OBJECTIVE: Imprecise conceptualizations of dissociation hinder understanding of trauma-related dissociation. An heuristic resolution for research and clinical practice is proposed. METHOD: Current conceptualizations of dissociation are critically examined. They are compared with a new theory that incorporates classical views on dissociation with other contemporary theories related to traumatization, viewing dissociation as a lack of integration among psychobiological systems that constitute personality, that is, as a structural dissociation of the personality. RESULTS: Most current views of dissociation are overinclusive and underinclusive. They embrace non-dissociative phenomena--rigid alterations in the level and field of consciousness--prevalent in non-traumatized populations, and which do not require structural dissociation. These views also largely disregard somatoform and positive symptoms of dissociation and underestimate integrative deficiencies, while emphasizing the psychological defensive function of dissociation. They do not offer a common psychobiological pathway for the spectrum of trauma-related disorders. Structural dissociation of the personality likely involves divisions among at least two psychobiological systems, each including a more or less distinct apperceptive centre, that is, a dissociative part of the personality. Three prototypical levels of structural dissociation are postulated to correlate with particular trauma-related disorders. CONCLUSIONS: Limitation of the concept of dissociation to structural dividedness of the personality sets it apart from related but non-dissociative phenomena and provides a taxonomy of dissociative symptoms. It postulates a common psychobiological pathway for all trauma-related disorders. Trauma-related dissociation is maintained by integrative deficits and phobic avoidance. This conceptualization advances diagnosis, classification, treatment and research of trauma-related disorders.
OBJECTIVE: Imprecise conceptualizations of dissociation hinder understanding of trauma-related dissociation. An heuristic resolution for research and clinical practice is proposed. METHOD: Current conceptualizations of dissociation are critically examined. They are compared with a new theory that incorporates classical views on dissociation with other contemporary theories related to traumatization, viewing dissociation as a lack of integration among psychobiological systems that constitute personality, that is, as a structural dissociation of the personality. RESULTS: Most current views of dissociation are overinclusive and underinclusive. They embrace non-dissociative phenomena--rigid alterations in the level and field of consciousness--prevalent in non-traumatized populations, and which do not require structural dissociation. These views also largely disregard somatoform and positive symptoms of dissociation and underestimate integrative deficiencies, while emphasizing the psychological defensive function of dissociation. They do not offer a common psychobiological pathway for the spectrum of trauma-related disorders. Structural dissociation of the personality likely involves divisions among at least two psychobiological systems, each including a more or less distinct apperceptive centre, that is, a dissociative part of the personality. Three prototypical levels of structural dissociation are postulated to correlate with particular trauma-related disorders. CONCLUSIONS: Limitation of the concept of dissociation to structural dividedness of the personality sets it apart from related but non-dissociative phenomena and provides a taxonomy of dissociative symptoms. It postulates a common psychobiological pathway for all trauma-related disorders. Trauma-related dissociation is maintained by integrative deficits and phobic avoidance. This conceptualization advances diagnosis, classification, treatment and research of trauma-related disorders.
Authors: Kristen R Choi; Julian D Ford; Ernestine C Briggs; Michelle L Munro-Kramer; Sandra A Graham-Bermann; Julia S Seng Journal: J Trauma Dissociation Date: 2019-02-04
Authors: Maria L Pacella; Leah Irish; Sarah A Ostrowski; Eve Sledjeski; Jeffrey A Ciesla; William Fallon; Eileen Spoonster; Douglas L Delahanty Journal: J Trauma Stress Date: 2011-05-25
Authors: Dan J Stein; Karestan C Koenen; Matthew J Friedman; Eric Hill; Katie A McLaughlin; Maria Petukhova; Ayelet Meron Ruscio; Victoria Shahly; David Spiegel; Guilherme Borges; Brendan Bunting; Jose Miguel Caldas-de-Almeida; Giovanni de Girolamo; Koen Demyttenaere; Silvia Florescu; Josep Maria Haro; Elie G Karam; Viviane Kovess-Masfety; Sing Lee; Herbert Matschinger; Maya Mladenova; Jose Posada-Villa; Hisateru Tachimori; Maria Carmen Viana; Ronald C Kessler Journal: Biol Psychiatry Date: 2012-10-09 Impact factor: 13.382