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Dissociation and Dissociative Disorders: Challenging Conventional Wisdom

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Abstract

Conventional wisdom holds that dissociation is a coping mechanism triggered by exposure to intense stressors. Drawing on recent research from multiple laboratories, we challenge this prevailing posttraumatic model of dissociation and dissociative disorders. Proponents of this model hold that dissociation and dissociative disorders are associated with (a) intense objective stressors (e.g., childhood trauma), (b) serious cognitive deficits that impede processing of emotionally laden information, and (c) an avoidant information-processing style characterized by a tendency to forget painful memories. We review findings that contradict these widely accepted assumptions and argue that a sociocognitive model better accounts for the extant data. We further propose a perspective on dissociation based on a recently established link between a labile sleep–wake cycle and memory errors, cognitive failures, problems in attentional control, and difficulties in distinguishing fantasy from reality. We conclude that this perspective may help to reconcile the posttraumatic and sociocognitive models of dissociation and dissociative disorders.
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2012 21: 48Current Directions in Psychological Science
Steven Jay Lynn, Scott O. Lilienfeld, Harald Merckelbach, Timo Giesbrecht and Dalena van der Kloet
Dissociation and Dissociative Disorders: Challenging Conventional Wisdom
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The current (fourth) edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV-TR) defines dissocia-
tion as “a disruption in the usually integrated functions of con-
sciousness, memory, identity, or perception of the environment”
(American Psychiatric Association, 2000, p. 519). Many psy-
chologists and psychiatrists view dissociation as a coping
mechanism designed to deal with overpowering stress (Dell &
O’Neil, 2009). One well-known form of dissociation is deper-
sonalization, in which individuals feel disconnected from
themselves; they may feel like an automaton or feel as if they
are watching themselves from a distance. Another is derealiza-
tion, in which individuals feel disconnected from reality; they
may feel as though they are in a dream or that things seem to
be moving in slow motion. Steven Spielberg’s 1998 film, Sav-
ing Private Ryan, vividly depicts an episode of derealization
(spoiler alert): After being shot, Captain John Miller (por-
trayed by Tom Hanks) witnesses the events around him unfold-
ing as if in a silent, slow-motion movie.
Certain forms of dissociation are widespread in the general
population; for example, most estimates suggest that nearly
50% of individuals have experienced depersonalization at
some point in their lives (Aderibigbe, Bloch, & Walker, 2001).
When mild and intermittent, such symptoms are rarely of clin-
ical concern. Nevertheless, in some cases, dissociation may
take the form of grossly impairing dissociative disorders.
These puzzling conditions include dissociative identity disor-
der (DID), formerly known as multiple personality disorder,
dissociative fugue, and depersonalization disorder. In the best
known dissociative disorder, DID, individuals supposedly
develop multiple coexisting personalities, known as “alters.”
In dissociative fugue, individuals purportedly suddenly forget
their past, travel from home or work (fugue has the same
root as fugitive), and adopt a new identity; in depersonaliza-
tion disorder, individuals experience frequent bouts of deper-
sonalization, derealization, or both. Dissociation also features
prominently in other psychological conditions not formally
classified as dissociative disorders, such as panic disorder,
borderline and schizotypal personality disorders, and posttrau-
matic stress disorder.
The origins of dissociation are poorly understood. Never-
theless, the clinical literature on dissociation has been marked
by three widely accepted assumptions associated with what is
often referred to as the posttraumatic model. Specifically, it
has long been assumed that chronic dissociation is (a) a coping
mechanism to deal with intense stressors, especially childhood
Corresponding Author:
Steven Jay Lynn, Psychology Department, Binghamton University (SUNY),
Binghamton, NY 13902
E-mail: stevenlynn100@gmail.com
Dissociation and Dissociative Disorders:
Challenging Conventional Wisdom
Steven Jay Lynn
1
, Scott O. Lilienfeld
2
, Harald Merckelbach
3
,
Timo Giesbrecht
3
, and Dalena van der Kloet
3
1
Binghamton University (SUNY),
2
Emory University, and
3
Maastricht University
Abstract
Conventional wisdom holds that dissociation is a coping mechanism triggered by exposure to intense stressors. Drawing on
recent research from multiple laboratories, we challenge this prevailing posttraumatic model of dissociation and dissociative
disorders. Proponents of this model hold that dissociation and dissociative disorders are associated with (a) intense objective
stressors (e.g., childhood trauma), (b) serious cognitive deficits that impede processing of emotionally laden information, and
(c) an avoidant information-processing style characterized by a tendency to forget painful memories. We review findings that
contradict these widely accepted assumptions and argue that a sociocognitive model better accounts for the extant data.
