Abuse History and Pathological Dissociation
and American College Students:
A Comparative Study
Dean Lauterbach, PhD
Eli Somer, PhD
Paul Dell, PhD
Haley VonDeylen, MS
ABSTRACT. This paper has three objectives: (1) to compare the abuse
histories of American and Israeli college students, (2) to closely examine
the different types of dissociative experiences among these students, and
(3) to compare the dissociative experiences of American and Israeli col-
lege students. The US sample reported higher levels of abuse than the
Israeli sample. The US and Israeli samples did not differ in overall level
of dissociation but the US sample had higher rank-ordered scores for
five kinds of dissociation: Flashbacks, Somatoform Dissociation, Per
secutory Voices, Temporarily Dissociated Knowledge or Skills, and Be
Dean Lauterbach is affiliated with Eastern Michigan University, Ypsilanti, MI.
Eli Somer is affiliated with the University of Haifa, Haifa, Israel.
Paul Dell is affiliated with the Trauma Recovery Center, Norfolk, VA.
Haley VonDeylen is affiliated with Eastern Michigan University, Ypsilanti, MI.
Address correspondence to: Dean Lauterbach, PhD, 507 Mark Jefferson Hall,
Department of Psychology, Eastern Michigan University, Ypsilanti, MI 48197 (E-mail
The authors would like to thank Dr. Eve Carlson for her thoughtful comments on an
earlier version of this manuscript.
This project was supported by a spring-summer grant awarded to the first author.
Journal of Trauma & Dissociation, Vol. 9(1) 2008
Available online at http://jtd.haworthpress.com
© 2008 by The Haworth Press. All rights reserved.
ing Told of Disremembered Behavior.
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KEYWORDS. Dissociation, multidimensional inventory of dissocia
ABUSE HISTORY AND PATHOLOGICAL DISSOCIATION
AMONG ISRAELI AND AMERICAN COLLEGE STUDENTS:
A COMPARATIVE STUDY
Child abuse is a considerable international problem, yet data about its
prevalence in different countries are sparse. The prevalence of child-
hood sexual abuse in nonclinical North American samples suggests
prevalence rates as high as 22.3% for childhood sexual abuse (Gorey &
Leslie, 1997). The prevalence of childhood sexual abuse was similarly
high in other countries [e.g., 13.14% (United Kingdom: Oaksford &
Frude, 2001), 25% (Israel: Schein et al., 2000), and 25% (Spain: Lopez,
Hernandez, & Carpintero, 1995)].
There has also been increased recognition of the role that culture may
play in the nature and severity of psychopathology. For example, the
last two editions of the Diagnostic and Statistical Manual of Mental Dis-
orders (American Psychiatric Association 1994; 2000) have attempted
to identify cultural features of disorders. More specifically, there is in
creased recognition of the need to examine whether any given symptom
is culture-specific (emic) or culturally universal (etic). Psychiatry has
long been aware that dissociation appears in a variety of cultures, but of
ten has culture-specific manifestations (e.g., amok, latah, pibloktoc, and
Several studies have examined the presence and severity of dissocia
tion in different countries. A study of the Hebrew version of the Dis
sociative Experiences Scale (Somer, Dolgin, & Saadon, 2001) reported
mean H-DES scores for non-clinical participants that were comparable
to DES scores from nonclinical samples in the US, and H-DES scores
that co-varied with clinical diagnosis. Persons with dissociative disor
ders had higher scores than persons with Posttraumatic Stress Disorder
(PTSD) or Acute Stress Disorder. These findings using the H-DES are
52 JOURNAL OF TRAUMA & DISSOCIATION
consistent with similar work using the DES in the United States
(Bernstein & Putnam, 1986). Barker-Collo (2001) found that DES
scores of New Zealand college students were similar to those of stu
dents from the United States, Scotland, and the Netherlands. These
studies examined mean group differences in global dissociation and did
not report data about specific types of dissociative experiences.
Most research on dissociation with college students, has used the
DES or the DES II (Carlson, 1997; Carlson & Putnam, 1993; Putnam et
al., 1996). The DES is a well-established brief (28 items) screening
measure with solid psychometric properties. Nevertheless, the DES
probably does not assess the full spectrum of pathological dissociation.
