Article

Dissociation: An insufficiently recognized major feature of complex posttraumatic stress disorder

Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.
Journal of Traumatic Stress (Impact Factor: 2.72). 10/2005; 18(5):413-23. DOI: 10.1002/jts.20049
Source: PubMed

ABSTRACT The role of dissociation in (complex) posttraumatic stress disorder (PTSD) has been insufficiently recognized for at least two reasons: the view that dissociation is a peripheral, not a central feature of PTSD, and existing confusion regarding the nature of dissociation. In this conceptual article, the authors address both issues by postulating that traumatization essentially involves some degree of division or dissociation of psychobiological systems that constitute personality. One or more dissociative parts of the personality avoid traumatic memories and perform functions in daily life, while one or more other parts remain fixated in traumatic experiences and defensive actions. Dissociative parts manifest in negative and positive dissociative symptoms that should be distinguished from alterations of consciousness. Complex PTSD involves a more complex structural dissociation than simple PTSD.

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    • "For the treatment of complex PTSD, starting with stabilizing interventions prior to EMDR or prolonged exposure has been shown to improve the overall treatment effect (Cloitre et al., 2010; Dorrepaal et al., 2010, 2012). Assessment and treatment of dissociative disorders in traumatized groups is called for in light of the severe clinical condition of such patients and their low treatment success when dissociative disorders are not recognized (Boon & Draijer, 1993; Friedl & Draijer, 2000; Hart et al., 2005; Moskowitz, 2011; Read et al., 2005; Ross & Keyes, 2004; Sar et al., 2003). "
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    • "A close relationship also exists between PTSD, dissociation , somatization, and a variety of other medical problems (see below). Some authors have argued that chronic interpersonal trauma, especially with childhood onset, such as incest, physical abuse, torture, or neglect, leads to a much broader range of symptoms, often with dissociative features, described as complex PTSD (C-PTSD) (Herman, 1992; Van der Kolk et al., 1996; Van der Hart et al., 2005; Cloitre et al., 2009). C-PTSD transcends current formulations of PTSD in three main areas of disturbance: (1) complex symptom presentations ; (2) characterological issues; and (3) vulnerability to repeated trauma. "
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    • "Given these and other study findings, dissociation must be understood as both dimensional (absorption and imaginative involvement) and as a typological construct indicating pathological dissociation (amnesia for dissociative states, derealization, depersonalization and identity alterations ) (Waller, Carlson, & Putnam, 1996). Under extreme stress, peritraumatic dissociative responses offer momentary psychological protection and include a subjective sense of numbing, detachment, absence of emotional responsiveness, feeling dazed and disoriented, inability to remember parts of a traumatic event, feeling outside of your body, feeling that the world is too intense or dull or feeling as if you are in a daze (APA, 2000; Nijenhuis, van Enyen, Kusters, & van der Hart, 2001; van der Hart et al., 2005). These transient peritraumatic dissociative responses support our ability to focus on the immediate situation while delaying emotional and cognitive flooding that may hamper survival behavior. "
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