We further propose a perspective on dissociation based on a recently established link between a labile sleep–wake cycle
and memory errors, cognitive failures, problems in attentional control, and difficulties in distinguishing fantasy from reality.
We conclude that this perspective may help to reconcile the posttraumatic and sociocognitive models of dissociation and
dissociative disorders.
Keywords
dissociation, dissociative disorder, dissociative identity disorder, trauma
Dissociation and Dissociative Disorders 49
sexual and physical trauma; (b) accompanied by cognitive
deficits that interfere with the processing of emotionally laden
information; and (c) marked by an avoidant information-
processing style characterized by a tendency to forget painful
memories. The coping mechanism outlined in (a) is typically
assumed to play a key causal role in dissociative disorders. For
example, many authors have argued that DID reflects individ-
uals’ attempts to “compartmentalize” and obtain psychologi-
cal distance from traumatic experiences such as child abuse
(Dell & O’Neil, 2009). In this article, we review recent
research that calls these widespread assumptions into question
and proposes novel and scientifically supported approaches
for conceptualizing dissociation and dissociative disorders.
The Posttraumatic Model
The posttraumatic model (Bremner, 2010; Gleaves, 1996) is
ostensibly supported by very high rates—sometimes exceed-
ing 90%—of reported histories of childhood trauma, most
commonly child sexual abuse, among patients with DID and
perhaps other dissociative disorders (Gleaves, 1996; Simeon,
Guralnik, Schmeidler, Sirof, & Knutelska, 2001). Neverthe-
less, a number of authors (e.g., Giesbrecht, Lynn, Lilienfeld, &
Merckelbach, 2008, 2010; Kihlstrom, 2005; Merckelbach &
Muris, 2001; Piper & Merskey, 2004; Spanos, 1994, 1996)
have questioned the oft-cited link between child abuse/
maltreatment and dissociation for several reasons.
First, in most studies (e.g., Ross & Ness, 2010), objective
corroboration of abuse is lacking. Second, the overwhelming
majority of studies of self-reported trauma and dissociation
are based on cross-sectional designs that do not permit causal
inferences; in these designs, individuals are typically assessed
for DID or other dissociative disorders and asked to recollect
whether they had been abused or neglected in childhood. Pro-
spective studies that circumvent the pitfalls of such retrospec-
tive reporting often fail to substantiate a link between
childhood abuse and dissociation in adulthood (Giesbrecht
et al., 2008; but see Bremner, 2010). Third, researchers have
rarely controlled for overlapping conditions or symptoms,
such as those of anxiety, eating, and personality disorders,
raising the possibility that the correlates of abuse are not spe-
cific to dissociative disorders. Fourth, the reported high levels
of child abuse among DID patients may be attributable to
selection and referral biases (Pope & Hudson, 1995); for
example, individuals with dissociative disorders may be espe-
cially likely to enter treatment if they are struggling with prob-
lems stemming from early abuse. Fifth, correlations between
abuse and psychopathology decrease substantially or disap-
pear when participants’ perception of family pathology is con-
trolled statistically (Nash, Hulsey, Sexton, Harralson, &
Lambert, 1993), which could mean that this association is due
to global familial maladjustment rather than abuse itself.
These five points of contention suggest ample reasons to be
skeptical of the claim that child abuse plays a central or direct
causal role in DID—although, as we will suggest later, it may
be one element of the complex etiological network that con-
tributes to this condition.
The Sociocognitive Model
In contrast to the posttraumatic model, the sociocognitive
model (Spanos, 1994; see also Aldridge-Morris, 1989; Lilien-
feld et al., 1999; McHugh, 1993; Sarbin, 1995) proposes that
DID is a consequence of social learning and expectancies.
This model holds that DID results from inadvertent therapist
cueing (e.g., suggestive questioning regarding the existence of
possible alters, hypnosis for memory recovery, sodium
amytal), media influences (e.g., television and film portrayals
of DID), and sociocultural expectations regarding the pre-
sumed clinical features of DID. In aggregate, the sociocogni-
tive model posits that these influences can lead predisposed
individuals to become convinced that indwelling entities—
alters—account for their dramatic mood swings, identity
changes, impulsive actions, and other puzzling behaviors (see
below). Over time, especially when abetted by suggestive
therapeutic procedures, efforts to recover memories, and a
propensity to fantasize, they may come to attribute distinctive
memories and personality traits to one or more imaginary
alters.