This brevity is in keeping with the intent of its authors to create a screen
ing instrument for dissociation. While the 8-item DES-Taxon subscale
(Waller, Putnam, & Carlson, 1996) provides greater clarity about patho
logical dissociation, it does not provide a rich description of those expe-
This paper reports findings from two exploratory studies that used
the Multidimensional Inventory of Dissociation 4.0 (Dell, 2006) to ex-
amine the type and severity of dissociation among college students.
This paper has three objectives: (1) to compare the abuse histories of
American and Israeli college students, (2) to examine the different types
of dissociative experiences among college students, and (3) to compare
the dissociative experiences of American and Israeli college students.
The combined sample of American and Israeli college students in
cluded 142 persons. There were 68 United States students (13 men and
55 women), and 74 Israeli students (11 men and 63 women). The sam
ples did not differ in gender composition, but the US sample was signif
icantly younger t(125.69) = 5.53, p < .0005 [US: M = 20.9 (3.7) Israeli:
M = 25.4 (5.8)].
Traumatic Experiences Questionnaire (TEQ
The TEQ (Nijenhuis, Spinhoven, van Dyck, van der Hart, & Vander
linden, 1998) is a 25-item measure that assesses a wide range of trauma.
Lauterbach et al. 53
The first ten items assess the presence/absence of a wide variety of
stresses and trauma (e.g., having to look after parents and/or siblings as
a child). The last 15 items assess the presence/absence of abusive expe
riences. The TEQ yields an overall index of number of traumas experi
enced, and weighted composite scores of five types of abuse (i.e.,
Emotional Neglect, Emotional Abuse, Physical Abuse, Sexual Harass
ment, and Sexual Abuse). Three items load onto each composite scale
with total scores for each determined by the relationship with the
abuser, the age at which the abuse occurred, and subjective ratings of
the impact of the experience. The TEQ has good psychometric proper
ties (Nijenhuis, 1999). Scores are stable over time (test-retest r = .91),
and are moderately correlated with dissociation (Nijenhuis et al., 1998).
The standard version of the TEQ was used with the US sample. The
TEQ was translated into Hebrew and the translated version was used
with the Israeli sample. The procedure for translating the TEQ was con-
sistent with established protocol. The TEQ was translated into Hebrew
by ES then back-translated into English by a native English speaker
who was blind to the initial instrument. ES then compared the original
and back-translated English versions and reconciled differences in the
essential meaning of items.
Multidimensional Inventory of Dissociation (MID 4.0
The MID 4.0 is a 259-item
measure of dissociation (Dell, 2002b).
Items were rationally derived and designed to comprehensively assess
the domain of dissociation. Respondents are asked to indicate “How of-
ten do you have the following experiences when you are not under the
influence of alcohol or drugs?” Item scores range from 0 (Never Hap
pens)to10(Always Happens). There are 171 items that assess dissocia
tion. The remaining items assess other clinical symptoms (psychosis &
cognitive distraction) and dimensions of validity (Defensiveness, Neu
rotic Suffering, Attention Seeking, Rare Symptoms, and Factitious
Behavior). The MID yields two global indices of pathological dissocia
tion. The Mean MID Score is the average frequency of occurrence of
each dissociative symptom and can range from 0 to 100. Thus, values
on this scale use the same metric as the DES. The Severe Dissociation
Score assesses the number of severe dissociative symptoms reported.
The MID has 13 primary dissociation scales, 11 scales that assess par
tially-dissociated influences of another self-state and 6 scales that assess
fully-dissociated actions of another self-state (see Table 1). Previous
studies examining the psychometric properties of the MID 3.0 were
54 JOURNAL OF TRAUMA & DISSOCIATION
Lauterbach et al. 55
TABLE 1. Listing of scales included on the Multidimensional Inventory of Dis
sociation and result of equivalence testing.
quite favorable (Dell, 2002a). With one exception (i.e., Psychosis), the
subscales are internally consistent (α range = .77 to .96). The MID 3.0
scores are significantly correlated with the DES (rs .90-.94) (Dell,
2002a) and the effects of physical (r = .45) and sexual abuse (r = .54)
The standard MID was used with the US sample. The MID was trans
lated into Hebrew and the translated version was used with the Israeli
sample. Previous analyses of the psychometric properties of the Hebrew
version of the MID (Somer & Dell, 2005) yielded promising findings.
