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In a review of the literature in this journal, Piedfort-Marin et al. (1921) identified what they purported to be myths about dissociative identity disorder (DID) and dissociative amnesia. When responding to these beliefs, they supported the Trauma Model of dissociation and argued for a causal etiological link between trauma and dissociative conditions. In contrast, they challenged the Sociocognitive Model (SCM), which they claimed rejects the existence of DID and associated disorders (e.g., dissociative amnesia) and considers symptoms to be the byproduct of fantasy, suggestion, and the iatrogenic effect of psychotherapies. In this article, we critically evaluate the authors’ arguments and propose a more balanced, accurate, and comprehensive view of the sociocognitive model. We demonstrate that this model neither rejects the existence of DID, nor a link between trauma and dissociation potentially mediated by a variety of cognitive-affective-behavioral variables. We argue, contrary to Piedfort-Marin et al., that the tendency to confabulate and other cognitive and sociocultural variables may also contribute to the development of DID. We contend that a multifactorial integrative etiological perspective can move the field beyond a limited focus on controversies that divide the TM and SCM models of dissociation.

A 20-year-old woman with no prior psychiatric and medical history presented with acute autobiographical memory loss and a psychogenic tremor. Her laboratory and imaging work-up revealed no infectious, inflammatory, or other organic etiologies. A lorazepam infusion-assisted interview successfully facilitated recovery of memories and elucidated precipitating events. We discuss the utility of drug-assisted interviews and the safety of benzodiazepine infusions for dissociative amnesia.

Background and objectives In the literature there are inconsistent data regarding the role of dissociation in OCD. No study explored the association between obsessive beliefs and dissociative symptoms in OCD. It is important to understand which clinical factors are related to dissociation in OCD as more severe dissociative symptoms, particularly absorption, have been found to be predictors of treatment non-response. In the present short report we describe the results of an exploratory study aimed to investigate the role of the obsessive beliefs as predictors of the different dissociative symptoms controlling for anxiety and OCD severity in a group of OCD patients. Methods Sixty treatment-seeking patients consecutively referred to psychiatric services were included (mean age=31.17 years, 53.30% females). The Dissociative Experiences Scale-II, the Obsessive Beliefs Questionnaire-46, the Yale-Brown Obsessive-Compulsive Scale, and the Beck Anxiety Inventory were administered. Results Higher anxious symptoms predicted higher Dissociative Amnesia, Depersonalization/Derealization, and Absorption/Imaginative Involvement. Higher OCD severity predicted higher Dissociative Amnesia. More severe Perfectionism predicted higher Absorption/Imaginative Involvement. Conclusion Perfectionism in OCD patients may be associated with a higher tendency to absorption and imaginative involvement. Future research should explore whether a psychotherapeutic intervention on perfectionism might improve the outcomes of the OCD patients with higher absorption tendencies.

Child sexual abuse (CSA) has been implicated in dissociative peritraumatic and post-traumatic symptoms and disorders. Although explicitly relevant to the legal process following alleged CSA, very little is known about dissociative manifestations in the context of forensic interviews with children following abuse. The current study was designed to uncoverperi- and post-traumatic dissociation of abused children as revealed in forensic interviews. The study examines the display of dissociation in 42 forensic interviews with children (29 girls, aged 4-14) following intra familial child sexual abuse (IFCSA). Thematic analysis was used to identify key expressions of dissociation in all of the forensic interviews. The analyses identified depersonalization and derealization in the children’s description of the abuse. This was manifested both in an inability to feel things that happened during the incidents or imagination and fantasies that were reported as part of the abusive incidents. The children’s interviews also revealed the potential manifestations of dissociative amnesia, which was evident in the children’s attempts to communicate their retrieval difficulties to the forensic interviewers. Finally, it was identified that the forensic interviews were a platform in which dissociative post-traumatic reactions were activated and often displayed in sensory flashbacks. The current findings uncover the importance of acknowledging trauma and dissociation in the context of forensic interviews with abused children and the urgent need to implement unique responses to trauma within practical guidelines.

BackgroundLittle is known about the neural correlates of dissociative amnesia, a transdiagnostic symptom mostly present in the dissociative disorders and core characteristic of dissociative identity disorder (DID). Given the vital role of the hippocampus in memory, a prime candidate for investigation is whether total and/or subfield hippocampal volume can serve as biological markers of dissociative amnesia.MethodsA total of 75 women, 32 with DID and 43 matched healthy controls (HC), underwent structural magnetic resonance imaging (MRI). Using Freesurfer (version 6.0), volumes were extracted for bilateral global hippocampus, cornu ammonis (CA) 1–4, the granule cell molecular layer of the dentate gyrus (GC-ML-DG), fimbria, hippocampal−amygdaloid transition area (HATA), parasubiculum, presubiculum and subiculum. Analyses of covariance showed volumetric differences between DID and HC. Partial correlations exhibited relationships between the three factors of the dissociative experience scale scores (dissociative amnesia, absorption, depersonalisation/derealisation) and traumatisation measures with hippocampal global and subfield volumes.ResultsHippocampal volumes were found to be smaller in DID as compared with HC in bilateral global hippocampus and bilateral CA1, right CA4, right GC-ML-DG, and left presubiculum. Dissociative amnesia was the only dissociative symptom that correlated uniquely and significantly with reduced bilateral hippocampal CA1 subfield volumes. Regarding traumatisation, only emotional neglect correlated negatively with bilateral global hippocampus, bilateral CA1, CA4 and GC-ML-DG, and right CA3.ConclusionWe propose decreased CA1 volume as a biomarker for dissociative amnesia. We also propose that traumatisation, specifically emotional neglect, is interlinked with dissociative amnesia in having a detrimental effect on hippocampal volume.

In everyday life, we are often exposed to traumatic experiences which can lead to diagnosis of posttraumatic stress disorder (PTSD). In Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (2013), PTSD, as part of trauma and stressor-related disorders, is defined by diagnostic criteria which include: (1) Exposure to actual or threatened death which, in the new version of DSM-5, compared to DSM 4, includes not only directly experiencing or witnessing the traumatic event but also learning that the traumatic event occurred to a close friend or family member. Also, experiencing repeated or extreme exposure to aversive details of the traumatic event can be criteria for the diagnosis of PTSD: (2) Presence of intrusion symptoms associated with the traumatic event (memories, dreams, dissociative reactions, distress, and physiological reactions); (3) Persistent avoidance of stimuli associated with the traumatic event; (4) Negative alterations in cognition and mood, which include the inability to remember an important aspect(s) of the traumatic event(s) often due to dissociative amnesia. Also, distorted cognitions, feelings of detachment, and persistent inability to experience positive emotions are described, among other symptoms, within these criteria.