A number of findings (e.g., Lilienfeld & Lynn, 2003;
Lilienfeld et al., 1999; Piper, 1997; Spanos, 1994) are consis-
tent with the sociocognitive model and present serious chal-
lenges to the posttraumatic model. For example, the number of
patients with DID, along with the number of alters per DID
patient, increased dramatically from the 1970s to the 1990s
(Elzinga, van Dyck, & Spinhoven, 1998), although the num-
ber of alters at the time of initial diagnosis appears to have
remained constant (North, Ryall, Ricci, & Wetzel, 1993). In
addition, the massive increase in reported cases of DID fol-
lowed closely upon the release in the mid-1970s of the best-
selling book (turned into a widely viewed television film in
1976), Sybil (Schreiber, 1973), which told the story of a young
woman with 16 personalities who reported a history of severe
child abuse at the hands of her mother (see Nathan, 2011;
Rieber, 2006, for evidence that many details of the Sybil story
are inaccurate). Manifestations of DID symptoms also vary
across cultures. For example, in India, the transition period as
the individual shifts between alter personalities is typically
preceded by sleep, a presentation that reflects common media
portrayals of DID in that country (North et al., 1993).
Moreover, mainstream treatment techniques for DID often
reinforce patients’ displays of multiplicity (e.g., asking ques-
tions like, “Is there another part of you with whom I have not
spoken?”), reify alters as distinct personalities (e.g., calling
different alters by different names), and encourage patients to
establish contact and dialogue with presumed alters. Interest-
ingly, many or most DID patients show few or no clear-cut
signs of this condition (e.g., alters) prior to psychotherapy
(Kluft, 1984), raising the specter that alters are generated by
treatment. Indeed, the number of alters per DID individual
50 Lynn et al.
tends to increase substantially over the course of DID-oriented
psychotherapy (Piper, 1997). Curiously, psychotherapists who
use hypnosis tend to have more DID patients in their caseloads
than do psychotherapists who do not use hypnosis (Powell &
Gee, 1999), and most DID diagnoses derive from a small num-
ber of therapy specialists in DID (Mai, 1995), again suggest-
ing that alters may be created rather than discovered in
therapy.
These sources of evidence do not imply that DID can typi-
cally be created in vacuo by iatrogenic (therapist-induced) or
sociocultural influences. Sociocognitive theorists acknowl-
edge that iatrogenic and sociocultural influences typically
operate against a backdrop of preexisting psychopathology.
Indeed, the sociocognitive model is consistent with findings
that many or most patients with DID, and to a lesser extent
other dissociative disorders, meet criteria for borderline per-
sonality disorder, a condition marked by extremely unstable
behaviors, such as unpredictable shifts in mood, impulsive
actions, and self-mutilation (Lilienfeld et al., 1999). Individu-
als with this disorder are understandably seeking an explana-
tion for their bewildering behaviors. The presence of hidden
alters may be one such explanation, and it may assume par-
ticular plausibility when suggested by psychotherapists or sen-
sational media portrayals.
Cognitive Mechanisms of Dissociation
Much of the literature on cognitive mechanisms of dissocia-
tion is more consistent with the sociocognitive model than
with the posttraumatic model. For example, researchers have
found little evidence for inter-identity amnesia among patients
with DID using objective measures of memory (e.g., event-
related potentials or behavioral tasks; Allen & Movius, 2000;
Huntjens et al., 2006). In such studies, investigators present
certain forms of information to one alter and see whether it is
accessible to another alter. In most cases, it is, demonstrating
that alters are not psychologically distinct entities.
Contradicting the claim that individuals with heightened
dissociation are defending against the impact of threat-related
information and therefore exhibit slower or impaired process-
ing of such information, patients with DID and other “high
dissociators” display better memory for to-be-forgotten sexual
words in directed-forgetting tasks (Elzinga, de Beurs, Sergeant,
van Dyck, & Phaf, 2000). This finding is strikingly discrepant
with the presumed coping function of dissociation. Studies of
cognitive inhibition in highly dissociative clinical and non-
clinical samples typically find a breakdown in such inhibition,
challenging the widespread idea that amnesia (i.e., extreme
inhibition) is a core feature of dissociation (Giesbrecht et al.,
2008, 2010).
The extant evidence therefore questions the widespread
assumption that dissociation is related to avoidant information
processing and suggests that apparent gaps in memory in
interidentity amnesia, or dissociative amnesia more generally,
could reflect intentional failures to report information.