The H-MID total score and the 13 primary scales were significantly cor
related with the DES (r = .53-.70) and with the total number of traumas
As noted by van de Vijver and Leung (1997), merely reporting indi
ces of internal consistency or bi-variate correlations between measures
of similar constructs does not ensure that instruments developed and
normed in one country perform the same way in other countries. Estab-
lishing such functional equivalence is an essential first step before re-
searchers can turn their attention to the focal questions. Two techniques
were chosen to examine scale level performance of the MID across
samples. First, indices of internal consistency-reliability (alpha) were
compared. The statistic to test for equality of two independent reliability
coefficients is (1-α1)/(1-α2). Using this index, 17 of 30 MID scales are
equivalent across samples (Table 1).
The second procedure for examining scale performance is an exten-
sion of a procedure outlined by van de Vijver and Leung (1997) for ex-
amining performance of dichotomous items. First, three groups were
formed based on total MID scores. Then, each scale score was dich
otomized. A series of 2(culture) ⫻ 2(symptom presence/absence) fre
quency tables were constructed, each of which is nested within the three
total MID groups. The goal is to determine whether scales perform sim
ilarly across different cultures at different overall levels of dissociation
severity. The Mantel-Haenszel procedure tests whether the odds of hav
ing a particular symptom type are identical for both cultures at all three
levels of total MID scores. As can be seen Table 1, 25 of the 28 MID
scales evidenced functional equivalence.
This research received written approval from the institutional review
boards at both universities. Potential participants were approached in
56 JOURNAL OF TRAUMA & DISSOCIATION
classes and told about the opportunity to earn extra credit in exchange
for completing a questionnaire packet. When the research participants
arrived at the testing site they were given a questionnaire packet con
sisting of the consent form, the TEQ, and the MID. After answering
questions, participants signed the consent form and procedures for com
pleting each questionnaire were then provided.
Description of Samples
To determine if the samples differed in level of exposure to abusive
experiences, a one-way ANOVA was computed. Levene’s test for
homogeneity of variance revealed that the two groups differed signifi-
cantly. Therefore, sample scores were rank-ordered and a Mann-Whit-
ney U was computed. For a number of reasons (i.e., limited sample size,
use of less powerful non-parametric tests) no post-hoc corrections for
alpha inflation secondary to multiple contrasts were made and alpha
was set at .05. The US students reported significantly higher rank-or-
dered scores than Israeli students for abuse type (emotional neglect: U =
1900.50, p < .005; emotional abuse: U = 1512.00, p < .0001; physical
abuse: U = 1980.50, p < .005; sexual harassment: U = 2017.00, p < .05);
sexual abuse U = 1808.50, p < .0001; and total trauma exposure: U =
1531.00, p < .0005). A substantial percentage of both samples reported
at least some exposure to abusive experiences (Table 2).
Lauterbach et al. 57
TABLE 2. Percentage of persons in Israeli and US samples who reported ex
periencing some level of abuse.
Comparison of Samples on Overall Dissociation
and 13 Primary Dimensions of Dissociation
There were no significant differences between the samples in overall
dissociation (i.e., MID Mean score & MID Severity score). The values
for the MID Mean, which are most similar to the DES mean score, were
substantially lower than DES scores that are typically seen in college
samples [United States M = 7.9(9.2), Israeli M = 5.9(6.9)]. A meta anal
ysis of DES scores (Ijzendoorn & Schuengel, 1996) found a mean value
of 14.4. A series of single group t-tests compared the MID mean values
for the focal groups with this theoretical population DES mean. The val
ues for both groups were significantly lower than this theoretical popu
lation mean [United States: t(66) = ⫺5.9, p < .0005; Israeli: t(73) =
⫺10.8, p < .0005].
Next, the US and Israeli students were compared on the 13 primary
dimensions of dissociation (see Table 1). The rank ordered scores of the
US group were significantly higher than the Israeli group for two of the
primary dimensions of dissociation: Flashbacks U = 1850.5, p < .01,
and Somatoform Dissociation, U = 1780.0, p < .005.
Comparison of Samples on Partially-Dissociated
and Fully-Dissociated Influences of Another Self-State
The rank-ordered scores of the two groups were compared on the
eleven scales assessing partially-dissociated influences of another self-
state and the six scales assessing fully-dissociated effects of another
self-state. There were three significant differences: Persecutory Voices,
U = 2066.5, p < .05, Temporarily Dissociated Knowledge or Skills, U =
1624.0, p < .0005, and Being Told of Disremembered Actions U =
1955.0, p < .05. In all cases, the rank-ordered scores of the US sample
were higher, indicating higher levels of dissociation.
