of this population. [ABSTRACT FROM AUTHOR]

Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (β = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required. [ABSTRACT FROM AUTHOR]

An editorial is presented on the trajectory of the periodical and its significant role in advancing understanding and care for complex trauma and dissociation. Topics discussed include the legacy of past editors, the importance of empirical research, defining complex trauma and pathological dissociation, and expanding the periodical's reach through diverse perspectives, case studies, and policy analyses.

The association and overlap between psychotic and dissociative phenomena have been increasingly recognized. Previous studies found that psychotic symptoms are closely associated with post-traumatic and dissociative symptoms and that these trauma-related phenomena may mediate the relationship between trauma and psychotic symptoms. It remained less explored which specific post-traumatic and dissociative symptom clusters are particularly associated with psychotic symptoms. This cross-sectional study used a data-driven approach (network analysis) to explore the associations among different psychotic and post-traumatic/dissociative symptom clusters in an online convenience predominantly female sample (N = 468)(59.2% had ever seen a psychiatrist). Participants completed well-established multidimensional measures that assessed different symptom clusters of psychosis, dissociation, and PTSD. In addition, multiple mediation analysis was conducted to examine which post-traumatic/dissociative symptoms could mediate the relationship between childhood and adulthood trauma and different psychotic symptoms. Our results confirmed previous findings that PTSD and dissociative symptoms are closely associated with psychotic symptoms. More importantly, both data-driven and multiple mediation analysis results indicated that identity dissociation was particularly associated with perceptual anomalies and bizarre experiences, while emotional constriction was particularly associated with negative symptoms. It is important to screen for trauma and dissociation and provide trauma-and dissociation-informed care when working with people at risk of or experiencing psychosis. Further longitudinal studies using more representative samples are needed. [ABSTRACT FROM AUTHOR]

The 11th revision of the International Classification of Diseases (ICD-11) introduced Complex Posttraumatic Stress Disorder (CPTSD) as a sibling disorder to PTSD. Dissociative symptoms have been implicated in the severity of ICD-11 CPTSD; however, no reviews have investigated how dissociation has been measured in studies investigating CPTSD, nor the relationship between CPTSD and dissociation. This systematic review aimed to identify measures used to assess dissociative symptoms in studies that have assessed CPTSD according to ICD-11 criteria and to synthesize the relationship between these constructs. PsycINFO, PubMed, Scopus and Web of Science were searched on March 31, 2021. Seventeen articles met inclusion criteria. CPTSD was most frequently measured by a version of the International Trauma Questionnaire. Twelve measures were used to assess for dissociative symptoms, the most common being the Dissociative Symptoms Scale and the Dissociative Experiences Scale. The relationship between CPTSD and dissociative symptoms was moderate-to-strong, but inconsistently reported. Further research is needed to determine the most appropriate measure(s) of dissociation in CPTSD. [ABSTRACT FROM AUTHOR]

The impacts of adverse childhood experiences (ACEs) have been well documented. One possible consequence of ACEs is dissociation, which is a major feature of post-traumatic psychopathology and is also associated with considerable impairment and health care costs. Although ACEs are known to be associated with both psychoform and somatoform dissociation, much less is known about the mechanisms behind this relationship. Little is known about whether social and interpersonal factors such as family environments would moderate the relationship between ACEs and somatoform dissociation. This paper discusses the importance of having a positive and healthy family environment in trauma recovery. We then report the findings of a preliminary study in which we examined whether the association between ACEs and somatoform dissociation would be moderated by family well-being in a convenience sample of Hong Kong adults (N = 359). The number of ACEs was positively associated with somatoform dissociative symptoms, but this association was moderated by the level of family well-being. The number of ACEs was associated with somatoform dissociation only when the family well-being scores were low. These moderating effects were medium. The findings point to the potential importance of using family education and intervention programs to prevent and treat trauma-related dissociative symptoms, but further investigation is needed. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including the need for trauma-informed approaches in research, theory, clinical practice, and public health policy to address disparities, discrimination, and violence in marginalized communities.