Moreover, the literature indicates that dissociation is marked
by a propensity toward false memories, possibly mediated by
heightened levels of suggestibility, fantasy proneness, and
cognitive failures (e.g., lapses in attention). Indeed, at least 10
studies from diverse laboratories have confirmed a link
between dissociation and fantasy proneness. In addition,
heightened levels of fantasy proneness are associated with the
tendency to overreport autobiographical memories and the
false recall of aversive memory material (Giesbrecht et al.,
2010). Accordingly, the relation between dissociation and fan-
tasy proneness may explain why individuals with high levels
of dissociation are especially prone to develop false memories
of emotional childhood events. This explanation dovetails
with data revealing links between dissociative symptoms and
hypnotizability (Frischholz, Lipman, Braun, & Sachs, 1992)
and high scores on the Gudjonsson Suggestibility Scale (Mer-
ckelbach, Muris, Rassin, & Horselenberg, 2000). Similarly,
dissociation increases the number of commission memory
errors (e.g., confabulations/false positives, problems discrimi-
nating perception from imagery) but not omission memory
errors, which are presumably associated with dissociative
amnesia (Holmes et al., 2005). These findings, together with
research demonstrating a link between dissociation and cogni-
tive failures, point to an association between a heightened risk
of confabulation and pseudomemories. They also raise ques-
tions regarding the accuracy of retrospective reports of trau-
matic experiences.
Still, these findings do not exclude some role for trauma in
dissociation. Suggestibility, cognitive failures, and fantasy
proneness could contribute to an overestimation of a genuine,
although perhaps modest, link between dissociation and
trauma. Alternatively, early trauma might predispose individu-
als to develop high levels of fantasy proneness, absorption (the
tendency to become immersed in sensory or imaginative expe-
riences; Tellegen & Atkinson, 1974), or related traits. In turn,
such traits may render individuals susceptible to the iatrogenic
and cultural influences posited by the sociocognitive model,
thereby increasing the likelihood of DID.
Sleep, Memory, and Dissociation
A recent theory connecting sleep, memory problems, and dis-
sociation may provide a conceptual bridge between the post-
traumatic model and the sociocognitive model. In a review of
23 studies, van der Kloet, Merckelbach, Giesbrecht, and Lynn
(2011) concluded that data from clinical and nonclinical sam-
ples provide strong support for a link between dissociative
experiences and a labile sleep–wake cycle. This link, they con-
tend, is evident across a range of sleep-related phenomena,
including waking dreams, nightmares, and hypnagogic (occur-
ring while falling asleep) and hypnopompic (occurring while
awakening) hallucinations. Supporting this hypothesis, studies
of the association between dissociative experiences and sleep
disturbances have generally yielded modest correlations
(in the range of .30 to .55), implying that unusual sleep
Dissociation and Dissociative Disorders 51
experiences and dissociation are moderately related constructs
(see also Watson, 2001).
Nevertheless, these studies typically relied on cross-sectional
designs. To address this limitation, Giesbrecht, Smeets, Lep-
pink, Jelicic, and Merckelbach (2007) deprived 25 healthy vol-
unteers of one night of sleep and found that sleep loss engenders
a substantial increase in dissociative symptoms. They also
found that this increase could not be accounted for by mood
changes or response bias.
van der Kloet, Giesbrecht, Lynn, Merckelbach, and de
Zutter (in press) later conducted a longitudinal investigation of
sleep experiences and dissociative symptoms among 266
patients who were evaluated on arrival and at discharge 6 to 8
weeks later. Sleep hygiene was a core treatment component.
Prior to treatment, 24% of participants met the clinical cut-off
for dissociative disorders (i.e., Dissociative Experiences Scale
> 30; Bernstein-Carlson & Putnam, 1993); at follow-up, this
number dropped to 12%. Although sleep improvements were
associated with a reduction in global psychopathology (e.g.,
anxiety, depression), this reduction did not account fully for
the specific effect of treatment on dissociation. The fact that a
sleep-hygiene intervention reduces dissociative symptoms
independent of generalized psychopathology bears notewor-
thy clinical implications. It also suggests that researchers may
wish to revisit the treatment of dissociative disorders. Surpris-
ingly, this clinically important area has received minimal
investigation: For example, Brand, Classen, McNary, and
Zaveri (2009) reported that only eight nonpharmacological
studies, none of which was a well-controlled randomized trial,
have examined treatment outcomes for DID.
van der Kloet et al.’s (in press) findings suggest an intrigu-
ing interpretation of the link between dissociative symptoms
and deviant sleep phenomena (see also Watson, 2001). Accord-
ing to their working model, individuals with a labile sleep–
wake cycle experience intrusions of sleep phenomena (e.g.,
dreamlike experiences) into waking consciousness, in turn
fostering dissociative symptoms. This labile sleep–wake cycle
may stem in part from a genetic propensity (Lang, Paris,
Zweig-Frank, & Livesley, 1998), distressing trauma-related
memories, or other unknown causal influences. van der Kloet
et al.’s model further proposes that disruptions of the sleep–
wake cycle degrade memory and attentional control, thereby
accounting for, or at least contributing to, the cognitive defi-
cits of highly dissociative individuals.