Forensic psychologists are sometimes faced with the task of educating triers of fact about the evidential weight of dissociative experiences reported by claimants in litigation procedures. In their two-part essay, Brand et al. (Psychological Injury and Law, 10, 283–297, 2017a; Psychological Injury and Law, 10, 298–312, 2017b) provide advice to experts who find themselves in such situation. We argue that the Brand et al. approach is problematic and might induce confirmation bias in experts. Their approach is not well connected to the extant literature on recovered memories, dissociative amnesia, memory distortions, and symptom validity testing. In some instances, Brand et al. (Psychological Injury and Law, 10, 283–297, 2017a; Psychological Injury and Law, 10, 298–312, 2017b) simplify the current body of knowledge about dissociation; in other instances, they ignore relevant empirical studies to an extent that is worrisome.

The diagnostic criteria set for posttraumatic stress disorder (PTSD) has gradually evolved from DSM-III, to DSM-IV, to DSM-5. Besides a broadening of the event criterion for PTSD, the symptom domain now involves many different brain circuits and types of symptoms, including: fear and anxiety; anger and aggression; negative cognition and mood; hypo-arousal; and dissociative symptoms. The dissociative subtype of PTSD in DSM-5 is defined by the presence of depersonalization or derealization. However, the diagnostic criteria for PTSD also include dissociative flashbacks and dissociative amnesia. If these symptoms were included in the definition of the dissociative type of PTSD in future editions of the manual, then most cases of PTSD would be dissociative in nature, and non-dissociative cases would be a minority subtype. There does not appear to be any sound conceptual reason for excluding amnesia and flashbacks from the criteria for dissociative PTSD.

There has been a growing interest in determining the antecedents of the significant associations between dissociative symptomatology and sleep. The aim of this study was to investigate the mediation effect of a tendency to elicit uncontrollable and excessive worry on the relationship between dissociation and poor sleep quality among non-shift working health staff. Eighty-five participants with a mean age of 31.19 ±7.14 (ranging from 18 to 54) involved within the study. The Penn State Worry Questionnaire (PSWQ), Dissociative Experiences Scale (DES), Pittsburgh Sleep Quality Index (PSQI) and a demographic questionnaire were administered. Mediation regression models were utilized to evaluate direct and indirect associations between worry, dissociation and sleep quality after controlling for age, gender, marital status, education, prior psychiatric disorders, familial loading and time spent watching TV series in a week. Regression models indicated that direct dose-response relationship between dissociative symptomatology and sleep quality was not statistically significant. However, indirect effects of dissociative symptoms though pathological worry were substantial. More specifically, we found that the DES total, absorption/imaginative involvement and dissociative amnesia had significant indirect effects on poor sleep quality via excessive worry as measured by the PSWQ. We concluded that dissociative symptoms are indirectly associated with sleep through negative repetitive thoughts such as pathological worry. Therefore, new generation therapeutic approaches particularly mindfulness therapy should be considered in the first-line treatments of sleep disturbance.

Raffaele Sperandeo,1,2,* Vincenzo Monda,3,* Giovanni Messina,4 Marco Carotenuto,5 Nelson Mauro Maldonato,1,2 Enrico Moretto,1,2 Elena Leone,1,2 Vincenzo De Luca,6 Marcellino Monda,3 Antonietta Messina3 1Department of Human Sciences, Università Della, Basilicata, 2School of Integrated Gestaltic Psychotherapy, Torre Annunziata, 3Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, 4Department of Clinical and Experimental Medicine, University of Foggia, Foggia, 5Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy; 6Department of Psychiatry, University of Toronto, Toronto, Canada *These authors contributed equally to this work Abstract: Dissociative phenomena are common among psychiatric patients; the presence of these symptoms can worsen the prognosis, increasing the severity of their clinical conditions and exposing them to increased risk of suicidal behavior. Personality disorders as long duration stressful experiences may support the development of dissociative phenomena. In 933 psychiatric outpatients consecutively recruited, presence of dissociative phenomena was identified with the Dissociative Experience Scale (DES). Dissociative phenomena were significantly more severe in the group of people with mental disorders and/or personality disorders. All psychopathologic traits detected with the symptom checklist-90-revised had a significant correlation with the total score on the DES. Using total DES score as the dependent variable, a linear regression model was constructed. Mental and personality disorders which were associated with greater severity of dissociative phenomena on analysis of variance were included as predictors; scores from the nine scales of symptom checklist-90-revised, significantly correlated to total DES score, were used as covariates. The model consisted of seven explanatory variables (fourfactors and three covariates) explaining 82% of variance. The four significant factors were the presence of borderline and narcissistic personality disorder, substance abuse disorders and psychotic disorders. Significant covariates were psychopathologic traits of anger, psychoticism and obsessiveness. This study, confirming Janet’s theory, explains that, mental disorders and psychopathologic experiences of patients can configure the chronic stress condition that produces functional damage to the adaptive executive system. The symptoms of dissociative depersonalization/derealization and dissociative amnesia can be explained, in large part, through their current and previous psychopathologic experiences. Keywords: mental disorders, personality disorders, amnesia, depersonalization/derealization&nbsp

Dear Dr. Olff,We concur with Huntjens, Rijkeboer, and Arnzt (2019) that the quantity and quality of dissociative identity disorder (DID) treatment research must become improved, and that multiple b...

