Colin A. Ross

Background: The Brief Betrayal Trauma Survey (BBTS) is a potentially useful tool for assessing different types of traumatic events. The BBTS has been widely used to test the betrayal trauma theory, but its reliability and validity remained uncertain. This study examined the test-retest reliability of the BBTS and its correlations with PTSD symptoms...

Internet gaming disorder (IGD) is a growing public health concern, with longitudinal studies linking it to a range of negative outcomes, including psychological distress and poor academic achievements. While the trauma model has been applied to other addictive behaviors, little is known about the relationship between childhood trauma, trauma-relate...

Recent studies showed that dissociation may be common and persistent in people with depression. Dissociation also predicts subsequent depressive symptoms. Both conditions have been linked with trauma exposure. Yet, little is known about the co-occurrence of depression and dissociation. This multi-sample study investigated the co-occurrence of depre...

Background: Although trauma-related symptoms (e.g., complex PTSD and dissociative symptoms) and psychotic symptoms often co-occur, little is known about the complex relationships among these symptoms over time. Objective: This study examined the bidirectional relationships among complex PTSD symptoms, dissociative symptoms, and positive symptoms o...

Maladaptive Daydreaming is a distinct syndrome in which the main symptom is excessive vivid fantasising, which causes clinically significant distress and functional impairment in academic, vocational, and social domains. Unlike normal daydreaming, maladaptive daydreaming is persistent, compulsive, and detrimental to one’s life. It involves detachme...

Objective: This paper describes the development and pilot evaluation of a single-session 20-minute educational video program for people with PTSD symptoms. Methods: A pilot randomized waitlist controlled trial was conducted with an international sample of adults with PTSD symptoms (N = 54). Results: Within-subjects analyses showed that participan...

The body of knowledge regarding the social work service needs of persons with complex dissociative disorders (DD) remains seriously limited. This paper presents two case reports of young women with a complex DD to illustrate the opportunities for social work intervention to improve quality of life outcomes. This study is the first to explore the so...

The use of single-item measures of self-rated mental health (SRMH) has been increasingly valued in epidemiologic research. However, little is known about the reliability and mental health correlates of SRMH in Chinese populations. This study examined the reliability and mental health correlates of SRMH in three Chinese samples. We analyzed data col...

Objective: The dissociative subtype of posttraumatic stress disorder (PTSD) was incorporated into the diagnostic criteria for PTSD in Diagnostic and Statisical Manual of Mental Disorders, Fifth Edition (DSM-5). The subtype requires the presence of persistent or recurrent depersonalization or derealization; however, several authors have suggested th...

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, lit...

Background: Previous studies have demonstrated the high prevalence of dissociative symptoms and their association with considerable healthcare costs. However, there is a lack of studies that describe whether dissociative symptoms persist and lead to other clinical outcomes over time in the community. Objectives: This study investigated the persiste...

Background: Previous studies have indicated that borderline personality disorder (BPD) is closely associated with trauma and dissociation. Nevertheless, BPD is a heterogeneous condition, and not all people with BPD have severe dissociation. This study examined whether the relationship of BPD features with trauma and dissociation would remain signif...

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 dissociati...

Objectives Complex post-traumatic stress disorder (CPTSD) is a newly recognized trauma disorder in ICD-11. Little is known about the prevalence and correlates of CPTSD in primary care settings. Its cultural aspects also remained minimally explored. This study investigated the prevalence and sociocultural correlates of PTSD and complex PTSD among Ch...

Background: Auditory verbal hallucinations, the experiences of hearing voices without external stimuli, are common in individuals with schizophrenia spectrum disorders. Recent models of auditory verbal hallucinations highlight dissociative processes in the psychopathology of voices, as there is evidence indicating a similar or even higher prevalenc...

The author replies to a critique of his paper about false memories in an effort to clarify issues on which there is disagreement. A key point made is that the validity of dissociation as a phenomenon, that is, as reported symptoms, does not depend on theories about the mechanisms of dissociation. There are no proven mechanisms for any mental health...

In the largest meta-analysis of studies on the prevalence of dissociative disorders (DDs) (Kate et al., 2020), DDs were found to affect 11.4% of college students. As reviewed by Lynn et al. (2020), however, the prevalence rates of dissociative amnesia (DA) and depersonalization/derealization disorder (DDD) in the general population vary across indi...