Accordingly, the sleep-dissociation perspective may
explain (a) how aversive events disrupt the sleep–wake cycle
and increase vulnerability to dissociative symptoms, and (b)
why dissociation, trauma, fantasy proneness, and cognitive
failures overlap. Thus, this perspective is commensurate with
the possibility that trauma engenders sleep disturbances that in
turn play a pivotal role in the genesis of dissociation and sug-
gests that competing theoretical perspectives may be amena-
ble to integration. The SCM holds that patients become
convinced that they possess multiple selves as a by-product
of suggestive media, sociocultural, and psychotherapeutic
influences. Their sensitivity to suggestive influences may arise
from increased salience of distressing memories (some of
which may stem in part from trauma) and susceptibility to
memory errors and a propensity to fantasize and experience
difficulties in distinguishing fantasy from reality, brought
about at least in part by sleep disruptions.
The data we have summarized have received only scant
attention in the clinical literature. Nevertheless, they have the
potential to reshape the conceptualization and operationaliza-
tion of dissociative disorders in the upcoming edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-
V, publication scheduled in 2013). In particular, they suggest
that sleep disturbances, as well as sociocultural and psycho-
therapeutic influences, merit greater attention in the conceptu-
alization and perhaps classification of dissociative disorders
(Lynn et al., in press). From this perspective, the hypothesis
that dissociative disorders can be triggered by (a) a labile sleep
cycle that impairs cognitive functioning, combined with
(b) highly suggestive psychotherapeutic techniques, warrants
empirical investigation. More broadly, the data reviewed point
to fruitful directions for our thinking and research regarding
dissociation and dissociative disorders in years to come.
Recommended Reading
Giesbrecht, T., Lynn, S. J., Lilienfeld, S.O., & Merckelbach, H.
(2008). (See References). Discusses the cognitive and neuropsy-
chological mechanisms of dissociation and surveys literature chal-
lenging claims regarding an avoidant coping style and cognitive
deficits that impede processing emotional material in dissociation.
Kihlstrom, J. F. (2005). (See References). An excellent review of the
literature, which argues that the evidence supporting the hypoth-
esis that dissociative disorders are the consequence of trauma is
weak and plagued by poor methodology and that there are no
convincing cases of trauma-based amnesia not attributable to
brain insult, injury, or disease.
Lilienfeld, S. O., & Lynn, S. J. (2003). (See References). Summarizes
controversies surrounding dissociative identity disorder and dis-
cusses the sociocognitive perspective on dissociation.
Spanos, N. P. (1996). (See References). A provocative book arguing
that multiple personality disorder is a cultural/historical construct
tied to inaccurate altered-state theories of hypnosis, recovered
memories and presumed childhood abuse, and suggestive tech-
niques in psychotherapy.
Watson, D. (2001). (See References). A seminal paper that reports
validity data for a now widely used scale of sleep-related experi-
ences (Iowa Sleep Experiences Survey) and evidence for a link
between dissociation and sleep-related experiences.
Declaration of Conflicting Interests
The authors declared that they had no conflicts of interest with
respect to their authorship or the publication of this article.
52 Lynn et al.
References
Aderibigbe, Y. A., Bloch, R. M., & Walker, W. R. (2001). Prevalence
of depersonalization and derealization experiences in a rural
population. Social Psychiatry and Psychiatric Epidemiology, 36,
63–69.
Aldridge-Morris, R. (1989). Multiple personality: An exercise in
deception. Hillsdale, NJ: Erlbaum.
Allen, J. J. B., & Movius, H. L., II. (2000). The objective assess-
ment of amnesia in dissociative identity disorder using event-
related potentials. International Journal of Psychophysiology,
38, 21–41.
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text rev.). Washington, DC:
Author.
Bernstein-Carlson, E., & Putnam, F. W. (1993). An update on the Dis-
sociative Experiences Scale. Dissociation, 6, 19–27.
Brand, B., Classen, C. C., McNary, S. W., & Zaveri, P. (2009). A
review of dissociative disorders treatment studies. Journal of
Nervous and Mental Disease, 197, 646–694.
Bremner, J. D. (2010). Cognitive processes in dissociation: Comment
on Giesbrecht et al. (2008). Psychological Bulletin, 136, 1–6.
Dell, P. F., & O’Neil, J. A. (2009). Dissociation and the dissociative
disorders: DSM-V and beyond. New York, NY: Routledge.