The interrelationships between the symptom domains of dissociation, such as the loss of continuity in subjective experience, the inability to access personal information, and the distortions about the perception of self and the environment, need to be better understood. In the current study, 2274 adults from Italy completed the Dissociative Experiences Scale-II (DES-II), and their responses were examined within a correlation network analysis framework. Fifteen dissociative experiences showed the strongest associations with the other dissociative experiences included in the measure, and they were selected for further analysis. A partial correlation network was calculated to reveal the associations between such experiences, and a community detection analysis was used to explore whether they formed distinct clusters in the network. Subsequently, a Bayesian network was estimated to examine the direction of the associations among the dissociative experiences, and a directed acyclic graph (DAG) was generated to estimate a potentially causal model of their relationships. The community detection analysis revealed three clusters of experiences that were conceptualized in terms of trance, experiential disconnectedness, and segregated behaviors. Dissociative amnesia was a common denominator of all the three clusters. The analysis of the DAG further suggested that dissociation can be conceptualized as a network in which dissociative experiences are layered into groups of symptoms that interact among them. Cognizance of the configuration and interactions among the dissociative domains and their related symptoms may be critical for better understanding the internal logic behind the dissociative processes and for addressing them effectively in clinical practice.

More than a third of the population report childhood adversity, and these experiences are associated with an increased risk of clinical and subclinical psychosis. The reason why some people go on to develop mental health problems and others do not is a key question for study. It has been hypothesized that dissociative processes mediate the relationship between early adversity and psychosis. The current study assessed whether dissociation, and specifically depersonalization (one component of dissociation), plays a mediating role in the relationship between childhood maltreatment and both hallucination proneness and delusional ideation. The study used a cross-sectional design and recruited a student sample to assess these relationships in a nonclinical group. Dissociation mediated the relationship between early maltreatment and both hallucination proneness and delusional ideation. In terms of specific dissociative processes, depersonalization did not mediate hallucination proneness or delusional ideation. Absorption mediated hallucination proneness; dissociative amnesia (negatively) and absorption mediated delusional ideation. It is likely that dissociation interferes with the encoding of traumatic information in nonclinical as well as clinical groups and in certain ways. Absorption may be particularly relevant. For some people, traumatic memories may intrude into conscious awareness in adulthood as psychotic-type experience.

Introduction Psychogenic nonepileptic seizures (PNES) and functional movement disorders (FMD) seem to represent the two ends of a continuum where different clinical phenotypes represent the manifestation of a common framework, involving dissociation. The aim of the present study was to assess dissociation and its subcomponents through the Mirror Gazing Test (MGT) in these functional neurological disorders (FNDs). Materials and methods Eleven patients with PNES, 17 with FMD, and 18 healthy controls (HCs) underwent a 10-minute MGT and completed the Strange Face Questionnaire (SFQ), an ad-hoc questionnaire assessing the sensations and perceptions they had looking in the mirror, and a short version of the Clinician-Administered Dissociative States Scale (CADSS). Results Patients with PNES, FMD, and HCs did not differ at the total score of the SFQ. Patients with PNES scored higher than HCs at the SFQ-subscale Dissociative Identity/Compartmentalization, at the CADSS Total Score and at its subscale Dissociative Amnesia, while patients with FMD scored higher than HCs at the CADSS subscale Depersonalization. Conclusions Patients with FMD reported more sensations falling in the detachment facet of dissociation, while patients with PNES in the compartmentalization one. We hypothesized that both facets of dissociation might be important pathophysiological processes for PNES and FMD and that different instruments (self-report clinical scales vs experimental tasks) might be able to detect different facets in different populations because they assess, respectively, “trait” and “state” dissociation.

Objective Few studies have assessed malingering in individuals with complex trauma and dissociation. This is concerning because these individuals' severe and ranging symptoms are associated with elevations on some, but not all, validity scales that detect symptom exaggeration. Dissociative individuals may experience dissociative amnesia, yet no study to date has examined how to distinguish clinical from malingered amnesia with dissociative samples. The current study examined whether the Test of Memory Malingering (TOMM) can accurately distinguish patients with clinically diagnosed dissociative identity disorder (DID) and simulators coached to imitate DID. Method Utility statistics classify individuals' TOMM scores as suggestive of clinical or simulated DID. TOMM scores from 31 patients diagnosed with DID via structured interviews were compared to those of 74 coached DID simulators. Results Discriminant analyses found scores from TOMM Trials 1 and 2 and total TOMM scores accurately classified clinical or simulated DID group status. In addition, TOMM Trial 1 demonstrated high specificity (87%) and positive predictive power (94%), as well as moderate sensitivity (78%), negative predictive power (63%), and overall diagnostic power (81%). Despite exposure to DID-specific information, simulators were not able to accurately feign the DID group's TOMM scores, which is inconsistent with the iatrogenic/sociocultural model of DID. Conclusion The TOMM shows promise as useful in clinical and forensic contexts to detect memory malingering among DID simulators without sacrificing specificity. Accurate distinction between genuine and feigned complex trauma-related symptoms, including dissociative memory, is integral to the accurate diagnosis of traumatized populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Fibromyalgia Syndrome (FMS) is a condition considered to represent a prototype of central sensitization syndrome, characterized by chronic widespread pain and along with symptoms of fatigue, non-restorative sleep and cognitive difficulties. FMS can be induced by trauma, infection or emotional stress with cumulative evidence that dissociation is relatively frequent in FMS patients. Two randomized controlled trials have shown that hyperbaric oxygen therapy (HBOT) can induce neuroplasticity and be effective in patients suffering from FMS. In this paper we present, for the first time, case series of female fibromyalgia patients who, in the course of HBOT, suddenly recalled repressed traumatic memories of childhood sexual abuse (CSA). The surfacing of the repressed (dissociative) memories decades after the sexual abuse events was sudden and utterly surprising. No psychological intervention was involved. As the memories surfaced, the physical pain related to FMS subsided. In one patient who had brain single photon emission CT (SPECT) before and after HBOT, the prefrontal cortex appeared suppressed before and reactivated after. The 3 cases reported in this article are representative of a total of nine fibromyalgia patients who experienced a retrieval of repressed memory during HBOT. These cases provide insights on dissociative amnesia and suggested mechanism hypothesis that is further discussed in the article. Obviously, prospective studies cannot be planned since patients are not aware of their repressed memories. However, it is very important to keep in mind the possibility of surfacing memories when treating fibromyalgia patients with HBOT or other interventions capable of awakening dormant brain regions.