Background Trauma has been increasingly linked to depression. Previous studies have suggested that comorbid post-traumatic stress disorder (PTSD) may be associated with poor outcomes in depression treatment. However, the prevalence and correlates of ICD-11 PTSD and complex PTSD (CPTSD) in people with depression remain unclear. Methods This study e...

Dissociation is an important yet commonly unrecognized issue in the field of mental health. Research shows that dissociative symptoms and disorders are common and are associated with considerable individual suffering and social costs. Thus, it is important to understand how to support people with dissociation so as to reduce their suffering and imp...

Complex post-traumatic stress disorder (CPTSD) has recently been recognized as an official psychiatric diagnosis in ICD-11, after years of research and advocacy in the field. It has been suggested that dissociative symptoms are a major feature of CPTSD. This scoping review aimed to summarize the existing knowledge base on the relationship between d...

Background To improve the outcomes of depression treatment, personalized treatments that take individual needs into account are recommended. Recent research suggests that a subgroup of depressed people who suffer from co-occurring dissociation may be more likely to have encountered traumatic or stressful experiences and they may also have more psyc...

Background: The overlapping symptoms of schizophrenia and dissociation have been increasingly recognized. This paper explains why it is reasonable to expect that there would be a substantial subgroup of patients diagnosed with schizophrenia spectrum disorders (SSDs) who suffer from pathological dissociation. Objective: As little is known about the...

This chapter explores the most pertinent research questions to understand and advance the study of dissociation. Drawing on specifi c themes, recommendations for future work are outlined at the end of each section. Our chapter in the fi rst edition of this book still contains questions empirically unanswered (e.g., genetics and neurobiology of diss...

Background: Childhood adversities have been increasingly recognized as a significant risk factor for depression. However, the underlying mediating mechanism between childhood adversities and depression requires further investigation. The literature shows that childhood adversities are also closely associated with post-traumatic stress disorder (PTS...

Betrayal trauma theory proposes that betrayal and non-betrayal traumas are different in terms of their nature and impacts. The theory predicts that dissociation is more strongly related to betrayal than to non-betrayal trauma, however there is a lack of cross-cultural evaluation of the theory. One competing theory is the socio-cognitive model, whic...

The authors interviewed 118 highly dissociative inpatients in a Trauma Program with the Dissociative Disorders Interview Schedule, the Dissociative Experiences Scale and the Adverse Childhood Experiences questionnaire; of the 118 participants 42 met DSM-5 criteria for dissociative identity disorder and 52 for other specified dissociative disorder....

Various authors have argued that dissociative amnesia is a synonym for repressed memories, recovered memories are almost always false memories, and dissociative amnesia and dissociative identity disorder are not valid disorders. These authors commit numerous errors of logic and scholarship; they misunderstand Freud's thinking about childhood sexual...

Pathological dissociation is a common trauma-related condition and is associated with considerable health and social care needs. People with pathological dissociation typically require psychosocial interventions, but there are many challenges in providing such interventions for this vulnerable population. An important question that remains unexplor...

In this workshop the presenters will review their research and clinical experience with dissociative disorders in China, Hong Kong, India and the Asian Pacific. This work has resulted in over 25 peer-reviewed papers. They will describe the prevalence of dissociative disorders in China, assessment tools they have used in their research, and a web-ba...

In order to investigate the potential role of autonomic imbalance in mental and physical disorders, it would be useful to have a relevant self-report measure. The authors developed the Autonomic Spectrum Questionnaire for this purpose. The authors administered the Autonomic Spectrum Questionnaire and other measures to 801 college students. They con...

A total of 491 participants from four previous studies, 443 of whom were diagnosed with dissociative identity disorder (DID) on the Dissociative Disorders Interview Schedule, completed the Dissociative Experiences Scale (DES). Their results were analyzed to determine how many were in the dissociative taxon (DES-T) on the DES. Of the 443 individuals...

Hearing voices is generally linked to biological factors, but its psychosocial aspects should not be overlooked. The empirical literature indicates the need for acknowledging the psychosocial aspects of voice-hearing experiences. We conducted a review of online health information about voice-hearing experiences and examined if the most widely acces...