Elzinga, B. M., de Beurs, E., Sergeant, J. A., van Dyck, R., & Phaf,
R. H. (2000). Dissociative style and directed forgetting. Cogni-
tive Therapy and Research, 24, 279–295.
Elzinga, B. M., van Dyck, R., & Spinhoven, P. (1998). Three contro-
versies about dissociative identity disorder. Clinical Psychology
& Psychotherapy, 5, 13–23.
Frischholz, E. J., Lipman, L. S., Braun, B. G., & Sachs, R. G. (1992).
Psychopathology, hypnotizability and dissociation. American
Journal of Psychiatry, 149, 1521–1525.
Giesbrecht, T., Lynn, S. J., Lilienfeld, S. O., & Merckelbach, H.
(2008). Cognitive processes in dissociation: An analysis of core
theoretical assumptions. Psychological Bulletin, 134, 617–647.
Giesbrecht, T., Lynn, S. J., Lilienfeld, S. O., & Merckelbach, H.
(2010). Cognitive processes, trauma, and dissociation: Miscon-
ceptions and misrepresentations (Reply to Bremner, 2009). Psy-
chological Bulletin, 136, 7–11.
Giesbrecht, T., Smeets, T., Leppink, J., Jelicic, M., & Merckelbach,
H. (2007). Acute dissociation after 1 night of sleep loss. Journal
of Abnormal Psychology, 116, 599–606.
Gleaves, D. H. (1996). The sociocognitive model of dissociative
identity disorder: A reexamination of the evidence. Psychologi-
cal Bulletin, 120, 142–159.
Holmes, E. A., Brown, R. J., Mansell, W., Fearon, R., Hunter,
E. C. M., Frasquilho, F., & Oakley, D. A. (2005). Are there two
qualitatively distinct forms of dissociation? A review and some
clinical implications. Clinical Psychology Review, 25, 1–23.
Huntjens, R. J. C., Peters, M. L., Woertman, L., Bovenschen, L. M.,
Martin, R. C., & Postma, A. (2006). Inter-identity amnesia in
dissociative identity disorder: A simulated memory impairment?
Psychological Medicine, 36, 857–863.
Kihlstrom, J. F. (2005). Dissociative disorders. Annual Review of
Clinical Psychology, 1, 1–27.
Kluft, R. P. (1984). Treatment of multiple personality disorders: A
study of 33 cases. Psychiatric Clinics of North America, 7, 9–29.
Lang, K. L., Paris, J., Zweig-Frank, H., & Livesley, W. J. (1998).
Twin study of dissociative experiences. Journal of Abnormal
Psychology, 186, 345–351.
Lilienfeld, S. O., & Lynn, S. J. (2003). Dissociative identity disorder:
Multiple personalities, multiple controversies. In S. O. Lilienfeld,
S. J. Lynn, & J. M. Lohr (Eds.), Science and pseudoscience in clini-
cal psychology (pp. 109–142). New York, NY: Guilford Press.
Lilienfeld, S. O., Lynn, S. J., Kirsch, I., Chaves, J., Sarbin, T.,
Ganaway, G., & Powell, R. (1999). Dissociative identity disorder
and the sociocognitive model: Recalling the lessons of the past.
Psychological Bulletin, 125, 507–523.
Lynn, S. J., Berg, J., Lilienfeld, S. O., Merckelbach, H., Giesbrecht,
T., Accardi, M., & Cleere, C. (in press). Dissociative disorders. In
M. Hersen, S. Turner, & D. Beidel (Eds.), Adult psychopathology
and diagnosis (6th ed.). New York, NY: John Wiley.
Mai, F. M. (1995). Psychiatrists’ attitudes to multiple personality dis-
order: A questionnaire study. Canadian Journal of Psychiatry, 40,
154–157.
McHugh, P. R. (1993). Multiple personality disorder. Harvard Men-
tal Health Newsletter, 10(3), 4–6.
Merckelbach, H., & Muris, P. (2001). The causal link between self-
reported trauma and dissociation: A critical review. Behaviour
Research and Therapy, 39, 245–254.
Merckelbach, H., Muris, P., Rassin, E., & Horselenberg, R. (2000).
Dissociative experiences and interrogative suggestibility in col-
lege students. Personality and Individual Differences, 29, 1133–
1140.
Nash, M. R., Hulsey, T. L., Sexton, M. C., Harralson, T. L., &
Lambert, W. (1993). Long-term sequelae of childhood sexual
abuse: Perceived family environment, psychopathology, and
dissociation. Journal of Consulting and Clinical Psychology,
61, 276–283.
Nathan, D. (2011). Sybil exposed. New York, NY: Free Press.