Women in jail represent a vulnerable population with high rates of trauma exposures and mental health problems. The majority of incarcerated women are also parents of minor children. This study represents the first approach to date to examine the relations among interpersonal violence exposures, adult attachment, mental health, and parenting in women in jail. The participants were randomly selected and included 120 mothers of minor children incarcerated at two jails in the Western U.S. Results of a structural equation model analysis indicate that lifetime interpersonal violence was associated with insecure attachment and women's current psychopathology (e.g. depression, PTSD, and dissociative symptoms). Further, insecure attachment was associated with higher levels of mental health problems and was negatively associated with perceptions of parenting. Examining the associations among these constructs in a sample of mothers in jail has potential to inform interventions to address mental health and parenting needs in this underserved population. [ABSTRACT FROM AUTHOR]

The experience of several potentially traumatic events (PTE) is a risk factor for higher somatization symptoms severity among adolescents. Attachment orientations and dissociation may influence the link between exposure to PTE and somatization symptoms severity. We analyzed the associations between direct exposure to PTE and somatization symptoms in Kenyan adolescents and explored the mediating role of attachment orientations and dissociation symptoms in the associations between direct exposure to PTE with somatization symptoms severity. A sample of 475 Kenyan adolescents completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modeling employing Preacher and Hayes' procedures (2008). Attachment anxiety and dissociation symptoms mediate the association between direct exposure to traumatic events and somatization symptoms. Higher exposure to traumatic events was significantly associated with higher attachment anxiety levels, which was associated with higher levels of dissociation symptoms, which was then associated with higher somatization symptoms severity. High levels of attachment anxiety and dissociation might aggravate somatization symptoms differently according to sex, which might be seen as a psychological distress mechanism subsequent to exposure to multiple PTE in African adolescents. [ABSTRACT FROM AUTHOR]

Sexual dysfunction is associated with psychological symptoms, including depression and anxiety. Sexual dysfunctions are often attributed to dissociation symptoms in individuals who reported sexual trauma histories. This study utilized a network approach to analyze relationships between sexual and psychological symptoms and examine whether the identified network structures differed between individuals who reported a history of sexual trauma and those who did not. Sexual dysfunction, history of sexual trauma, internalizing symptoms, dissociation symptoms, sex-related shame, and negative body image were assessed in 1,937 United States college students (women = 69.5%). Nearly half (46.8%) of the participants reported a sexual trauma history in their lifetime. Using regularized partial correlation networks, the relationships between sexual and psychological symptoms were analyzed and compared between groups with and without trauma histories. Internalizing symptoms were positively correlated with sexual dysfunction regardless of the presence of sexual trauma history. Anxiety had a stronger influence in the trauma network than in the no-trauma network. Feeling separated from the body during sexual activity was a central symptom and was related to difficulties relaxing and enjoying sex only in the trauma network. Sex-related shame appeared to play a more important role in men compared to women. To improve clinical practice of assessing and treating sexual dysfunction, researchers and clinicians should consider core symptoms that connect different aspects of sexual and psychological functioning while being aware of the unique role of dissociation in the context of traumatic stress. [ABSTRACT FROM AUTHOR]

The article focuses on the history and evolution of the International Society for the Study of Trauma and Dissociation's (ISSTD) Professional Training Program (PTP), tracing its origins to the year 2000. Topics include the development of the program, its restructuring, increased global participation, and plans for future advanced training modules in areas such as psychopharmacology, institutional betrayal, and addictions and eating disorders.

ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) is a disorder of six symptom clusters including reexperiencing, avoidance, sense of threat, affective dysregulation, negative self-concept, and disturbed relationships. Unlike earlier descriptions of complex PTSD, ICD-11 CPTSD does not list dissociation as a unique symptom cluster. We tested whether the ICD-11 CPTSD symptoms can exist independently of dissociation in a nationally representative sample of adults (N = 1,020) who completed self-report measures. Latent class analysis was used to identify unique subsets of people with distinctive symptom profiles. The best fitting model contained four classes including a "low symptoms" class (48.9%), a "PTSD" class (14.7%), a "CPTSD" class (26.5%), and a "CPTSD + Dissociation" class (10.0%). These classes were related to specific adverse childhood experiences, notably experiences of emotional and physical neglect. The "PTSD," "CPTSD," and "CPTSD + Dissociation" classes were associated with a host of poor health outcomes, however, the "CPTSD + Dissociation" class had the poorest mental health and highest levels of functional impairment. Findings suggest that ICD-11 CPTSD symptoms can occur without corresponding dissociative experiences, however, when CPTSD symptoms and dissociative experiences occur together, health outcomes appear to be more severe. [ABSTRACT FROM AUTHOR]

Depersonalization-derealization disorder (DPD) is characterized by persistent or recurrent experiences of detachment from oneself and surroundings, as well as a sense of unreality. Considering the inadequacy of current research on treatment, we performed a systematic review of the available pharmacotherapies, neuromodulations, and psychotherapies for DPD. The systematic review protocol was based on PRISMA 2020 guidelines and pre-registered. The PubMed, Web of Science, PsycINFO, Embase, the Cochrane Library, Scopus, and ScienceDirect databases were searched from inception to June 2021. All treatments for DPD and all study types, including controlled and observational studies as well as case reports, were assessed. Of the identified 17,540 studies, 41 studies (four randomized controlled trials, one non-randomized controlled trial, 10 case series, and 26 case reports) involving 300 participants met the eligibility criteria. We identified 30 methods that have been applied independently or in combination to treat DPD since 1955. The quality of these studies was considered. The relationship between individual differences, such as symptoms, comorbidities, history, and duration since onset, and treatment effects was explored. The results suggest that a series of treatments, such as pharmacotherapies, neuromodulation, and psychotherapies, could be considered in combination. However, the quality and quantity of studies were generally low considering the high prevalence of DPD. The review concludes with suggestions for future research and an urgent call for more high-quality research. [ABSTRACT FROM AUTHOR]

People with dissociative symptoms are generally poly-symptomatic and require high levels of healthcare resources. Post-traumatic stress disorder (PTSD) and depressive symptoms are two major disabling comorbid symptoms in people with dissociative symptoms. While the sense of control over symptoms may be associated with PTSD and dissociative symptoms, the interplay among these factors over time remains unexplored. This study examined the predictors of PTSD and depressive symptoms in people with dissociative symptoms. Longitudinal data from 61 participants with dissociative symptoms were analyzed. Participants completed self-report measures of dissociative, depressive, and PTSD symptoms and the sense of control over symptoms two times (T1 & T2) with an interval of over one month. PTSD and depressive symptoms were not transient or time-specific, but they persisted over time in our sample. Hierarchical multiple regression analyses revealed that, after controlling for age, treatment usage and baseline symptom severity, T1 symptom management scores (β = −.264, p =.006) negatively predicted T2 PTSD symptoms, while T1 PTSD symptoms (β =.268, p =.017) positively predicted T2 depressive symptoms. T1 depressive symptoms (β = −.087, p =.339) did not predict T2 PTSD symptoms. The findings highlight the importance of improving symptom management skills and treating comorbid PTSD symptoms when working with people with dissociative symptoms. [ABSTRACT FROM AUTHOR]