A replication study of treatment outcomes for patients at a residential treatment center for substance use disorders was conducted. A set of measures was completed on admission and discharge by 200 patients admitted to a residential treatment center for substance use disorders. Participants in the replication sample did not differ from those in the...

Objective Studies on maladaptive daydreaming have shown that it has a number of comorbidities including dissociative disorders, yet no studies have examined the reciprocal relationship. The aim of this study was to determine the frequency of maladaptive daydreaming in a sample of psychiatric inpatients with high levels of dissociation. Methods The...

The ability to predict which groups of mental health service users are more likely to require psychosocial care could facilitate intervention planning and optimize utilization of resources. Dissociation may be a transdiagnostic indicator of psychosocial intervention needs because dissociation is theoretically and empirically associated with psychos...

Auditory hallucinations are widely regarded as symptoms of brain disease treated with medications. In an alternative paradigm, voices are understood as trauma-driven dissociated, disowned, or disavowed aspects of self; the goal is not to suppress them but to integrate them during psychotherapy. Auditory hallucinations are common in dissociative ide...

People with pathological dissociation should receive proper clinical attention and timely support. Recent studies have shown that pathological dissociation is common in the Chinese context. However, little is known about the clinical features of Chinese people with pathological dissociation. This paper reports the first data regarding trauma histor...

Auditory hallucinations are common among people seeking treatment for trauma and dissociation and can result in diagnostic challenges. This study examined the correlates of hearing voices in two samples of people seeking interventions for dissociation - a sample of 83 English speakers and a sample of 82 Chinese speakers. We found that, compared wit...

Purpose: Although people with pathological dissociation (PD) can benefit from specific interventions, there are challenges in providing suitable interventions for them in the field (e.g., high cost, lack of specialized services, stigma). Many people with PD cannot receive dissociation-focused services in their current service locations. It is impor...

Purpose: Early identification of borderline personality disorder (BPD) is important as timely interventions are beneficial and cost-effective. Unrecognized BPD not only results in suffering for individuals and their families, but also leads to considerable social costs. Although web-based measures have the potential to facilitate screening assessme...

Depression is a common and challenging comorbid condition in people with pathological dissociation. To our knowledge, this preliminary study is the first study that has looked at the clinical correlates of depression in a sample of people with pathological dissociation (N = 72). We found that severe depression is common in this sample and that depr...

Background Adverse childhood experiences are an important public health issue. It is well documented that they are associated with many health problems. Nevertheless, little is known about childhood emotional abuse and neglect (CEA and CEN) among Hong Kong people. Objective This study aimed to explore the demographic and mental health correlates o...

Maladaptive daydreaming is a proposed disorder characterized by excessive daydreaming that causes subjective distress and/or interferes with function. The daydreaming involves complex inner worlds, characters, and plots that are understood by the person as fantasy, and the daydreaming may occupy many hours per day. The disorder has good reliability...

Purpose : Post-traumatic stress disorder (PTSD) is a common mental health problem but it is often unrecognized in health care and social service settings. Reliable and valid measures are important for practitioners to screen for PTSD in the Chinese context. This study developed and pilot tested a Chinese version of the PTSD Checklist for DSM-5 (PCL...

Social workers are major mental health service providers in many countries and regions. This paper presents five reasons to explain why complex dissociative disorders (complex DD) should receive more attention from social workers. We conducted a preliminary review of complex DD in the social work literature. In March 2018, we searched all articles...

Adverse childhood experiences (ACEs) have become a major concern in the mental health field. The literature suggests that ACEs could be associated with various mental health problems. Yet, ACEs require further investigation in Chinese cultures, especially in Hong Kong. Both the frequency of ACEs and their relationships with dissociation remain unkn...

Be A Teammate With Yourself is written for people who have experienced trauma or stress, and for people with any kind of post-traumatic and dissociative reactions. People with a trauma related mental disorder (e.g., post-traumatic stress disorder, borderline personality disorder, dissociative disorder) may also benefit from this self-help resource....