North, C. S., Ryall, J.-E., Ricci, D. A., & Wetzel, R. D. (1993). Mul-
tiple personalities, multiple disorders. New York, NY: Oxford
University Press.
Piper, A. (1997). Hoax and reality: The bizarre world of multiple per-
sonality disorder. Northvale, NJ: Jason Aronson.
Piper, A., & Merskey, H. (2004). The persistence of folly: Critical
examination of dissociative identity disorder. Part 1: The excesses
of an improbable concept. Canadian Journal of Psychiatry, 49,
592–600.
Pope, H. G., & Hudson, J. I. (1995). Does childhood sexual abuse
cause adult psychiatric disorders? Essentials of methodology.
Journal of Psychiatry & Law, 12, 363–381.
Powell, R. A., & Gee, T. L. (1999). The effects of hypnosis on disso-
ciative identity disorder: A reexamination of the evidence. Cana-
dian Journal of Psychiatry, 44, 914–916.
Rieber, R. W. (2006). The bifurcation of the self: The history and
theory of dissociation. New York, NY: Springer.
Ross, C., & Ness, L. (2010). Symptom patterns in dissociative iden-
tity disorder patients and the general population. Journal of
Trauma & Dissociation, 11, 458–468.
Dissociation and Dissociative Disorders 53
Sarbin, T. R. (1995). On the belief that one body may be host to
two or more personalities. International Journal of Clinical and
Experimental Hypnosis, 43, 163–183.
Schreiber, F. R. (1973). Sybil. New York, NY: Warner.
Simeon, D., Guralnik, O., Schmeidler, J., Sirof, B., & Knutelska, M.
(2001). The role of childhood interpersonal trauma in depersonali-
zation disorder. American Journal of Psychiatry, 158, 1027–1033.
Spanos, N. P. (1994). Multiple identity enactments and multiple per-
sonality disorder: A sociocognitive perspective. Psychological
Bulletin, 116, 143–165.
Spanos, N. P. (1996). Multiple identities and false memories: A socio-
cognitive perspective. Washington, DC: American Psychiatric
Association.
Tellegen, A., & Atkinson, G. (1974). Openness to absorbing and self-
altering experiences (“absorption”), a trait related to hypnotic sus-
ceptibility. Journal of Abnormal Psychology, 83, 268–277.
van der Kloet, D., Giesbrecht, T., Lynn, S. J., Merckelbach, H., & de
Zutter, A. (in press). Sleep normalization and decrease in disso-
ciative experiences: Evaluation in an inpatient sample. Journal of
Abnormal Psychology.
van der Kloet, D., Merckelbach, H., Giesbrecht, T., & Lynn, S. J.
(2011). Fragmented sleep, fragmented mind: The role of sleep
in dissociative disorders. Manuscript submitted for publication.
Watson, D. (2001). Dissociations of the night: Individual differences
in sleep-related experiences and their relation to dissociation and
schizotypy. Journal of Abnormal Psychology, 110, 526–535.
... Ils considè rent que les ré cits de traumatismes que font les personnes TDI sont principalement des exagé rations ou des affabulations dues à une tendance à l'affabulation, à l'imaginaire, à la suggestibilité ou à des distorsions cognitives [18] et la propension à l'affabulation serait corré lé e au dé veloppement de pseudo-souvenirs. La position de Lynn et al. [60] n'est pas que la dissociation donne lieu à des tendances à l'affabulation, à des distorsions cognitives et de la suggestibilité , mais au contraire qu'il y aurait un chevauchement entre ces caracté ristiques et la dissociation ; pourtant les é tudes montrent qu'il n'y aurait pas de lien entre la dissociation et la suggestibilité [18,19]. La rêverie ainsi que l'imagination sont des processus normaux que tout un chacun expé rimente au quotidien. ...
... Alors que les spé cialistes du TDI considè rent les traumatismes ré pé té s de l'enfance associé s à la né gligence comme l'origine centrale du TDI [21,110], certains auteurs soutiennent qu'il n'y a pas de preuves solides de cela [46,53,60,61]. Les partisans du MSC critiquent en particulier la rigueur mé thodologique de certaines é tudes. ...
... Né anmoins, une autre é quipe de chercheurs [33] admet ne pas avoir trouvé de soutien à l'idé e que les symptô mes dissociatifs seraient entiè rement dus à la pré disposition à l'imaginaire, et Merckelbach et al. [67] s'ouvrent finalement au MPT. Lynn et al. [60] concè dent que le trauma peut avoir un effet sur la dissociation, avec des influences indirectes par des difficulté s de sommeil et des troubles de la ré gulation é motionnelle. Il faut souligner que ces derniers symptômes sont des symptômes typiques du trouble de stress post-traumatique. ...