Dissociative experiences are thought to occur acutely (e.g., during or immediately following trauma) or chronically and are considered to reduce the subjective distress accompanying stressful events. Growing evidence is consistent with a model that distinguishes between two qualitatively different types of phenomena—“compartmentalization” and “detachment.” Compartmentalization involves a deficit in the ability to deliberately control processes or actions that would normally be amendable to such control (e.g., amnesia and dissociative identities). Detachment refers to an experienced state of disconnection from the self or the environment (e.g., depersonalization, derealization, and numbing). In the present contribution, we discuss both detachment and compartmentalization phenomena. In addition, we discuss both dissociation as an acute response to trauma and persistent dissociation in the form of the most severe and chronic of the dissociative disorders, dissociative identity disorder (DID). We attend to the burgeoning empirical literature on memory processing and dissociation given the central role of these cognitive operations in the development and maintenance of the dissociative disorders, and more broadly, posttraumatic symptomatology. We end with a more general appeal for more transdiagnostic studies of dissociative phenomena, both in the areas of detachment and compartmentalization, emphasizing that dissociative disorders are not a category of mysterious diagnoses that need to be understood outside of well-known cognitive operations. Keywords: dissociation; dissociative identity disorder (DID); trauma; detachment; compartmentalization; dissociative amnesia

Objective The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents, first evaluating evidence for the depersonalization/derealization dissociative subtype of PTSD as defined by the DSM-5, and then examining a broader set of dissociation symptoms. Method A sample of treatment-seeking, trauma-exposed adolescents ages 12 to 16 (N=3,081) from the National Child Traumatic Stress Network Core Data Set was used to meet the study objectives. Two models of PTSD/dissociation co-occurrence were estimated using latent class analysis, one with two dissociation symptoms and the other with ten dissociation symptoms. After model selection, groups within each model were compared on demographics, trauma characteristics, and psychopathology. Results Model A, the depersonalization/derealization model, had five classes: (1) dissociative subtype/high PTSD; (2) high PTSD; (3) anxious arousal; (4) dysphoric arousal; and (5) a low symptom/reference class. Model B, the expanded dissociation model, identified an additional class characterized by dissociative amnesia and detached arousal. Conclusion These two models provide new information about the specific ways PTSD and dissociation co-occur and illuminate some differences between adult and adolescent trauma symptom expression. A dissociative subtype of PTSD can be distinguished from PTSD alone among adolescents, but assessing a wider range of dissociative symptoms is needed in order to fully characterize adolescent traumatic stress responses.

It has been claimed that the progress of psychiatry has lagged behind that of other medical disciplines over the last few decades. This may suggest the need for innovative thinking and research in psychiatry, which should consider neglected areas as topics of interest in light of the potential progress which might be made in this regard. This review is concerned with one such field of psychiatry: dissociation and dissociative disorders. Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity. While dissociative identity disorder (DID) is the most pervasive condition of all dissociative disorders, partial representations of this spectrum may be diagnosed as dissociative amnesia (with or without fugue), depersonalization disorder, and other specified dissociative disorders such as subthreshold DID, dissociative trance disorder, acute dissociative disorders, and identity disturbances due to exposure to oppression. In addition to constituting disorders in their own right, dissociation may accompany almost every psychiatric disorder and operate as a confounding factor in general psychiatry, including neurobiological and psycho-pharmacological research. While an anti- dissociative drug does not yet exist, appropriate psychotherapy leads to considerable improvement for many patients with dissociative disorders.

This study examined the association between exposure to domestic violence and dissociative symptoms. A sample of 68 Israeli opiate use disorder patients in recovery, 80 battered Arab Israeli women, and 103 respondents from a community sample participated in structured interviews that included the Dissociative Disorders Interview Schedule (DDIS), the Dissociative Trance Disorder Interview Schedule (DTDIS), and the Dissociative Experiences Scale (DES). As predicted, community participants reported significantly less exposure to traumatizing events and lower levels of dissociative psychopathology than individuals sampled from specialized treatment centers. In all, 91% of battered female participants were taxon-positive for dissociative disorder with 1 of every 2 respondents reporting symptoms corresponding to dissociative amnesia and depersonalization disorder, suggesting that this group may be particularly vulnerable to dissociative psychopathology. Extrasensory and paranormal experiences (ESP) and dissociative trance disorder experiences were strongly related to dissociative experiences and features of dissociative identity disorder (DID). These statistical associations suggest that dissociative disorders and ESP/trance experiences may share an underlying construct. Further research is needed on trauma and dissociation among female victims of domestic abuse in patriarchal, collectivist societies, particularly in the Arab world.

Dissociative amnesia is characterized by an inability to retrieve information already saved in memories. 5-HT has some role in neural regulatory control and may be related to the recovery from dissociative amnesia. To examine the role of 5-HT 1A receptors in the recovery from dissociative amnesia, we performed two positron emission tomography (PET) scans on a 30-year-old patient of dissociative amnesia using [ 11 C]WAY-100635, the first at amnesic state, and the second at the time he had recovered. Exploratory voxel-based analysis (VBA) was performed using SPM software. 5-HT 1A BP ND images were compared between the patient at amnesic and recovery states and healthy subjects (14 males, mean age 29.8±6.45) with Jack-knife analysis. 5-HT 1A receptor bindings of the patient at the recovery state were significantly higher than those of healthy subjects in the right superior and middle frontal cortex, left inferior frontal and orbitofrontal cortex and bilateral inferior temporal cortex. The increase in BP ND values of recovery state was beyond 10% of those of amnesia state in these regions except in the right superior frontal cortex. We considered that neural regulatory control by the increase of 5-HT 1A receptors in cortical regions played a role in the recovery from dissociative amnesia.