The incorrect belief that anorexia nervosa is predominantly genetic is maintained in the psychiatric literature by a series of misquotations and misrepresentations of research data. An example of this type of scholarship is as an editorial in The American Journal of Psychiatry . Data from family and twin studies referenced in the editorial provide...

This chapter aims to give an overview of findings on childhood trauma in patients diagnosed with psychotic disorders and dissociative disorders. Existing evidence consistently shows a high prevalence of trauma in people with psychosis. The majority of patients of both sexes living with psychosis had experienced abuse in childhood. Dissociative diso...

The authors hypothesized that their Integrated Addiction Model, a trauma-focused treatment approach at a residential treatment center for substance use disorders, would result in a reduction of depression, anxiety, posttraumatic stress, and dissociative symptoms from admission to discharge. The Beck Depression Inventory (BDI), Beck Anxiety Inventor...

This chapter describes the features of dissociative schizophrenia and the clinical model and research data supporting its existence. In classical dissociative identity disorder (DID), the characteristic symptoms are due to full switches of executive control between highly structured, personified, and discrete ego states, or alter personalities. Typ...

Introduction Dissociative symptoms are common in people with trauma-related disorders and often co-occur with other psychiatric conditions. In particular, the relationships between dissociative symptoms, Schneiderian first-rank symptoms and borderline personality symptoms are still contentious, poorly understood and require more attention. Objecti...

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-...

The trophoblast model of cancer is incorporated into The Gonzalez Protocol for treatment of cancer and a range of noncancer chronic diseases. The other main component of the Protocol involves the prescription of detailed diets and supplementation. The foundation of the diet and supplementation component of the Protocol is the theory of autonomic ty...

Accurate interpretations of psychological assessments rely heavily on forthright reporting. However, researchers and practitioners recognize that examinees can easily invalidate their test results by underreporting symptoms or overstating positive attributes. Rogers (2008) delineated two distinct but related forms of positive impression management...

Las autolesiones suelen ser una estrategia de afrontamiento derivada del trauma, que pueden entenderse desde la perspectiva del modelo de procesamiento adaptativo de la información (PAI) y tratarse con terapia de desensibilización y reprocesamiento mediante movimientos oculares (EMDR) (Shapiro, 1995, 2001). Las autolesiones a menudo están conectada...

Purpose: Pathological dissociation (PD) is an easily overlooked phenomenon in the mental health field. Standardized assessment is important for identifying dissociative symptoms and disorders. However, the use of PD measures in Chinese cultures needs investigation. This pilot study investigated the psychometric properties of three PD measures amon...

A set of measures of trauma, dissociation, altered states of consciousness, and spiritual experiences was administered to a convenience sample of 100 inpatients in a hospital Trauma Program. The inpatients had an average Dissociative Experiences Scale score of 42.3 and an average Adverse Childhood Experiences Scale score of 6.6, both of which are v...

Pathological dissociation is widely regarded as a cross-culturally occurring condition related to trauma and adversity and is an important construct in the mental health field. Yet, the frequency of pathological dissociation in both clinical and nonclinical populations in Hong Kong remains unknown. In addition, the relationship of pathological diss...

A recent study of the frequency of schizophrenia in 22q11.2 deletion syndrome illustrates the serious problems with genome-wide association studies in schizophrenia. In an editorial accompanying the paper in The American Journal of Psychiatry, it is stated that this deletion occurs in only 0.3% of cases of schizophrenia, and yet it is said to be on...

Les sévices auto-infligés constituent une stratégie de coping actionnée par le trauma qui peut se comprendre du point de vue du modèle du Traitement adaptatif de l’information (TAI) et se prendre en charge par la psychothérapie EMDR (désensibilisation et retraitement par les mouvements oculaires) (Shapiro, 1995, 2001). Les sévices auto-infligés son...

The literature on maladaptive daydreaming may be useful in case conceptualization and treatment planning in a subset of dissociative identity (DID) cases. These are DID cases with elaborate inner worlds, high numbers of “alter personalities,” and often histories of Satanic ritual abuse, or involvement in government mind control programs. I recommen...

Thirty-seven inpatients in a hospital-based Trauma Program completed a set of measures at admission and at 6 and 10-months follow-up. On the Dissociative Disorders Interview Schedule, the average number of secondary features of dissociative identity disorder at baseline was 3.6 (SD ⇤ 4.2), and the average score on the Dissociative Experiences Scale...