A number of studies have investigated the relationship between mindfulness and dissociation and suggested that mindfulness-based interventions could be effective in the treatment of dissociative symptoms. A recent study in healthy volunteers found that attention and emotional acceptance mediates this relationship. However, no study has yet been performed among a clinical sample to assess this association. We recruited 90 patients (76 women) suffering from Posttraumatic Stress Disorder (PTSD). They completed self-report questionnaires to measure PTSD, dissociation, emotion regulation difficulties, childhood trauma, mindfulness abilities and cognitive abilities. We found that mindfulness abilities, emotional difficulties, dissociation and attention-concentration were all related to each other. Using a step-by-step approach and bootstrapping techniques, we found a significant indirect effect of mindfulness abilities on dissociation through non-acceptance (confidence interval 95%=-.14 to −.01) and attentional difficulties (confidence interval 95%=-.23 to −.05). Patients with higher levels of dissociative symptoms have less capacity for mindfulness. Our results support Bishop et al.'s model proposing that attention and emotional acceptance are the two active components of mindfulness. To extend our findings, clinical trials are required to evaluate a causal relationship and the effectiveness of mindfulness-based interventions for patients suffering from dissociation. [ABSTRACT FROM AUTHOR]

Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs. Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses. Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure. Conclusion: Clients and therapists in the TOP DD Network programme described the programme’s components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs. [ABSTRACT FROM AUTHOR]

Background: While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe. Objective: We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics. Methods: We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (Fragebogen zu Dissoziativen Symptomen-20) in a large aggregate sample (n = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics. Results: Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout. Conclusions: The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment. [ABSTRACT FROM AUTHOR]

A significant number of individuals receiving mental health care exhibit a history of traumatic experiences. Accompanying dissociative symptoms often amplify the complexity of their required treatment. This article introduces a novel understanding and treatment approach for post-traumatic stress symptoms, inclusive of dissociation, derived from attachment and mentalization theories. Initially, we outline the different expressions of dissociation and the prevailing knowledge concerning their associations with diverse clinical manifestations and their role in trauma. We subsequently reinterpret these clinical symptoms through an attachment and mentalization lens, then proceed to elaborate on the new trauma-focused mentalization-based treatment and its therapeutic objectives. The article culminates with a case study that exemplifies the application of this approach in a clinical setting. [ABSTRACT FROM AUTHOR]

Associative processes that provide salience through sorting of mental content rely upon dissociative processes to remove non-salient content from awareness, like not noticing the glasses on your nose. When association fails in trauma, as capacities to assimilate and accommodate experience are outstripped by that experience being outside the usual range of human experience, then more elaborate dissociative experience like depersonalization and derealization may become active to help us tolerate our perception even if it costs the price of isolated affect or additional amnesia for experience. With repetition of traumatic experience identity confusion and identity alteration may occur, effectively generating the less common dissociative identity disorder. This guide first explores the basis of dissociative experience as a prelude to the reader's foray into the subject of this special issue of this journal. Additionally, the writer delves into aspects of the work of a world-class collection of authoritative articles to fully flesh them out or emphasize critically important perspectives. Finally, the centrality of the relationship in psychotherapy is emphasized as a requirement for effective treatment when persistent dissociative processes dominate the activities of a wounded human mind. [ABSTRACT FROM AUTHOR]

Dissociative identity disorder (DID) is life-long, childhood-onset, posttraumatic developmental disorder where chronic early-life maltreatment and attachment disturbances prevents the child's development of a continuous sense of self across emotional states, relationships, and social contexts. As development proceeds, these self-states acquire a sense of themselves, a capacity for information processing, memory, emotion, and behavior. Conceptualizing DID involves paradoxes and apparent contradictions. DID has been categorized as a severe mental illness with major psychiatric comorbidities. Studies show that DID individuals have a unique personality organization with repeated, often covert posttraumatic reactivity, especially in relationships (e.g., therapy). Paradoxically, research shows that, during development, DID individuals preserve psychological resiliencies consistent with responsivity to long-term, psychodynamically informed treatment. These include, when not stressed, capacities for therapeutic alliance, reality testing, and observing ego. [ABSTRACT FROM AUTHOR]