This paper had three primary objectives: (1) to compare the abuse
histories of American and Israeli college students, (2) to provide a
detailed report of the types and severity of dissociative experiences
reported by college students, and (3) to compare the dissociative experi
ences of American and Israeli college students. These two sets of data
58 JOURNAL OF TRAUMA & DISSOCIATION
provide information regarding the extent to which dissociation may be
culture specific, as opposed to culturally universal.
Surprisingly, these two groups reported marked differences in level
of exposure to abuse. In every domain measured by the TEQ, the US
sample reported higher levels of abuse.
There are at least three possible
explanations for these findings. First, there may be a genuine difference
in abuse exposure experienced by American and Israeli students. This
explanation, however, is inconsistent with the similar rates of child sex
ual abuse that were reported in previous studies in the USA (22.3%,
Gorey & Leslie, 1997) and Israel (25.0%, Schein et al., 2000). Second,
the US sample was younger than the Israeli sample (ages = 20.9 and
25.4, respectively). It is possible that the younger cohort interpreted
items on the TEQ differently than their older counterparts. However,
the magnitude of the differences between these two groups makes this
explanation unlikely. Third, it is possible that cultural differences influ-
ence the willingness of US and Israeli college students to report abusive
Given the magnitude of the differences in exposure to abuse, and the
robust relationship between exposure to abuse and dissociation, a corre-
sponding difference in frequency of dissociative experiences might be
anticipated. While, the US and Israeli students did not differ in overall
dissociation, American students had higher scores on two primary di-
mensions of dissociation, two partially-dissociated manifestations of
another self-state, and one fully-dissociated effect of another self-state.
The present study examined 32 MID scales (overall dissociation = 2,
primary dimensions = 13, partially-dissociated influences = 11, and
fully-dissociated influences = 6). Thus, 27 of 32 contrasts revealed no
significant differences between the two samples suggesting that the
MID can be administered in Hebrew with results consistent with those
in the US. These findings are consistent with the notion that overall se
verity of dissociation may be a universal phenomenon (etic), but they
also suggest that culture (and other factors) may be related to specific
kinds of dissociation (emic). It should be noted, however, that few stud
ies have directly compared cultural groups on overall severity of disso
ciation and severity of specific dimensions of dissociation. Most studies
have compared groups on overall level of dissociation. For example,
Xiao et al. (2006) found that dissociation was far lower in Chinese sam
ples (clinical and non-clinical) than in a Canadian general population
sample. Investigators are only beginning to compare the psychometric
properties of dissociation measures developed in the United States with
their performance in other cultures (e.g., Nilsson & Svedin, 2006) and
Lauterbach et al. 59
currently no studies have examined factorial invariance of extant disso
ciation measures across cultures.
Although this study advances our understanding of the universality
of dissociation among college students, one important limitation should
be noted. The TEQ, while relatively comprehensive, assesses some
events that are nontraumatic (i.e., “emotional neglect by more distant
members of family”). Moreover, some of the behavioral descriptors
provided to test takers are sufficiently vague to produce over-reporting.
For example, the behavioral descriptors for emotional neglect include
“being left alone, or receiving insufficient affection.” Similarly, the be
havioral anchors for emotional abuse include teasing and name-calling
by siblings. Future research should employ a more rigorous measure of
trauma exposure. In addition, future researchers might which to exam
ine both the factorial and metric equivalence of the TEQ across samples
[within culture(s)], and across cultures.
1. A number of trauma exposure instrument have been developed that have the
same acronym (TEQ: Vrana & Lauterbach, 1994) or a similar one (TLEQ: Kubany,
2000). All references to the “TEQ” in this manuscript will refer to the Dutch TEQ.
2. Unless specifically stated otherwise, all references to the MID in this paper refer
to version 4.0.
3. Subsequent to the completion of this paper, the MID 4.0 was revised twice. The
MID 5.0 has 229 items and the MID 6.0 has 218 items. Each version of the MID has a
corresponding scoring protocol. The scoring protocol for version 4.0 was used in the
present study. The scoring program for the present study was written by DL. All ques
tions regarding development and use of the MID should be directed to PD.
4. While the US sample reported significantly higher levels of abuse, this is not
meant to imply that the US sample has a higher level of trauma exposure. Were this ar
ticle to focus on events such as exposure to terrorist attacks, the Israeli sample would no
doubt obtain higher scores.
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