Background: Sixty-three inpatients in a psychiatric hospital who had previously undergone bariatric surgery were interviewed by the hospital dietitian. The purpose of the study was to determine the frequency of adverse childhood experiences in this population. Methods: Participants completed the Adverse Childhood Experiences (ACE) Scale. Result...

In order to determine the comorbidity profile of individuals meeting criteria for a proposed new disorder, Daydreaming Disorder (more commonly known as Maladaptive Daydreaming, MD), the Structured Clinical Interview for DSM-5 and the Structured Clinical Interview for DSM-IV Dissociative Disorders were administered to 39 participants who met criteri...

The philosophical foundations of reductionist biological psychiatry are internally selfcontradictory. Mind is simultaneously disallowed and "explained" by the reductionist approach; this internal self-contradiction invalidates reductionist biological psychiatry at the level of its philosophical foundation. Three theories that dominate science today...

Extensive LSD testing was conducted by the US Army at Edgewood Arsenal and other locations from 1955 to 1967. A number of different reports have been produced describing the health effects of this testing, including the Veterans Health Initiative Report in 2003. By and large, these reports gloss over and minimize the short and long-term side effect...

Daydreaming, a common mental activity, can be excessive and accompanied by distress and impaired functioning in daily life. Although currently not formally identified by diagnostic manuals, daydreaming disorder (maladaptive daydreaming-MD) is a clinically well-defined phenomenon. However, research is lacking regarding the diagnostic reliability of...

Identifying dissociation is important for mental health services because it could fundamentally affect one’s diagnosis and treatment plan. The Dissociative Experiences Scale (DES) is a widely-used self-report scale for measuring dissociative experiences. It has been translated into many languages and used in many countries. However, there is no val...

Individuals in treatment for dissociative identity disorder (DID) not uncommonly describe childhood involvement in organized, multi-perpetrator ritual abuse. They described being “programmed” by the perpetrators and feel that the programming is out of their control. The author has developed a set of treatment strategies and interventions for such c...

In order to determine the comorbidity profile of individuals meeting criteria for a proposed new disorder, Daydreaming Disorder (more commonly known as Maladaptive Daydreaming, MD), the Structured Clinical Interview for DSM-5 and the Structured Clinical Interview for DSM-IV Dissociative Disorders were administered to 39 participants who met criteri...

Severe, chronic childhood trauma commonly results in a set of negative core self-beliefs. These include blaming the self for the abuse, feeling unworthy and unlovable, believing the world would be better off if one committed suicide, and believing that one does not deserve peace or happiness. Linked to these cognitive errors are beliefs that one is...

Responses by Miccio-Fonseca (2015) and DeFeo (2015) to a commentary by Ross on problems with the sexual disorders sections of DSM-5 are based on a misunderstanding of Ross’s article (2015a). Miccio-Fonseca and DeFeo describe what they consider to be confusion and misunderstanding in Ross’s opinions about gender, sexuality, and related topics. Howev...

Hostile voices are a common problem in both dissociative identity disorder and psychosis. They may take the form of command hallucinations for suicide, or express negative thoughts and feelings about the self. The authors describe a psychotherapeutic treatment approach for hostile voices that converse with each other, keep up a running commentary o...

Self-harm is frequently a trauma-driven coping strategy that can be understood from the perspective of the adaptive information processing (AIP) model and treated with eye movement desensitization and reprocessing (EMDR) therapy (Shapiro, 1995, 2001). Self-harm is often connected with memories of adverse and traumatic life experiences. Identifying...

A self-report version of the Dissociative Disorders Interview Schedule (SR-DDIS) was administered to 100 inpatients in a hospital-based Trauma Program. All participants had previously completed the interviewer-administered version of the interview schedule (DDIS). When comparing the overall results on the DDIS and SR-DDIS for the 100 inpatients, th...

Jean-Martin Charcot who studied hysteria at the Salpetriere hospital in Paris late in the nineteenth century is often portrayed as a great neurologist. According to standard accounts, his female hysterical patients imitated the seizures of epileptic patients at the Salpetriere in order to get attention because of their dramatic, self-centered natur...