This article explores the relationship between developmental trauma, dissociation, and substance abuse within the framework of the self-medication hypothesis. By means of presenting a clinical vignette, the article illustrates how substance abuse can serve as a maladaptive coping strategy for managing overwhelming emotions that stem from traumatic experiences in attachment relationships during childhood. Individuals who have undergone developmental trauma may dissociate negative attachment memories and their related emotions, which consequently leads to compartmentalization of their internal states and hinders their self-regulation abilities. In such scenario, substances can act as external regulators of distressing emotions, distancing these individuals from their traumatic memories and facilitating the adoption of an omnipotent and self-reliant attitude. Hence, it is of utmost importance for clinicians to accurately identify and address the self-medication needs of these individuals. This is fundamental in facilitating these clients' capacity to acknowledge, explore, and integrate their distressing memories as intrinsic elements of their identity, thereby fostering the development of a unified and cohesive self-concept. [ABSTRACT FROM AUTHOR]

The Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) posits that suicide stems from a motivation to die by suicide, emanating from perceived-burdensomeness and failed belongingness, and a capacity to kill oneself. We propose a bridge between IPTS and dissociation theory/research via a recent reformulation of Melanie Klein's notion of the depressive position, as comprised of three elements: Demeaning affect, compensatory affect-regulatory maneuvers, and mental representation of self-as-deficient and others as judgmental/punitive and at times seductive. This position is formed in childhood, proceeds to adulthood, and is projected into the future with the hope of finding respite from criticism. This hope is then thwarted by the sufferer's interpersonal action leading to interpersonal strife. We posit that, in the Basic Level, a trauma-based, dissociative structure is formed, whereby the reformulated depressive position disengages from benign and benevolent mental processes, in turn creating interpersonal havoc. In the Advanced Level, dissociative mechanisms are utilized to assist the now depressed-suicidal position to succeed in its mission: Killing the self. A chilling case illustration of this pattern is presented and discussed. Clinically, we recommend a routine measurement of both dissociation and suicide risk, and appraisal of the psychodynamic connecting dissociation and suicidality. [ABSTRACT FROM AUTHOR]

The present paper seeks to propose, using a combination of psychoanalytic and linguistic thinking, a distinction between three degrees of symbolicity across the somatoform dissociative continuum: the metaphorical, in which there is a symbolic connection between the somatoform phenomenon and the traumatic content, the metonymic, which constitutes a revival of the traumatic experience without the ability to reflect on it, and the psychotic, in which the somatoform phenomenon is experienced as ego-syntonic, thus neither causes distress nor evokes thinking. Three clinical vignettes demonstrate how the higher the degree of symbolization, the more effective the therapeutic process. Finally, a fourth vignette demonstrates how acoustic association in the therapist's countertransference can constitute an antidote to the patient's acoustic dissociation, allowing the reclaiming of the capacity for linking. [ABSTRACT FROM AUTHOR]

Dissociative depression is a complex and chronic mood disorder characterized by a combination of persistent depressive symptoms and intermittent major depressive episodes. A key feature of dissociative depression is the existence of dissociative symptoms that are linked to prolonged stress experienced during childhood and infancy. Disturbances of sense of self and agency are core indicators of the disorder. Common symptoms include thoughts of guilt and worthlessness, difficulties with concentration and decision-making, changes in appetite and sleep, and suicidal ideation. Additionally, individuals may exhibit various expressive patterns such as borderline phenomena, psychoticism, trauma-related enactments, and attempts at control through somatization, compensatory narcissism, and obsessions. One challenge is that dissociative depression often does not respond well to biological treatments alone. Psychotherapeutic interventions that do not specifically address the dissociative aspect may also be ineffective. The required comprehensive approach involves working through layers of therapeutic reality to reverse the process that led to the status quo. An intensive psychodynamic practice with a renewed theoretical understanding (Dialectical Dynamic Therapy-DDT) is necessary to identify the leverage points that can bring about radical inner change. The aim is to alleviate the barriers that prevent individuals from realizing their full potential assigned in the beginning of life. [ABSTRACT FROM AUTHOR]