Dalenberg et al. (2012) argued that convincing evidence (a) supports the longstanding trauma model (TM), which posits that early trauma plays a key role in the genesis of dissociation; and (b) refutes the fantasy model (FM), which posits that fantasy proneness, suggestibility, cognitive failures, and other variables foster dissociation. We review evidence bearing on Dalenberg et al.'s 8 predictions and find them largely wanting in empirical support. We contend that the authors repeat errors committed by many previous proponents of the TM, such as attributing a central etiological role to trauma in the absence of sufficient evidence. Specifically, Dalenberg et al. leap too quickly from correlational data to causal conclusions, do not adequately consider the lack of corroboration of abuse in many studies, and underestimate the relation between dissociation and false memories. Nevertheless, we identify points of agreement between the TM and FM regarding potential moderators and mediators of dissociative symptoms (e.g., family environment, biological vulnerabilities) and the hypothesis that dissociative identity disorder is a disorder of self-understanding. We acknowledge that trauma may play a causal role in dissociation but that this role is less central and specific than Dalenberg et al. contend. Finally, although a key assumption of the TM is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma-dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorders. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Present neuroimaging findings suggest two subtypes of trauma response, one characterized predominantly by hyperarousal and intrusions, and the other primarily by dissociative symptoms. The neural underpinnings of these two subtypes need to be better defined. Fourteen women with childhood abuse and the current diagnosis of dissociative amnesia or dissociative identity disorder but without posttraumatic stress disorder (PTSD) and 14 matched healthy comparison subjects underwent functional magnetic resonance imaging (fMRI) while finding their way in a virtual maze. The virtual maze presented a first-person view (egocentric), lacked any topographical landmarks and could be learned only by using egocentric navigation strategies. Participants with dissociative disorders (DD) were not impaired in learning the virtual maze when compared with controls, and showed a similar, although weaker, pattern of activity changes during egocentric learning when compared with controls. Stronger dissociative disorder severity of participants with DD was related to better virtual maze performance, and to stronger activity increase within the cingulate gyrus and the precuneus. Our results add to the present knowledge of preserved attentional and visuospatial mnemonic functioning in individuals with DD.

Dissociative amnesia is relatively rare form of the dissociative disorder. This paper aims at describing the salient features of a case of functional autobiographical amnesia in a young adult and the approach adopted in the psychological management of this case. The case highlights concerns of the therapist at various stages of the therapy process.

Principal axis factor analysis with promax rotation extracted 3 factors from the 42 memory and amnesia items of the Multidimensional Inventory of Dissociation (MID) database (N = 2,569): Discovering Dissociated Actions, Lapses of Recent Memory and Skills, and Gaps in Remote Memory. The 3 factors' shared variance ranged from 36% to 64%. Construed as scales, the 3 factor scales had Cronbach's alpha coefficients of .96, .94, and .93, respectively. The scales correlated strongly with mean Dissociative Experiences Scale scores, mean MID scores, and total scores on the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). What is interesting is that the 3 amnesia factors exhibited a range of correlations with SCID-D-R Amnesia scores (.52, .63, and .70, respectively), suggesting that the SCID-D-R Amnesia score emphasizes gaps in remote memory over amnesias related to dissociative identity disorder. The 3 amnesia factor scales exhibited a clinically meaningful pattern of significant differences among dissociative identity disorder, dissociative disorder not otherwise specified-1, dissociative amnesia, depersonalization disorder, and nonclinical participants. The 3 amnesia factors may have greater clinical utility for frontline clinicians than (a) amnesia as discussed in the context of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nosology of the dissociative disorders or (b) P. Janet's (1893/1977 ) 4-fold classification of dissociative amnesia. The author recommends systematic study of the phenomenological differences within specific dissociative symptoms and their differential relationship to specific dissociative disorders.

Symptoms of dissociation, including dissociative amnesia, depersonalization, and derealization, commonly develop in individuals subject to chronic and repeated trauma during development. This includes the trauma of environmental inability to facilitate development of adequate cognitive strategies for coping with strong negative emotions. Dissociation likely involves dysregulated balance of prefrontal inhibition of limbic structures and inadequate regulation of attentional bias by both prefrontal and limbic systems. There is currently no established psychopharmacologic treatment for dissociative symptoms. Here the case of a woman with severe dissociative symptoms that were markedly improved with the administration of mixed amphetamine salts is discussed. Potential neurobiologic mechanisms for dissociative symptom improvement with psychostimulants are discussed.

Background The Dissociative Experience Scale for adolescent (A-DES), a 30-item, multidimensional, self-administered questionnaire, was validated using a large sample of American young people sample. We reported the linguistic validation process and the metric validity of the Italian version of A-DES in the Italy. Methods A set of questionnaires was provided to a total of 633 participants from March 2015 to April 2016. The participants consisted of 282 boys and 351 girls, and their average age was between 18 and 24 years old. The translation process consisted of two consecutive steps: forward–backward translation and acceptability testing. The psychometric testing was applied to Italian students who were recruited from the Italian Public Schools and Universities in Sicily. Informed consent was obtained from all participants at the research. All individuals completed the A-DES. Reliability and validity were tested. Results The translated version was validated on a total of 633 Italian students. The reliability of A-DES total is .926. It is composed by 4 subscales: Dissociative amnesia, Absorption and imaginative involvement, Depersonalization and derealization, and Passive influence. The reliability of each subscale is: .756 for dissociative amnesia, .659 for absorption and imaginative involvement, .850 for depersonalization and derealization, and .743 for passive influence. Conclusions The Italian version of the A-DES constitutes a useful instrument to measure dissociative experience in adolescents and young adults in Italy. Electronic supplementary material The online version of this article (doi:10.1186/s12991-016-0120-4) contains supplementary material, which is available to authorized users.

The present study attempted to assess the dissociative symptoms and overall dissociative disorder comorbidity in patients with obsessive-compulsive disorder (OCD). In addition, we examined the relationship between the severity of obsessive-compulsive symptoms and dissociative symptoms. All patients admitted for the first time to the psychiatric outpatient unit were included in the study. Seventy-eight patients had been diagnosed as having OCD during the 2-year study period. Patients had to meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD. Most (76.9%; n = 60) of the patients were female, and 23.1% (n = 18) of the patients were male. Dissociation Questionnaire was used to measure dissociative symptoms. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Dissociative Disorders interviews and Yale-Brown Obsessive Compulsive Checklist and Severity Scale were used. Eleven (14%) of the patients with OCD had comorbid dissociative disorder. The most prevalent disorder in our study was dissociative depersonalization disorder. Dissociative amnesia and dissociative identity disorder were common as well. The mean Yale-Brown score was 23.37 ± 7.27 points. Dissociation Questionnaire scores were between 0.40 and 3.87 points, and the mean was 2.23 ± 0.76 points. There was a statistically significant positive correlation between Yale-Brown points and Dissociation Questionnaire points. We conclude that dissociative symptoms among patients with OCD should alert clinicians for the presence of a chronic and complex dissociative disorder. Clinicians may overlook an underlying dissociative process in patients who have severe symptoms of OCD. However, a lack of adequate response to cognitive-behavioral and drug therapy may be a consequence of dissociative process.