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... If this characterization is valid, the next step is to attempt to understand the origin of this experience. For example, some hypotheses for DID and DTPD state that they are expressions of unconscious or voluntary mental mechanisms activated for filtering out the memory of past or present physical or emotional trauma (Spiegel et al. 2013) or of cognitive characteristics like memory errors, cognitive failures, problems in attentional control and difficulties in distinguishing fantasy from reality (Lynn et al. 2012). Are these hypotheses valid for the origin of channeling experiences? ...
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... Dissociation is often seen in combination with panic disorder, borderline and schizotypal disorders and PTSD. There is also a link between dissociation, a labile sleep-wake cycle, and cognitive problems such as memory errors, problems in attentional control, cognitive failures, and reality testing (Lynn et al., 2012). Experimental and phenomenological research on people with schizophrenia showed that mechanisms like the automatic unconscious processing of sensory information may be impaired, leading to observable abnormalities at a conscious level (Giersch and Mishara, 2017). ...
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... Plusieurs limites s'opposent à la conclusion selon laquelle les études prospectives permettent d'interpréter les proportions de déclarations d'absences de souvenirs traumatiques durant de longues périodes (parfois des décennies) comme étant de l'amnésie dissociative. Premièrement, comme cela a été relevé à plusieurs reprises, bon nombre d'études prospectives n'ont pas proposé d'éléments corroborant les faits décrits par les participants (e.g., Lynn et al., 2014 ;Lynn, Lilienfeld, Merckelbach, Giesbrecht, & van der Kloet, 2012). Bien évidemment, il ne s'agit pas de soupçonner quelconque mensonge de la part des participants, mais plutôt de mettre en garde face à soit certains faux souvenirs d'événements complets (i.e., voir plus bas), soit des distorsions importantes de souvenirs. ...
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Severe dissociation is trauma-related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma-based (e.g., depression, anxiety disorders, and obsessive-compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop-out rates. We set out to better understand the etiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between- and within-subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for six months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly-traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.
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In psychopathology, dissociation typically refers to a disturbance in the normal integration of thoughts, feelings, and experiences into consciousness and memory. In this article, we review the literature on how sleep disturbances relate to dissociative symptoms and memory failure. We contend that this body of research offers a fresh perspective on dissociation. Specifically, we argue that dissociative symptoms are associated with a labile sleep-wake cycle, in which dreamlike mentation invades the waking state, produces memory failures, and fuels dissociative experiences. The research domain of sleep and dissociation can accommodate the dominant idea in the clinical literature that trauma is the distal cause of dissociation, and it holds substantial promise to inspire new treatments for dissociative symptoms (e.g., interventions that focus on normalization of the sleep-wake cycle). We conclude with worthwhile paths for further investigations and suggest that the sleep-dissociation approach may help reconcile competing interpretations of dissociative symptoms. © The Author(s) 2012.
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Numerous recent studies have suggested a possible link between childhood sexual abuse and adult psychiatric disorders. However, these studies must be interpreted with careful attention to the problems of selection bias, information bias, and the effects of confounding variables. To our knowledge, no available studies in the scientific literature have adequately controlled for all three of these sources of error. Indeed, many published studies are so vulnerable to these forms of error that they are rendered almost valueless. Therefore at present we cannot reasonably conclude whether childhood sexual abuse is, or is not, an etiologic factor in adult psychiatric disorders.
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The present study examined whether scores on the Dissociative Experiences Scale (DES) are related to interrogative suggestibility, as measured by the Gudjonsson Suggestibility Scale (GSS-1). In addition, an attempt was made to identify factors that may mediate this relationship. The DES and GSS were administered to a sample of 56 female undergraduate students along with self-report measures of cognitive failures and fantasy proneness. DES and cognitive failures were found to be related to total GSS scores. In contrast, fantasy proneness was not linked to total GSS scores. Correcting for the influence of cognitive failures attenuated the correlation between DES and GSS. This suggests that cognitive efficiency is one of the mediating factors operating in the connection between dissociation and interrogative suggestibility.
Book
Dissociation and the Dissociative Disorders: DSM-V and Beyond is a book that has no real predecessor in the dissociative disorders field. It (1) reports the most recent scientific findings and conceptualizations about dissociation, (2) defines and establishes the boundaries of current knowledge in the dissociative disorders field, (3) identifies and carefully articulates the field’s current points of confusion, gaps in knowledge, and conjectures, (4) clarifies the different aspects and implications of dissociation, and (5) sets forth a research agenda for the next decade. In many respects, Dissociation and the Dissociative Disorders: DSM-V and Beyond both defines and redefines the field.