Maladaptive daydreaming (MD) is the excessive employment of immersive daydreaming characterized by highly absorbing fantasy experiences that become a preferred focus of consciousness at the expense of living in the real world. Active dissociative processes like depersonalization and derealization, including those also characteristic of dissociative identity disorder (DID): amnesia, identity confusion, and identity alteration, may be present and, like in DID, seem to be psychodynamically driven. Comorbidity with attention deficit disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and others is typical. Often associated with profound shame experience, it is, like DID, a condition that tends to be concealed and requires a clinician to be knowledgeable about its nature before a diagnosis can occur and effective treatment be initiated. We introduce the concept, explore its clinical associations and manifestations, and provide several case vignettes to illustrate the breadth and depth of this potentially debilitating variation on daydreaming. [ABSTRACT FROM AUTHOR]

Dissociative amnesia is controversial. We tested other factors that could contribute to an inability to remember an important aspect of a traumatic event: how traumatic the event was, organic amnesia, dissociative state, childhood amnesia, expression suppression, sleep disturbance, repeated experiences, and ordinary forgetting. Trauma survivors who reported an inability to remember an important aspect of a traumatic event rated the event as traumatic as trauma survivors who reported no such inability to remember. Moreover, all cases of an inability to remember an important aspect of the traumatic event could be explained by at least one factor other than dissociative amnesia. These findings are contrary to dissociative amnesia. Compared to participants who reported no inability to remember an important aspect of the traumatic event, participants who did report an inability to remember were more likely to (1) have felt disconnected from their body during the traumatic event, which may have altered memory encoding, (2) have experienced sleep problems in the year after the traumatic event, which may have reduced memory consolidation, and (3) have experienced the traumatic event repeatedly, which may have led to less detailed memories. These findings have implications for the inclusion of dissociative amnesia in the DSM. [ABSTRACT FROM AUTHOR]

Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms. This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms. We analyzed longitudinal data from an international sample of people self-reporting depressive emotions (N = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31). More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally (r =.286 to.528, p <.001) and longitudinally (r =.181 to.462, p <.001) correlated with depressive symptoms. A sense of current threat (β =.146, p <.05) and negative self-concept (β =.173, p <.05) at baseline significantly predicted depressive symptoms after one year. These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice. Post-traumatic and dissociative symptoms are common in people with depressive symptoms. These symptoms generally persist over one year and predict more depressive symptoms at follow-up. Trauma-related symptoms should be regularly screened for in clinical settings. [ABSTRACT FROM AUTHOR]

The clinical guidelines for the treatment of dissociation focus primarily on psychotherapy. However, different psychoactive drugs are used in clinical practice. The use of opioid antagonists has been proposed as a therapeutic option based on the theory that dissociation might be a phenomenon mediated by dysregulation of the endogenous opioid system. To review and meta-analyse the available evidence on the efficacy of the opioid antagonists naltrexone, naloxone, and nalmefene as treatments for dissociative symptoms and disorders. The PRISMA guidelines were followed, and this review was registered in Prospero with reference number CRD42021280976. The search was performed in the PubMed, Scopus, Web of Science, EMBASE, PsycINFO, and PubPsych databases. 1,798 citations were obtained. After removing duplicates and applying inclusion and exclusion criteria, we included 5 comparative studies with 9 dissociation measures that had included a total of 154 participants, of whom 134 had been treated with an opioid antagonist. The results of the meta-analysis showed a treatment effect for dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62–2.31)]. However, the studies we included were very heterogeneous [Q = 66.89 (p <.001)] and there may have been publication bias. Although more research is needed and the results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities, opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate – large effect size in reducing these symptoms. The results of the meta-analysis showed a treatment effect for dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62–2.31)]. The results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities. Opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate – large effect size in reducing these symptoms. [ABSTRACT FROM AUTHOR]