The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma. Refereed/Peer-reviewed

Brain damage was traditionally seen as the product of a neurological disease or injury. Nevertheless, modern brain imaging techniques have provided increasing evidence for alterations in brain tissue and metabolism for a number of psychiatric disorders. Though for a while “dissociated” ( Spiegel, 2006 ) from the clinical and scientific arena, dissociative disorders have in the last several years received a renewed interest among several groups of researchers, who embarked on the work of disentangling their neural correlates. We review data from our own research as well as others, which point to distinct changes in brain regions underlying dissociative amnes(t)ic disorders. These changes may consist of overall reductions in brain metabolism or more selective alterations primarily in the right temporo-frontal cortices. Recent evidence with refined magnetic resonance imaging techniques furthermore reveals selective fiber degenerations in these regions. While these changes may persist and probably even intensify in some patients, they may be reversible in others – especially if treatment is carried out successfully within short time after onset. Implications of these findings for the pathogenetic conceptualization of dissociative amnes(t)ic disorders are outlined.

The authors conducted 50 clinical interviews on inpatients with clinical diagnoses of schizophrenia at Shanghai Mental Health Center. A dissociative type of schizophrenia was identified in 22% of the 50 cases. Diagnostic criteria for the proposed dissociative type of schizophrenia are that an individual meets at least three of six criteria: dissociative amnesia; depersonalization; the presence of two or more distinct identities or personality states; auditory hallucinations; extensive comorbidity; and severe childhood trauma. According to the authors’ model, psychotherapy is a primary treatment model for this subtype of schizophrenia. Five cases are presented that illustrate the features of dissociative schizophrenia, and a proposal is made for conducting randomized, prospective treatment outcome studies in a variety of cultures and languages.

This case is discussed in the contexts of affect theory, attachment theory, and dissociative experience. Dissociative adaptations to living that become entrenched resistances during psychotherapeutic inquiry give way to a scrupulous attention to the characteristics of dissociative experiencing. Somatosensory free association and appreciation of experiential aspects of depersonalization, derealization, and dissociative amnesia open new areas of negotiation between patient and therapist. Paradigms from infant attachment and adult attachment research parsimoniously explicate psychodynamic formulations. "Conflicted interest" and "conflicted disinterest" are proposed to flesh out appreciation of the child's inner experience during Type A and Type C attachment experiences. The Type D attachment style is consistent with a dissociative phenotype. The concept of "isolated subjectivity" can help explain the extent to which individuals both know and don't know about their experience, in the same moment, and without conscious conflict or anxiety.

Hypnosis and the related phenomenon of dissociation have long been linked to trauma. Evidence is reviewed regarding the relationship between trauma and dissociation, the prevalence of these dissociative symptoms in the acute aftermath of trauma, and their salience in predicting the development of later PTSD symptoms. The evidence reviewed regarding the prevalence of dissociative and other symptoms in the immediate aftermath of trauma formed the basis for including Acute Stress Disorder (ASD) as a new diagnosis in the DSM-IV. Dissociative amnesia is described as the key commonality between formally induced hypnosis and dissociative symptomatology, and controversy regarding traumatic amnesia is discussed. Finally principles of psychotherapy involving hypnosis and related techniques for dissociative and other post-traumatic symptoms are reviewed.

It has been argued that Symptom Validity Testing (SVT) has limited sensitivity in correctly identifying feigned autobiographical memory loss (e.g., dissociative amnesia) because malingerers would easily understand that below change performance on the SVT implies feigned memory loss. The current study tested this assumption in a sample of undergraduate students (N = 20) who committed a mock crime and then were instructed to feign complete amnesia for this event. Next, they had to answer 15 forced-choice questions that always contained the correct answer and an equally plausible alternative. Results show that a nontrivial minority of participants (40%) performed below chance. As well, understanding the SVT rationale appeared not to be related to random behaviour. Taken together, the results indicate that SVT procedures might be helpful in identifying feigned dissociative amnesia.

We reviewed all patients with dissociative disorders (nine patients with dissociative amnesia or dissociative fugue) and conversion disorders (10 patients) who were admitted and treated during the past 15 years. Needs frustrated at the appearance of the symptoms and those fulfilled at discharge were studied in both groups using Maslow's hierarchy of needs. The patients of both groups who encountered troubles in their life events were found to have frustrated needs. These symptoms tended to be accompanied more often by frustrations regarding a 'need for love' in the dissociative disorders group and by frustration in the need for 'self-esteem and self-actualization' in the conversion disorders group. In addition, needs of lower orders were already threatened at onset in many patients. The symptoms disappeared in patients in whom the situation completely improved (needs were fulfilled), but the symptoms were alleviated or unchanged in those in whom the problems remained unresolved.

IntroductionWe present the case report of a 21-year-old Chinese female, who was brought to the emergency department. We open the debate between the operative criteria stablished by DSM-5 of the clinical entity dissociative amnesia and Shenjing Shuairuo - the Chinese “culture-bound syndrome”.ObjectivesTo expose the relevance of the cultural formulation in the clinical evaluation of patients with a different non-Western culture in Psychiatry.AimsThe Shenjing Shuairuo syndrome (“nervous system weakness”) was originally descripted in China, it has a gradual onset, usually after a stressful event. It involves a minimum 3 of 5 symptoms group: weakness, emotions, excitement, neurological pain and sleep. This complex group of symptoms overlap with dissociative syndrome such as dissociative amnesia.Methods/resultsThe cultural formulation interview (CFI) was used for the diagnostic and subsequent treatment of dissociative amnesia with fugue in a different culture patient who met the clinical criteria of this two divergent clinic entities.ConclusionsIn our clinical practice, we will deal with different culture patients, who could present common clinical entities or with the so-called “culture-bound syndromes”. The cultural formulation of the clinical cases will help the clinicians to diagnose and have better treatment's options in clinical manifestations do not correspond to the conventional entities included in mostly Western-based nomenclatures.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Some claim that treatment for dissociative identity disorder (DID) is harmful. Others maintain that the available data support the view that psychotherapy is helpful.We review the empirical support for both arguments.Current evidence supports the conclusion that phasic treatment consistent with expert consensus guidelines is associated with improvements in a wide range of DID patients' symptoms and functioning, decreased rates of hospitalization, and reduced costs of treatment. Research indicates that poor outcome is associated with treatment that does not specifically involve direct engagement with DID self-states to repair identity fragmentation and to decrease dissociative amnesia.The evidence demonstrates that carefully staged trauma-focused psychotherapy for DID results in improvement, whereas dissociative symptoms persist when not specifically targeted in treatment. The claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment and the phenomenology of DID. Given the severe symptomatology and disability associated with DID, iatrogenic harm is far more likely to come from depriving DID patients of treatment that is consistent with expert consensus, treatment guidelines, and current research.

Dissociative amnesia (DA) among subjects with a dissociative disorder and/or borderline personality disorder (BPD) recruited from a nonclinical population was examined. The Steinberg Dissociative Amnesia Questionnaire (SDAQ), the Childhood Trauma Questionnaire, and the self-report screening tool of the BPD section of the Structured Clinical Interview for DSM-IV(SCID-BPD) were administered to 1,301 college students. A total of 80 participants who were diagnosed with BPD according to the clinician-administered SCID-BPD and 111 nonborderline controls were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) by a psychiatrist blind to diagnosis and scale scores. Internal consistency analyses and test-retest evaluations suggested that the SDAQ is a reliable instrument for the population studied. Of the participants, 20.6% reported an SDAQ score of 20 or above and impairment by DA. Those who had both dissociative disorder and BPD (n = 78) had the highest SDAQ scores. Both disorders had significant effects on the SCID-D total and amnesia scores in the variance analysis. On SDAQ scores, however, only BPD had this effect. There was a significant interaction between the 2 disorders for the SCID-D total but not for the SDAQ or SCID-D amnesia scores. BPD represented the severity of dissociation and childhood trauma in this study group. However, in contrast to the dissociative disorders, BPD was characterized by better awareness of DA in self-report. The discrepancies between self-report and clinical interview associated with BPD and dissociative disorders are discussed in the context of betrayal theory (J. J. Freyd, 1994) of BPD and perceptual theory (D. B. Beere, 2009) of dissociative disorders.

Objective: To compare the opinions of Canadian psychiatrists regarding dissociative disorder diagnoses with those of previously surveyed American psychiatrists. Method: We sent a 1-page questionnaire to a stratified representative sample of 550 Canadian psychiatrists. Results: Eighty percent of Canadian psychiatrists responded. Fewer than one-third replied that dissociative amnesia and dissociative identity disorder should be included without reservations in the DSM-IV; fewer than 1 in 7 felt that the validity of these diagnoses was supported by strong scientific evidence. French- and English-speaking Canadians had similar opinions. Overall, Canadians were significantly less accepting than Americans. Conclusion: Both Canadian and American psychiatrists show little consensus regarding the diagnostic status or scientific validity of dissociative amnesia and dissociative identity disorder.

In most of the recent scientific and clinical literature, dissociation has been equated with dissociative amnesia, depersonaliza- tion, derealization, and fragmentation of identity. However, according to Pierre Janet and several World War I psychiatrists, dissociation also pertains to a lack of integration of somatoform components of experi- ence, reactions, and functions. Some clinical observations and contem- porary studies have supported this view. Somatoform dissociation, which can be measured with the Somatoform Dissociation Questionnaire (SDQ-20), is highly characteristic of dissociative disorder patients, and a core feature in many patients with somatoform disorders and in a subgroup of patients with eating disorders. It is strongly associated with reported trauma among psychiatric patients and patients with chronic pelvic pain presenting in medical healthcare settings. Motor inhibitions and anesthesia/analgesia are somatoform dissociative symptoms that are similar to animal defensive reactions to major threat and injury. Among a wider range of somatoform dissociative symptoms, these particular symptoms are highly characteristic of patients with dissocia- tive disorders. The empirical findings reviewed in this article should have implications for the contemporary conceptualization and defini- tion of dissociation, as well as the categorization of somatoform disor- ders in a future version of the DSM. (Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website

The latest edition of the International Classification of Diseases (ICD-10)1 defines dissociation as “ . . . a partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of body movements” (p 151). Thus defined, the concept of dissociation captures a heterogeneous group of psychiatric conditions previously subsumed within the broader construct of hysteria. The dissociative (conversion) disorders category in ICD-10 comprises subcategories of dissociative amnesia, dissociative fugue, trance and possession disorders, dissociative anaesthesia and sensory loss, dissociative motor disorders and dissociative convulsions, and waste basket categories included to capture uncommon, impure, or less severe instances of dissociation. Other symptoms previously viewed as hysterical are placed within the somatoform disorders category of ICD-10, on the grounds that their primary characteristic is an apparent disturbance of bodily rather than cerebral function. By contrast, DSM-IV2 classifies convulsions, motor dysfunction, and sensory loss as somatoform disorders, despite adopting an otherwise similar definition of dissociation and categorisation of dissociative complaints. In the context of this editorial we embrace the more inclusive scheme offered by ICD-10. The basis for their inclusion within current psychiatric nosology is the assumption that dissociative disorders are primarily psychological in nature.1 Nevertheless, the concept of dissociation has important implications for practice and research within the neurological sphere also. Dissociative psychopathology was witnessed almost exclusively within the neurological setting until the late 19th and early 20th centuries, and many such patients present to neurologists even now. What is striking about dissociative symptoms is their apparent similarity to those found in many common neurological conditions, and it is often extremely difficult to distinguish between the two; the case of dissociative convulsions provides an instructive example. Recent estimates suggest that between 9% and 50% of patients referred to specialist …

1. To investigate whether abnormalities in objective neurophysiologic measures are observable in patients with probable dissociative generalized amnesia, the P300 and N100 event-related potentials were evaluated in six such patients in both acute stage and after recovery from amnesia. Findings were compared with those in 12 age- and gender-matched healthy subjects. 2. While latencies did not differ from those of control subjects, P300 amplitudes in acute-stage recordings were lower than those in controls. Repeated recordings in the patients showed a significant increase in P300 amplitude after recovery from amnesia. 3. Amplitude and latency of N100 did not differ between the patient and control groups, nor changed significantly after retrieval of memory. 4. These findings suggest that some unknown biological and/or psychologic mechanisms that cause retrograde autobiographic amnesia may impair cognitive function as reflected in an objective neurophysiologic measure such as the P300.

The dissociative disorders have often been underdiagnosed by psychiatric processionals. Reasons for this underdiagnosis are diverse and include: unfamiliarity with the diagnoses, unfamiliarity with dissociative symptomatology, lack of appreciation of the epidemiology of dissociative disorders, and even outright disbelief in certain dissociative disorders diagnoses, primarily dissociative identity disorder 42,43,46 and dissociative amnesia, especially if either the amnesia or identity alteration are related to criminal offenses. In order to provide the clinician with a more complete and reliable diagnostic armamentarium, this article reviews the clinical phenomenology and epidemiology of the dissociative disorders. Following this review, several instruments useful in the diagnosis of dissociative disorders are described, including the Dissociative Experiences Scale (DES), Structured Clinical Interview for Dissociative Disorder, and Minnesota Multiphasic Personality Inventory (MMPI). Finally, the diagnostic use of sodium amytal and hypnosis is described.

Proponents of the iatrogenic model of the etiology of dissociative identity disorder (DID) have expressed concern that treatment focused on direct engagement and interaction with dissociated self-states harms DID patients. However, empirical data have shown that this type of DID treatment is beneficial. Analyzing data from the prospective Treatment of Patients With Dissociative Disorders (TOP DD) Study, we test empirically whether DID treatment is associated with clinically adverse manifestations of dissociated self-states: acting so differently that one feels like different people, hearing voices, and dissociative amnesia. We show that, over the course of the study, there were significant decreases in feeling like different people and hearing voices. These results indicate that this form of DID treatment does not lead to symptomatic worsening in these dimensions, as predicted by the iatrogenic model. Indeed, treatment provided by TOP DD therapists reduced, rather than increased, the extent to which patients experienced manifestations of pathological dissociation. Because severe symptomatology and impairment are associated with DID, iatrogenic harm may come from depriving DID patients of treatment that targets DID symptomatology.

Suspects awaiting trial often claim that they cannot remember important parts of their violent crimes. It is not unusual that forensic experts readily accept such claims and interpret them in terms of dissociative amnesia or, more specifically, a "red-out". This interpretation hinges on the assumption that heightened levels of stress implicated in violent crimes interfere with memory. We argue that the notion of red-out is a priori not plausible and that alternative interpretations-primarily malingering and substance-induced organic amnesia-should be considered and ruled out first before concluding that memory loss is dissociative in nature. We illustrate our point with four cases that superficially have the contours of red-out tragedies. We believe that, in such cases, neuropsychological tests and/or psychopharmacological information on dose-response relationships can assist forensic experts to exclude malingering or substance-induced amnesia. There is no reason for not using tests and tools from neuropsychology and psychopharmacology.

BackgroundThis study is a three-month follow-up study in order to assess the short-term impact of traumatic stress among 53 Swedish survivors of the Estonia disaster.MethodA questionnaire consisting of general questions about conditions during and after the disaster and self-assessment by Post Traumatic Symptom Scale (PTSS–10), Impact of Event Scale (IES), Sense of Coherence–short version (SoC–12), and the DSM–IV list of dissociative symptoms of Acute Stress Disorder formulated as questions regarding individual reactions was distributed.ResultsThe response rate was 79.2% (n=42). The participants scored an average of 3.9 on PTSS–10, 28.5 on IES (‘intrusion’ and ‘avoidance’ subscales) and 62.8 on SoC–12, which shows elevated levels of post-traumatic stress reactions but a normal level of sense of coherence. The reported occurrence of dissociative symptoms during the disaster was as follows: emotional numbing in 43% of the survivors, reduction of awareness in 55%, derealisation in 67%, depersonalisation in 33%, and dissociative amnesia in 29%. Survivors scoring low in SoC scored significantly higher in both PTSS–10 and IES than those with high scores in SoC. All dissociative symptoms were predictive of post-traumatic reactions.ConclusionsThis study substantiates the importance of assessing dissociative symptoms during a life-threatening event as a possible predictor for later post-traumatic reactions and possible PTSD. The Sense of Coherence Scale may be useful as an instrument to sort out survivors at risk.

The concept of dissociation refers to disruptions in attentional control. Attentional control is an executive function. Few studies have addressed the link between dissociation and executive functioning. Our study investigated this relationship in a sample of undergraduate students (N = 185) who completed the Dissociative Experiences Scale and the Random Number Generation Task. We found that minor disruptions in executive functioning were related to a subclass of dissociative experiences, notably dissociative amnesia and the Dissociative Experiences Scale Taxon. However, the two other subscales of the Dissociative Experiences Scale, measuring depersonalization and absorption, were unrelated to executive functioning. Our findings suggest that a failure to inhibit previous responses might contribute to the pathological memory manifestations of dissociation.

Although they were for a while “dissociated” (Spiegel, 2006) from the clinical and scientific arena, dissociative disorders have in the last several years received a renewed interest among several groups of researchers, who embarked on the work of identifying and describing their underlying neural correlates. Dissociative disorders are characterized by transient or chronic failures or disruptions of integration of otherwise integrated functions of consciousness, memory, perception, identity or emotion. The DSM-IV-TR (2000) includes nowadays under the heading of dissociative disorders several diagnostic entities, such as dissociative amnesia and fugue, depersonalization disorder, dissociative identity disorder and dissociative disorder not otherwise specified (such as Ganser syndrome). In contrast to DSM-IV-TR, ICD-10 (1992) also comprises under the category of dissociative (conversion) disorder the entity of conversion disorder (with its various forms), which is in DSM-IV-TR (2000) captured under the heading of somatoform disorders (and probably will remain under the same heading in the upcoming DSM-V).

This article reports on the use of hypnosis to facilitate the diagnostic process and the treatment of an unusual case of adult psychogenic amnesia. An Iraqi citizen living in the U.S. developed an atypical case of Dissociative Amnesia, Systematized type, post-automotive collision. The amnesia presented with features encompassing complete loss of the patient’s native language. Dissociation theory as a conceptualization of hysterical reactions was employed as the basis in the formulation of this case. The differential diagnosis was facilitated by the Hypnotic Diagnostic Interview for Hysterical Disorders (HDIHD) Adult Form, an interview tool specifically designed for cases such as this. Treatment consisted exclusively of ego strengthening and time projection approaches in hypnosis. It was hypothesized that, as the coping capacities became more viable, the dissociative symptoms would remiss. After 6 weekly visits the patient regained complete command of his native language. Follow-up at 6 months indicated that the patient remained devoid of symptoms.